ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash radiation ndash chemical agents ndash trauma ndash electric shock ndash temperature extremes
32
Nosocomial
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Acquired in a health care facilitybull Usually present in facilities and carried by
health care workers to the patient
bull Many are antibiotic-resistant
bull Can cause serious and even life-threatening infections
33
Nosocomial(continued)
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Examples are ndash Staphylococcusndash pseudomonasndash enterococci
bull Infection-control programs are used in facilities to prevent and deal with nosocomial infections
34
35
Nosocomial(continued)
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
Did You Knowbull Health care workers that provide direct
patient care should not wear artificial nails or extenders
bull Artificial nails have been linked to infections in patients
36
Hand Care
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Itrsquos important to keep hands and nails healthy Keep nails short and hand moisturized Use only the hand lotion provided by the hospital as it is designed to go with the hospitalrsquos hand hygiene soap and gloves
Opportunistic
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Infections that occur when the bodyrsquos defenses are down
bull Usually do not occur in normal immune system
bull Examples (in individuals with AIDS)ndash Kaposirsquos sarcoma (rare type of cancer)ndash Pneumocystis carinii pneumonia
37
CHAIN OF INFECTION
Chain of Infection
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Must be present for disease to occur and spread from one individual to anotherndash InfectiousCausative agent (Pathogen)ndash Reservoir (Host) ndash an area where causative
can livebull Human bodybull Animalsbull Environmentbull Fomites ndash objects contaminated with infectious
material commonly doorknobs bedpans urinals linens instruments and specimen containers
39
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash Portal of exitbull Way for agent to escape from reservoir
ndash Mode of transmissionbull A way that causative agent can be transmitted
to another reservoir or hostndash Direct contactndash Indirect contact
ndash Portal of entrybull Way for causative agent to enter a new
reservoir or host
ndash Susceptible hostbull A person likely to get an infection or disease
40
Common Body Defenses
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Skinbull Hairsbull Mucous membranesbull Ciliabull Coughing and sneezingbull Hydrochloric acid (HCL) in the stomachbull Tears ndash contain bacteriocidal chemicalsbull Feverbull Inflammation response ndash leukocytesbull Immune response ndash antibodies chemicals
41
Ending the Chain of Infection
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Eliminate any step in the chain and infection is stopped
bull Follow practices to interrupt or break the chain
bull Remember pathogens are everywhere
bull Prevention is a continuous process 42
Aseptic Techniques
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Asepsis defined as the absence of disease-producing microorganisms
bull Sterile means free from all organisms including spores and viruses
bull Contaminated means organisms and pathogens are present
43
44
Aseptic Techniques
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Major aim maintaining cleanliness and eliminating or preventing every aspect of contamination
Common Aseptic Techniques
1 Thorough handwashing
2 Good personal hygiene
3 Disposable gloves
4 Cleaning instruments and equipment
5 Proper cleaning of environment45
Levels of Aseptic Control
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Antisepsisndash Antiseptics prevent or inhibit growth of pathogenic organisms
but not effective against spores or virusesndash Can be used on the skin
bull Alcohol betadine
bull Disinfectionndash A process that destroys pathogenic organisms but not always
effective against spores or virusesndash Can irritate skin used mainly on objects
bull Bleach solutions
bull Sterilizationndash A process the destroys all microorganisms including pores and
virusesndash Ex steam under pressure (autoclave) gas radiation and
chemicals on objects 46
Summary
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Important for health care workers to know and use proper aseptic techniques at all times
bull Prevents spread and transmission of disease
47
Bioterrorism
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Bioterrorism use of microorganisms or biologic agents for warfare to infect humans animals or plants
bull Have been used over time by different nations not only in war but also on innocent people
48
49
Examples from history
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash 1346 ndash throwing dead plague victims over wall of a city to cause epidemic
ndash 1763 ndash British giving Delaware Indians items contaminated with smallpox
ndash WWI ndash Germans using animal and human pathogens
ndash WWII ndash Japanese experimenting on POW with different pathogens
ndash 1960s ndash various countries developing biologic weapons
ndash 1995 ndash Release of sarin gas in Tokyondash 2001 ndash Anthrax contaminated mail in US
Biologic Agents
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Microorganisms with characteristics suitable for bioterrorismndash Inexpensive available easily produced
spreads quicklyndash Maintains its survivalndash Brings death or disabilityndash Travels from person to personndash Difficult to preventtreat
50
Biologic Agents(continued)
