© 2009 Delmar, Cengage Learning Chapter 14 Infection Control.
-
Upload
marcus-higgins -
Category
Documents
-
view
254 -
download
7
Transcript of © 2009 Delmar, Cengage Learning Chapter 14 Infection Control.
© 2009 Delmar, Cengage Learning
Chapter 14
Infection Control
© 2009 Delmar, Cengage Learning
14:1 Principles of Infection Control
• Understanding is essential to all health care workers
• Provide a basic knowledge of how disease is transmitted
• Main emphasis on prevention of disease transmission
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes
• Small living organisms
• Not visible to the naked eye
• Microscope must be used to see them
• Found everywhere in the environment
• Found on and in the human body
• Many are part of normal flora of body
• May be beneficial
(continues)
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes(continued)
• Called nonpathogens when not harmful to the body
• Some cause infections and disease
• Called pathogens (germs) when able to harm the body
(continues)
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes(continued)
• Most prefer warm environments
• Most prefer darkness
• Need source of food and moisture
• Need for oxygen varies
• Human body is ideal supplier of all the requirements
© 2009 Delmar, Cengage Learning
Microbe Classifications
• Bacteria
• Protozoa
• Fungi
• Rickettsiae
• Viruses
© 2009 Delmar, Cengage Learning
Bacteria
• Simple, one-celled organisms
• Multiply rapidly
• Classified by shape and arrangement
(continues)
© 2009 Delmar, Cengage Learning
Bacteria(continued)
• Cocci are round or spherical in shape– Diplococci—in pairs – Streptococci—in chains– Staphylococci—clusters or groups
• Examples of diseases
(continues)
© 2009 Delmar, Cengage Learning
Bacteria(continued)
• Bacilli are rod shaped– Occur singly, in pairs, or in chains– May have flagella– Ability to form spores
• Examples of diseases
(continues)
© 2009 Delmar, Cengage Learning
Bacteria(continued)
• Spirilla are spiral or corkscrew shaped– Includes comma-shaped vibrio and corkscrew
spirochete
• Diseases include syphilis and cholera
© 2009 Delmar, Cengage Learning
Antibiotics
• Antibiotics are used to kill bacteria
• Some strains of bacteria have become antibiotic-resistant
• When antibiotic-resistant, the antibiotic is no longer effective against the bacteria
© 2009 Delmar, Cengage Learning
Protozoa
• One-celled, animal-like organism
• Found in decayed materials and contaminated water
• May have flagella for movement
• Some are pathogenic
• Examples of diseases
© 2009 Delmar, Cengage Learning
Fungi
• Simple, plant-like organisms
• Live on dead organic matter
• Yeast and molds
• Can be pathogenic
• Examples of diseases
• Antibiotics do not kill
• Antifungal medications
© 2009 Delmar, Cengage Learning
Rickettsiae
• Parasitic microorganisms
• Cannot live outside the cells of another living organism
• Transmitted to humans by the bites of insects (e.g., fleas, lice, ticks, mites)
• Examples of diseases
• Antibiotics are effective against many of them
© 2009 Delmar, Cengage Learning
Viruses
• Smallest microorganisms
• Must use electron microscope to see
• Must be inside another living cell to reproduce
• Spread by blood and body secretions
• Very difficult to kill
• Cause many diseases
(continues)
© 2009 Delmar, Cengage Learning
Viruses(continued)
• Viruses infecting animals can mutate to infect humans
• Examples include:– Severe acute respiratory syndrome (SARS)– West Nile Virus (WNV)– Monkeypox– Ebola and Marburg– H5N1
© 2009 Delmar, Cengage Learning
Virus—Hepatitis B
• Also called serum hepatitis
• Caused by HBV
• Transmitted by blood serum and body secretions
• Affects the liver
• Vaccine available for protection
• Vaccine is expensive
(continues)
© 2009 Delmar, Cengage Learning
Virus—Hepatitis B(continued)
• Vaccine given in a series of three injections
• By law, employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions
• If employee refuses, written statement must be signed documenting refusal
© 2009 Delmar, Cengage Learning
Hepatitis C
• Caused by HVC
• Transmitted by blood and blood-containing body fluids
• Many infected individuals are asymptomatic
• Others have mild symptoms
• Can cause severe liver damage
(continues)
© 2009 Delmar, Cengage Learning
Hepatitis C (continued)
• Currently, no vaccine ready for use
• Vaccine is in development stage
• Extremely difficult to destroy HVC
