Infection Control

The purpose of infection control is to minimize and remove a variety of disease-causing micro-organisms from the health care environment. Microorganisms are organisms that can only been seen through a microscope, including bacteria, protozoa, algae, and fungi. Microorganisms become pathogenic when they are not in their normal host or environment and cause disease.

There are four types of microorganisms:

  • virus

    • ex: rhinovirus (common cold), varicella (chickenpox), HIV/AIDS, Hepatitis, COVD-19

  • fungi

    • ex: Histoplasmosis (lung infection passed on by certain bird/bat droppings), Tinea pedis (athlete’s foot)​​​​​​​, Candida albicans (yeast infection)

  • bacteria

    • ex: E. Coli, UTI, Cholera (vibrio cholerae, bordetella pertussis (whooping cough)

  • parasites: are further classified into four other categories

    • protozoa

    • helminths

    • ectoparasite

    • rickettsia

    • ex: Toxoplasmosis, Pinworm, Tapeworm, Scabies, Lice​​​​​​​, Lyme disease

To prevent spread of pathogens medical asepsis should be completed. Medical asepsis is a cleaning technique that includes frequent hand hygiene, proper use of gloves, cleaning and sterilizing medical equipment, and sanitizing surfaces to reduce the number of pathogens. Surgical asepsis is the complete removal of all micro-organisms and must be used during invasive procedures. Diseases caused by pathogens are called infectious or communicable diseases, which is illness that is spread from one person to another or from an animal to a person or from a surface or food.

A few ways to maintain asepsis:

  • Clean and disinfect the office daily. Be sure to focus on all high-traffic areas, (for example, examination rooms, restrooms, height/weight scale area, patient check in/out areas) and inspect office surfaces or objects that can be contaminated or require frequent disinfection. 

  • Remove trash.

  • Move sick and contagious patients from the reception area to an exam room or separate them from well patients upon arrival to a medical facility.

  • Provide appropriate personal protective equipment including gloves, gowns, masks, and eye protection as needed for each situation.

  • Do not allow eating or drinking in lab, clinical, or patient areas.

  • Post reminder signs regarding good hand hygiene and covering coughs or sneezes.

Direct transmission takes place when there is contact with an infected person or body fluid that is carrying the pathogen. Contact with a mosquito, pencil, or contaminated table would be considered indirect transmission, which provides an intermediate step between the portal of exit and portal of entry.

Infectious agent: all healthcare settings contain infectious agents brought in by patients, visitors, volunteers, and personnel

Means of transmission: can be broken, different infectious agents have different means of transmission, there are three categories

  • airborne:allow the patient to enter the facility by a different route, place the patient in an isolation room, have the patient place a face mask on, and have the health care working use appropriate PPE such as mask, gloves, and gown.

  • contact: sing proper PPE such as gloves and gown, washing hands before and after working with the patient, and disinfecting the exam room are all precautions that should be taken.

  • droplet: get the patient to an exam room as quickly as possible, have the patient put on a face mask, and have the health care professional use appropriate PPE such as mask and gloves.

susceptible host: final link in chain is host which infectious agent must reach a host in which it can survive and reproduce

Chain of infection: infectious agent —→ reservoir/source —→ portal of exit —→ means of transmission —→ portal of entry to host —→ susceptible host

  • can only be controlled through breaking it

Universal precautions and guidelines are set in place to prevent health care professionals from exposure to infections when providing first aid or health care. Are used when in contact with

  • Blood products

  • Human tissue

  • Body fluids such as cerebrospinal fluid, amniotic fluid, and pleural fluid

  • Any body fluid visibly contaminated with blood

  • Vaginal secretions and semen

Health care professionals are responsible not only for protecting their patients but also for protecting themselves from blood-borne pathogens. The Centers for Disease Control and Prevention has been recommending standard precautions since 1987.

Some general guidelines of standard precautions are as follows.

  • Wash hands before and after every procedure.

  • Use gloves with encountering patient blood/body fluids, handling anything contaminated with blood, performing venipuncture, handling blood specimens, and cleaning up body fluids or blood.

  • Cover any scratches or breaks in the skin.

  • Refrain from eating, drinking, or chewing gum while working.

  • Wear appropriate personal protective equipment (PPE) if blood or body fluid splatter could occur.

  • Clean all spills immediately with appropriate cleaning supplies.

  • Dispose of sharps immediately.

  • Place sharps or broken glass in a puncture-proof container.

