33 Infection Control Techniques

CHAPTER 33 Infection Control Techniques Learning Outcomes 33.1 Describe the medical assistant s role in infection control. 33.2 Describe methods of infection control. 33.3 Compare and contrast medical and surgical asepsis. 33.4 Describe how to perform aseptic hand washing. 33.5 Compare and contrast the procedures for sanitization, disinfection, and sterilization. 33-2 Learning Outcomes (cont.) 33.6 Describe measures used in sanitization. 33.7 List various methods used in disinfection and the advantages and disadvantages of each. 33.8 Discuss the goal of surgical asepsis. 33.9 Explain what an autoclave is and how it operates. 33.10 List the steps in the general autoclave procedures. 33-3 Learning Outcomes (cont.) 33.11 Explain how to wrap and label items for sterilization in an autoclave. 33.12 Describe how to complete the sterilization procedure using an autoclave. 33.13 Define the Blood-Borne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). 33-4 Learning Outcomes (cont.) 33.14 Explain the role of Universal Precautions in the duties of a medical assistant. 33.15 List the procedures and legal requirements for disposing of hazardous waste. 33.16 Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease. 33.17 Discuss the need for specific guidelines for isolating patients in health-care settings. 33-5 Learning Outcomes (cont.) 33.18 Describe the appropriate use of personal protective equipment in various situations. 33.19 Explain the purpose of immunization. 33.20 Describe your role in educating patients about immunizations. 33.21 Explain how to educate patients in preventing disease transmission. 33-6 1

Introduction Patients coming to the office for treatment may be more susceptible to infections Immunizations and patient education are important methods of infection control 33-7 MA s Role in Infection Control To control infectious diseases, the cycle of infection must be broken Apply principles of infection control in office setting 33-8 You will be introduced to Occupational Safety and Health Administration (OSHA) guidelines, the Blood-Borne Pathogen Standard, reporting guidelines, and isolation procedures. MA s Role in Infection Control (cont.) Follow correct sanitization, disinfection, and sterilization procedures Help patients understand basic disease prevention Educate patients about immunizations Administer immunizations 33-9 What is your role as a medical assistant in controlling infection in the medical office? ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures. Correct! 33-10 Infection Control Methods Eliminate elements needed for disease to occur Knowledge of Medical asepsis Based on cleanliness As few microorganisms as possible Surgical asepsis Sterile environment No microorganisms 33-11 Medical Asepsis Keep office clean: Reception area: sick vs. well patients Reception room clean, well lit, and ventilated Keep furniture in good repair Strict no food or drink policy Empty trash as necessary 33-12 2

33-13 33-14 Medical Asepsis (cont.) During medical assistant procedures Prevent cross-contamination Hand washing Beginning of day After breaks Before and after each patient Before and after handling equipment or specimens After blowing your nose or coughing Medical Asepsis (cont.) Other precautions Avoid leaning against sinks, supplies, equipment Avoid touching your face and mouth Use tissues when you cough or sneeze, and always wash your hands afterward Avoid working directly with patients when you have a cold; wear gloves and mask if you must Stay home if you have a fever 33-15 Sanitization 33-16 Describe the difference between medical and surgical asepsis. ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms. Scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow For cleaning items that touch only healthy, intact skin OR First step in disinfection and sterilization for other equipment 33-17 33-18 Sanitization (cont.) Collect items for sanitization Place in water and special detergent solution Use utility gloves Separate sharps from other equipment Scrub items Follow manufacturers guidelines Dry thoroughly Examine carefully Sanitization (cont.) Rubber and plastic items Syringes and needles use disposable whenever possible Ultrasonic cleaning For delicate instruments and those with moving parts Sound waves generated through a cleaning solution to loosen contaminants 3

