1. Infection Control

2. Understanding the basic principles of infection control is essential for any healthcare worker in any field of health care.
Our essential question is:
How are diseases transmitted and what are the main ways to prevent disease transmission?

3. Principles of Infection Control
Microorganism (or microbe) – small, living organism that is not visible to the naked eye.
Found everywhere in the environment, including on and in the human body
Nonpathogens – microorganism that is not capable of causing disease
Pathogens – microorganisms that cause infection and disease

4. Microorganisms can be beneficial in one body system and pathogenic in another body system
EX: E. Coli – digestive system – normal flora
urinary system - infection

5. To grow and reproduce, microorganisms need:
Warm environment - body temp ideal
Dark environment
Source of food
Source of moisture
Aerobic organisms require oxygen
Anaerobic organisms live and reproduce in absence of oxygen
Human body is ideal supplier of all requirements of microorganisms

6. Main Classes of Microorganisms
Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
Helminths

7. Group Work
Each group will be assigned a pathogen in which they will become experts on.
Describe pathogen
How are they classified?
If possible, describe their shape?
What diseases does this pathogen cause?
What is some other interesting info you would like to share?

8. Bacteria Simple one-celled organisms Multiply rapidly
Classified by shape and arrangement
Cocci
Bacilli
Spirilla
Antibiotics are used to kill bacteria

9. Bacteria Cocci Round or spherical in shape
If occurs in pairs – diplococci
Cause diseases such as gonorrhea, meningitis, pneumonia
If occur in chains – streptococci
Causes diseases such as strep throat and rheumatic fever
If occur in clusters - staphylococci

10. Bacteria Cocci (cont’d – Staphylcocci)
Most common pyogenic (pus-producing) microorganisms.
Cause infections such as boils, wound infections, and toxic shock.

11. Bacteria Bacilli Rod-shaped bacteria Occur singly, in pairs, in chains
Many contain flagella (threadlike projections similar to tails – allow to move)
Have ability to form spores (thick- walled capsules) when conditions for growth are poor.
In spore form, bacilli extremely difficult to kill

12. Bacteria Bacilli (cont’d)
Causes diseases such as tuberculosis, tetanus, pertussis, botulism, diphtheria, typhoid

13. Bacteria (Spirilla) Comma shaped and corkscrew shaped
Causes diseases such as syphilis and cholera

15. Application: Divide paper in thirds
Label the first column Cocci Bacteria, second column Bacilli Bacteria, third column Spirilla Bacteria.
Draw a diagram of each type of bacterial shape indicating 4 types of cocci, 3 types of bacilli, and 3 types of spirilla
Label diagrams
List at least 5 diseases caused by cocci and bacilli, and 2 diseases caused by spirilla

16. Protozoa One-celled animal like organism
Usually found in decayed materials and contaminated water, animal or bird feces, insect bites
Many contain flagella to allow them to move freely
Cause diseases such as malaria, amebic dysentary, trichomonas (STD) , African sleeping sickness

17. Protozoa (Malaria)

18. Fungi Small, plant-like organisms Live on dead organic matter
Yeasts and molds are 2 common forms
Causes diseases such as ringworm, athlete’s foot, thrush, yeast vaginitis
Antibiotics do not kill fungi
Antifungal medicines - expensive, long course of treatment, may cause liver damage

20. Rickettsiae
Parasitic microorganisms (cannot live outside the cells of another organism)
Found in fleas, ticks, lice, and mites and transmitted to humans by the bites of the insects
Causes diseases such as Rocky Mountain Spotted Fever
Treat with antibiotics

22. Viruses Smallest microorganism– visible only with electron microscope
Cannot reproduce unless inside another living cell
Spread from human to human by blood and other body secretions
Can be resistant to disinfectants
Antibiotics not effective

23. Virus (cont’d)
Causes diseases such as common cold, measles, mumps, chickenpox, herpes, warts, influenza, polio
3 diseases of major concern to healthcare worker:
Hepatitis B
Hepatitis C
AIDS

24. New and different viruses emerge constantly because viruses are prone to mutating and changing genetic information.
Viruses that infect animals can mutate to infect humans – often fatally
Examples: SARS (severe acute respiratory infection), West Nile Virus, monkeypox, Ebola