  • Dispose of all biohazard waste in appropriate biohazard container

Categories of regulations to follow:

Category 1: Tasks that have a chance of body fluids or blood spilling or splashing, or tasks that can cause exposure to blood or body fluids such as a minor surgical procedure

Category 2:Tasks that do not usually involve chance of exposure, such as CPR; precautions must still be taken

Category 3: Tasks that do not require any PPE, such as taking a patient’s vital signs

Bloodborne Pathogen Standard: developed by OSHA to minimize personnel exposure to blood borne pathogens and addresses (the 2001 revision addressed the use of new technologies and accommodations from the Needlestick Safety and Prevention Act)

  • written exposure control pain

  • implementation of standard precautions

  • engineering and work practice controls: Devices used to isolate or remove the blood-borne pathogen hazard from the workplace. 

  • personal protective equipment

  • housekeeping, equipment cleaning and sterilization

  • signs, labels, and colo-coding

  • emergency procedures

  • isolation reporting

Tuberculosis control safety is guided by the OSHA respiratory Standard which is contained in Title 29 Section 1910.134 of the Code of Federal Regulations

If use of a respirator is required for your job, a medical evaluation has to be completed on your ability to use a respirator by a physician, and re-evaluations have to be completed every two years. Fit test must also be completed if you are to wear a tight-fitting respirator.

Occupational exposure to pathogens and TB: refers to reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious material that may result from performance of a healthcare worker’s duty

Health Care Associated Infection:infections people get while they’re receiving health care for another condition, can happen in any health care facility, including hospitals, ambulatory surgical centers, and long-term care facilities (ex: UTI, post-operative infections, respiratory infections)

Elements of the Infection Control Plan (readily available to staff at risk):

  • exposure determination

  • patient and family education

  • engineering controls

  • housekeeping

  • work practice controls

  • vaccinations

  • PPE

  • emergenty procedures

  • standard and transmission based precautions

  • incident reporting

  • violation reporting

Infectious diseases are spread through

  • bloodborne pathogens: infectious microorganisms in blood that can cause disease.

    • fluids that transmit these pathogens: blood, semen, vaginal secretions, cerebrospinal fluid (fluid around spinal cord), synovial fluid (fluid around joints), pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, HIV containing cells and cultures

    • ex: HIV, HBV (hepatitis B virus), and HCV (hepatitis C virus) (Hepatitis causes liver issues)

  • airborne: microorganisms expelled by an infected person and transported by minute droplets or dust particles that remain suspended in the air for long periods of time. special air handling and ventilation is needed to prevent airborne transmission.

    • ex: myycobacterium tuberculosis, other potentially infectious material OPIM

  • other methods: are in body fluids and are spread through contact or droplets entering the body

How to Don an Doff PPE:

  • Donning nonsterile gloves

    • Perform handwash.

    • Select appropriate size of nonsterile gloves.

    • Place hand through opening and pull glove up to wrist.

    • Repeat on other hand.

    • Adjust gloves as necessary.

  • Doffing nonsterile, contaminated gloves

    • Grasp palm of glove of nondominant hand with dominant hand.

    • Pull glove off the nondominant hand in a downward motion while turning the glove inside out. Hold in dominant hand.

    • Roll the glove up into the dominant hand.

    • Place two fingers of the ungloved hand under the cuff of the other gloved, dominant hand, making sure not to touch the outside of the glove.

    • Pull the glove over the hand, turning it inside out over the other glove.

    • Throw away the gloves in the appropriate container.

    • Wash hands.

Hand sanitizer should have at least 60% alcohol

Sanitization: The cleaning process that reduces the number of micro-organisms to a safe level.

disinfection:the process of destroying pathogens or rendering them inactive on surfaces and items, such as countertops and surgical instruments

Low-level disinfection kills most vegetative bacteria and some viruses and fungi.

  • used for Exam tables and countertops

  • ex: hydrogen peroxide

Intermediate-level disinfection kills vegetative bacteria and most viruses and fungi but does not kill spores.

  • used for Stethoscopes, percussion hammers, blood pressure cuffs

  • ex: Isopropyl alcohol

High-level disinfection kills all micro-organisms except for a small number of bacterial spores.

  • used for instruments that do not penetrate soft tissues or bone but contact mucous membranes, such as endoscopes

  • ex: Cidex OPA

Any time a new chemical is brought into the work environment safety data sheets, SDS, information must accompany the chemical. Each SDS is in the same format so professionals can find information quickly in case of an accidental exposure or emergency.

Sterilization is the destruction of all living organisms, including pathogens and their spores. Prior to sterilization, disinfection and sanitization must occur. some of these techniques include:

  • Autoclave (250-270 degrees farenheigt)

  • Instrument Cleaner

  • Germicidal Disinfectants

  • Disposables