What is sanitation, and what types of items is it adequate for cleaning? ANSWER: Sanitation is scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. It is adequate for cleaning items that touch only healthy, intact skin. 33-19 Disinfection Adequate for instruments that do not penetrate skin or mucous membranes and surfaces not considered sterile OR Second step in infection control prior to sterilization Will not kill spores, certain viruses 33-20 Nice Job! 33-21 33-22 Disinfection (cont.) Using disinfectants Cleaning products applied to inanimate materials to reduce or eliminate infectious organisms Antiseptics are antiinfective cleaning agents used on human tissue Follow manufacturers guidelines Disinfection (cont.) Factors impacting effectiveness of disinfectants Number of times solution is used Wet items surface moisture may dilute solution Traces of soap left from sanitization alters chemical composition Evaporation 33-23 33-24 Disinfection (cont.) Choose the correct disinfectant Germicidal soap products Alcohol Acid products Formaldehyde Glutaraldehyde cold disinfection Bleach Iodine and iodine compounds Disinfection (cont.) Handling disinfected supplies Prevent contamination with other surfaces Use sterile transfer forceps Wear gloves Store in clean, moisturefree environment 4

What is the difference between a disinfectant and an antiseptic? ANSWER: Disinfectants are cleaning products applied to inanimate materials to reduce or eliminate infectious organisms. Antiseptics are anti-infective cleaning agents used on human tissue. 33-25 Surgical Asepsis Goal is to keep the surgical environment completely free of all microorganisms Used for even minor operations and injections The more extensive the procedure, the greater the risk of infection 33-26 Sterilization Required for all instruments or supplies that Penetrate the skin Contact normally sterile areas of the body Object is either sterile or not sterile If unsure of sterility, consider it not sterile Prior to sterilization Sanitize Disinfect 33-27 The Autoclave Primary method of sterilization Pressurized steam Operates at lower temperatures than dry heat sterilization Moisture causes coagulation of proteins in microorganisms at lower temperatures Cell walls burst when cell cools, killing the microorganism 33-28 The Autoclave (cont.) Wrap sanitized and disinfected items Special porous fabric, paper, or plastic Items should not touch Label Check water level distilled water only Preheat, but do not overheat 33-29 The Autoclave (cont.) Load, choose correct setting, run cycle Temperature 250 to 270 F Pressure 15 to 30 pounds Unload Store items properly Clean, dry location Shelf life based on packaging, but generally 30 days 33-30 5

33-31 33-32 The Autoclave (cont.) Clean autoclave and area Quality control checks Sterilization indicators confirm that items have been exposed to correct volume of steam at the correct temperature for the correct length of time Biological indicators contain bacterial spores and confirm that sterilization occurs The Autoclave (cont.) Prevent incomplete sterilization Correct timing Adequate temperature Properly wrapped packs Adequate steam levels Timing Preset for load types Use sterilization indicators The Autoclave (cont.) Temperature Too high steam too little moisture Too low steam too much moisture Do not overcrowd autoclave Steam level If incorrect, items will not be sterile at end of cycle 33-33 Sterile Technique Strict adherence to set order of procedures Sterile against sterile Clean against clean Unclean against unclean Surgical scrub 33-34 Surgical Asepsis During surgical procedures Do not touch sterile items without sterile gloves or transfer forceps Aseptic technique Throughout surgical procedures Caring for surgical wounds 33-35 Surgical Asepsis (cont.) After procedures Sanitize, disinfect, and sterilize reusable items Disinfect surfaces Waste disposal Biohazard waste containers Leak-proof containers either color-coded red or labeled with biohazard symbol Biohazardous materials Biological agents that can spread disease to living things 33-36 6

33-37 33-38 1. What items need to be sterilized? ANSWER: Sterilization is required for all instruments or supplies that penetrate the skin or come in contact with normally sterile areas of the body. 2. The physician is going to remove a small growth from your patient s back. In order to prepare for this procedure, what steps would you take to prevent the spread of infection? ANSWER: Use medical asepsis while preparing the patient, and then use surgical asepsis during the procedure. Right! 33-39 33-40 OSHA Guidelines Blood-Borne Pathogen Standards Protect health-care workers from health hazards on the job Also protect patients and others who come to medical facilities Dictate how to handle infectious or potentially infectious wastes Discarded Held for processing OSHA Guidelines (cont.) Blood-Borne Pathogen Standards Measures to prevent the spread of infection Provide a margin of safety by ensuring that medical facilities meet minimal standards for asepsis Requirements for training, keeping records, housekeeping, and personal protective gear 33-41 33-42 OSHA Guidelines (cont.) Universal Precautions Prevent health-care workers from exposure to infections Assume that all blood and body fluids are infected with blood-borne pathogens OSHA Guidelines (cont.) Standard Precautions Combination of Universal Precautions and Body Substance Isolation guidelines Used in health-care facilities to prevent transmission of disease 7

