1. Infection Control Techniques33
Infection Control Techniques

2. Learning Outcomes
33.1 Describe the medical assistant’s role in infection control.
33.2 Describe methods of infection control.
33.3 Compare and contrast medical and surgical asepsis.
33.4 Describe how to perform aseptic hand washing.
33.5 Compare and contrast the procedures for sanitization, disinfection, and sterilization.

3. Learning Outcomes (cont.)
33.6 Describe measures used in sanitization.
33.7 List various methods used in disinfection and the advantages and disadvantages of each.
33.8 Discuss the goal of surgical asepsis.
33.9 Explain what an autoclave is and how it operates.
33.10 List the steps in the general autoclave procedures.

4. Learning Outcomes (cont.)
33.11 Explain how to wrap and label items for sterilization in an autoclave.
33.12 Describe how to complete the sterilization procedure using an autoclave.
33.13 Define the Blood-Borne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA).

5. Learning Outcomes (cont.)
33.14 Explain the role of Universal Precautions in the duties of a medical assistant.
33.15 List the procedures and legal requirements for disposing of hazardous waste.
33.16 Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease.
33.17 Discuss the need for specific guidelines for isolating patients in health-care settings.

6. Learning Outcomes (cont.)
33.18 Describe the appropriate use of personal protective equipment in various situations.
33.19 Explain the purpose of immunization.
33.20 Describe your role in educating patients about immunizations.
33.21 Explain how to educate patients in preventing disease transmission.

7. Introduction
Patients coming to the office for treatment may be more susceptible to infections
Immunizations and patient education are important methods of infection control
You will be introduced to Occupational Safety and Health Administration (OSHA) guidelines, the Blood-Borne Pathogen Standard, reporting guidelines, and isolation procedures.

8. MA’s Role in Infection Control
To control infectious diseases, the cycle of infection must be broken
Apply principles of infection control in office setting

9. MA’s Role in Infection Control (cont.)
Follow correct sanitization, disinfection, and sterilization procedures
Help patients understand basic disease prevention
Educate patients about immunizations
Administer immunizations

10. Correct! Apply Your Knowledge
What is your role as a medical assistant in controlling infection in the medical office?
ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures.
Correct!

11. Infection Control Methods
Eliminate elements needed for disease to occur
Knowledge of
Medical asepsis
Based on cleanliness
As few microorganisms as possible
Surgical asepsis
Sterile environment
No microorganisms

12. Medical Asepsis Keep office clean:
Reception area: sick vs. well patients
Reception room clean, well lit, and ventilated
Keep furniture in good repair
Strict “no food or drink” policy
Empty trash as necessary

13. Medical Asepsis (cont.)
During medical assistant procedures
Prevent cross-contamination
Hand washing
Beginning of day
After breaks
Before and after each patient
Before and after handling equipment or specimens
After blowing your nose or coughing

14. Medical Asepsis (cont.)
Other precautions
Avoid leaning against sinks, supplies, equipment
Avoid touching your face and mouth
Use tissues when you cough or sneeze, and always wash your hands afterward
Avoid working directly with patients when you have a cold; wear gloves and mask if you must
Stay home if you have a fever

15. Apply Your Knowledge Good Answer!
Describe the difference between medical and surgical asepsis.
ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms.
Good Answer!

16. Sanitization
Scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow
For cleaning items that touch only healthy, intact skin OR
First step in disinfection and sterilization for other equipment

17. Sanitization (cont.) Collect items for sanitization Scrub items
Place in water and special detergent solution
Use utility gloves
Separate sharps from other equipment
Scrub items
Follow manufacturers’ guidelines
Dry thoroughly
Examine carefully

18. Sanitization (cont.) Rubber and plastic items
Syringes and needles – use disposable whenever possible
Ultrasonic cleaning
For delicate instruments and those with moving parts
Sound waves generated through a cleaning solution to loosen contaminants

19. Nice Job! Apply Your Knowledge
What is sanitation, and what types of items is it adequate for cleaning?
ANSWER: Sanitation is scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. It is adequate for cleaning items that touch only healthy, intact skin.
Nice Job!

