Unit Objectives Flashcards
an organism in a humans blood that can cause disease and infection (ex: HIV)
Bloodborne Pathogen
thing/person a disease affects; where it starts
host
Period of time between invasion of a pathogen and the onset of symptoms; pathogen enters the host and the host shows symptoms of being sick; could be hours, could be years
incubation period
Period of time during which the host is shedding organisms that can infect another person; differs from person to person
communicable period
when a microorganism grows or incubates
incubation
spread of diseases through contact
communication
the way a microorganism enters a host
portal of entry
something/someone exposed to infection or disease of an organism that can be affected by a pathogen
susceptible host
a period of time between invasion by a pathogen and when the presence of the pathogen can be detected by testing
window period
infection caused by microorganisms that are commonly present on the body or in the environment that usually don’t make a healthy person ill; someone who is immunocompetent will get sick
opportunistic infection
an infection aquired by a person in the hospital or any health care setting that is unrelated to why that person is in the hospital
nosocomial infection
guidelines developed by OSHA for protection of employees and prevention of bloodborne pathogens someone may have come in contact with
Universal Precautions
guidelines that were established by the Center for Disease Control (CDC) in Atlanta, GA; guidelines for prevention of bloodborne pathogens for both healthcare workers and patients/clients
These precautions represent a system of infection control in which it is assumed that every direct contact with a patient’s body fluids is potentially infectious
Standard Precautions
Practices that help to reduce the number and spread of microorganisms
medical asepsis
practices that render and keep objects and areas free of all microorganisms
examples: surgeons before surgery
surgical asepsis
the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or on an item to the point where they are no longer capable of transmitting infectious microorganisms/particles
decontamination
a process that destroys all forms of microbial life, including bacterial spores; this process is more intense than decontamination and includes the use of heat, steam, gas, soak, etc.
sterilization
destroying all areas of microbial life except high numbers of bacterial spores; ex: hot water pasteurization, exposure to certain chemicals
the destruction or removal of pathogenic organisms, but not necessarily their spores
disinfection
separation from others; will be in a private room and have dedicated equipment to his/her room
healthcare provider would need clean gloves (not sterile) and a gown to enter this type of room and remove before leavin the room
examples of someone in this type of room may have MRSA, VRE, VICA, uncontrolled diahrea, body lice, scabies, impetigo, etc.
contact isolation
separate room for an kind of infection that is spread by the mist of the air
healthcare provider would need a mask only to enter this type of room
examples of someone placed in this type of room: someone with mumps, rubella,
droplet isolation
separation from others; will be in a private room with a (-) negative airflow; will contain a hepafilter air machine in the room to clean the air
healthcare provider will need an N95 Dust Mist Mask fitted to his/her face
examples of someone in this type of room: someone with diseases like measles, Tuberculosis (TB)
airborne isolation
separation from others; a room that is used for infections that can be spread through the air and can be spread through contact; rooms need to be private with no air flow
healthcare providers need N95 Dust MIst Mask, gown, and gloves (clean gloves) to enter this type of room
examples of someone placed in this type of room: someone with chicken pox (lesions), herpes zoster infections; especially in immunocompetent/immunocompromised individuals, shingles, etc.
airborne plus contact isolation
a form of surgical asepsis; this place consists of bandages, dressings, tools, equipment, etc.
sterile field
What is the exposure risk inherent in the healthcare industry?