25. HIV and Flu Viruses

26. Viruses of Special Concern to the Healthcare Worker
Hepatitis B
Hepatitis C
AIDS

27. Hepatitis B Caused by HBV virus
Transmitted by blood, serum and other secretions
Affects liver – can lead to destruction of liver cells
Can remain active for several days in dried blood
Vaccine available – expensive – series of 3
By law, employers must provide vaccine to healthcare worker for free

28. Hepatitis C Caused by HCV virus
Transmitted by blood or blood-containing fluids
No vaccine available
Patients often asymptomatic or mild flu symptoms
Can cause liver damage
Extremely difficult to destroy
Can remain active for several days in dried blood

29. AIDS Acquired Immune Deficiency Syndrome
Caused by HIV (human immunodeficiency virus)
Suppresses immune system
Cannot fight off cancers or infections that would not normally affect healthy person
No cure
No vaccine

30. Microorganisms need certain things to grow and reproduce:
Most prefer a warm environment – body temp
Most prefer darkness
Most need food
Most need moisture

31. Aerobic organisms – are organisms which require oxygen to live
Anaerobic organisms – do not require oxygen

32. Microorganisms can produce toxins:
Toxins = poisons
Ex: tetanus produces a toxin that damages the CNS (central nervous system)

33. Helminths Multicellular parasitic organisms Called worms or flukes
Transmitted to humans when humans ingest the eggs or larvae in contaminated food, ingest meat contaminated with worms, or the worm penetrates the skin.

34. Examples of Helminths:
Hookworms – attach to small intestine and can infect heart and lungs
Ascariasis – live in small intestine and can cause obstruction of the intestine
Trichinella spiralis – causes trichinosis contracted by eating raw or inadequately cooked pork
Enterobiasis (pinworms) mainly affects young children

35. Hookworm in intestine

36. Hookworm beneath skin

37. ascriasis

38. Trichinella spiralis

39. 4 Classifications of Infectious Diseases
Endogenous
Exogenous
Nosocomial
Opportunistic

40. Endogenous - infection /disease originates in body
Endogenous - infection /disease originates in body . Ex: tumor, congenital abnormality
Exogenous – infection/disease originates outside body. Ex: pathogenic organisms that invade body
Nosocomial infection – infection acquired by an individual in a healthcare facility. Ex: staph
Opportunistic – occurs when the body’s defenses are weak. Ex: Kaposi’s sarcoma

42. Chain of Infection:
For diseases to occur and spread from one individual to another, certain conditions must be met… Chain of Infection
Causative agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

43. Causative Agent: A pathogen: Bacteria Virus Fungi Protozoa Rickettsiae
Helminth
What causes the infection/disease?

44. Reservoir: A place where the pathogen can live: Human body Animals
Environment
Fomites (objects contaminated with infectious material) Ex: door knobs, linens, instruments, etc

45. Portal of Exit:
A way to escape from the reservoir where it has been growing
urine
Feces
Saliva
Tears
Blood
Draining wounds
Mucous discharge

46. Mode of Transmission:
Way it can be transmitted to another reservoir or host where it can live.
Direct person to person contact
Direct contact with body secretion containing pathogen
Ex: contaminated hands
Indirect contact such as food, air, soil, insects, feces, clothing, instruments and equipment

47. Portal of Entry: Way to enter a new reservoir or host Breaks in skin
Breaks in mucous membranes
Respiratory tract
Digestive tract
Circulatory system

48. If the defense mechanisms of the body are intact and functioning, a human can frequently fight off the causative agent and not contract the disease.

49. Susceptible Host:
Person likely to get an infection

50. Application:
Using your textbook, identify 8 Body Defenses that work to prevent a causative agent from entering the human body.
Give an example of each
Identify how each defense mechanism prevents the causative agent from entering the body

51. Body Defenses Mucous membranes Cilia Coughing and sneezing
Hydrochloric acid – in stomach
Tears in the eye
Fever
Inflammation (WBC destroy pathogens)
Immune response (antibodies)

52. Scenario:
Flu is caused by the influenza virus. Anyone can get the flu, which is a viral infection that attacks the respiratory system including your nose, throat, bronchial tubes and lungs. You’re especially at risk if you’re older, have diabetes, chronic heart disease or an impaired immune system. Someone you know has the flu, coughs and sneezes and then you touch something they’ve handled. That’s why the flu spreads anywhere people congregate…schools, cruise ships, day cares, etc.