OSHA Guidelines (cont.) Categories of tasks I. Tasks that expose a worker to blood, body fluids, or tissues and require specific protective measures II. III. Tasks that usually do not involve risk of exposure but require precautions in certain situations Tasks that have no risk of exposure, so no special protection is required 33-43 Respiratory Hygiene/Cough Etiquette Guidelines established by CDC Education Posting signs Controlling source or transmission Proper hand hygiene Separating patients with respiratory infections from other patients 33-44 Personal Protective Equipment Protective gear worn to protect against physical hazards Employers must provide PPE at no charge to the employee Disposable, sterile exam and utility gloves Masks and protective eyewear or face shields Protective clothing 33-45 Postprocedure Cleanup Decontaminate all exposed surfaces Replace protective coverings on surfaces or equipment Decontaminate receptacles Pick up any broken glass with tongs Discard all potentially infectious waste materials 33-46 OSHA Guidelines (cont.) Apply guidelines daily on the job Exposure incidents Contact with infectious substance Rules apply to all serious infections HIV, HBV HBV vaccine Transmission to patients Nosocomial infection an infection acquired by a patient in a health-care facility 33-47 OSHA divides medical tasks by level of risk. What are these risk categories? ANSWER: There are three categories of risk: Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measures Category 2: Usually do not involve risk of exposure, but precautions are required in certain situations Category 3: No risk of exposure, so no special protection is required 33-48 8

33-49 33-50 Reporting Guidelines Certain diseases must be reported to state or county health department Information is forwarded to the CDC control of the spread of infection Reporting Guidelines (cont.) National Notifiable Disease Surveillance System (Table 33-2) Examples HIV/AIDS Cholera Rubella Legionellosis Mumps Tetanus Hepatitis Lyme disease Smallpox Tuberculosis 33-51 33-52 How is the information on reportable diseases used by the CDC? ANSWER: The CDC uses the information reported to them to help control the spread of infection. Isolation Guidelines CDC guidelines Types of precautions needed Patients requiring precautions Create an environment that protects against pathogens Standard Precautions 33-53 33-54 Isolation Guidelines (cont.) Select appropriate PPE Gloves Masks, face shields, respirators Gowns Table 33-3 Mrs. Findley brings her child with chickenpox into the medical office. What type of personal protective equipment should you use when caring for this child? ANSWER: Chickenpox requires airborne and contact precautions, so you should use gloves and a mask and goggles or a respirator. Nice! 9

33-55 33-56 Immunizations Immunization Administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases Reduces risk of infection spread Decreases the susceptibility of the host Immunization Recommendations Immunization schedules for children Advisory Committee on Immunization Practices American Academy of Pediatrics American Academy of Family Physicians Immunization schedules for adults The National Coalition of Adult Immunization (NCAI) 33-57 33-58 Immunizations (cont.) When administering, you must explain The need for immunization Side effects Soreness at site Low-grade fever General malaise Immunizations (cont.) Concerns Pediatric patients Do not give if child has fever Informed consent explain benefits and risks Contraindications symptoms that render the use of a remedy or procedure inadvisable because of the risk Immunization records National Childhood Vaccine Injury Act of 1988 Instruct parents keep record as proof of immunization 33-59 33-60 Immunizations (cont.) Pregnant patients Avoid live virus vaccines FDA categories A, B, C, D, and X Elderly Dispel common misconception and cost concerns More likely to develop side effects Immunizations (cont.) Immunocompromised patients May experience minimal to dangerous effects Adjust dosage or delay administration Must also consider immunization status of family and caregivers Health-care workers Hepatitis B vaccination offered by employer at no cost to employee 10