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull High priority agents includendash Smallpox contagious and infectious disease
result of the Variola virusbull Vaccine can protect against some types of smallpoxbull One type hemorrhagic smallpox is usually fatal
ndash Anthrax infectious disease caused by spores of Bacillus anthracisbull Spores highly resistant to destructionbull Can live in soil for years
ndash Plague infectious disease from the bacteria Yersinia pestisbull Transmitted by bites of infected fleas 51
Biologic Agents(continued)
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash Botulism paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinumbull Toxin causes muscle paralysis
ndash Tularemia infectious disease from the bacteria Fracisella tularensis
ndash Filoviruses infectious diseases causing severe hemorrhagic feverbull 2 are Ebola virus and Marburg virusbull No effective treatment existsbull 50-90 of infected individuals die
52
Preparing for Bioterrorism
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Bioterrorism attack would result in a public health emergency
bull Would have impact on health care facilitiesbull Social disorder would ensuebull Comprehensive plan was prepared ndash
Bioterrorism Act of 2002
53
Preparing for Bioterrorism(continued)
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Bioterrorism Act 2002 passed by Congress and signed into law
bull Involves local regional state and national government and includesndash Early detection by communitiesndash Public to be notifiedndash Infection control and educationndash Funding available for studying organisms
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
ndash Guidelines and restrictionsndash Nationwide immunizationsndash Protection of foodwater suppliesndash Trained personnel availablendash Emergency management controlsndash Investigation of potential threatsndash Preparation of health care facilitiesndash Efficiency of communication
55
Summary
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull All health care workers need to be aware of bioterrorism
bull Attack could occur at any time
bull Being prepared and properly trained will result in saving many lives
56
Washing Hands
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Major aspect of standard precautionsbull Most important aseptic techniquebull Hands are perfect media for the spread
of pathogens
57
Purpose of Handwashing
bull Prevent and control spread of pathogens
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Protect the health care worker from disease and illness
58
Recommendations for Handwashing
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Regular handwashing with plain soap and water
bull Antiseptic handwashing with antimicrobial soap and water
bull Antiseptic hand rub with alcohol-based cleaner (waterless)
59
When to Wash Hands
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull On arrival at facilitybull Immediately before leaving facilitybull Before and after every patient contactbull After contact with patientrsquos skinbull Before moving from a contaminated
site to a clean site
60
When to Wash Hands(continued)
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Anytime the hands become contaminated during a procedure
bull Before applying glovesbull Immediately after removing glovesbull When gloves are torn or puncturedbull Before and after handling specimensbull After contact with any soiled or
contaminated item
61
When to Wash Hands(continued)
bull After picking up any item off the floor
bull After personal use of the bathroom
bull Following a cough sneeze or using a tissue
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Before and after any contact with mouth or mucous membranes
62
>
Principles of Handwashing
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Use soap as a cleansing agentbull Use warm waterbull Use friction (15 seconds) bull Clean all surfacesbull Clean nails and wristsbull Point fingertips down bull Use dry paper towels to turn faucet off
63
Waterless Hand Cleaning
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Alcohol-based gel lotion or foambull Used if hands are not contaminated
with blood or body fluidsbull Apply cleaner to palm of handbull Rub hands together vigorously for at
least 15 seconds until drybull After six to ten cleanings hands need
to be washed with soap and water
64
Observing Standard Precautions
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Blood and body fluids are the main ways pathogens are spread
bull Major pathogens HBV HCV HIV
bull Extreme care must be taken at all times
when there is an area object or person contaminated with blood or body fluids
65
Bloodborne Pathogen Standards
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Established in 1991 by OSHAbull Must be followed by all health care
workersbull Civil penalties if not implemented
and followed
66
Regulation Requirements
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Written exposure control planbull Identify all employees with occupational
exposurebull Provide Hepatitis B vaccines free of
chargebull Provide personal protective equipment
67
Regulation Requirements(continued)
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Provide adequate handwashing facilities and supplies
bull Ensure worksite is maintained in a clean sanitary condition
bull Follow measures for immediate decontamination of surfaces when contaminated
68
Regulation Requirements(continued)
bull Dispose of infectious waste correctly
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Enforce rules of limited activities in any potentially contaminated area