53. Identify the: Causative agent Reservoir Portal of exit
Mode of transmission
Portal of entry
Susceptible host

54. E. coli is short for Escherichia coli—a germ that causes severe cramps and diarrhea. E. coli is a leading cause of bloody diarrhea. The symptoms are worse in children and older people, and especially in people who have another illness. E. coli infection is more common during the summer months and in northern states.
Healthy beef and dairy cattle may carry the E. coli germ in their intestines. The meat can get contaminated with the germ during the slaughtering process. When beef is ground up, the E. coli germs get mixed throughout the meat.
The most common way to get this infection is by eating undercooked hamburgers. You can be infected
with the E. coli germ if you don’t use a high enough temperature to cook your beef, or if you don’t cook it long enough. When you eat undercooked beef, the germs enter your stomach and intestines.

55. If any part of the chain of infection is eliminated, the spread of disease or infection will be stopped.
Healthcare workers must understand chain of infection to interrupt or break the chain and prevent spreading of disease.
Pathogens are everywhere ….preventing their transmission is an ongoing process

56. Ways to Break Chain of Infection
Contamination – organisms and pathogens are present
Aseptic techniques – maintaining cleanliness, and eliminating or preventing contamination
Examples of common aseptic techniques:
Handwashing
Good personal hygiene
Disposable gloves
Proper cleaning of instruments
Thorough cleaning of environment

57. Levels of Aseptic Control
Antisepsis – antiseptics prevent growth of pathogens….not effective against spores or viruses. Can be used on skin (alcohol, betadine)
Disinfection – process that destroys or kills pathogens…sometimes effective against spores or viruses. Usually used on objects and not skin (disinfectants such as bleach)
Sterilization – destroys all microorganisms including spores and viruses (autoclave)

58. How to use an Autoclave

59. Application: Draw the chain of infection
Label each of the 6 sections of the chain of infection
Identify 3 ways to break each section of the chain of infection

60. Bioterrorism
Bioterrorism is the use of microorganisms or biological agents as weapons to infect humans.
Major concern of biological agents used not only in wars, but also against unsuspected civilians (ex: mail attack with anthrax)
Could cause an epidemic and public health emergency
Every healthcare worker must be alert to the threat of bioterrorism

61. Application:
Discussion of high priority agents that have been identified as potential bioterrorism agents

64. Handwashing
Handwashing is the most important method used to practice aseptic technique.
Most effective way to prevent spread of infection.
Hands are perfect medium for the spread of pathogens.
Proper handwashing helps prevent and control spread of pathogens AND protects health worker from disease and illness.

65. When should you wash hands?
Before and after every patient contact
Anytime hands become contaminated during procedure
Before applying and immediately after removing gloves

66. CDC recommendations for handwashing:
Regular handwashing – soap and water; routine cleansing of hands when hands are visibly dirty or soiled with blood/body fluids
Antiseptic handwashing – antimicrobial soap and water; before invasive procedures, critical care units, specific organism transmission based precautions
Antiseptic handrubs – alcohol based hand cleaners – ONLY if hands are not visibly dirty and are not soiled with blood/body fluids

67. Principles of Handwashing
Soap
Warm water
Friction
Clean all surface areas
Point fingertips downward
Use paper towels to turn faucet off and on
Clean nails also

68. Proper Handwashing Tips:
Soap – preferably dispenser – sudsy action/alkali content removes germs
Warm water – creates better lather than cold
Friction – rubs off pathogens from skin surface
Clean all surface area of hands
Point fingertips downward
Dry paper towels to turn faucet on and off – pathogens can travel through wet paper towel
Clean nails – brush or rubbing against palms

69. Soap Used as a cleansing agent
Aid in removal of germs through sudsing and alkali content
Pathogens trapped in soap suds and rinsed away
Liquid soap better than bar soap

70. Warm water Less damage to skin than hot water
Increases lather of soap better than cold water

71. Friction Must use friction - rubs off pathogens from surface of skin
Rub hands together using friction for approximately 20 seconds.

72. Clean all Surfaces
Clean all surfaces of hands – including palms, back and tops of hands, between fingers.

73. Nails
Nails must be cleaned with an orange/cuticle stick, brush, or rubbing the nails against the palm of the opposite hand.
Nails must be kept short to prevent scratching the skin, injuring patients, breaking through gloves.

