Module 6: Infection control and Saftey

varicella

chicken pox

Direct or indirect contact from infected droplets or airborne secretions

viral meningitis

Direct contact, respiratory secretions, and oral-fecal route

Bacterial meningitis

Direct contact, infected droplets from respiratory tract

conjunctivitis

Direct or indirect contact with eye discharge or discharge from upper respiratory tract of infected patient

Rhinovirus

common cold - Direct or indirect contact from airborne respiratory secretion droplets

Strep throat

Direct contact with infected individual, respiratory secretions

Pertussis

whooping cough - direct contact with respiratory secretion droplets

influenza

direct contact with respiratory secretion droplets

Viruses

Rhinovirus (common cold)

Varicella (chicken pox)

HIV/AIDS

Hepatitis

Coronavirus

Bacteria

E.coli

Vibiro cholerae (cholera)

Bordetella pertussis (whooping cough)

Fungi

Histoplasmosis (lung infection)

Tinea pedis (athletes foot)

Candida albicans (yeast infection)

Parasites

Toxoplasmosis

Pinworm

Tapeworm

Scabies

Lice

lyme disease

Reservoir

An environment conducive to pathogen survival, often the patient but can also be an inanimate object.

Portal of exit

passageway that the pathogen uses to exit reservoir (through infected fluids of an infected individual)

Direct transmission

when there is contact with the infected person or body fluid that is carrying the pathogen

Indirect transmission

when there is an intermediate step between portal of exit and portal of entry

from where do pathogens enter host?

Open wound, mouth, nose, eye, intestines, UI tract, reproductive system

Universal precautions

guidelines set to prevent exposure to infections when providing health care

consider each patient potentially infectious

apply while dealing with: Blood products, human tissue, body fluids (CSF, amniotic fluid, pleural fluid), any body fluid contaminated with blood, vaginal secretions/semen

Standard precautions

Recommended by CDC to protect health care professional

Wash hands before and after each procedure

use gloves when encountering patient blood/body fluids

cover any scratches or breaks in skin

refrain from eating, drinking, chewing gum while working

wear appropriate PPE

clean all spills immediately with appropriate cleaning supplies

dispose of sharps immediately

place sharps or broken glass in puncture proof container

dispose of all biohazard waste in appropriate container

Job task category I

tasks that have chance of body fluids or blood spilling/splashing, or tasks that can cause exposure to blood or body fluids

minor surgical procedure

Job task Category II

Tasks that do not usually involve chance of exposure but precautions still must be taken

CPR

Job task category III

Tasks that don’t require any PPE

Taking vital signs

What if MA feels sick?

stay home refrain from contact with patients

only return to work if MA has been fever free for atleast 24 hours without the use of any fever reducing medications

Needle saftey and prevention act

Health care professionals must use devices that help reduce the risk of needlestick injuries (needle safety devices)

facilities must maintain a detailed logbook of any needlestick or sharps injuries from dirty/contaminated sharps

implement work practice controls to reduce risk of injury

Transmission based precautions

additional precautions when working with patient with suspected infection

Contact precautions

transmission through direct and indirect touching

PPE: gloves and gown

washing hands before and after working with patient and disinfecting exam room

Droplet precautions

transmission by contact of secretions (cough or sneeze)

get patient to exam room as soon as possible and have them put on a face mask

PPE: mask and gloves

Airborne precautions

Transmission by infectious agents floating inn the air (expose anyone near patient)

allow patient to enter facility by different route place patient in isolation room and have them wear a mask

PPE: mask, gloves, gown

Employer written exposure control plan

part of OSHA’s standard to reduce risk of occupational risk of infectious disease

Must contain: engineering controls, workplace controls, PPE, Hep B vaccine, post exposure followup, labels and signs to communicate hazards, information/training to employees, Documented employee medical training.

Donning nonsterile gloves

perform handwash

select size

place hand through opening and pull up to wrist

repeat on other hand

doffing nonsterile contaminated gloves

grasp palm of glove of nondominant hand and pull of glove in downward motion while turning glove inside out

role up glove in dominant hand

place two fingers in under cuff of other gloved hand and turn it inside out

What is the most widely used PPE in health care setting

Gloves

Aseptic techniques

clean and disinfect office daily (esp in high traffic areas)

remove trash

move sick/contagious patients to exam room upon arrival

provide appropriate PPE for each situation

don’t allow eating/drinking in lab, clinical, patient areas

reminder signs abt good hand hygiene and covering coughs/sneezes

medical asepsis

reduce the number of pathogenic microorganisms and prohibit their growth, does not provide for complete pathogen free environment but reduces their numbers and ability to multiply/continue chain of infection

Surgical asepsis

complete removal of all microorganisms and must be used during invasive procedures

eliminate microorganisms from entering the body

all PPE and instruments must be sterile

Handwashing

use alcohol based hand sanitizers if sink is not available but only if hands that are not visibly soiled

if hands are visibly dirty then wash with soap and water

Proper handwashing required

Before and after patient contacting

after contact with contaminated surfaces

before performing aseptic procedure

before and after contact with supplies

after contact with contaminated body site

after glove removal

hands are visibly soiled

Alcohol based hand sanitization allowed

After contact with contaminated body site

before and after contact with supplies or equipment

after contact with contaminated surfaces

before and after patient contact

handwashing technique

remove all jewelry except plain ring/band

turn on faucet to lukewarm

wet hands, apply 3 mL/3 pumps of soap

lather using circular motion with friction while holding fingertips downward

continue for 15-20 seconds

pay special attention to nails

Alcohol based sanitizer technique

must use 60% alcohol

sanitation

the cleaning process that is often the first step in assuring that medical equipment and instruments are as clean as possible

reduces number of microbes and removes debris (body fluids/blood)

gloves must be worn and if sharp objects then wear thick utility

Ultrasonic sanitization

uses sound waves to loosen debris so object is free from excess material instead of friction

for delicate equipment and reduces risk of potential sharps injury

Disinfection

destroying pathogens or rendering them inactive on surfaces

doesn’t destroy all microbial spores it reduces spread of infection

Alcohol

intermediate disinfectant

use: fixed equipment, patient care items, drying agent

advantage: fast acting, no residue, no staining

disadvantages: wet contact time 5 mins, flammable, inactivated by organic material, can dissolve materials, harden and swell plastic, is fixative (more difficult to remove residual soil)

