Infection Control and Biological Safety

Infection Control and Biological Safety

Learning Objectives

• Understand Routine Practices: Familiarize with key principles that ensure safe laboratory practices, focusing on minimizing the risk of infection and enhancing the safety of both staff and patients.

• Recognize Safety Devices: Identify basic safety equipment in laboratories, such as emergency showers, eyewash stations, and safety cabinets, and understand their proper usage and importance in an emergency.

• Incident Reports: Learn about the procedures for documenting incidents in clinical labs, emphasizing the importance of transparency for safety improvement and risk management.

• Infection Control: Define infection control within a healthcare setting, summarizing key strategies for preventing the spread of infectious diseases.

• Universal/Standard Precautions: Evaluate the effectiveness of standard infection control methods and consider additional practices required to manage specific risks in laboratory settings.

• Routes of Infection: Discuss various paths that pathogens can exploit to infect hosts, including direct contact and airborne transmission, emphasizing preventive strategies for each route.

• Preventing Blood-borne Pathogens: Explore comprehensive strategies designed to minimize risks, including vaccinations, workplace policies, and educational programs aimed at healthcare workers.

• Needlestick Protocols: Detail the established protocols to follow in the event of exposure to blood-borne pathogens through needlestick injuries, emphasizing immediate actions and medical consultation.

• Isolation Procedures: Provide in-depth guidelines regarding different isolation measures used to protect both patients and healthcare workers based on the nature of the infection.

Key Definitions

• Infection: A condition that arises from the invasion of the body by microorganisms, which can lead to disease processes.

• Microbe: Microscopic organisms, encompassing viruses, bacteria, fungi, and protozoa that can exist in various environments.

• Pathogen: Refers to infectious agents that can cause disease in a host organism, often leading to public health concerns.

• Biohazard: Any biological material that poses a threat to human health or the environment, necessitating specific handling protocols.

Aerosols

• Definition: Aersols are solid or liquid particles suspended in air that can be inhaled and may contain infectious agents.

• Types:

  • Solid Aerosols: Include particles like dust and smoke that can act as carriers for pathogens.

  • Liquid Aerosols: Consist of mists or droplets, often containing infectious agents from processes like coughing or spraying.

• Biological Aerosols: Specifically include infectious organisms such as bacteria and viruses that can be transmitted through aerosolized particles, posing significant risks in healthcare settings.

Vectors

• Definition: Organisms, primarily arthropods like insects, that carry and transmit infectious agents from one host to another.

• Examples:

  • Malarial Parasite: Transmitted by Anopheles mosquitoes, highlighting the importance of vector control in malaria prevention.

  • Dengue Virus: Spread by Aedes mosquitoes, which thrive in urban environments, necessitating community awareness and vector control strategies.

Reservoirs

• Types:

  • Humans: Serve as a primary reservoir for many pathogens, emphasizing the need for vaccination and preventive health measures.

  • Animals: Wild and domestic animals can harbor zoonotic pathogens that pose risks to human health.

  • Environmental: Includes soil, water, and organic matter that can serve as reservoirs for various pathogens, stressing the importance of environmental hygiene.

Infections in Healthcare Settings

Infections in Healthcare Settings

• Nosocomial Infections: These infections develop at least 48 hours after patient admission to the healthcare facility and can significantly increase patient morbidity and prolong hospital stays due to their secondary nature. They often arise from a lack of adherence to infection control protocols and can lead to complications, necessitating additional medical interventions, which contribute to increased healthcare costs.

• Healthcare Associated Infections (HAI): A broader category encompassing infections acquired in any healthcare setting, including outpatient facilities. HAIs can originate from contaminated medical devices, healthcare workers, or the hospital environment. These infections can result in severe complications ranging from bloodstream infections to surgical site infections. Specific examples include:

  • Ventilator-Associated Pneumonia (VAP): An infection of the lungs that occurs in people who are on mechanical ventilation through an endotracheal or tracheostomy tube. It is primarily caused by bacteria entering the lungs from contaminated secretions.

  • Methicillin-Resistant Staphylococcus Aureus (MRSA): A type of staph bacteria that has become resistant to many antibiotics, making infections particularly difficult to treat. MRSA can cause severe skin infections and lead to conditions such as bloodstream infections and pneumonia.

  • Candida Albicans: A fungus that can cause infections in patients with weakened immune systems, often leading to candidiasis, which can affect the mouth, throat, and genitals, or can enter the bloodstream.

  • Clostridium Difficile (C. diff): A bacterium that causes inflammation of the colon, leading to severe diarrhea. It often occurs following antibiotic treatment that disrupts normal gut flora, allowing C. diff to thrive. It is a major cause of antibiotic-associated diarrhea.