• Can survive and remain active for several days in dried blood
• Health care workers must follow precautions to protect against virus
© 2009 Delmar, Cengage Learning
Acquired Immune Deficiency Syndrome (AIDS)
• Caused by the Human Immunodeficiency Virus (HIV)
• Suppresses the immune system• Individual becomes susceptible to
cancers and infections that would not affect a healthy person
• No cure presently and no vaccine• Take precautions for prevention
© 2009 Delmar, Cengage Learning
Helminths
• Multicellular parasites otherwise known as worms or flukes
• Are transmitted:– By eating contaminated food– Being bitten by infected insects– When worms enter the skin
© 2009 Delmar, Cengage Learning
How Pathogens Cause Infection and Disease
• Some produce poisons called toxins
• Some cause an allergic reaction
• Others attach and destroy the living cells
they invade
© 2009 Delmar, Cengage Learning
Classifications of Diseases and Infections
• Endogenous
• Exogenous
• Nosocomial
• Opportunistic
© 2009 Delmar, Cengage Learning
Endogenous
• Originates within the body
• Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body
© 2009 Delmar, Cengage Learning
Exogenous
• Originates outside the body
• Examples: radiation, chemical agents, trauma, electric shock, and temperature extremes
© 2009 Delmar, Cengage Learning
Nosocomial
• Acquired in a health care facility
• Usually present in facilities and carried by health care workers to the patient
• Many are antibiotic-resistant
• Can cause serious and even life-threatening infections
(continues)
© 2009 Delmar, Cengage Learning
Nosocomial(continued)
• Examples are staphylococcus, pseudomonas, and enterococci
• Infection-control programs are used in facilities to prevent and deal with nosocomial infections
© 2009 Delmar, Cengage Learning
Opportunistic
• Infections that occur when the body’s defenses are down
• Usually do not occur in normal immune system
• Examples: Kaposi’s sarcoma (rare type of cancer) and Pneumocystis carinii pneumonia in individuals with AIDS
© 2009 Delmar, Cengage Learning
Chain of Infection
• Present for disease to occur and spread from one individual to another– Causative agent– Reservoir– Portal of exit– Mode of transmission– Portal of entry– Susceptible host
© 2009 Delmar, Cengage Learning
Common Body Defenses
• Mucous membranes• Cilia• Coughing and sneezing• HCL in the stomach• Tears• Fever• Inflammation response • Immune response
© 2009 Delmar, Cengage Learning
Ending the Chain of Infection
• Eliminate any step in the chain and infection is stopped
• Follow practices to interrupt or break the chain
• Remember, pathogens are everywhere
• Prevention is a continuous process
© 2009 Delmar, Cengage Learning
Aseptic Techniques
• Asepsis: absence of disease-producing microorganisms
• Contaminated: any object or area that may contain pathogens
• Major aim: maintaining cleanliness and eliminating or preventing every aspect of contamination
© 2009 Delmar, Cengage Learning
Common Aseptic Techniques
• Thorough handwashing
• Good personal hygiene
• Disposable gloves
• Cleaning instruments and equipment
• Proper cleaning of environment
© 2009 Delmar, Cengage Learning
Levels of Aseptic Control
• Antisepsis—used on the skin
• Disinfection—used mainly on objects
• Sterilization—use of steam under pressure, gas, radiation, and chemicals on objects
© 2009 Delmar, Cengage Learning
Summary
• Important for health care workers to know and use proper aseptic techniques at all times
• Prevents spread and transmission of disease
© 2009 Delmar, Cengage Learning
14:2 Bioterrorism
• Bioterrorism: use of microorganisms or biologic agents for warfare
• Infecting humans, animals, or plants
• Have been used over time by different nations not only in war but also on innocent people
© 2009 Delmar, Cengage Learning
Biologic Agents
• Microorganisms with characteristics suitable for bioterrorism:– Inexpensive, available, easily produced, spreads
quickly– Maintains its survival– Brings death or disability– Travels from person to person– Difficult to prevent/treat
(continues)
© 2009 Delmar, Cengage Learning
Biologic Agents(continued)
• High priority agents include:– Smallpox: contagious and infectious disease,
result of the Variola virus– Anthrax: infectious disease caused by
Bacillus anthracis– Plague: infectious disease from the bacteria
Yersinia pestis
(continues)
© 2009 Delmar, Cengage Learning