Chlorine

low-intermediate disinfectant

Use: dialysis machines, bleach for laundry, bathtubs, 1:10 bleach solution recommended for blood spills

Advantage: fast acting (min contact time 2.5 mins)

disadvantage: inactivated by organic matter, corrosive, stains fabric & plastics, unstable

Iodophores

low disinfectant

use: patient care equipment

advantage: fast acting (<2 mins)

disadvantage: corrosive to metal and plastic, stains fabric, longer time to kill fungi

Phenols

low - intermediate disinfectant

use: housekeeping for walls and floors

advantage: for housekeeping use, residual activity can be reactivated with moisture

disadvantage: residual activity can harm patients, corrosive

Quaternary ammonium

low-intermediate disinfectant

use: housekeeping for walls and floors, useful for some instruments if rinsed well

advantages: wetting agents with built-in detergent

disadvantage: contact time - 6-10 mins, can be inactivated by cotton/charcoal, not compatible with soap

Cleaning order

hand hygiene: aseptic handwashing/alcohol sanitizer, use clean towel to clean doorknobs or faucets

Examination table: remove disposable paper covering table

Surfaces: disinfect work surfaces (examination table, sink, countertop, computer keyboard)

Low level disinfection

kills most vegetative bacteria and some viruses/fungi

used for tables and countertops

hydrogen peroxide

Intermediate level disinfection

kills vegetative bacteria and most viruses and fungi (doesn’t kill spores)

stethoscopes, percussion hammers, blood pressure cuffs

isopropyl alcohol

High level disinfection

kills all microorganisms except for some bacterial spores

instruments that contact mucous membranes (endoscopes)

Cidex, OPA

Safety Data Sheets (SDS)

OSHA requires that all employers provide this to employees any time a new chemical is brought into work environment

includes:

• Identification

• Hazard ID

• Composition/ingredients

• First-aid

• firefighting measures

• accidental release measures

• handling and storage

• exposure control

• physical and chemical properties

• stability and reactivity

• toxicology info

• other nonmandatory content

sterilization

destruction of all living organisms (including pathogens and their spores)

sanitizing and disinfection must occur before sterilization

Process: dry heat, gas, chemicals, UV, ionizing radiation, steam under pressure

How long are items considered sterile

30 days if packaging stays intact and dry

Autoclaving

most widely accepted practice to achieve sterilization

What temperature should the autoclave reach?

250-270 F

What is the amount of time necessary to establish sterility with an autoclave?

Depends on what items follow manufactures guidelines

unwrapped items = 20 mins

wrapped items = 30 mins

wrapping instruments prior to autoclaving

wrapped with double ply autoclave paper or peel apart polypropylene pouches

with autoclave paper use two layers to maintain sterility

Guidelines when wrapping instruments

• discard any autoclave paper that is torn/has holes

• wrap hinged instruments in open position by placing gauze between the tip

• Pouches: place handle of instrument into end that will be opened first

• Autoclave paper: use autoclave tape to seal package in addition to placing indicator strip inside with instrument

  • Label outside with date, time, initials, instrument

Sterilization indicators

change color when sterilization is achieved

steam reaching optimum temp for required length

can be chemical and biologic

lines will turn black when sterilization is achieved

OSHA bloodborne pathogens standard of 1991

OSHA’s standard for how to handle infectious waste

How often should eyewash stations be inspected?

should be inspected monthly to ensure they are in working order

Biohazard waste bag

items contaminated with blood and bodily fluids (gloves, gauze, dressings)

Biohazard waste box

items contaminated with blood or bodily fluids such as table covers and disposable gowns

Biohazard sharps container

needles, lancets, sharp objects

When handling biohazard material

wear PPE (including gloves)

Immediately place biohazard material in correct disposal

keep containers upright and closed

drop items into sharps container and don’t push them in

discard of sharps container when it is at fill line

When should sharps container be put for disposal?

When the container is two thirds full (at fill line)

What if biohazardous waste contaminates the outside of biohazard bag, or if intergrity is compromised?

it must be double bagged

Biohazard bags material

must be made of impermeable polyethylene or polypropylene material and a lid should be present on all boxes/receptacles

Exposure control plans

each employer must have system in place to report any exposures

Exposure to blood

CDC recommends to was the area that was cut with soap and water

flush any splashes to the face with water or irrigate the eyes

exposure needs to be reported to immediate supervisor and incident exposure form must be filled out

Refrigerator temperatures

should always be between 36 F and 46 F

How often should refrigerators and freezers be temp checked?

should be checked and logged daily where medications are stored

How often should exposure control plan be reviewed

upon hire and annually

How long should instruments be submerged when doing chemical sterilization to be considered sterilized?

submerged in chemical bath for 8 hrs with closed lid

OSHA regulations require employers to make which of the following vaccines available at no cost to health care workers

Hepatitis B