Working at a medical practice, you are accidentally stuck with a contaminated needle. What does the practice need to do to comply with OSHA standards?
Infection Control
Chapter 19
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1
Learning Objectives
Lesson 19.1: Infectious Disease
Process and Types of Infections
1. Describe the characteristics of pathogenic
microorganisms.
2. Do the following related to the chain of infection:
•
•
•
Apply the chain of infection process to the healthcare
practice.
Compare viral and bacterial cell invasion.
Differentiate between humoral and cell-mediated immunity.
3. Summarize the impact of the inflammatory
response on the body’s ability to defend itself
against infection.
4. Analyze the differences among acute, chronic,
latent, and opportunistic infections.
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2
Disease
Any sustained, harmful alteration of the
normal structure, function, or metabolism of
an organism or cell
➢ Genetic, drug-induced, autoimmune,
degenerative, communicable, or infectious
An unaffected person (carrier) can transmit
infection to another person
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3
Chain of Infection
Infectious agent
Reservoir host
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
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4
Viruses
Smallest of all pathogens
Intracellular parasites that take over DNA or
RNA of invaded cell
Interferon produced by cells helps protect
cells from viruses
Treatment is palliative (relief of symptoms)
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Bacteria
Tiny, simple cells that produce disease in a
variety of ways
Classified according to their shape, or
morphology
➢ Cocci (spherical)
➢ Bacilli (rod shaped)
➢ Spirilla (spiral shaped)
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Antibiotic Resistance
One of the world’s most significant public
health problems
Resistance occurs when an antibiotic is used
inappropriately to treat an infection
➢ Prescribe antibiotic therapy only when it will
benefit the patient
➢ Treat the patient with an antibiotic that is specific
to the infecting pathogen
➢ Prescribe the recommended dose and treatment
duration of the medication
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Fungi
Include such organisms as mushrooms,
molds, and yeasts
Grow best in warm, moist environments
Treatment with antifungal agents
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Protozoa
Unicellular parasites that can replicate and
multiply rapidly once inside host
Frequently are seen in tropical climates
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Reservoirs
Second link in chain of infection
May be people, insects, animals, water, food,
or contaminated instruments
Must gain entrance into a host or else they will
die
Reservoir host supplies nutrition for organism,
allowing it to multiply
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Portal of Exit
How pathogen escapes reservoir host
Exits include mouth, nose, eyes, ears,
intestines, urinary tract, reproductive tract,
and open wounds
Use Standard Precautions to help control
spread of infection
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Transmission
Direct transmission occurs from contact with
infected person or discharges from infected
person
Indirect transmission occurs from:
➢ Droplets in air expelled by coughing, speaking, or
sneezing
➢ Vectors that harbor pathogens
➢ Contaminated food or drink
➢ Contact with contaminated objects (called fomites)
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Portal of Entry
How transmitted pathogen gains entry into a new
host
May be mouth, nose, eyes, intestines, urinary
tract, reproductive system, or an open wound
Anatomic defenses include integumentary
system, tears, cilia, mucous membranes, and pH
of body fluids
Second line of defense is immune system and
inflammatory process
➢ Humoral immunity
➢ Cell-mediated immunity
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Inflammatory Response
(Slide 1 of 2)
Process results in four classic symptoms of
inflammation:
➢ Erythema (redness)
➢ Edema (swelling)
➢ Pain
➢ Heat
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Inflammatory Response
(Slide 2 of 2)
Inflammation mediators are released and
cause three different responses at cellular
level
➢ Blood vessels at the site dilate
➢ Release of white blood cells (WBCs) to the site
➢ Chemotaxis, or release of chemical agents,
occurs, attracting even more WBCs to the site
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Acute Infection
Rapid onset of symptoms but lasts a relatively
short time
Prodromal period is the time when patient
first shows vague, nonspecific symptoms of
disease
Symptoms appear after the tissue damage
begins
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Chronic Infection
Persists for a long period, sometimes for life
Some chronic infections are asymptomatic,
but virus is transmissible
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Latent Infection
Persistent infection in which symptoms cycle
through periods of relapse and remission
➢ Examples include cold sores, genital herpes, and
varicella
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Opportunistic Infections
Caused by organisms not typically pathogenic
but occur in hosts with an impaired immune
system response
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Learning Objectives
Lesson 19.2: OSHA Standards,
Asepsis, and Sanitization
(Slide 1 of 2)
5.
Do the following related to the Occupational Safety and
Health Administration (OSHA) standards for the healthcare
setting:
•
•
•
•
•
•
Specify potentially infectious body fluids.
Integrate OSHA’s requirement for a site-based exposure control
plan into facility management procedures.
