Infection Control

Asepsis and Infection Control

Introduction to Asepsis

  • Asepsis is the state of being free from pathogenic microorganisms, and aims to prevent contamination, protecting both patients and healthcare workers.

  • Medical asepsis involves practices to keep areas as clean as possible without making them sterile, reducing the number of microorganisms. This includes using alcohol-based sanitizers, bleach solutions, and regular hand soap.

  • Surgical asepsis (sterile asepsis) ensures that items are free of all microbes and spores, maintaining a completely sterile environment. This is crucial during surgeries and invasive procedures to prevent infections.

Types of Microorganisms

  • Pathogenic Microorganisms: Cause disease through various mechanisms, including tissue invasion and toxin production.

    • Examples: Bacteria (e.g., Streptococcus), fungi (e.g., Candida).

  • Nonpathogenic Microorganisms: Do not cause disease and are part of the normal flora, aiding in digestion and immunity.

    • Examples: Bacteria in the nose or vaginal canal, E. coli in the colon (when in the colon only).

E. Coli as an Example

  • In the colon, E. coli is nonpathogenic, aiding in vitamin K production and preventing colonization by harmful bacteria.

  • In the digestive system or urethra, it becomes pathogenic, causing diseases like UTIs, gastroenteritis, and even sepsis.

  • UTIs are often caused by women wiping the wrong way, transferring E. coli from the colon to the urethra, leading to infection.

Examples of Disease Transmission

  • Picking your nose (which contains staph) and then putting your finger in your eye can cause conjunctivitis (pink eye), resulting in inflammation and discharge.

Communicable Diseases

  • Communicable diseases must be reported to the National Notifiable Diseases System of the CDC through the local health department to monitor and control outbreaks.

  • Examples of communicable diseases:

    • Chickenpox (Varicella)

    • Conjunctivitis (Pinkeye)

    • H Flu (Haemophilus influenzae)

    • Measles (Rubeola)

    • Meningitis (viral or bacterial)

    • MRSA (methicillin-resistant Staphylococcus aureus)

    • Mumps (Infectious Parotitis)

    • Pertussis (Whooping Cough)

    • Rubella (German Measles)

    • Strep Throat (Streptococcal Pharyngitis)

    • VRE (vancomycin-resistant enterococci)

Incubation Period

  • Incubation Period: The time interval between exposure to an infection and the appearance of the first symptom, during which the pathogen multiplies without causing noticeable symptoms.

Susceptibility and Vulnerability

  • Susceptibility: A person's likelihood of contracting a disease based on their immune system's strength, influenced by genetics and overall health.

    • Factors increasing susceptibility: stress, lack of sleep, poor nutrition, and chronic diseases.

  • Vulnerability: Being liable to injury or harm due to weakened immunity or pre-existing conditions such as diabetes, HIV/AIDS, or immunosuppressant medications.

Pathogens and Their Requirements

  • Pathogens: Microorganisms that cause disease by invading the host and disrupting normal bodily functions.

  • Requirements for growth:

    • Warmth: Optimal temperature for replication.

    • Moisture: Necessary for metabolic processes.

    • Dark environments: Protection from UV radiation.

Normal Flora and Natural Immunity

  • Normal flora helps maintain body balance and provides natural immunity against certain infections by competitive exclusion and producing antimicrobial substances.

Environmental Requirements for Microorganisms

  • Oxygen: Some microorganisms need oxygen (aerobes) to produce energy through aerobic respiration, while others do not (anaerobes) and use anaerobic respiration.

  • pH Levels:

    • Blood pH needs to stay between 4.35 and 4.45. If lower or higher, it can be fatal, leading to acidemia or alkalemia.

    • Bacteria thrive in higher alkalinity, which can disrupt the body's normal pH balance.

    • Ketosis (from not eating) can result in a pH less than 6, causing metabolic acidosis.

  • Temperature:

    • Microorganisms grow best at the average body temperature of 98.6 degrees Fahrenheit or 37 degrees Celsius, facilitating rapid replication.