  • Tuberculosis (TB): An infectious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs but can also impact other parts of the body. TB can be particularly challenging in healthcare settings due to its airborne transmission.

  • Urinary Tract Infections (UTI): Common HAIs, often associated with catheter use, caused by various organisms, most commonly Escherichia coli. UTIs can range from asymptomatic to severe infections involving the kidneys, requiring prompt diagnosis and treatment.

  • Vancomycin-Resistant Enterococcus (VRE): Bacteria in the gastrointestinal tract that have developed resistance to vancomycin, an antibiotic used to treat serious infections. VRE infections are challenging to manage and often occur in patients with weakened immune systems or those who have undergone invasive procedures.[ also live in your intestine ]

Infection Control Program

• Purpose: Established to safeguard both patients and healthcare staff from infections, breaking the chain of infection through effective strategies and protocols.

• Chain of Infection

  The "chain of infection" describes the six links required for an infection to spread: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link in this chain can prevent the spread of infection.

  1. Infectious Agent:

  • Refers to the microorganism (bacteria, viruses, fungi, parasites) that can cause disease.

  • Examples: E. coli bacteria, the influenza virus, or the fungus Candida.

  1. Reservoir:

  • The place where the infectious agent lives and multiplies.

  • Examples: A person, an animal, the environment, or contaminated objects.

  1. Portal of Exit:

  • How the infectious agent leaves the reservoir.

  • Examples: The mouth (saliva, vomit), nose (secretions), cuts in the skin (blood), or the gastrointestinal tract (feces).

  1. Mode of Transmission:

  • How the infectious agent is transmitted from the reservoir to a new host.

  • Examples: Direct contact (touching), indirect contact (contaminated surfaces), airborne transmission (coughing, sneezing), or through vectors (e.g., mosquitoes).

• Components:

  • Employee monitoring and training on infection control practices.

  • Implementation of treatment guidelines, surveillance for outbreaks, and adopting additional precautions when outbreaks occur.

Infection Control Practices

• Personal Protective Equipment (PPE): Essential items including gloves, masks, gowns, and face shields designed to protect against exposure to infectious agents.

• Hand Hygiene: Reinforce the critical importance of proper handwashing techniques and the use of alcohol-based hand sanitizers in preventing infection transmission.

• Environmental Controls: Emphasizing the need for regular cleaning and disinfection of surfaces and equipment to minimize risk.

Evolution of Infection Prevention

• Timeline:

  • 1970: isolation techniques for use in hospitals.

  • 1985: Introduction of Universal Precautions to safeguard healthcare personnel against blood-borne infections.

  • 1996: Adoption of Standard Precautions to expand protection protocols, addressing a wider range of pathogens and modes of transmission.

  • 1999: Routine Practices and Additional Precautions

  • 1987: Body Substance Isolation

Standard vs. Routine Practices

• Routine Practices: Guidelines designed to be applied universally with all patients at all times in Canada, ensuring a base level of safety and infection control.

• Standard Precautions: Framework established in the USA that outlines specific measures for managing exposure risks based on the type of healthcare interaction.

Transmission-Based Precautions

1. Airborne Precautions: For pathogens transmitted through the air, requiring specialized ventilation and isolation arrangements.

2. Droplet Precautions: For respiratory illnesses that spread via droplets larger than 5 microns, necessitating the use of surgical masks and spatial separation.[happens when an infected patient coughs, sneezes}

3. Contact Precautions: Employed when infections are spread by direct or indirect contact, requiring gloves and gowns as part of the protective gear.

Chain of Infection

• Components: Understanding each component is crucial to breaking the chain of transmission and preventing infections.

• Agent: The specific pathogen responsible for the disease.[bacteir,virus]

• Reservoir: Where the pathogen lives and multiplies.[ people,animals,food,]

• Portal of Exit: How the pathogen exits the reservoir. [ coughing, sneezing,}

• Mode of Transmission: The means by which the pathogen spreads.[ direct contact indirect]

• Portal of Entry: The path through which the pathogen enters a host.[mouth,nose,eyes]

• Susceptible Host: Individual at risk for infection, often due to immunocompromised conditions or lack of immunity.[anyone]

Additional Precautions

• Definition: Extra measures employed when patients are confirmed to be infectious; designed to provide heightened safety and prevent the spread of infection beyond routine practices.

• Types:

  • Airborne: For pathogens that can remain suspended in the air.

  • Droplet: For respiratory infections requiring protections from larger droplets.

  • Contact: For infections requiring physical barriers to prevent spread.

Isolation Procedures

• Purpose: To protect both healthcare workers and vulnerable patients from infectious individuals through containment strategies.

• Types:

  • Reverse Isolation: Protects immunocompromised patients from infections, using barriers to prevent pathogen exposure.

  • Regular Isolation: For patients known to be contagious, requiring clear communication and compliance with isolation protocols.