What is an immunization? ANSWER: An immunization is the administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases. 33-61 Preventing Disease Transmission Patient education Health promotion Disease prevention Disease treatment Medical assistant role in patient education Share responsibility Reinforce and explain instructions 33-62 Preventing Disease Transmission (cont.) 33-63 Preventing Disease Transmission (cont.) 33-64 Educate patient on Nutrition and diet Exercise and weight control Prevention of STDs Smoking cessation Alcohol and drug abuse prevention and treatment Proper use of medications and prescribed treatments Stress-reduction techniques Goal of patient education Help patients take care of themselves Encourage patients to participate actively in their own health care 33-65 In Summary 33-66 What three areas should patient education focus on? What is the medical assistant s role in patient education? ANSWER: Patient education should focus on health promotion, disease prevention, and disease treatment. The medical assistant shares responsibility with the physician and other staff members and should reinforce and explain instructions given by others. 33.1 It is the medical assistant s responsibility to apply the principles of infection control by following correct sanitization, disinfection, and sterilization procedures, helping patients understand basic disease prevention, administering immunizations, and teaching patients about the importance of immunizations. 33.2 The two basic methods of infection control are medical asepsis (clean technique) and surgical asepsis (sterile technique). Bravo! 11

33-67 33-68 33.3 The goal of medical asepsis is to prevent the spread of infection in the medical environment by reducing the number of microorganisms. Surgical asepsis requires that all organisms be eliminated. 33.4 Aseptic hand washing removes accumulated dirt and microorganisms by wetting your hands, applying soap, carefully scrubbing every surface of the hands, rinsing, and carefully drying with clean paper towels. 33.5 Sanitization is the scrubbing of instruments and equipment with special brushes and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. Disinfection uses special cleaning products applied particularly to instruments and equipment to reduce or eliminate infectious organisms. Sterilization is usually accomplished through the use of steam and pressure in an autoclave. 33.6 Sanitize instruments by soaking them in a disinfecting solution, carefully scrubbing every surface of each instrument, rinsing thoroughly, and allowing them to dry. 33.7 There are several types of disinfectants, each with different properties. Choose a disinfectant based on the type of instrument and the level of disinfection required. 33.8 The goal of surgical asepsis is to destroy all microorganisms. 33.9 An autoclave is a device that uses steam and pressure to sterilize instruments and equipment. 33-69 33.10 The general steps for using the autoclave include preparing the instruments, checking the water level, preheating the chamber, loading the instruments, choosing the correct settings, running the autoclave, and allowing the instruments to dry at the end of the cycle. 33.11 Instruments should be carefully wrapped in a porous material, bag, or envelope and labeled with the contents of the pack, date, and your initials. 33-70 33.12 To ensure that the sterilization procedure is complete, you should make sure you use the correct amount of time, the correct temperature, and adequate levels of steam. In addition, you should avoid overcrowding the chamber. 33.13 Laws set forth in the OSHA Blood-Borne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures. According to these rules, any potentially infectious waste materials must be discarded or held for processing in biohazardous waste containers 33-71 33.14 Standard Precautions prevent health-care workers from exposing themselves and others to infections. Following Standard Precautions means assuming that all blood and body fluids are infected with bloodborne pathogens. 33.15 OSHA requires that all hazardous waste be placed in properly labeled biohazard containers and disposed of in an appropriate manner. 33-72 12

33-73 33-74 33.16 The CDC requires reporting of certain diseases to the state or county department of health, who then reports the information to the National Notifiable Disease Surveillance System of the CDC. 33.17 The CDC issued the current Guideline for Isolation Precautions in Hospitals to ensure that an environment is created that protects people from disease-causing microorganisms. 33.18 There are a number of different types of personal protective equipment, including gloves, gown, masks, and goggles. Choosing the correct type depends on the exposure type. 33.19 Immunizations prevent infection by reducing the susceptibility of the host to infection. 33-75 End of Chapter 33 33-76 33.20 As a medical assistant, you should educate patients about the importance of getting immunizations and following the immunization schedule. You should also discuss potential hazards and side effects of immunizations. 33.21 You should emphasize the basic principles of hygiene and disease prevention, including frequent hand washing, routine bathing and dental care, covering coughs and sneezes, eating well, and avoiding stress. Soap and education are not as sudden as a massacre, but they are more deadly in the long run. ~ Mark Twain 13