1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 22 Infection Control and Medical Asepsis

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Impact of Infectious Diseases Discovery of germ theory: Louis Pasteur and Robert Koch Pharmacologic agents: antibiotics and vaccines Edward Jenner: smallpox vaccine Epidemiology: history, cause, patterns of infectious diseases

3. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Impact of Infectious Diseases Infection control and prevention Resistant microorganisms Bloodborne pathogen transmission Increased immunosuppressed populations Global access Effect infectious diseases have on lifestyles

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Process of Infection Caused by pathogenic microorganisms capable of causing disease Normal flora Similar steps occur in all infectious diseases MAs must apply theory of disease growth and transmission

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Process of Infection Growth requirements for microorganisms –Oxygen –Lack of or no oxygen –Moisture –Nutrition –Temperature –Darkness –Time –Neutral or slightly alkaline pH

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle (Fig 22.1, p. 507) Infectious agent: microorganisms Reservoir: people, food, equipment Portal of exit: secretions, excretions Means of transmission: airborne, ingestion Portal of entry: broken skin, mucus membrane Susceptible host: elderly, immunosuppressed

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Control Based on the concept that transmission of infections will be prevented when any level of the cycle is broken or interrupted

8. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle Infectious agents –Viruses: influenza, hepatitis, herpes –Bacteria: E. coli, S. pneumoniae Chlamydia, tetanus –Fungi: candida, toxoplasmosis Yeast infection –Parasites: protozoa, metazoa Malaria, trichomoniasis –Rickettsia: typhus, Rocky Mountain Spotted Fever, Lyme Disease –Prions: Mad cow disease

9. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle Reservoir –Source of a pathogen Portal of exit –Method by which infectious agent leaves reservoir

10. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle Modes of transmission –Direct contact –Droplet –Airborne –Vector Portal of entry –Enter susceptible host

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle Susceptible host –Number and specific type of pathogen –Duration of exposure to pathogen –General physical condition –Psychological health status –Occupation or lifestyle environment –Presence of underlying diseases or conditions –Youth or advanced age

12. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Cycle Susceptible host –Nosocomial infection or healthcare-associated infections (HAI) –Rise of antibiotic resistant bacteria (virulent bacteria) MRSA: methicillin-resistant Staphylococcus aureus VRE: vancomycin-resistant Enterococcus C. dif: clostridium difficile

13. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease The body’s natural barriers –Physical First line of defense Skin and associated accessories –Chemical Tears, sweat, mucus, saliva, gastrointestinal secretions, vaginal secretions –Cellular White blood cells

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease Inflammatory response –Response when body invaded by pathogen or physical trauma –Nonspecific response –Prolonged inflammation is an indication of infection and the need for antibiotic therapy

15. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease Order of Inflammatory response –Blood vessels dilate –Blood flow to area causes redness and heat –Plasma moves into tissue causing swelling –Nerve damage causes pain –White blood cells move into injured tissue –Pathogens are destroyed

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease The immune system and immunity –Protect against pathogens and abnormal cell growth –Cell-mediated immunity: attacks against viruses, fungi, organ transplants, cancer cells –Humoral immunity: antibody mediated system

17. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease The immune system and immunity –Recognition of invader –Growth of defenses; multiplication of helper T cells and B cells –Attack against infection; antibodies made –Slowdown of immune response after death of infectious agent

18. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease The immune system and immunity –Resistance: after exposure to pathogen; antigen– antibody reaction –Naturally acquired active immunity From contracting infectious agent; usually permanent –Artificially acquired active immunity Vaccination; semi- permanent to permanent –Congenitally acquired passive immunity Antibodies pass to fetus from mom; temporary –Artificially acquired passive immunity Ready made antibodies; temporary

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Body’s Defense Mechanisms for Fighting Infection and Disease The immune system and immunity –Specific defenses: things that protect us against specific pathogen –Nonspecific defenses: not so particular –Immunization: provides immunity with active or passive vaccines by stimulating the body to produce antibodies Live attenuated (changed) pathogens: altered, live pathogen Pathogenic toxins: the “poison” from a pathogen Killed pathogens: inactivated pathogens