Biologic Agents(continued)
– Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum
– Tularemia: infectious disease from the bacteria Fracisella tularensis
– Filoviruses: infectious diseases causing severe hemorrhagic fever known as Ebola virus and Marburg virus
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism
• Bioterrorism attack would result in a public health emergency
• Would have impact on health care facilities
• Social disorder would ensue
• Comprehensive plan
(continues)
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism(continued)
• Bioterrorism Act 2002 passed by Congress and signed into law
• Involves local, regional, state, and national government and includes:– Early detection by communities– Public to be notified– Infection control and education– Funding available
(continues)
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism(continued)
– Guidelines and restrictions– Nationwide immunizations– Protection of food/water supplies– Trained personnel available– Emergency management controls– Investigation of potential threats– Preparation of health care facilities– Efficiency of communication
© 2009 Delmar, Cengage Learning
Summary
• All health care workers need to be aware
of bioterrorism
• Attack could occur at any time
• Being prepared and properly trained will result in saving many lives
© 2009 Delmar, Cengage Learning
14:3 Washing Hands
• Major aspect of standard precautions
• Most important aseptic technique
• Hands are perfect media for the spread of pathogens
© 2009 Delmar, Cengage Learning
Purpose of Handwashing
• Prevent and control spread of pathogens
• Protect the health care worker from disease and illness
© 2009 Delmar, Cengage Learning
Recommendations for Handwashing
• Regular handwashing with plain soap and water
• Antiseptic handwashing with antimicrobial soap and water
• Antiseptic hand rub with alcohol-based cleaner (waterless)
© 2009 Delmar, Cengage Learning
When to Wash Hands
• On arrival at facility
• Immediately before leaving facility
• Before and after every patient contact
• After contact with patient’s skin
• Before moving from a contaminated site to a clean site
(continues)
© 2009 Delmar, Cengage Learning
When to Wash Hands(continued)
• Anytime the hands become contaminated during a procedure
• Before applying gloves
• Immediately after removing gloves
• When gloves are torn or punctured
• Before and after handling specimens
• After contact with any soiled or contaminated item (continues)
© 2009 Delmar, Cengage Learning
When to Wash Hands(continued)
• After picking up any item off the floor
• After personal use of the bathroom
• Following a cough, sneeze, or using a tissue
• Before and after any contact with mouth or mucous membranes
© 2009 Delmar, Cengage Learning
Principles of Handwashing
• Use soap as a cleansing agent
• Use warm water
• Use friction
• Clean all surfaces
• Point fingertips down
• Use dry paper towels to turn faucet on and off
• Clean nails
© 2009 Delmar, Cengage Learning
Waterless Hand Cleaning
• Alcohol-based gel, lotion, or foam
• Used if hands are not contaminated with blood or body fluids
• Apply cleaner to palm of hand
• Rub hands together vigorously for at least 15 seconds
• After six to ten cleanings hands need to be washed with soap and water
© 2009 Delmar, Cengage Learning
14:4 Observing Standard Precautions
• Blood and body fluids are the main ways pathogens are spread
• Major pathogens: HBV, HBC, HIV
• Extreme care must be taken at all times when there is an area, object, or person contaminated with blood or body fluids
© 2009 Delmar, Cengage Learning
Bloodborne Pathogen Standards
• Established in 1991 by OSHA
• Must be followed by all health care workers
• Civil penalties if not implemented and followed
© 2009 Delmar, Cengage Learning
Regulation Requirements
• Written exposure control plan
• Identify all employees with occupational exposure
• Hepatitis B vaccines free of charge
• Provide personal protective equipment
(continues)
© 2009 Delmar, Cengage Learning
Regulation Requirements(continued)
• Provide adequate handwashing facilities and supplies
• Ensure worksite is maintained in a clean, sanitary condition
• Follow measures for immediate decontamination of surfaces when contaminated
(continues)
© 2009 Delmar, Cengage Learning
Regulation Requirements(continued)
• Dispose of infectious waste correctly