20. Disinfection
Adequate for instruments that do not penetrate skin or mucous membranes and surfaces not considered sterile OR
Second step in infection control prior to sterilization
Will not kill spores, certain viruses

21. Disinfection (cont.) Using disinfectants
Cleaning products applied to inanimate materials to reduce or eliminate infectious organisms
Antiseptics are anti-infective cleaning agents used on human tissue
Follow manufacturers’ guidelines

22. Disinfection (cont.) Factors impacting effectiveness of disinfectants
Number of times solution is used
Wet items – surface moisture may dilute solution
Traces of soap left from sanitization – alters chemical composition
Evaporation

23. Disinfection (cont.) Choose the correct disinfectant
Germicidal soap products
Alcohol
Acid products
Formaldehyde
Glutaraldehyde – “cold disinfection”
Bleach
Iodine and iodine compounds

24. Disinfection (cont.) Handling disinfected supplies
Prevent contamination with other surfaces
Use sterile transfer forceps
Wear gloves
Store in clean, moisture-free environment

25. Apply Your Knowledge Excellent!
What is the difference between a disinfectant and an antiseptic?
ANSWER: Disinfectants are cleaning products applied to inanimate materials to reduce or eliminate infectious organisms. Antiseptics are anti-infective cleaning agents used on human tissue.
Excellent!

26. Surgical Asepsis
Goal is to keep the surgical environment completely free of all microorganisms
Used for even minor operations and injections
The more extensive the procedure, the greater the risk of infection

27. Sterilization Required for all instruments or supplies that
Penetrate the skin
Contact normally sterile areas of the body
Object is either sterile or not sterile
If unsure of sterility, consider it not sterile
Prior to sterilization
Sanitize
Disinfect

28. The Autoclave Primary method of sterilization Pressurized steam
Operates at lower temperatures than dry heat sterilization
Moisture causes coagulation of proteins in microorganisms at lower temperatures
Cell walls burst when cell cools, killing the microorganism

29. The Autoclave (cont.) Wrap sanitized and disinfected items
Special porous fabric, paper, or plastic
Items should not touch
Label
Check water level – distilled water only
Preheat, but do not overheat

30. The Autoclave (cont.) Load, choose correct setting, run cycle Unload
Temperature 250°to 270°F
Pressure 15 to 30 pounds
Unload
Store items properly
Clean, dry location
Shelf life based on packaging, but generally 30 days

31. The Autoclave (cont.) Clean autoclave and area Quality control checks
Sterilization indicators – confirm that items have been exposed to correct volume of steam at the correct temperature for the correct length of time
Biological indicators – contain bacterial spores and confirm that sterilization occurs

32. The Autoclave (cont.) Prevent incomplete sterilization Timing
Correct timing
Adequate temperature
Properly wrapped packs
Adequate steam levels
Timing
Preset for load types
Use sterilization indicators

33. The Autoclave (cont.) Temperature Do not overcrowd autoclave
Too high – steam too little moisture
Too low – steam too much moisture
Do not overcrowd autoclave
Steam level
If incorrect, items will not be sterile at end of cycle

34. Sterile Technique Strict adherence to set order of procedures
Sterile against sterile
Clean against clean
Unclean against unclean
Surgical scrub

35. Surgical Asepsis During surgical procedures
Do not touch sterile items without sterile gloves or transfer forceps
Aseptic technique
Throughout surgical procedures
Caring for surgical wounds

36. Surgical Asepsis (cont.)
After procedures
Sanitize, disinfect, and sterilize reusable items
Disinfect surfaces
Waste disposal
Biohazard waste containers
Leak-proof containers either color-coded red or labeled with biohazard symbol
Biohazardous materials
Biological agents that can spread disease to living things

37. Apply Your Knowledge 1. What items need to be sterilized?
ANSWER: Sterilization is required for all instruments or supplies that penetrate the skin or come in contact with normally sterile areas of the body.

38. Right! Apply Your Knowledge
2. The physician is going to remove a small growth from your patient’s back. In order to prepare for this procedure, what steps would you take to prevent the spread of infection?
ANSWER: Use medical asepsis while preparing the patient, and then use surgical asepsis during the procedure.
Right!