Other Growth Requirements

  • Nutrients: Carbon, nitrogen, and other organic compounds.

  • Water: Essential for cellular functions and transport.

  • A host to inhabit: Provides a suitable environment for survival and reproduction.

Stages of Infection Control: Chain of Infection

  • The infection cycle, or chain of infection, illustrates how diseases transmit from one person to another, emphasizing the interconnectedness of factors.

  • Breaking the chain through methods like handwashing, sterilization, and proper disposal of contaminated materials is crucial in preventing the spread of infection.

Components of the Chain of Infection

  1. Infectious Agent: A pathogen such as:

    • Bacteria: Single-celled organisms that can cause infections like pneumonia and sepsis.

    • Virus: Acellular entities that require a host to replicate, causing diseases like influenza and HIV.

    • Parasite: Organisms that live on or inside a host, causing diseases like malaria and giardiasis.

    • Fungi: Eukaryotic organisms that can cause infections like athlete's foot and candidiasis.

  2. Sanitizing, Disinfecting, and Sterilizing are methods to break the chain of infection, reducing the microbial load on surfaces and preventing transmission. Handwashing is also essential.

Bacteria

  • Bacteria vary in morphology (form and structure):

    • Spiral (e.g., Spirillum)

    • Round (e.g., Cocci)

    • Rod-shaped (e.g., Bacilli)

  • Being present doesn't automatically mean disease; normal flora exists and plays a vital role in maintaining health.

  • Single-celled microorganisms lack nuclei or organelles, reproducing through binary fission.

  • Examples: E. coli (urinary tract and intestinal infections), Bordetella pertussis (whooping cough), Staphylococcus aureus (skin infections).

Viruses

  • Viruses are the smallest microorganisms, viewed only by electron microscopes, consisting of genetic material (DNA or RNA) enclosed in a protein coat.

  • Classified by type of DNA or RNA, determining their replication mechanisms and host specificity.

  • Reproduce by attaching to a host cell, taking it over, and self-replicating, thus destroying the host cell and releasing new viral particles.

  • Examples: HIV/AIDS, herpes, chickenpox, hepatitis, cold, flu, measles, and Zika virus.

  • Viral infections must run their course; some viruses stay in the body indefinitely, such as Epstein Barr, causing mononucleosis and potentially leading to other complications.

  • HPV (human papillomavirus) has many strains and can come and go, with some strains causing warts and others leading to cervical cancer.

Fungi

  • Simple parasitic plants that depend on other life forms for nutrients, obtaining nourishment from living or dead organic matter.

  • Molds (multicellular fungi) thrive in warm, dark, humid conditions, producing spores that can cause allergic reactions and respiratory issues.

  • Yeast multiplies via budding, especially in sugary mediums, leading to infections like candidiasis.

  • Diabetics must be cautious about yeast infections due to sugar in urine, which promotes the growth of Candida albicans.

  • ompound Medicines

    • Compound medicine: Pharmacy creates its own customized medication.

    • Lloyd Pharmacy: Previously compounded medications like the "swish and swallow" cough syrup.

    • Current Compounding Pharmacies:- Duramed.

      • Barney's (limited compounding at one location).

      • Specific pharmacy in Surrey Center (location detail needed).

    • Increased Use by Physicians:- Traditional antibiotics are systemic, affecting the entire body.

      • Targeted treatment is desired for localized conditions (e.g., outer ear infections), allowing for specific and concentrated application.

    • Challenges:- Lists of compound pharmacies may be outdated due to frequent changes in the industry.

      • Availability varies geographically, with compound pharmacies more common in some areas than others.

      • Locating a reliable and qualified compound pharmacist can be difficult.

      • Compound pharmacies often operate with special or limited hours.

      • Prescriptions may not always be available for same-day pickup.

      • Complementary medicine practitioners (e.g., chiropractors) sometimes offer compounded supplements (not requiring prescriptions).