- coughing/sneezing (air)
- present on an object
- present in/on an open wound
- transmitted via direct contact
- transmitted through medical object/various kinds of equipment, needles, doorknobs
- blood or any other bodily fluid vaginal secretions/semen
- ear infections
- intestinal tract (ex: ecoli); human fecal contamination
- water
- arsenic
- eyes
- urinary tract
- shaking hands (human to human direct contact)
Various ways a microorganism can leave a host
- has to be a portal of entry; break in the skin, break in the mucus membrane of the body (nasal tract, respiratory, intestinal tract, mouth, nose, ears, eyes, etc.); if it gets into the bloodstream, can spread throughout the body
- people who are already sick; it is a lot easier for them to get something else or get even more sick (ex: chemo patients; chemo suppresses the immune system do the person is more likely to get sick)
Ways a microorganism enters a host
MRSA
Methycillin Resistant Staph Aureus
VRSA
Vencomycin Resistant Staph Aureus
BRE
Bancalmycin Resistant Enteroccus
CDC
Center for Disease Control
OSHA
Occupational Safety and Health Administration
Common Nosocomial Infections
Urinary Tract Infections (UTI)
Surgical Tract Infections
Respiratory Tract Infections
Bloodstream Infections
Skin Infections
Gastointestinal Tract Infections
Central Nervous System Infections
Fungal Infections; yeast and other fungi
Pneumonia
Bacterias (staph, escherichia coli, pseudomas)
Hostess of antibiotic (MRSA, VRSA, BRE)
Barriers to Infection
Gloves
Protective clothing
Face Shield
Eye Protection
Surgical Mask
Mouth piece/recitation device for CPR
No artificial nails
Cap
N95 Dust Mist Mask
Major Dictates of Standard Precautions
- Barriers; gloves, masks, cap, eye protection, etc
- Hand Care; hand washing, gloves, no artificial nails
- Sharps (Needles, scalpel blades); dispose of them properly and do not remove safety cap until ready to use
- Avoid eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in a patient area
- Avoid hand contact with mucous membranes of your eyes, nose, mouth, or ears
- Handle all linen carefully and dispose of properly
- Avoid unnecessary contact with a patient who places you at risk to contact a body fluid or waste product, especially blood
- Report incidents of conduct with patient’s body fluid or waste product on an unprotected area of your body; seek immediate assistance if a direct blood-to-blood contact occurs between you and a patient
Hands: wash before and after treating the patient
PTA needs: Gloves and Gown
Private room
All equipment is dedicated equipment and stays in the room
Contact Precautions
Hands: wash before and after leaving the room
PTA needs: Mask
Private Room is needed/provided
For patient transport: place a surgical mask on the patient if possible
Droplet Precautions
Wash hands before entering and leaving the room
PTA Needs: Mask; N-95 Respirator (dust/mist mask)
Private room with negative (-) airflow; door must remain closed
Patient Transport: Place surgical mask on the patient if possible
Airborne Precautions
HIV stats in the US
1 million people are living with HIV in the US
1/5 of those people are unaware of their infection
It is said that 5,600-5,700 people are infected with HIV each year
People with HIV in the US has increased, however, those with HIV are living longer than before
Estimated that at the end of 2007, there were 576,000 people that have died from HIV in the US
These people include: MSM (Men having sex with other men <- most common), Injection drug users <- most common, African Americans, Heterosexual women, younger people are disproportionally infected with HIV, and Hispanics
HIV
Human-immunodeficiency virus
How is HIV spread?
- Sexual intercourse; people who have a history of multple sex partners are more susceptible to aquire HIV when there is already another sexually transmitted disease present
- Sharing of needles in injection drug use; or other contaminiated equipment
- A child being born to an infected mother (as baby passes through the birth canal)
- Being stuck with HIV contaminated needle or sharp object
- Receiving blood products, organs, or tissues from people who are/were infected with HIV
- Unsafe medical or dental practices; when dentists would not wear gloves or face shields
- Being bitten by someone with HIV
- Coming in contact with bodily fluids, especially blood
- Coming in contact with open wounds or mucous membranes of that person with HIV
HIV is NOT spread via what?
- Water
- Insects
- Saliva (if you take biting out of the picture)
- Tears/perspiration
- Kissing
Stage 1 of HIV
Acute Primary Progression - Stage 1
- HIV enters the body, immediately attacks large numbers of CD4+ cells (T cells); white blood cells critical to maintaining a healthy immune system, virus is a retrial virus (uncanny ability to replicate rapidly and can mutate and evolve rapidly and hide in the body; this is what makes it so difficult to treat)
- Virus can look different in one person from the other
- Virus is constantly trying to hide
- Trying to replicate
- And Trying to manipulate the immune system
- After entering the host for the first time, rapid, diving, enters lymph tissue; thymus, spleen, lymph nodes; about 70% of people will experience relatively mild flu-like symptoms in 2-5 weeks (fever, headache, fatigue, might have lymphadenopathy; enlarged lymph nodes)
Stage 2 of HIV
Immune System fights back - Stage 2
- Levels of HIV decrease dramatically in the body but are not gone, they are still present; however, the flu-like symptoms go away
HIV virus can lie dormant in the patient, hiding in cells, shielded from the body’s immune system
Person may be symptom free for years, but virus is replicated thoughout this whole time; SEVERAL BILLION viruses are replicated in the body each day!
