Infection Control

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What causes people to get sick? How is disease spread from one person to another person? What can be done to stop the spread of infection and disease? As a health care worker, it is important to know the answers to these questions. When you understand what causes infection, you can learn how to prevent it. Infection control is a set of practices and procedures that will help to prevent the transmission of disease within a health care facility. Infectious and Communicable Diseases Diseases can be classified according to whether or not they can be transmitted from one person to another person.

An infectious disease results from an invasion of microorganisms, such as bacteria or viruses. A communicable disease is a type of infectious disease that can be transmitted from one person to another person. Not all infectious diseases are communicable. For example, Lyme disease is caused by bacteria, but it cannot be transmitted from person to person. Hepatitis B, on the other hand, is caused by a virus. The hepatitis B virus can be passed from person to person if exposure to blood or bodily fluids occurs. One of the goals of infection control is to prevent the transmission of these communicable diseases.

Transmission of Communicable Diseases Not all communicable diseases are transmitted the same way. Some communicable diseases are spread through direct contact. Examples of direct contact are touching an open wound on an infected person or having a sexual relationship with an infected person. Communicable diseases can also be spread through indirect contact. Indirect contact includes inhaling the air after an infected person has sneezed or handling soiled bed sheets from an infected patient. For example, AIDS, Hepatitis B, and strep throat can be spread only through direct contact.

On the other hand, chicken pox, pink eye, and pneumonia can be spread through direct or indirect contact. There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease. Chain of Infection For a communicable disease to be passed from one person to another, certain conditions must be met. These conditions are known as the chain of infection. The following list describes the steps in the chain of infection: 1The chain of infection begins with a pathogen, which is called the causative agent.

1The causative agent must find a reservoir or a place for the causative agent to live and grow. A reservoir could be a human, an animal, or any surface or object. 1Next, the pathogen must have a portal of exit to leave the reservoir. In humans, pathogens can leave the body through blood, bodily fluids, or excrement. 1After the pathogen leaves the reservoir, it must be moved to another reservoir where it can continue to live and grow. This process is called the mode of transmission. 1The pathogen must have access to a portal of entry, which is the place the pathogen will enter the new reservoir.

1If the new reservoir has weak defenses, it will contract the disease or infection. The new reservoir is called the susceptible host. If any part of the chain is broken, the spread of the disease or infection will stop. Health care workers must practice principles of infection control in order to break the chain of infection. Mode of Transmission In the chain of infection, transmission can occur in several ways. The following list contains the primary modes of transmission: ?Airborne Transmission: Transmission through droplets in a sneeze or cough ?Bloodborne Transmission: Transmission through blood or body fluid?

Vectorborne Transmission: Transmission through an outside source, such as mosquitoes and ticks ?Sexual Transmission: Transmission through sexual contact with an infected person ?Foodborne Transmission: Transmission through infected or contaminated foods ?Casual Contact: Transmission by close body-to-body contact or sharing personal items, such as a hairbrush or comb Standard Precautions The Centers for Disease Control and Prevention (CDC) is a federal agency that prevents and controls diseases. The CDC developed a list of standard precautions that should be used for all patients, regardless of their type of sickness.

The CDC created the standard precautions for two reasons. The first reason is to protect health care workers from contact with infectious materials. The second reason is to protect patients from contracting infectious diseases. Standard precautions include guidelines for patient contact and environmental cleanliness. ?Standard Precautions for Patient Contact ?Standard Precautions for Environmental Cleanliness Standard Precautions for Patient Contact According to the CDC, every bodily fluid must be considered infectious.

Therefore, health care workers must use appropriate personal protective equipment, such as gloves, masks, eyewear, and gowns, when they are likely to contact infectious materials. Infectious materials include blood and other body fluids, mucous membranes, non-intact skin, and tissue specimens. Hands must be washed frequently to avoid spreading infection. Hands should always be washed before and after wearing gloves, before and after performing a procedure, after contacting blood or other body fluids, and between patient contacts. Health care workers must bandage their cuts and scratches properly.