    • Examples of Compounded Medications and Supplements:- Testosterone (hormone replacement therapy).

      • MP Thyroid (thyroid hormone replacement).

    • Insurance Coverage:- Insurance companies typically do not cover compound medicines, making them an out-of-pocket expense.

      • Finding compounding pharmacies that meet specific patient needs can be challenging.

    Augusta

    • Perceptions of Augusta:- Augusta is often seen as a closed-minded community controlled by a small, influential group.

    Dollar General

    • Proximity of Discount Stores:- Dollar Generals, Dollar Trees, and Family Dollars are frequently located in close proximity to one another.

      • Example: A Dollar General situated in the middle of a residential neighborhood with restricted access for delivery trucks.

    • Market Saturation:- Dollar General Market, Dollar Tree, Family Dollar, and Dollar General stores are all present on the same road, potentially indicating market saturation.

      • Concerns exist that Dollar General may be over saturating the market, leading to increased competition and potential negative impacts on local businesses.

    Deering

    • Historical Significance:- The first house ever built in the area is reportedly located under the water tank.

    Communicable Diseases

    • Parasites: Organisms that derive nourishment from another living organism.- Helmets (worms): Multicellular parasites.

      • Protozoa (single-celled animals): Microscopic parasites that can move using hair-like projections, flagella, or tails.- Example: Trichomonas vaginalis.

      • Toxoplasmosis: A disease transmitted through cat feces, posing a risk to pregnant women.- Harmful to pregnant women, potentially causing birth defects or miscarriage.

      • Malaria: A mosquito-borne disease caused by protozoan parasites.- From mosquitoes, leading to fever, chills, and flu-like symptoms.

      • Protozoa can cause:- Diarrhea and dysentery.

        • Bowel infections, leading to abdominal pain and discomfort.

        • Inflammation of the brain (encephalitis), resulting in neurological symptoms.

      • Trich: A sexually transmitted infection/disease (STI/STD).- Looks like a ladybug under a microscope, characterized by vaginal discharge, itching, and painful urination.

      • Ova and parasites (O&P) test: A diagnostic test to detect parasites' eggs in stool samples.- Checks for parasites' eggs in stool samples, aiding in the identification of parasitic infections.

      • Helmets (pinworms, hookworms, tapeworms): Intestinal parasites that can cause various symptoms.- Cause diarrhea, itching, and abdominal discomfort.

        • Worms lay eggs at night, causing children to scratch the anal area.- Sign: Sleeping with butt in the air due to itching.

        • Larvae of hookworms penetrate the skin, leading to infection.

      • Ectoparasites (scabies, lice): Parasites that live on the skin's surface.- Cause red, dry, scaly, irritated skin, leading to intense itching and discomfort.

        • Look scaly under a microscope, aiding in diagnosis.

      • Rickettsiae: Obligate intracellular parasites that depend entirely on their host for survival.- Depend completely on their host to survive, as they cannot reproduce outside of a host cell.

        • Larger than viruses and can be seen under a breakthrough microscope.

        • Examples: Fleas, lice, mites, and ticks, which transmit rickettsial diseases through their bite.

        • Feed on blood, transmitting pathogens to humans and animals.

    • Lice: Wingless insects that infest the hair and scalp.- Lice cannot live without a host and require human blood to survive.

      • They die in 48-72 hours without a host, so leaving a house for 72 hours is sufficient to eliminate lice.

      • Cosmetologists treat lice in the yard to prevent infestation of the house or shop.

      • Lice prefer very clean hair, contrary to popular belief.

      • Unclean hair may prevent lice infestation.

      • Fair-haired individuals are more prone to lice infestation.

    • Vectors: Insects or arthropods that transmit diseases from one host to another.- Fleas, lice, mites, and ticks serve as vectors for various diseases.

      • Insects that carry disease, transmitting pathogens through their bite or contact.

      • Transmit diseases through blood feeding or infectious feces, introducing pathogens into the host's body.

      • Diseases: Lyme disease, Rocky Mountain spotted fever, and tularemia are transmitted by vectors.