bull Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)
69
Regulation Requirements
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Post signs at the entrance to work areas with occupational exposure to biohazardous materials
bull Use Red Biohazard Labels
bull Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
bull Provide training to employees 70
Needle-Stick Safety Act
bull Passed by Congress in 2000
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Centers for Disease Control and Prevention (CDC) estimated 600000 to 800000 needle sticks per year
bull OSHA revised Bloodborne Pathogen Standard to requirements of this act
71
Employer Requirements
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Identify and use effective and safer medical devices
bull Incorporate changes in annual update of exposure control plan
bull Solicit input from non-managerial employees who are responsible for direct patient care
72
Employer Requirements(continued)
bull Maintain a sharps injury log
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Ensure that every employee uses standard precautions at all times
73
Standard Precautions
bull Rules developed by the CDC
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Every body fluid must be considered potential source of infection
bull All patients must be considered potential source of infection
74
When to Use Standard Precautions
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Any situation where you might come in contact withndash Blood or any fluid that contains bloodndash Body fluids secretions and excretionsndash Mucous membranesndash Nonintact skinndash Tissue or cell specimens
75
Gloves
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Gloves must be changed after contact with each patient
bull When removing gloves do not contaminate your skin
bull Hands must be washed immediately after removal of gloves
bull Gloves must not be reused
76
When to Wear Gloves
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Whenever contact with body fluids secretions or excretions
bull When handling or cleaning contaminated items or surfaces
bull Performing any invasive procedure
bull Performing venipunctureblood tests
77
Gowns
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Worn during procedures that may cause splashing or spraying
bull Helps prevent contamination of clothing or uniforms
bull Contaminated gowns must be handled per policy
bull Hands must be washed immediately after removing gown
78
Masks and Eye Protection
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Worn during procedures that may cause splashing or spraying
bull Prevents exposure of mucous membranes of the mouth nose and eyes to pathogens
bull Use masks once then discardmdashchange every 30 minutes if needed
79
Masks and Eye Protection(continued)
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Protective eyewear and face shields protect front top bottom and sides of eyes
bull If not disposable must be cleaned and disinfected before reuse
80
Sharp Objects
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Use extreme caution to avoid cuts and punctures
bull When possible use safe needles or needleless system
bull Follow policies regarding needlesbull Use sharps containersbull Follow laws regarding disposal of
sharp objects
81
Spills or Splashes
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Wipe up immediatelybull Wear gloves when wiping upbull Use disposable cleaning clothesbull Use disinfectant which contains 10
bleach solutionbull Clean all contaminated surfacesbull For large spills can use absorbent
powder to absorb fluid
82
>
Resuscitation Devices
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Use to avoid the need for mouth-to-mouth resuscitation
bull Place in convenient location that is readily accessible
83
Waste and Linen Disposal
bull Wear gloves
bull Follow agency policy
bull Use biohazard bags appropriately
84
Injuries
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Report any cut or injury needle stick or splashing of blood or body fluids immediately
bull Follow agency policy
85
Summary
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Standard precautions need to be followed at all times by every health care worker
bull Observing these precautions can help break the chain of infection
bull Health care workers can protect themselves their patients and all other individuals
86
Sterilizing with an Autoclave
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Autoclave ndash Equipment that uses steam under pressure or gas to sterilize equipment and suppliesndash Most efficient method of sterilizationndash Units available in various sizes
bull Procedure ndash Equipment must be properly preparedndash Thoroughly washed and rinsedndash Wrapped with material that allows steam to
penetratendash Indicators placed to ensure proper sterilizationndash Sufficient time allowed for completion
87
Using Chemicals for Disinfection
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Chemicals are frequently used for aseptic controlndash Not sterilization
bull Used on instruments that do not penetrate body tissue or are destroyed by high heatndash Examples include dental instruments percussion
hammers scissors thermometersbull Preparation includes proper cleaning and rinsing of
equipment before use of chemicalsbull Some chemicals 90 isopropyl alcohol 10 bleach
solution gluteraldehyde iodophor bull Must remain in solution for specific amount of time
depending on chemical used
88
Cleaning with Ultrasonic Unit