• Enforce rules of limited activities in any potentially contaminated area
• Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
(continues)
© 2009 Delmar, Cengage Learning
Regulation Requirements(continued)
• Post signs at the entrance to work areas with occupational exposure to biohazardous materials
• Red biohazard labels• Provide a confidential medical evaluation
and follow-up for any employee with an exposure incident
• Provide training to employees
© 2009 Delmar, Cengage Learning
Needle Stick Safety Act
• Passed by Congress in 2000
• Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle sticks per year
• OSHA revised Bloodborne Pathogen Standard to requirements of this act
© 2009 Delmar, Cengage Learning
Employer Requirements
• Identify and use effective and safer medical devices
• Incorporate changes in annual update of exposure control plan
• Solicit input from nonmanagerial employees who are responsible for direct patient care
(continues)
© 2009 Delmar, Cengage Learning
Employer Requirements(continued)
• Maintain a sharps injury log
• Ensure that every employee uses standard precautions at all times
© 2009 Delmar, Cengage Learning
Standard Precautions
• Rules developed by the CDC
• Every body fluid must be considered potential source of infection
• All patients must be considered potential source of infection
© 2009 Delmar, Cengage Learning
When to Use Standard Precautions
• Any situation where you might come in contact with:– Blood or any fluid that contains blood– Body fluids, secretions, and excretions– Mucous membranes– Nonintact skin– Tissue or cell specimens
© 2009 Delmar, Cengage Learning
Gloves
• Gloves must be changed after contact with each patient
• When removing gloves, do not contaminate your skin
• Hands must be washed immediately after removal of gloves
• Gloves must not be reused
© 2009 Delmar, Cengage Learning
When to Wear Gloves
• Whenever contact with body fluids, secretions, or excretions
• When handling or cleaning contaminated items or surfaces
• Performing any invasive procedure
• Performing venipuncture/blood tests
© 2009 Delmar, Cengage Learning
Gowns
• Worn during procedures that may cause splashing or spraying
• Helps prevent contamination of clothing or uniforms
• Contaminated gowns must be handled per policy
• Hands must be washed immediately after removing gown
© 2009 Delmar, Cengage Learning
Masks and Eye Protection
• Worn during procedures that may cause splashing or spraying
• Prevents exposure of mucous membranes of the mouth, nose, and eyes to pathogens
• Use masks once then discard—change every 30 minutes if needed
(continues)
© 2009 Delmar, Cengage Learning
Masks and Eye Protection(continued)
• Protective eyewear and face shields protect front, top, bottom, and sides of eyes
• If not disposable, must be cleaned and disinfected before reuse
© 2009 Delmar, Cengage Learning
Sharp Objects
• Use extreme caution to avoid cuts and punctures
• When possible, use safe needles or needleless system
• Follow policies regarding needles
• Use sharps containers
• Follow laws regarding disposal of sharp objects
© 2009 Delmar, Cengage Learning
Spills or Splashes
• Wipe up immediately• Wear gloves when wiping up• Use disposable cleaning clothes• Use disinfectant which contains 10%
bleach solution• Clean all contaminated surfaces• For large spills, can use absorbent
powder to absorb fluid
© 2009 Delmar, Cengage Learning
Resuscitation Devices
• Use to avoid the need for mouth-to-mouth resuscitation
• Place in convenient location that is readily accessible
© 2009 Delmar, Cengage Learning
Waste and Linen Disposal
• Wear gloves
• Follow agency policy
• Use biohazard bags appropriately
© 2009 Delmar, Cengage Learning
Injuries
• Report any cut or injury, needle stick, or splashing of blood or body fluids immediately
• Follow agency policy
© 2009 Delmar, Cengage Learning
Summary
• Standard precautions need to be followed at all times by every health care worker
• Observing these precautions can help break the chain of infection
• Health care workers can protect themselves, their patients, and all other individuals
© 2009 Delmar, Cengage Learning
14:5 Sterilizing with an Autoclave
• Equipment that uses steam under pressure or gas
• Most effective method of sterilization
• Available in various sizes and types
• Preparation of equipment or supplies
• Wrapping items for autoclaving
(continues)