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Stages of Infectious Diseases Incubation Prodromal Acute Acme Declining Convalescent Sequelae

21. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Disease Transmission Consider each patient potentially infectious for AIDS, hepatitis B and C, other bloodborne pathogens Apply techniques of Standard Precautions

22. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. HIV and Hepatitis B and C HIV and AIDS –AIDS caused by bloodborne virus HIV –HIV responsible for T-cell destruction –Carried in semen, blood, other body fluids –No curative treatment of HIV infections –Antiviral drugs used to slow process

23. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. HIV and Hepatitis B and C Acute viral hepatitis diseases –Liver inflamed; hepatic cells destroyed –Several types of viral hepatitis –Risk for contracting HBV and HCV greater than for contracting HIV –No vaccine to prevent HCV –No treatment after exposure to prevent infection –Medication: immunomodulators

24. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Reporting Infectious Disease Certain infectious diseases must be reported to state and county health departments CDC requires information reported to them –Notifiable Disease Surveillance System Helps CDC control spread of infection

25. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Reporting Infectious Disease Partial list of diseases that must be reported to CDC (Table 22.6, p. 531) –AIDS/HIV, Hepatitis A,B,C, Malaria, Meningitis, Syphilis, Gonorrhea –Chickenpox does not need to be reported

26. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Infection control guidelines for all health care professionals Blood and body fluids –Blood, secretions, excretions Personal protective equipment –Gloves, mask, gown, goggles/face shield Needlestick –Contaminated needles never recapped, broken off, removed from syringes, manipulated –Disposed of in approved puncture-proof container designated for sharps

27. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Safety devices to avoid needlesticks –Jet injection –Built in safety feature –Works passively –Easy to tell if safety feature has been activated –Safety feature can’t be deactivated –Easy to use –Safe and effective in patient care

28. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Blood –All body fluids, secretions, excretions regardless of whether they contain visible blood –Nonintact skin –Mucous membranes Personal protective equipment (PPE) >>

29. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Transmission-based precautions –Airborne, contact, droplet precautions –Use of barriers (gown, mask, goggles, gloves, cap) Biohazard puncture-proof sharps container>>

30. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Disposal of infectious waste –Items in contact with patient blood or body fluids –Place in appropriate biohazard containers –Incinerated (burned) or sterilization by autoclave

31. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Removing Contaminated Gloves

32. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Federal organizations and infection control –CDC: studies pathogens and diseases –Standard Precautions –Transmission-Based Precautions –Guideline for Isolation Precautions –Personal protective equipment (PPE) –Respiratory hygiene/cough etiquette

33. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Regulations The goal is to ensure safety in the work place The mission of OSHA –Save lives –Prevent injury –Protect the health of America’s workers

34. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Regulations The Bloodborne Pathogen Standard –Methods of compliance to prevent exposure Universal Precautions Engineering and work practice controls Personal protective equipment (PPE) Cleanliness of work areas Hepatitis B vaccine Follow-up after exposure Medical records

35. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Regulations Please refer to the video “OSHA Guidelines” through the instructor companion site.

36. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Regulations and Students Students with potential exposure to chemicals and bloodborne pathogens should follow OSHA safety procedures Students do not fall under OSHA guidelines Potential increases when invasive procedures performed

37. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Medical Asepsis Hand washing: most important thing health care workers can do to avoid spreading germs Cleaning and disinfecting contaminated surfaces Standard and Transmission-Based Precautions

38. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Medical Asepsis Sanitization Disinfection Sterilization –Medical assistant sanitizing instrument. Note the heavy duty gloves. >>

39. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioterrorism Use of biologic weapons (pathogenic microorganisms) to create fear Agents can spread through air, food, water Can be very difficult to detect and difficult to protect against Most dangerous: anthrax, botulism, pneumonic/bubonic plague, smallpox, tularemia