      • Deer ticks carry Lyme disease, a bacterial infection affecting multiple body systems.

      • Lyme disease: Characterized by a bullseye rash at the site of the tick bite.

      • Ringworm: A fungal infection characterized by a round rash with no bullseye pattern.

      • Scabies: An infestation of the skin by mites, resulting in S-shaped marks in the skin.

    • Symptoms of Lyme disease:- Flu-like symptoms, including fever, fatigue, and muscle aches.

      • Arthritic joints, leading to pain and inflammation.

      • Body aches, causing discomfort and stiffness.- Ask patients about the presence of a round rash with a red dot in the middle, indicative of Lyme disease.

      • Round marks are what Lyme disease looks like, aiding in diagnosis.

    Chain of Infection

    • Reservoir: A place where pathogens can survive and multiply, serving as a source of infection.- Examples: People, equipment, food, water, animals, and insects can act as reservoirs for pathogens.

      • Break the chain by:- Proper hygiene practices, such as hand washing and personal cleanliness.

        • Cleaning supplies and equipment regularly to remove pathogens.

        • Cleaning linens and laundry to prevent the spread of infection.

    • Portal of Exit: The manner in which a microorganism leaves the reservoir.- Through:- Body secretions, such as saliva, mucus, and wound drainage.
      - Excretions, including feces and urine.
      - Respiratory droplets expelled during coughing or sneezing.
      - Blood and other bodily fluids.

      • Direct or indirect contact with infected individuals or contaminated surfaces.

      • Break the chain by:- Isolation of infected individuals to prevent further transmission.

        • Covering mouth and nose when coughing or sneezing to contain respiratory droplets.

        • Sterile dressings applied to wounds to prevent pathogen release.

    • Means of Transmission (Modes of Transmission): The ways in which microorganisms travel from the reservoir to the portal of exit and then to a susceptible individual.- Susceptibility depends on the individual's immune system and overall health.

      • Enough of the microorganism is needed to cause infection, as the infectious dose varies among pathogens.

      • Traveler's diarrhea can be caused by drinking water in certain countries due to contamination.- Local populations acclimate to the environment and develop immunity to local pathogens.

        • Areas with wells should be safer, as well water is typically filtered and less prone to contamination.

        • Some countries use rain barrels for water collection, increasing the risk of contamination if not properly treated.

      • Direct Contact: Physical contact with an infected person or their body fluids.- Contact with infected person or body fluids, such as touching, kissing, or sexual contact.

        • Includes bloodborne transmission, such as through sharing needles or exposure to infected blood.

      • Indirect Contact: Transmission of pathogens through intermediaries or vehicles.- Inhaling contaminants, such as airborne particles or droplets containing pathogens.

        • Handling a fomite (chair, table, tissue, doorknob), which is an inanimate object contaminated with pathogens.

        • Airborne transmission (moisture from breathing, sneezing, coughing - up to 20 feet or more).

        • Ingesting contaminated food or water, leading to foodborne or waterborne illnesses.

        • Vector (insect) transmits the disease, such as mosquitoes transmitting malaria or ticks transmitting Lyme disease.- Examples: Mosquito or tick.

          • Type of Indirect Contact.

      • Break the chain by:- Hand washing regularly with soap and water to remove pathogens.

        • Wearing gloves, masks, gowns, and goggles (PPE - Personal Protective Equipment) to protect against exposure.- Wearing goggles, gowns, masks, gloves.

          • Foot covers are NOT part of PPE for disease transmission.

        • Medical and surgical asepsis techniques to maintain cleanliness and prevent contamination.

        • Proper disposal of contaminated objects, such as sharps and infectious waste.

        • Incineration of trash in hospitals to eliminate pathogens.

        • Sharps containers for sharp objects to prevent needlestick injuries.

    • Portals of Entry: The ways in which a pathogen enters the host's body.- Eyes, ears, nose, throat, mouth, intestinal tract, urinary tract, reproductive tract, non-intact skin serve as entry points for pathogens.