39. OSHA Guidelines Blood-Borne Pathogen Standards
Protect health-care workers from health hazards on the job
Also protect patients and others who come to medical facilities
Dictate how to handle infectious or potentially infectious wastes
Discarded
Held for processing

40. OSHA Guidelines (cont.)
Blood-Borne Pathogen Standards
Measures to prevent the spread of infection
Provide a margin of safety by ensuring that medical facilities meet minimal standards for asepsis
Requirements for training, keeping records, housekeeping, and personal protective gear

41. OSHA Guidelines (cont.)
Universal Precautions
Prevent health-care workers from exposure to infections
Assume that all blood and body fluids are infected with blood-borne pathogens

42. OSHA Guidelines (cont.)
Standard Precautions
Combination of Universal Precautions and Body Substance Isolation guidelines
Used in health-care facilities to prevent transmission of disease

43. OSHA Guidelines (cont.)
Categories of tasks
Tasks that expose a worker to blood, body fluids, or tissues and require specific protective measures
Tasks that usually do not involve risk of exposure but require precautions in certain situations
Tasks that have no risk of exposure, so no special protection is required

44. Respiratory Hygiene/Cough Etiquette
Guidelines established by CDC
Education
Posting signs
Controlling source or transmission
Proper hand hygiene
Separating patients with respiratory infections from other patients

45. Personal Protective Equipment
Protective gear worn to protect against physical hazards
Employers must provide PPE at no charge to the employee
Disposable, sterile exam and utility gloves
Masks and protective eyewear or face shields
Protective clothing

46. Postprocedure Cleanup
Decontaminate all exposed surfaces
Replace protective coverings on surfaces or equipment
Decontaminate receptacles
Pick up any broken glass with tongs
Discard all potentially infectious waste materials

47. OSHA Guidelines (cont.)
Apply guidelines daily on the job
Exposure incidents
Contact with infectious substance
Rules apply to all serious infections – HIV, HBV
HBV vaccine
Transmission to patients
Nosocomial infection – an infection acquired by a patient in a health-care facility

48. Apply Your Knowledge ___ __
OSHA divides medical tasks by level of risk. What are these risk categories?
ANSWER: There are three categories of risk:
Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measures
Category 2: Usually do not involve risk of exposure, but precautions are required in certain situations
Category 3: No risk of exposure, so no special protection is required
___ __

49. Reporting Guidelines
Certain diseases must be reported to state or county health department
Information is forwarded to the CDC – control of the spread of infection

50. Reporting Guidelines (cont.)
National Notifiable Disease Surveillance System (Table 33-2)
Examples
HIV/AIDS  Cholera
Rubella  Hepatitis
Legionellosis  Lyme disease
Mumps  Smallpox
Tetanus  Tuberculosis

51. Good Answer! Apply Your Knowledge
How is the information on reportable diseases used by the CDC?
ANSWER: The CDC uses the information reported to them to help control the spread of infection.
Good Answer!

52. Isolation Guidelines CDC guidelines
Types of precautions needed
Patients requiring precautions
Create an environment that protects against pathogens
Standard Precautions

53. Isolation Guidelines (cont.)
Select appropriate PPE
Gloves
Masks, face shields, respirators
Gowns
Table 33-3

54. Nice! Apply Your Knowledge
Mrs. Findley brings her child with chickenpox into the medical office. What type of personal protective equipment should you use when caring for this child?
ANSWER: Chickenpox requires airborne and contact precautions, so you should use gloves and a mask and goggles or a respirator.
Nice!

55. Immunizations Immunization Reduces risk of infection spread
Administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases
Reduces risk of infection spread
Decreases the susceptibility of the host

56. Immunization Recommendations
Immunization schedules for children
Advisory Committee on Immunization Practices
American Academy of Pediatrics
American Academy of Family Physicians
Immunization schedules for adults
The National Coalition of Adult Immunization (NCAI)

57. Immunizations (cont.) When administering, you must explain
The need for immunization
Side effects
Soreness at site
Low-grade fever
General malaise

58. Immunizations (cont.) Concerns Pediatric patients
Do not give if child has fever
Informed consent – explain benefits and risks
Contraindications – symptoms that render the use of a remedy or procedure inadvisable because of the risk
Immunization records
National Childhood Vaccine Injury Act of 1988
Instruct parents keep record as proof of immunization

59. Immunizations (cont.) Pregnant patients Elderly
Avoid live virus vaccines
FDA categories A, B, C, D, and X
Elderly
Dispel common misconception and cost concerns
More likely to develop side effects

60. Immunizations (cont.) Immunocompromised patients Health-care workers
May experience minimal to dangerous effects
Adjust dosage or delay administration
Must also consider immunization status of family and caregivers
Health-care workers
Hepatitis B vaccination offered by employer at no cost to employee

61. Apply Your Knowledge Great! What is an immunization?
ANSWER: An immunization is the administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases.
Great!