Patient contact should be limited if a worker has a wound or skin condition that is likely to seep or bleed. In addition, health care workers that are sick must avoid direct contact with patients. Whenever possible, face shields should be used instead of mouth-to-mouth contact during CPR. These devices should be stored in convenient places throughout a medical facility Standard Precautions for Environmental Cleanliness Used sharps should be placed into puncture-proof, bio hazardous waste containers. Sharps include needles, surgical blades, syringes, and razors. Additionally, needles should never be bent or broken after use, and they should never be recapped. Spills must be cleaned up immediately.

Appropriate personal protective equipment should be worn when cleaning. It is also important to read the manufacturer’s instructions and the sheet before using a chemical cleaning solution. All infectious waste must be discarded in a bio hazardous waste bag. Infectious waste includes gloves, gowns, masks, disposable eyewear, contaminated dressings, drainage bags, disposable basins and bedpans, and other disposable items that have contacted blood or other body fluids. Linens that are contaminated with blood or other body fluids must be placed in bio hazardous laundry bags.

Contaminated linens must be soaked in disinfectant solution before laundering. Transmission-Based Precautions Standard precautions are practiced with all patients, regardless of their sickness. The CDC developed another set of precautions that are only used with patients who have been diagnosed with highly communicable diseases. These precautions are called transmission-based precautions. ?Airborne Precautions ?Droplet Precautions ?Contact Precautions Airborne Precautions Some communicable diseases are spread by tiny airborne droplets. When an infected person coughs or sneezes, tiny droplets are released into the air.

Because the droplets are so small, they can remain in the air for a long time and cause infection in people who inhale the droplets. Diseases that require airborne precautions include tuberculosis and chicken pox. Patients who are diagnosed with this type of communicable disease must be treated with special care. First, they should be placed into a private room. This practice is called isolation. Second, health care workers who enter the private room must wear special respiratory protection, such as a high-efficiency particulate air filter (HEPA mask). Finally, the room must be kept at negative pressure with the door closed.

Negative pressure will keep droplets from being drawn into other rooms. Droplet Precautions For some types of communicable diseases, droplets that are released when a patient sneezes or coughs are large and do not stay in the air for a long period of time. Droplet precautions are required for these diseases. Diseases that require droplet precautions include pneumonia, influenza, and whooping cough. Patients with these diseases must be placed into an isolation room, but negative air pressure is not needed. Health care workers who enter these rooms must wear standard surgical masks. However, respiratory filters are not required.

Contact Precautions Some communicable diseases can be spread through contact and indirect contact. Two examples are MRSA (methicillin-resistant staphylococcus aureus) and VRE (vancomycin-resistant enterococcus). These two infections are highly contagious and very dangerous. Therefore, special precautions must be applied to patients with these diseases. Patients who require contact precautions must be placed in an isolation room. Health care workers who treat these patients must put on gowns and gloves before entering the room. After the procedure, personal must be removed and discarded carefully to avoid transmitting the disease.

Whenever possible, the medical equipment used on these patients should be disposable or used only with the infected patient. If equipment must be used for additional patients, it must be disinfected and sterilized first. Bloodborne Pathogens Bloodborne pathogens are pathogens that are transmitted through blood or bodily fluid from an infected person to another person. Bloodborne pathogens include HBV, HCV, and HIV. HBV and HCV are the viruses that cause hepatitis B and C. HIV is the virus that causes AIDS. Bloodborne Pathogens Standard Health care workers may be exposed to blood and body fluid.

TheOccupational Safety and Health Administration (OSHA) is a government agency that enforces safety standards in the workplace. One of these standards is called the Bloodborne Pathogens Standard. The Bloodborne Pathogens Standard includes, but is not limited to, these requirements: ?Have an exposure control plan to minimize exposure to blood and other potentially infectious materials (OPIMs) ?Identify workers who are at risk ?Wear personal protective equipment (PPE), such as gloves, face shields, and gowns ?Use safety needles and dispose of needles in puncture proof containers ?

