Infection Control Techniques

1. 33 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. Patients coming to the office for treatment may be more susceptible to infections Immunizations and patient education are important methods of infection control Introduction You will be introduced to Occupational Safety and Health Administration (OSHA) guidelines, the Blood-Borne Pathogen Standard, reporting guidelines, and isolation procedures.

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

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

10. 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. 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 Medical Asepsis

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

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 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. 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 Sanitization

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

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

22. 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 Disinfection (cont.)

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 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 • 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 • Correct timing • Adequate temperature • Properly wrapped packs • Adequate steam levels • Timing • Preset for load types • Use sterilization indicators

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

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

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

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

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. 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 Postprocedure Cleanup

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