© 2009 Delmar, Cengage Learning
Sterilizing with an Autoclave(continued)
• Autoclave indicators
• Loading the autoclave
• Time period for sterilization
• Care of items after autoclaving
• Dry heat sterilization
• Follow directions on specific autoclave
• Follow agency policy
© 2009 Delmar, Cengage Learning
14:6 Using Chemicals for Disinfection
• May not kill spores and viruses
• Disinfect, but do not sterilize
• Used to disinfect instruments that do notpenetrate body
• Preparation of items
• Chemical solutions used
(continues)
© 2009 Delmar, Cengage Learning
Using Chemicals for Disinfection (continued)
• Read manufacturer’s instructions
• Antirust tablets or solutions added
• Requirements for disinfection
• Chemical must completely cover items
• Care of chemical solutions
© 2009 Delmar, Cengage Learning
14:7 Cleaning with an Ultrasonic Unit
• Uses sound waves for cleaning
• Method of aseptic control
• Only ultrasonic solutions should be used in unit
• Permanent tank of ultrasonic unit
• Items cleaned in ultrasonic unit
(continues)
© 2009 Delmar, Cengage Learning
Cleaning with an Ultrasonic Unit (continued)
• Care of glass beakers
• Care of the permanent tank
• Read manufacturer’s instructions before using any ultrasonic unit
© 2009 Delmar, Cengage Learning
Summary
• Different methods provide different levels of aseptic control
• Method used depends on equipment and level of aseptic control required
• Read manufacturer’s instructions• Clean, rinse, and dry all equipment
before processing• Handle all items carefully
© 2009 Delmar, Cengage Learning
14:8 Using Sterile Techniques
• Many procedures require use of sterile techniques to protect a patient from infection
• Surgical asepsis keeps an object or area free from living organisms
• Sterile: free from all organisms
• Contaminated: organisms and pathogens present
(continues)
© 2009 Delmar, Cengage Learning
Using Sterile Techniques(continued)
• Important to differentiate between sterile and contaminated areas or items while using sterile technique
• Correct techniques must be strictly followed to maintain sterility and prevent contamination
(continues)
© 2009 Delmar, Cengage Learning
Using Sterile Techniques(continued)
• Clean working area required
• Handling of sterile supplies
• Sterile field: area used for placement of sterile supplies
• All sterile items need to be checked
• Observe agency guidelines for date
• Necessary to keep sterile field dry
© 2009 Delmar, Cengage Learning
Removing Articles from Sterile Wraps
• Drop technique—for gauze, pads, dressings, and small items
• Mitten technique—for bowls, drapes, and linens
• Transfer forceps—for cotton balls and small items
© 2009 Delmar, Cengage Learning
14:9 Transmission-BasedIsolation Precautions
• Some diseases are communicable – Caused by organisms that can be transmitted easily
• Epidemic—spreads from person to person and affects large numbers
• Pandemic—spreads over a wide geographic area
• These precautions are in addition to the Standard Precautions
(continues)
© 2009 Delmar, Cengage Learning
Transmission-BasedIsolation Precautions
(continued)
• Helps prevent spread of disease
• Protects patient, family, and health care workers
• Type used depends on the causative organism of the disease
© 2009 Delmar, Cengage Learning
How Communicable Diseases Spread
• Direct contact with a patient
• Contact with dirty linen, equipment, and supplies
• Contact with blood, body fluids, secretions, and excretions
© 2009 Delmar, Cengage Learning
Terms Defined
• Contaminated or dirty: items that contain disease-producing organisms; must not be touched unless protected
• Clean: items that do not contain the organisms; protect these areas from contamination
© 2009 Delmar, Cengage Learning
Classifications of Precautions
• Standard precautions
• Airborne precautions
• Droplet precautions
• Contact precautions
© 2009 Delmar, Cengage Learning
Protective or Reverse Isolation
• Method used to protect certain patients from organisms present in the environment
• Used mainly for immunocompromised patients
• Precautions vary depending on patient’s condition
© 2009 Delmar, Cengage Learning
Summary
• Exact procedures for maintaining transmission-based isolation will vary from one facility to another
• Variations caused by different factors
• Basic principles remain the same in any facility and are directed toward preventing the spread of disease