T cells cannot react fast enough and the body is unable to fight off infections
Clinical Latency of HIV
Too much virus, too little T cells in the body
When he or she presents one or more opportunistic infections and T cell count is down (less than 200 cells per cubic cm in the body); normal person would have 800-1200 T cell count per cubic cm in the body
The progression of AIDS
(acquired immunodeficiency syndrome)
What are some factors that impact disease progression?
Eugene Mutation
High Viral Load; a lot more of the virus in something; for example, more from a transplant than a needle
HAART: Highly Active Anti-retroviral Therapy; three drugs all taken together
- Rapid weight loss
- Fever
- Night sweats
- Extreme Fatigue
- Lymphadenopathy (enlarged lymph nodes)
- GI issues; Diarrhea
- Lesions or sores in mouth/other mucous membranes in the body; gut
- Memory Loss
- Depression
- Neurological Disorders (attacks the CNS)
- Pnemonia
- Colored lesions (brownish/purplish) on skin or mucous membranes
- No cure for AIDS
- Prognosis (predicted outcome) = DEATH
Symptoms of HIV
What is the incubation period of HIV?
Can be a few weeks, months, or even years (up to 10 years or longer)
It is estimated that 50% of HIV infected patients develop AIDS within 10 years of being exposed to virus
Someone could get infected with the virus and not get sick for many years before knowing they are infected
What is the communicable period for HIV?
3 - 4 weeks after infection with the organism,
until DEATH
What are some opportunistic infections associated with HIV?
A Person with HIV’s immune system is tanking so they are much more susceptible to things that would not usually make someone else sick
Examples commonly associated with AIDS:
- Pneumocystis carinii (Genus, species); a parasite; pneumonia
- Candida albicaus; white yeast (yeast infection, you can get one anywhere in the body)
- Herpes simplex; virus that causes cold sores in mouth
- Herpes zoster; virus that causes chicken pox and can cause shingles
- Kaposi’s Sarcoma; brown or purplish lesions on skin; vascular malignancy of unknown etiology (etiology = cause)
What is the window period for HIV?
Averges in the range of 2-8 weeks, but it can be as long as 6 months, during which time the blood contains the viruses by blood tests are negative (-)
What type of testings and diagnosis are affiliated with recognizing HIV?
Blood testing reviews; testing for presence organism itself or of antibodies that are produced from organism (most of the time is antibodies)
- 1st test :Elisa test- enzyme linked immunoabsorbent assay; if test comes back positive (+), then they do a 2nd test:
- 2nd test: Western Blot – conformation test (only performed if Elisa test comes back positive (+)
What type of treatment is avaliable for a person with HIV?
Usually treating opportunistic infections affiliated with HIV
Anti-viral agents
Antibiotics
AZT – drug used to treat HIV
Two drugs that are new: Saquinavir and Retonavir (anti-viral agents) combined in cocktail drug
Vaccines with things of flu, shingles
At least 31 Antiretroviral drugs used to treat HIV; prevent virus from replicating; cannot completely eliminate
It is against the law to refuse to treat a person with HIV, for that reason, and it against the law to treat a person who has HIV any differently than any other patient
Treat every patient as if they HAVE HIV
If test question; say you treat every patient the same, make assumption that they have a communicable disease. Be cautious ALWAYS, protect yourself
What is the proper way to wash you hands in a medical asepsis setting
- Trying to prevent the spread of disease
- 30 seconds
- Remove all jewelry except for the wedding band (make sure you take your watch off)
- Turn on the water and adjust the temperature to warm (with arm, if there are longer handles)
- Wet your hands, wrists and forearms
- Keep your hands at a neutral position; not up or down
- Apply soap (liquid if at all possible)
- Wash the palm (for ten (10) seconds) and dorsum (back of hand; for ten (10) seconds) of the hand; try not to touch the side of the sink or anything like that
- Wash each individual finger (should take at least ten (10) seconds)
- Wash your wrists and up half your forearms (in lab; for clinic, hands and lower part of wrists)
- With fingers relatively relaxed, rinse from proximal (closer to the heart) to distal; book says to only rinse one time (do not rinse what you did not wash with soap); but in lab we are to rinse 3 times to make sure we get off the soap off
- Leave the water turned on and dry your hands with dry paper towel; only dry what you have washed
- Take a new clean paper towel and turn the sink off then throw it away
What is the proper way to wash your hands in a surgical asepsis setting?