Explain the major areas included in the OSHA Compliance
Guidelines.
Discuss protocols for disposal of biologic chemical materials.
Remove contaminated gloves while following the principles of
Standard Precautions.
Summarize the management of post-exposure evaluation and
follow-up and participate in bloodborne pathogen training and a
mock exposure event.
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Learning Objectives
Lesson 19.2: OSHA Standards,
Asepsis, and Sanitization
(Slide 2 of 2)
Apply the concepts of medical and surgical asepsis to the
healthcare setting.
7. Discuss proper hand washing and demonstrate the proper
hand washing technique for medical asepsis.
8. Differentiate among sanitization, disinfection, and sterilization
procedures, and select barrier/personal protective equipment
while demonstrating the correct procedure for sanitizing
contaminated instruments.
9. Discuss the role of the medical assistant in asepsis.
6.
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21
OSHA Standards for
the Healthcare Setting
Universal Precautions: All blood and certain
body fluids must be treated as if known to be
infectious for blood-borne pathogens
➢ Precautions must be implemented for all patients,
regardless of the information available about
person’s individual health history
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Potentially Infectious Materials
Body fluids
➢ Semen
➢ Vaginal secretions
➢ Cerebrospinal fluid (CSF)
➢ Synovial fluid
➢ Pleural fluid
➢ Peritoneal fluid
➢ Amniotic fluid
➢ Saliva in dental procedures
➢ Any body fluid that is visibly contaminated and in
situations in which it is difficult/impossible to
differentiate between body fluids
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OSHA’s Bloodborne
Pathogens Standard
Needlestick Safety and Prevention Act
➢ Employers must keep a confidential sharps injury
log that describes the device involved and details
of how and where incident occurred
Parenteral exposure includes accidental
needlesticks, occupation-related human bites,
and exposure of nonintact skin
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CDC’s Hand Hygiene
Recommendations
Visibly soiled hands
➢ Wash a minimum of 15 seconds with antimicrobial soap
and warm, running water
Alcohol-based hand rubs
➢ Used before and after contact with each patient, and
also after removing gloves
➢ To use properly, apply the label-recommended amount
to palm of one hand and rub hands together, covering
all surfaces until hands are dry
Healthcare workers with artificial nails have
more pathogenic microbes under their nails
Natural nail tips should be no longer than ¼
inch
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Barrier Protection
Barrier protection, or PPE, includes specialized
clothing or equipment that prevents the
healthcare worker from coming into contact
with blood or other potentially infectious
material
➢ Disposable gloves, face masks, face shields,
protective glasses, shoe covers, laboratory coats,
barrier gowns, mouthpieces, and resuscitation bags
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When Gloves Must Be Worn
Touching a patient’s blood, body fluids,
mucous membranes, or skin that is not intact
Handling items and surfaces contaminated
with blood and body fluids
Performing venipuncture, finger sticks,
injections, and other vascular procedures
Assisting with any surgical procedure
Handling, processing, and disposing of all
specimens of blood and body fluids
Cleaning and decontaminating spills of blood
or other body fluids
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Using Standard Precautions to
Remove Contaminated Gloves
The goal is minimize exposure to pathogens
by aseptically removing and discarding
contaminated gloves
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Environmental Protection
(Slide 1 of 4)
Refers to minimizing risk of occupational
injury by isolating or removing any physical or
mechanical health hazard in medical
workplace
➢ Read warning labels on biohazard containers and
equipment
➢ Minimize splashing or spraying of potentially
infectious materials
➢ Bandage any breaks or lesions on your hands
before gloving
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Environmental Protection
(Slide 2 of 4)
If any body surface is exposed to potentially
infectious material, scrub area with
antimicrobial soap and warm, running water
as soon as possible after exposure
If your eyes come into contact with body
fluids, continuously flush them with water as
soon as possible for a minimum of 15
minutes using an eye wash unit
Contaminated needles and other sharps
should never be recapped, bent, broken, or
resheathed
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Environmental Protection
(Slide 3 of 4)
Contaminated sharps should not be
processed in a way that requires employees
to reach into containers to grasp them
Immediately after use, dispose of syringes
and needles, scalpel blades, and other sharp
items in a labeled, leak-proof, punctureresistant biohazard container
All specimens must be placed in a container
that prevents leakage during collection,
handling, processing, storage, transport, and
shipping
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Environmental Protection
(Slide 4 of 4)
Equipment requiring repair that has been
contaminated with blood or body fluids should be
decontaminated before being repaired in the office
or transported for repair
Smoking, eating, drinking, applying cosmetics or lip
balm, and handling contact lenses are prohibited in
work areas where there is reasonable likelihood of
contamination from pathogens
Food and beverages cannot be kept in
refrigerators, freezers, or cabinets or on
countertops where infectious materials could be
present
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Housekeeping Controls
(Slide 1 of 2)
Work surfaces must be immediately