74. Point Fingertips Downward
Keep fingertips pointed downward. Downward direction prevents water from going up forearms and then running down to contaminate clean hands.

75. Turn faucet off with dry paper towels
Dry paper towels must be used to turn faucet off. This prevents the contamination of the hands from pathogens on the faucet. Pathogens can travel easier through a wet paper towel than a dry paper towel.

76. Head to sinks to practice!
Application:
Head to sinks to practice!

77. Standard Precautions
Standard Precautions – rules developed by the CDC to prevent the spread of infection
Every body fluid and every patient is considered a potential source of infection
OSHA developed:
Bloodborne Pathogen Standard
Needlestick Safety Act

78. Application: Read pg 377 Bloodborne Pathogen Standard
What are the 3 pathogens of major concern to healthcare workers?
Who created the Bloodborne Pathogen Standard?
What is PPE and what is an employer’s responsibility regarding PPE?

79. Application: Read pg 377 Needlestick Safety Act
Who developed the Needlestick Safety Act?
Why was this act passed?
List 4 requirements of employers regarding the Needlestick Safety Act. Give an example of each.

80. Standard Precautions Basic rules of standard precautions: Hand hygiene
Gloves
Gowns
Masks and eye protection
Sharps
Spills and splashes
Resuscitation devices

81. Cont’d
Waste and linen disposal
injuries

82. PPE
PPE – Personal Protective Equipment

83. Donning PPE
Gown
Mask
Goggles
Gloves

84. Removing PPE
Gloves
Gown
Eyewear
Mask

85. Application: Read pgs 385—387 Sterilizing with Autoclave
Read pgs Using Chemicals for Disinfecting
Read pgs Cleaning with an Ultrasonic Cleaner
Describe each method.

86. Sterile Technique Sterile = free from all pathogens
Contaminated = pathogens present
Sterile field – never reach across a sterile field
What is the difference between clean and sterile?
Create a double bubble map comparing and contrasting using an autoclave vs. disinfecting with chemicals.

87. How to don sterile gloves

88. Transmission-Based Isolation Procedures
Communicable disease – a disease which is caused by a pathogen which can easily be transmitted to others.
Read pg 408
What is the difference between a pandemic and an epidemic

89. Epidemic – occurs when communicable disease spreads rapidly from person to person and affects a large number of people at the same time
Pandemic – exists when the outbreak of disease occurs over a wide geographical area and a effect a large portion of the population

90. Transmission-Based Isolation Precautions
Methods or techniques of caring for people with communicable diseases
Ex: TB, whooping cough, wound infections
Standard Precautions are used on all patients
Transmission –Based Isolation techniques are used to provide extra protection against specific diseases.
The type of transmission –based isolation precaution used depends on the diseaes

91. Application: Read pgs.409-413
Create a double bubble map which compares and contrasts 2 types of transmission-based isolation precautions

92. Airborne Precautions
Patients who are infected with pathogens transmitted by airborne droplet nuclei
Ex: measles (rubella), varicella (chicken pox), TB
Precautions: door kept closed, healthcare providers and visitors wear HEPA mask
Pt wears surgical mask if leaves room

93. Droplet Precautions
Pt infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking,etc
Ex: flu (influenza), meningitis, pneumonia
Private room
Masks

94. Contact Precautions
Pt infected with pathogens that can be easily transmitted by either direct or indirect contact
Ex: gastrointestinal, respiratory, skin or wound infections
Private room, gloves, gown, linens changed daily

95. Reverse Isolation
Methods used to protect certain patients from microorganisms
Used mainly for immunocompromised pts
Ex: transplant pts, chemotherapy , severely burned pts, weak immune system
Place in room that has been cleaned and disinfected, gloves, gown, mask, frequent disinfecting of room, special filters may be used to purify air.

96. Group Work to Demonstrate Working in a Hospital Isolation Unit
Divide into 7 groups
Reader
Recorder
Reporter

97. Group 1: Donning Isolation Garments
Group 2: Transfer food
Group 3: dispose of leftover food
Group 4: transfer of soiled linens
Group 5: transfer trash
Group 6: transfer equipment
Group 7: Removing Isolation Garments