Decontaminate equipment and work areas and dispose of wastes in containers with the biohazard label ?Provide hepatitis B vaccinations to workers who are at risk ?Report incidents of workers being exposed to blood and OPIMs ?Evaluate and treat workers who have been exposed to blood and OPIMs ?

Train workers each year on bloodborne pathogens Vaccinations Vaccination is the process of administering weakened or deadened microorganisms to people in order to give them resistance, or immunity, to disease. Vaccinations trigger patients’ immune systems to resist disease. Vaccinations prevent people from getting diseases, as opposed to curing diseases once people have gotten them.

More specifically, when people are given a vaccination, their immune systems destroy the weakened or deadened microorganisms. If the people are exposed to the actual disease in the future, their immune systems are able to quickly destroy it. In most cases, the people never even know that they were attacked by the disease. Available Vaccinations Vaccinations are used to protect people from many diseases that may cause severe illness and even death. These diseases include the following: ?Diphtheria ?Hepatitis A ?Hepatitis B ?Measles ?Mumps ?Rubella ?Pertusis, or whooping cough ?Pneumonia ?Polio ?Tetanus, or lockjaw ?Varicella, or chickenpox

?Influenza, or the flu ?Tuberculosis ?Bacterial meningitis ?Smallpox ?Typhoid fever ?Anthrax Vaccinations have made many once-common diseases rare. Vaccinations and Health Care Workers Vaccinations protect health care workers from disease. And vaccinated health care workers protect patients and their families, co-workers, and their own families. As a result, the Centers for Disease Control and Prevention (CDC) recommends that health care workers receive vaccinations for these diseases: ?Tetanus, or lockjaw ?Diphtheria ?Pneumonia ?Hepatitis B ?Influenza, or the flu ?Measles ?Mumps ?Rubella ?

Varicella, or chickenpox In certain circumstances, the CDC recommends that health care workers also receive vaccinations for these diseases: ?Tuberculosis ?Hepatitis A ?Bacterial meningitis ?Typhoid fever ?Smallpox ?Pertussis, or whooping cough Asepsis Asepsis is a condition that is free of pathogens. Maintaining asepsis in a health care facility is the primary way to prevent the spread of disease from person to person. It works by breaking the chain of infection. Medical and Surgical Asepsis The two basic types of asepsis are medical asepsis and surgical asepsis.

Medical asepsis is maintaining a clean environment in order to reduce the number of pathogens. It is also called clean technique. Common medical aseptic practices include hand washing, routine cleaning, and using personal protective equipment (PPE), such as gloves and masks. Surgical asepsis is maintaining a sterile field. A sterile field is an environment that is free from all microorganisms and spores. Surgical asepsis is also known as sterile technique. It is required for most invasive procedures and operations. In order for an environment to stay sterile, only sterile items can come into contact with other sterile items. Surgical asepsis takes skill and foresight. ?Sterilizing ?

Disinfecting ?Cleaning Sterilizing The three levels of asepsis are sterilizing, disinfecting, and cleaning. Sterilization is the highest level of asepsis. It is a type of surgical asepsis that kills all microorganisms, including viruses and spores. Sterilization is used on instruments and equipment, not on people. Sterilization methods include pressurized steam, dry heat, chemical solutions, and gas. The most common piece of equipment used for sterilization in a medical office is an autoclave, which uses pressurized steam to kill microorganisms. Autoclaves sterilize equipment at temperatures of 250°F (121°C) for 15 to 30 minutes.

Dry heat uses temperatures of 320°F (160°C) for at least an hour for sterilization. It is used for instruments that corrode easily, such as those made of non-stainless steel. Some chemical solutions can also be used for sterilization. However, items must soak in the solutions for at least 10 hours to become sterile. Chemical sterilization is used with equipment that is too large for autoclaving or cannot withstand high temperatures, such as rubber, plastic, and fiber optics. Wheelchairs and beds are sterilized using large gas ovens. Gas sterilization is typically used in hospitals. Disinfecting.