decontaminated with a disinfectant after
accidental spills of blood or body fluids, at end
of each procedure, and at end of each shift
Disinfection and decontamination of all reusable
containers must be done on a routine basis
Sharps containers must be as close as possible
to work area
Never pick up spilled material or broken
glassware with the hands
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Housekeeping Controls
(Slide 2 of 2)
Handle soiled linen as little as possible and
always wear gloves or other protective
equipment during disposal
Contaminated materials and/or infectious
waste must be handled with extreme caution
to prevent exposure
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Protocols for Disposal of
Biologic Chemical Materials
Biomedical waste should be collected in
containers that are leakproof and strong
Workers who handle biomedical waste should
observe Standard Precautions
Biologic waste containers/boxes should not be
held in healthcare facilities for more than 30 days
Sharps are instruments intended to cut or
penetrate the skin
Boxes for disposal of chemicals should be
labeled with the chemicals’ names and any other
pertinent data
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Hepatitis B Vaccination
Must be available free of charge to all
employees at risk for exposure
Intramuscular injection in three doses
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Postexposure Follow-Up
Wash or flush exposed area and receive
confidential medical evaluation
File incident report and screen and test
person for HBV, HCV, and HIV
Receive copy of physician’s written opinion
within 15 days of evaluation
Receive health counseling about risks and
adverse outcomes
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Aseptic Techniques
Asepsis
➢ Free from infection or infectious material
Medical asepsis
➢ Destruction of disease-causing organisms after
they leave the body
Surgical asepsis
➢ Destruction of organisms before they enter the
body
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Bacteria on the Skin
Transient bacteria
➢ Surface bacteria introduced by fomites
Resident bacteria
➢ Found under fingernails, in hair follicles, openings
of sebaceous glands, and deeper layers of skin
Most effective barrier against infection is
unbroken skin
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Hand Hygiene
Wash correctly before and after every patient
Warm water, antimicrobial soap, friction
Alcohol-based hand rubs may substitute
unless hands are visibly contaminated
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Sanitization
Cleansing process that reduces number of
microorganisms to a safe level
Removes debris such as blood and other
body fluids from instruments or equipment
Wear gloves while performing sanitization
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Ultrasonic Sanitization
Sound waves can be used to sanitize
instruments
Instruments are placed in an ultrasonic bath
of cleaner and water
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Disinfection
Process of killing pathogenic organisms or of
rendering them inactive
Disinfecting agents vary in effectiveness and
must be used according to instructions
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Levels of Disinfectants
CDC defines three levels of disinfectants:
➢ Low-level disinfectants can kill most vegetative
bacteria, some fungi, and some viruses
➢ Intermediate-level disinfectants can kill
mycobacteria, vegetative bacteria, most viruses,
and most fungi, but they do not kill spores
➢ High-level disinfectants will kill all microorganisms
except large numbers of bacterial spores
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Common Errors in Disinfection
Instruments are not thoroughly sanitized;
attached organic matter inhibits or prevents action
of disinfectant
Sanitized instruments are not dried
Disinfectant solution is left in an open container;
evaporation changes its concentration
Solutions are not changed after the
recommended period
Solutions are not prepared properly or are not
mixed properly
Manufacturer’s recommended temperature for
use and storage are not maintained
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Sterilization
Destruction of all microorganisms
Essential for surgical asepsis
Area should be set aside in each office for
sterilization
Clear, clean plastic bags in which to store
sterile packs may be kept in sterile area
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Role of the Medical
Assistant in Asepsis
Spread of pathogens can be controlled only
through application of the Bloodborne
Pathogens Standard and by proper
sanitization, disinfection, and sterilization of
supplies, equipment, and work surfaces
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47
Patient Coaching
While washing your hands, explain to the
patient that this routine is part of daily hygiene
Advise patient to carry an alcohol-based hand
rub and use it throughout the day
Explain the use of disposable tissues or bent
elbow to cover nose and mouth when coughing
or sneezing
Discuss proper ways of discarding used tissues
Instruct patient in the differences between
sterile and clean dressings and bandages
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Suggestions for Asepsis and
Infection Control Education
Set up an information table in the waiting
room with take-home pamphlets and
literature
Mail, e-mail, or post a periodic newsletter to
patients about infection control
Demonstrate and explain aseptic procedures
to patients and family members
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Legal and Ethical Issues
It is imperative that disinfection and sterilization
are performed precisely and effectively
Carelessness can cause nosocomial infections
in patients
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Questions?
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