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Ultrasonic cleaning uses sound wavesndash These produce millions of microscopic bubbles
in a cleaning solutionndash When bubbles stick an object they explode a
process known as cavitation and drive the solution onto the article to be cleaned
ndash Dirt and residue are easily and gently removed in this process
ndash Different solutions used for different materials most are toxic that can cause skin irritation
ndash This is NOT sterilization
89
Using Sterile Techniques
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Many procedures require use of sterile techniques to protect a patient from infection
bull Surgical asepsis keeps an object or area free from living organisms
bull Sterile free from all organismsbull Contaminated organisms and
pathogens present
90
Using Sterile Techniques(continued)
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Important to differentiate between sterile and contaminated areas or items while using sterile technique
bull Correct techniques must be strictly followed to maintain sterility and prevent contamination
91
Using Sterile Techniques(continued)
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Clean working area requiredbull Handling of sterile suppliesbull Sterile field area used for placement
of sterile suppliesbull All sterile items need to be checkedbull Observe agency guidelines for datebull Necessary to keep sterile field dry
92
Removing Articles from Sterile Wraps
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Drop techniquemdashfor gauze pads dressings and small items
bull Mitten techniquemdashfor bowls drapes and linens
bull Transfer forcepsmdashfor cotton balls and small items
93
149 Transmission-BasedIsolation Precautions
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Isolation precautions are in addition to the Standard Precautions
bull Some diseases are communicable ndash Caused by organisms that can be
transmitted easilybull Epidemicmdashspreads from person to
person and affects large numbersbull Pandemicmdashspreads over a wide
geographic area
94
95
Isolation Precautions
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or ldquoisolationrdquo The type of precautions depends upon how the infection is spread Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Protects patient family and health care workers
bull Type of Isolation used depends on the causative organism of the disease
96
How Communicable Diseases Spread
bull Direct contact with a patient
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Contact with dirty linen equipment and supplies
bull Contact with blood body fluids secretions and excretions
97
Terms Defined
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Contaminated or dirty items that contain disease-producing organisms must not be touched unless protected
bull Clean items that do not contain the organisms protect these areas from contamination
98
Classifications of Precautions
bull Standard precautions
bull Airborne precautions
bull Droplet precautions
bull Contact precautions
99
100
Airborne Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nucleindash Remain suspended in the air or on dust
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
Droplets can remain suspended in the air for hours
Fate of Droplets
105
Droplet Precautions
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing sneezing talking laughing
bull Examplesndash Haemophilus influenza meningitis and pneumoniandash Neisseria meningitis and pneumoniandash Multidrug resistant Streptococcus meningitis
pneumonia sinusitis and otitis media diphtheria pertussis mumps severe viral influenza
106
Droplet Precautions
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Patient placed in private roomndash Can be with patient with same disease but
over 3 foot distance separationbull Masks must be worn if within 3 feetbull Mask worn on patient when transported
107
108
Contact Isolation
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact
bull Examplesndash Gastrointestinal respiratory skin or wound
infections caused by multidrug-resistant organisms incontinent patients with Ecoli Shigella hepatitis A rotavirus viral or hemorrhagic conjunctivitis or fevers and any skin infections
109
Contact Isolation
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
bull Patient placed in private room or with someone with same illness
bull Gloves must be worn upon entering roombull Gloves must be changed after contact with infectious materialbull Gloves must be removed before leaving room ndash hands must be
washed with antimicrobial agentbull Gown must be worn if chance of contact with patient surfaces
or items in room then removed before leaving roombull Patient should not leave room except for essential purposesbull Room disinfected dailybull Equipment left in room - disinfected upon patient discharge
110
Contact Isolation
Protective or Reverse Isolation
bull Method used to protect certain patients from organisms present in the environment
bull Used mainly for immunocompromised patients
bull Precautions vary depending on patientrsquos condition
111
Summary
bull Exact procedures for maintaining transmission-based isolation will vary from one facility to another
bull Variations caused by different factors
bull Basic principles remain the same in any facility and are directed toward preventing
the spread of disease 112
113
What Else Can You Do
bull Make sure you have been immunized and donrsquot come to school if you are sick
bull Places of employment will ask for written proof of immunity to measles mumps rubella and chickenpox upon employment