      • Break the chain by:- PPE (personal protective equipment) to create a barrier against pathogen entry.

        • Sterile technique during medical procedures to prevent contamination.

        • Proper disposal of needles and sharps to prevent needlestick injuries.

        • Ensuring skin integrity (first line of defense) by keeping skin clean, moisturized, and protected.

        • Covering wounds with sterile dressings to prevent pathogen entry.

    • Susceptible Host: An individual who is at risk of infection due to various factors.- Populations with low resistance:- Elderly individuals with weakened immune systems.
      - Frail individuals with underlying health conditions.
      - Immunosuppressed people, such as those with HIV/AIDS or undergoing chemotherapy.
      - People with chronic diseases, trauma, or both, making them more vulnerable to infection.

      • Break the chain by:- Get healthy by adopting a healthy lifestyle and maintaining overall wellness.

        • Exercise regularly to strengthen the immune system.

        • Proper nutrition to support immune function.

        • Reduce your stress levels, as chronic stress can weaken the immune system.

        • Maintain Intact Immune System through vaccination and preventive measures.

        • Immunizations to protect against vaccine-preventable diseases.

    Chain of Infection Summary

    1. Infectious Agent (Microorganisms): Bacteria, virus, parasite, rhipocyte: The pathogen responsible for causing infection.- Break the chain: Clean, disinfect, and sterilize surfaces and equipment to eliminate pathogens.

    2. Reservoir or Source: People, equipment, food, water, animals, and insects: The environment where the pathogen resides and multiplies.- Break the chain: Proper hygiene, clean supplies/equipment/linens to prevent pathogen transmission.

    3. Portal of Exit: Secretions, excretions, respiratory/blood/body fluids: The means by which the pathogen leaves the reservoir.- Break the chain: Sterile dress wounds, isolation techniques, cover mouth/nose to contain pathogens.

    4. Means of Transmission: Indirect contact (fomites), direct contact (exudate), bloodborne, airborne, ingestion: The ways in which the pathogen spreads from the reservoir to the susceptible host.- Break the chain: Hand washing, dispose contaminated objects, medical/surgical asepsis, PPE to prevent pathogen transmission.

    5. Portal of Entry: Non-intact skin, mucous membrane, reproductive tract, digestive system, respiratory: The means by which the pathogen enters the host's body.- Break the chain: Skin integrity, cover wounds, sterile technique, hand washing, PPE, dispose of sharps to prevent pathogen entry.

    6. Susceptible Host: Elderly, frail, immunosuppressed, chronic disease, trauma: An individual at risk of infection due to weakened defenses.- Break the chain: Stress reduction, proper nutrition, immunizations, exercise, intact immune system (healthy lifestyle) to strengthen host defenses.

    Stages of Infectious Diseases

    • Incubation Stage: The time interval between initial infection and the appearance of the first signs and symptoms.- Pathogen enters the body and replicates without signs or symptoms, making diagnosis challenging during this stage.

    • Prodromal Stage: The period when early, nonspecific symptoms begin to manifest.- Onset of signs and symptoms, such as fatigue, malaise, and low-grade fever.

      • Runny nose, itchy eyes, malaise may occur during this stage.

    • Acute Stage: The phase when the disease reaches its peak intensity and characteristic symptoms are evident.- Disease reaches highest point of development, with severe symptoms that aid in diagnosis.

      • Severe aches, chills, vomiting, diarrhea may be present during the acute stage.

      • Symptoms help distinguish the specific disease, allowing for targeted treatment.

    • Declining Stage: The period when symptoms begin to subside, indicating the body's immune response is working to combat the infection.

    • Convalescent Stage: The recovery phase when symptoms gradually disappear and the body returns to its pre-infection state.- Symptoms have mostly vanished, although the individual may still feel weak or fatigued.

      • Pathogen is mostly eliminated from the body, reducing the risk of transmission.