Blood Borne Pathogens

• Definition: Refers to infectious microorganisms found in blood that can lead to significant health risks for healthcare workers.

• Common Types: Include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), with the emphasis on the importance of vaccination against HBV for all healthcare workers.

Reducing Pathogen Transmission

During Collections:

• Wash hands and don new gloves: before each collection.

• Wear safety glasses: to avoid mucous membrane splashes.

• Never recap needles.

• Dispose of used needles: into a rigid sharps container immediately.

• Use available engineering controls: including self-sheathing needles and plastic blood collection tubes.

• In the Lab:

  • Keep specimens capped for centrifugation; if possible, use centrifuge buckets with lids.

  • Open specimens by placing gauze over the cap of the tube and gently twisting or opening the top in the direction away from you. Open tubes in a biological safety cabinet if possible.

  • Wear gloves when handling all specimens.

  • Do NOT wash, disinfect, or reuse gloves.

  • Remove gloves when touching non-contaminated items such as telephones and computer terminal keyboards.

  • In Case of Leaking Specimens:

    • Discard leaking specimens appropriately and request a new specimen. If obtaining a new specimen is not feasible, then disinfect the outside of the container.

    • Eliminate procedures that generate aerosols or find means to reduce exposure to aerosols.

    • Perform any procedure that may generate aerosols in a biological safety cabinet or wear a face shield.

    • Use closed tube testing systems when feasible.

    • Store personal items away from the laboratory.

    • Wear lab coats or gowns in the lab and remove when leaving.

    • Keep clean lab coats away from used lab coats.

    • Use disinfectants to clean surfaces liberally; learn the proper choice and use of disinfectants.

    • Develop and communicate procedures regarding the treatment and disposal of contaminated items which are consistent with institutional policies.

    • Learn the biological spill response procedure and the location of the necessary equipment to respond to a spill or exposure.

    • Familiarize yourself with the occupational health program, particularly policies related to immunization and emergency post-exposure follow-up.

Eyewash and Shower Stations

• Eyewash Stations: Must be easily accessible, no more than 10 sec walking with adequate signage; should flush eyes for a minimum of 15 minutes in case of exposure to harmful substances.

• Showers: Need to be within walking distance for immediate access; activated by pull chains or levers for quick operation during emergencies.

• Testing the Eyewash Station

  1. Check for Running Water (activate weekly)
     a) The valve activates immediately and remains open until closed by the user.

  2. Check for Flow
     a) The water stream should be about 6 inches long, with both streams crossing at the center of the eyewash nozzle.

  3. Check for Water Temperature
     a) Tepid water – 16 to 38 degrees Celsius.

  4. Documentation
     a) All maintenance performed is documented and retained for auditing purposes.

  5. flush for 15 min

Needlestick & Exposure Protocols

• Immediate Steps: In the event of a needlestick injury, cleanse the wound thoroughly, seek medical care promptly, and report the incident for further investigation into safety measures.

• Follow-up: Important testing and counseling should be conducted after exposure to assess risk and prevent further complications.

• Importance: All incidents should be reported as part of a non-punitive culture; the focus is on improving safety protocols and preventing the recurrence of similar incidents in the future.

• Needlestick & Other Blood or Body Fluid Exposure Protocol

  1. Cleanse Site Immediately: Use soap and water.

  2. If Mucous Membrane: Flush with emergency eyewash.

  3. Avoid Cleaning: Do NOT use alcohol, hydrogen peroxide, bleach, or other chemicals.

  4. Do NOT ‘Milk’ or Squeeze: Avoid applying pressure to the wound site.

  5. Allow to Bleed Freely: Then cover lightly.

  6. Try to Identify Source: Note the name or accession number of the source.

  7. Seek Immediate Medical Assistance: Promptly get medical care.

  8. Report to Supervisor: Inform your supervisor about the incident.

  9. Participate in Incident Investigation: Engage in the follow-up investigation.

  10. Obtain Post-Exposure Follow-Up: Get appropriate medical follow-up from a healthcare professional.

      Post-Exposure Follow-up

      After a post-exposure event, a plan should be followed that includes:

      • Timely Response: Prophylaxis should start within 2 hours of exposure.

      • Documentation: The incident should be documented.

      • Identification of Source Patient: The source patient should be identified.

      • Testing of Source Patient’s Blood: Testing should occur if consent has been obtained or if provincial regulations provide a mechanism to compel the source to provide a bodily substance for testing.

      • Testing of Employee’s Blood: Testing should occur if consent is obtained.

      • Counseling: Counseling should be provided to the exposed individual.

Cleaning Levels

• Antiseptic

  • Definition: Antiseptics are substances that prevent sepsis, the presence of microorganisms or their toxic products within the bloodstream. The term comes from Greek, where 'anti' means "against" and 'septikos' means "putrefactive".