- Remove all jewelry from hands, ears, and neck
- Approach the sink with hands above the elbows
- Avoid touching the sick or anything like that; most likely the environment you are in for this, sinks have foot controls
- Turn on the water to adjust the temperature to warm
- Wet your hands, wrist, and forearms
- Apply liquid soap
- Wash palm and dorsum of hand; using friction and rotary movements, interlace fingers, wash each individual finger
- Remember to refrain from touching the side of sink or any other object while washing them
- Washing wrists, forearms, and up to 3” above the elbows
- You will be washing for as long as 7 minutes (maybe longer)wash over and over and over; a lot of times you will have a scrub brush, make sure you get nails good as well
- Hold fingers upward when you go to rinse
- Rinse fingers first and proceed proximal (from fingers to elbows; so water drips off elbows)
- Use sterile cloth towel to dry hands, wrists, and elbows that were washed
- Dispose of towels that you dried off with
- Take a clean towel to turn off faucet (if necessary)
Describe donning of protective clothing worn in the healthcare envirmonment
Wash hands
Apply Cap
Apply Mask
Apply Gown
Apply Gloves
Describe doffing of protective clothing worn in the healthcare environment
Remove gown first
Remove gloves (can take off gloves with gown)
Remove mask
Remove cap
Wash hands
Contrast the varioius types of isolation procedures and state the purpose for each
Contact isolation: Syndromes; MRSA, VISE, VRE, Aminoglycoside resistant, Gram-negatives, Uncontrolled Diarrhea, lice, scabies, impetigo; Gown and gloves needed in a private room with dedicated equipment
Droplet isolation: Syndromes; Mumps (rubella); mask needed in a *private room *
Airborne isolation: Syndromes; Measles, TB; N-95 Dust Mist Mask needed in a private room with negative air flow with a closed door
Airborne plus contact isolation: Syndromes; Chickenpox, Herpes Zoster; N-95 Dust Mist Mask, a gown, and gloves needed in a private room with negative airflow with a closed door
Describe what constitutes a sterile field and what constitutes contamination of an establised sterile field
- To maintain the sterility of certain objects within that field; things like dressings, bandages; keep from contaminating those objects
- Have a surface that has been cleaned (disinfected) as much as possible
- Sterile towel or inside of sterile package is used as sterile base/tray
- Sterile towel; something that will come from central supply; in a paper package that is a colored strip with a date on it
- Contamination is going to occur anytime a non-sterile item touches a sterile item; if this happens, the contaminated item is discarded and it is necessary to reestablish a sterile field
- Only packages labeled sterile are considered sterile; if not labeled, then it is not sterile, and if opened, then it is not sterile anymore
- Certain things you DO NOT want to do over a sterile field:
- Sneeze, cough, or talk
- Reach across a sterile field to get something on the other side
- Turn your back on an established sterile field
- Place any sterile item within a 1” field around the sterile field (leave a 1” boarder around the outside of sterile field)
- After you put on sterile attire, the only part considered sterile until contaminated are the gloves, the gown above the waste, the front, and the sleeves (the back of the gown is not because we cannot see that anymore)
- Allow moisture into the area of the sterile field
- Area below a table or whatever the surface is to support the sterile materials is not sterile and a sterile object is taken out of the sterile field, ex: swiped under table; then it is no longer sterile
- Know your facilities protocol for distributing of non-sterile objects (rules should be taught or posted)
- Do your part to prevent the spread of infection, somebody’s life might depend on what you do and what you don’t do. If you are going to error, it is better to error on the safe side.