      • Risk of relapse if medication is stopped too early, allowing the pathogen to rebound and cause recurrent illness.

    Body's Immune System

    • Immunity is best when the body is in good physical, emotional, and mental condition, as overall wellness supports optimal immune function.

    • Specialized Defense Mechanisms:- Respiratory Tract:- Hair-like cilia filter pathogens, trapping them and preventing them from entering the lungs.
      - Coughing and sneezing reflexes to expel pathogens from the respiratory system.

      • Body Secretions (tears, sweat, urine, mucus):- Wash away pathogens, flushing them out of the body.

        • Low pH discourages bacterial growth, creating an unfavorable environment for pathogens.

      • Hydrochloric Acid in Stomach:- Low pH discourages growth of ingested pathogens, preventing them from causing gastrointestinal infections.

      • Secretions maintains low pH to be acidic, inhibiting bacterial growth and supporting overall immune defense.

    Universal and Standard Precautions

    • Prevent disease transmission in healthcare settings, protecting both healthcare providers and patients.

    • Universal Precautions: CDC precautions to prevent transmission of HIV, HBV, and other bloodborne pathogens by treating all blood and body fluids as potentially infectious.- CDC precautions to prevent transmission of HIV, HBV, and other bloodborne pathogens.

      • Treat all blood and vitals as potentially infectious to minimize the risk of exposure.

      • HIV is more difficult to contract than HBV, but both pose significant health risks.

    • Standard Precautions: Recommended by the CDC for the safety and welfare of healthcare providers and the public, incorporating elements of universal precautions and emphasizing infection control practices.- Recommended by the CDC for the safety and welfare of healthcare providers and the public.

      • Hand hygiene (washing hands with soap and water) is essential for preventing the spread of infection.

      • Use standard blood and body fluid precautions to minimize the risk of exposure.

      • Appropriate protection against exposure to blood and body fluids is routine, including the use of gloves, gowns, masks, and eye protection.

      • Wash hands before and after gloving to maintain hand hygiene and prevent contamination.

      • Wear gloves for contact with blood, body fluids, mucous membranes, or non-intact skin to protect against pathogen exposure.

      • Change gloves and wash hands after each patient contact to prevent cross-contamination.

      • Use non-latex, powder-free gloves if allergic to latex or powder to prevent allergic reactions.

      • Bandage all scratches and paper cuts to prevent pathogen entry and protect against infection.

      • Refrain from direct patient care if you have an exudative skin condition or contagious disease until it clears up to prevent transmission to patients.

    Working Safely

    • Never eat, drink, chew gum, or smoke while working to prevent contamination and maintain a safe work environment.

    • Wear PPE (gloves, mask, face shield, gown, apron, goggles) when a splash is possible to protect against exposure to infectious materials.

    • Always recap bottles, jars, and tubes immediately to prevent spills and contamination.

    • Clean up spills immediately with a liquid germicide or bleach solution (1 cup bleach to 10 cups water) or a commercial spill kit to disinfect the area and prevent the spread of pathogens.

    • Work in a well-lit, uncluttered, ventilated, and quiet area to minimize distractions and prevent accidents.

    • Immediately discard all sharps in a puncture-proof container to prevent needlestick injuries.

    • Never break needles off or handle needles after use to avoid accidental punctures.

    • Package broken glass in puncture-proof containers and mark caution, broken glass to prevent injuries during disposal.

    • Place reusable metal instruments in a disinfectant solution after rinsing in cold water (sanitizing) to kill pathogens.

    • Use disposable equipment in mouth-to-mouth resuscitation (mouthpieces or resuscitation bags) to prevent the transmission of infectious diseases.

    • Strict adherence to safety precautions should be practiced during pregnancy to protect both the mother and the developing fetus.

    • If a coworker is sick or feverish, they should stay home until fever-free for 24 hours to prevent the spread of illness in the workplace.

    OSHA

    • OSHA (Occupational Safety and Health Administration) regulations ensure safety in the workplace by setting standards for workplace safety and health.