62. Preventing Disease Transmission
Patient education
Health promotion
Disease prevention
Disease treatment
Medical assistant role in patient education
Share responsibility
Reinforce and explain instructions

63. Preventing Disease Transmission (cont.)
Educate patient on
Nutrition and diet
Exercise and weight control
Prevention of STDs
Smoking cessation
Alcohol and drug abuse prevention and treatment
Proper use of medications and prescribed treatments
Stress-reduction techniques

64. Preventing Disease Transmission (cont.)
Goal of patient education
Help patients take care of themselves
Encourage patients to participate actively in their own health care

65. Bravo! Apply Your Knowledge
What three areas should patient education focus on? What is the medical assistant’s role in patient education?
ANSWER: Patient education should focus on health promotion, disease prevention, and disease treatment.
The medical assistant shares responsibility with the physician and other staff members and should reinforce and explain instructions given by others.
Bravo!

66. In Summary
33.1 It is the medical assistant’s responsibility to apply the principles of infection control by following correct sanitization, disinfection, and sterilization procedures, helping patients understand basic disease prevention, administering immunizations, and teaching patients about the importance of immunizations.
33.2 The two basic methods of infection control are medical asepsis (clean technique) and surgical asepsis (sterile technique).

67. In Summary (cont.)
33.3 The goal of medical asepsis is to prevent the spread of infection in the medical environment by reducing the number of microorganisms. Surgical asepsis requires that all organisms be eliminated.
33.4 Aseptic hand washing removes accumulated dirt and microorganisms by wetting your hands, applying soap, carefully scrubbing every surface of the hands, rinsing, and carefully drying with clean paper towels.

68. In Summary (cont.)
33.5 Sanitization is the scrubbing of instruments and equipment with special brushes and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. Disinfection uses special cleaning products applied particularly to instruments and equipment to reduce or eliminate infectious organisms. Sterilization is usually accomplished through the use of steam and pressure in an autoclave.
33.6 Sanitize instruments by soaking them in a disinfecting solution, carefully scrubbing every surface of each instrument, rinsing thoroughly, and allowing them to dry.

69. In Summary (cont.)
33.7 There are several types of disinfectants, each with different properties. Choose a disinfectant based on the type of instrument and the level of disinfection required The goal of surgical asepsis is to destroy all microorganisms An autoclave is a device that uses steam and pressure to sterilize instruments and equipment.

70. In Summary (cont.)
33.10 The general steps for using the autoclave include preparing the instruments, checking the water level, preheating the chamber, loading the instruments, choosing the correct settings, running the autoclave, and allowing the instruments to dry at the end of the cycle Instruments should be carefully wrapped in a porous material, bag, or envelope and labeled with the contents of the pack, date, and your initials.

71. In Summary (cont.)
33.12 To ensure that the sterilization procedure is complete, you should make sure you use the correct amount of time, the correct temperature, and adequate levels of steam. In addition, you should avoid overcrowding the chamber.
33.13 Laws set forth in the OSHA Blood-Borne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures. According to these rules, any potentially infectious waste materials must be discarded or held for processing in biohazardous waste containers

72. In Summary (cont.)
33.14 Standard Precautions prevent health-care workers from exposing themselves and others to infections. Following Standard Precautions means assuming that all blood and body fluids are infected with blood-borne pathogens OSHA requires that all hazardous waste be placed in properly labeled biohazard containers and disposed of in an appropriate manner.

73. In Summary (cont.)
33.16 The CDC requires reporting of certain diseases to the state or county department of health, who then reports the information to the National Notifiable Disease Surveillance System of the CDC.
33.17 The CDC issued the current Guideline for Isolation Precautions in Hospitals to ensure that an environment is created that protects people from disease-causing microorganisms.

74. In Summary (cont.)
33.18 There are a number of different types of personal protective equipment, including gloves, gown, masks, and goggles. Choosing the correct type depends on the exposure type.
33.19 Immunizations prevent infection by reducing the susceptibility of the host to infection.

75. In Summary (cont.)
33.20 As a medical assistant, you should educate patients about the importance of getting immunizations and following the immunization schedule. You should also discuss potential hazards and side effects of immunizations.
33.21 You should emphasize the basic principles of hygiene and disease prevention, including frequent hand washing, routine bathing and dental care, covering coughs and sneezes, eating well, and avoiding stress.

76. End of Chapter 33
Soap and education are not as sudden as a massacre, but they are more deadly in the long run.
~ Mark Twain