  • Function:

  • Antiseptics prevent or inhibit the growth and development of microorganisms without necessarily killing them.

  • Safety: Antiseptics are considered safe to use on human skin and are commonly used to clean the site before blood collection.

  • Common Antiseptic: The most commonly used antiseptic for routine blood collection is 70% isopropyl alcohol (isopropanol), which is available in individually wrapped prep pads.

• Decontamination: The process aimed at making materials safe to handle, involving the removal of contamination. [has 3 antiseptics,disinfection, sterilization]

• Disinfection

  • Definition: Disinfection is defined in the Canadian Biosafety Standard as a process that eliminates most forms of microorganisms. It is much less effective than sterilization, which kills all forms of microbial life.

  • Uses of Chemical Disinfectants:

  • Used for decontamination on surfaces and equipment which cannot be autoclaved.

  • Employed after spills of biohazard material.

  • Utilized in discard jars and pipette jars.

  • Choosing a Disinfectant: Consider the following factors:

  • Types of organisms suspected or known to be contaminants.

  • Items or surfaces to be decontaminated.

  • Hazards posed to the worker by the disinfectant.

  • Whether the material to be disinfected can inactivate the disinfectant.

  • Contact time required for effective disinfection.

  • Disinfectants:

  • Chemical substances or solutions regulated by the Environmental Protection Agency (EPA) that are used to remove or kill microorganisms on surfaces and instruments.

  • Not safe to use on human skin.

  • Do not kill bacterial spores.

  • Sodium hypochlorite (bleach) products are preferred for their effectiveness.

  • Solutions made from generic 5.25% household bleach may be used.

  • A contact time of at least 10 minutes is required for bleach-based and some other disinfectants to

• Sterilization

  • Definition: Sterilization is defined as a technical procedure to kill all microorganisms and their spores using high temperature with steam, dry heat, or boiling liquid (e.g., autoclaves).

  • Characteristics of a Sterile Object: A sterile object is totally free of living microbes, including viruses, bacteria, and their spores.

  • Requirement for Reusable Medical Equipment: Reusable medical equipment must be sterilized before reuse.

Disease Types

Infectious diseases arise from pathogens such as viruses, bacteria, fungi, and parasites that can invade the body. Non-communicable diseases are typically associated with lifestyle factors, genetics, and environmental influences, but they do not spread between people. Hereditary diseases originate from genetic mutations passed down from parents to offspring. Additional disease types like deficiency diseases stem from nutrient lack, physiological diseases from bodily dysfunction, and lifestyle diseases from unhealthy habits.

1. Infectious Diseases:

• Viral: Common cold, influenza, COVID-19, hepatitis, measles.

• Bacterial: Strep throat, tuberculosis, salmonellosis, chlamydia.

• Fungal: Ringworm, fungal nail infections, thrush.

• Parasitic: Giardiasis, toxoplasmosis, hookworm infections.

1. Non-Communicable Diseases:

• Cardiovascular Diseases: Heart disease, stroke, high blood pressure.

• Cancers: Lung cancer, breast cancer, colon cancer.

• Chronic Respiratory Diseases: Asthma, COPD.

• Diabetes: High blood sugar levels.

• Mental Health Conditions: Depression, anxiety, schizophrenia.

• Digestive Diseases: Inflammatory bowel disease, cirrhosis.

• Kidney Disease: Chronic kidney disease.

• Arthritis and Bone Diseases: Osteoarthritis, osteoporosis.

• Allergies and Respiratory Conditions: Allergies, hay fever.

1. Hereditary Diseases:

• Genetic Diseases: Cystic fibrosis, sickle cell anemia, Huntington's disease.

• Non-Genetic Hereditary Diseases: Certain types of arthritis, osteoporosis.

1. Other Disease Categories:

• Deficiency Diseases: Due to a lack of nutrients.

• Physiological Diseases: Related to the body’s functionality.

• Lifestyle Diseases: Associated with unhealthy lifestyle choices.

• Disseminated Diseases: Spread throughout the body.

• Localized Diseases: Affect a specific area or organ.

Routine Practices Include:

• Risk Assessment: Evaluating potential hazards and implementing strategies to mitigate infection transmission risks.

• Hand Hygiene: Emphasizing the importance of proper handwashing techniques and the use of alcohol-based hand sanitizers to prevent infection transmission.

• Personal Protective Equipment (PPE): Utilizing essential safety items such as gloves, masks, gowns, and face shields to protect against exposure to infectious agents.

• Environmental Controls: Implementing regular cleaning and disinfection of surfaces and equipment to minimize the risk of infection in healthcare settings.

• Administrative Controls: Establishing policies, procedures, and training to ensure compliance with infection control measures and promote a