Disinfection is the middle level of asepsis. Disinfection is a type of medical that destroys most pathogens, but is not always effective on viruses and spores. Because disinfectants are usually chemical solutions, the disinfection process is generally used on objects and equipment, rather than on people. Common disinfectant solutions include chlorine and bleach. An object must soak in a disinfectant solution for at least 20 minutes to be properly disinfected. Cleaning Cleaning is the lowest level of asepsis. It is also called sanitization. The cleaning process does not require harsh chemicals to destroypathogens, so cleaning can be used on people.

Examples include using soap to wash hands or using alcohol to prepare a patient’s skin for a procedure. Antiseptic solutions such as iodine, betadine, and alcohol are often used in the cleaning process. Cleaning can also be used on objects and equipment. However, the process does not destroy viruses or spores Hand Cleansing Hand cleansing is the most basic and important type of medical asepsis. Hand cleansing is the number one way to prevent the spread of infection. Hands can act as a mode of transmission in the chain of infection by carrying pathogens from one patient to another patient.

Additionally, when pathogens are on a health care worker’s hands, the health care worker is in danger of contracting the disease or infection. Because of this danger, health care workers must use appropriate hand cleansing hygiene. When to Cleanse Hands Health care workers should cleanse their hands frequently, including: ?When arriving at the health care facility and immediately before leaving the facility. ?Before and after every patient contact. ?Before and after performing a procedure. ?Before and after handling a specimen. ?Before and after touching the mouth, eyes, or nose. ?Before donning gloves and immediately after removing gloves.?

After contacting soiled or contaminated items. ?After picking up any item from the floor. ?After using the bathroom. ?After coughing, sneezing, or using a tissue. Methods of Hand Cleansing According to the Centers for Disease Control (CDC), there are two methods health care workers should use to cleanse their hands. The first method is hand washing. Hand washing involves using plain soap and water to cleanse the hands. Health care workers should wash their hands when they are visibly dirty or soiled. The second method is an alcohol-based hand rub. An alcohol-based hand rub involves using an alcohol-based lotion or gel to cleanse the hands.

Alcohol-based hand rubs are more effective than hand washing at removing microorganisms. Health care workers should use an alcohol-based hand rub on their hands when they are not visibly soiled. Procedure for Hand Cleansing Individual agencies may have specific procedures that their employees must follow. The following process is an example of a hand cleansing procedure that might be found at any agency. Hand Washing 1Dispense a paper towel and use it to turn the faucet on. Do not touch the inside of the sink, as it is considered contaminated. 1Test the temperature of the water with your hand. Allow the water to reach a warm temperature.

Hot water damages the skin. Dispose of the paper towel into a waste container. 1Point your fingers downward and wet your hands and wrists. 1Dispense liquid soap into your hands and work the soap into lather. 1Lather all surfaces of your wrists, hands, and fingers for at least 20 seconds. Rub firmly, as friction is needed to rub pathogens off the skin. You may find it helpful to hum “Happy Birthday”, twice in your head to be sure that you wash long enough. 1Clean your fingernails with a nail brush or by rubbing fingertips against the palm of the opposite hand. 1Rinse your hands and wrists while keeping your fingers pointed downward.

Pointing them upward may contaminate your hands, wrists, or arms with dirty water. 1Dispense a clean paper towel and use it to dry your hands and wrists. Dispose of the paper towel when it becomes wet. If needed, dispense another paper towel to finish drying. Dispose of the towel. 2Dispense a clean paper towel and use it to turn off the faucet. Dispose of the paper towel. Alcohol-based Hand rub 1Dispense the appropriate amount of alcohol-based liquid or gel into the palm of your hand. Check the manufacturer guidelines for the amount of liquid or gel to use. 1Rub your hands together, covering all surfaces, until the liquid has dried.

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