infection control

• Infection


  When a microorganism invades the body, multiplies and causes injury or disease
• Types of infection

  • Communicable
  • Nosocomial & healthcare-associated infections (HAIs)
• Pathogen


  A microbe that can cause diseases, and microbes could be bacteria, fungi, protozoa, or viruses
• Components of the chain of infection


  • Infectious (causative) agent
  • Reservoir
  • Exit pathway
  • Means of transmission
  • Entry pathway
  • Susceptible host
• Infectious (causative) agent


  • Pathogenic microbe such as virus, bacteria, fungus, protozoa, rickettsia
• Reservoir


  • Source of infection agent or place where the microbe could grow, survive and multiply which could be in humans, animals, food, water, soil or equipment
• Exit pathway


  • A way or manner where an infectious agent can leave the reservoir host which could be through secretions and exudates, tissue specimens, blood, feces or urine
• Means of transmission


  • Airborne, direct (touching or kissing) or indirect contact (contaminated objects), droplets (coughing or sneezing), vector (insect, anthropod or animal) and vehicle (food, water or drugs)
• Entry pathway


  • Refers to the way an infectious agent enters a host that is susceptible to infection which includes body orifices, mucous membranes, and breaks in skin
• Susceptible host

  • Someone who is prone to infection due to age, health or immune status. They usually include the elderly, newborn, patients who are immune suppressed, unvaccinated, and those suffering from acute or chronic illness
• Infection control program


  Set of procedures to break the chain of infection
• Components of an infection control program


  • Effective hand hygiene procedure
  • Good nutrition
  • Immunization against common pathogens
  • Insect and pest control
  • Isolation and decontamination procedures
  • Use of proper safety devices
  • Use of PPE when needed
  • Proper disposal of sharps and other waste
• Four functions of an infection control program


  • Protect patients, employees, and visitors from infection
  • Screen employees for infectious diseases and require immunization when needed
  • Provide evaluation and treatment to health workers who were exposed to infections while performing their duty
  • Monitor employees and patients who are at risk of infection and collect data from patients and health worker who were exposed to such
• Proper procedures for hand hygiene


  1. Stand a few inches from the sink

  2. Turn on the faucet and place hands under the running water

  3. Use soap and work up lather to ensure that surfaces are reached

  4. Scrubbing for at least 15 seconds is necessary

  5. Apply a little friction and rub hands together for at least 15 seconds

  6. Rinse the hands from the wrist to fingertips using a downward motion

  7. Dry hands using a clean paper towel

  8. Use the paper towel to close the faucet except when it is foot or motion activated
• Hand hygiene


  An essential part of standard precaution and an effective way to prevent the spread of infection
• Methods of hand hygiene

  • Routine hand washing
  • Hand antisepsis
• Routine hand washing


  Uses plain soap and water, when hands are visibly dirty, after known exposure, before eating, after using the restroom
• Hand antisepsis


  Uses of alcohol-based hand sanitizer to remove transient microorganisms, sanitizer is preferred when hands are not visibly dirty, hand rub for 20 seconds until it dries
• Donning of PPE


  Gown should be put on first, mask should cover both the nose and mouth, gloves should be pulled over the gown cuff
• Removing of PPE


  Gloves are removed first, gown should be pulled from the shoulders towards the hand so it is turned inside out, mask should be removed by only touching the string
• Gloves


  Worn during blood collection and specimen handling, prevent contamination of hands, reduce chances of transmission of microorganisms, worn over the cuffs of the lab gown to ensure protection
• Proper gloves removal


  The wrist of one hand is grasped by the opposite hand, the glove is pulled inside out and off the hand, place the recently removed glove in the gloved hand, the fingers of the non-gloved hand are slipped under the wrist of the remaining glove but make sure not to touch the exterior surfaces, the second glove is pulled inside out, drop the gloves in the proper receptacle
• Nursery and neonatal ICU infection control technique


  Do the proper hand washing procedure before putting on the PPE, the phlebotomist should only bring items necessary for the specimen collection, blood collection tray should be left outside the nursery, preferably the anteroom, remove gloves, wash hands, and use a new pair of gloves between patients
• Standard and transmission-based precautions for blood-borne pathogens


  Procedures to protect against exposure to blood-borne pathogens
• Blood-borne pathogens (BBP)


  • Hepatitis B Virus (HBV)
  • Hepatitis D Virus
  • Hepatitis C Virus (HCV)
• Hepatitis B Virus (HBV)


  • Best defense is HBV vaccination, exposure hazards are blood and other body fluids, can survive a week on objects, transmitted via needle sticks, sexual contacts, symptoms include flu-like, fatigue, loss of appetite, mild fever, muscle/joint/abdominal pain, nausea, vomiting
• Hepatitis D Virus


  • No vaccine available, exposure hazards are blood and other body fluids, can survive a week on objects, transmitted via needle sticks, sexual contacts, symptoms include flu-like, fatigue, loss of appetite, mild fever, muscle/joint/abdominal pain, nausea, vomiting
• Hepatitis C Virus (HCV)


  • No vaccine available, exposure hazards are blood & serum; sometimes saliva, infection primarily occurs after large and multiple exposures, transmitted via needle sticks, sexual contacts, symptoms include flu-like, fatigue, loss of appetite, mild fever, muscle/joint/abdominal pain, nausea, vomiting
• Exposure control plan for blood-borne pathogen exposure


  When a contaminated needle or sharp object pierces the skin of the health worker, body fluid or blood splashes in the eyes, nose or mouth, cut, scratch or abrasion has made contact with blood or body fluid, human bite cuts the skin, for needle stick or other sharp injury: carefully remove the shards or foreign object, wash the site thoroughly with soap and water for at least 30 seconds, for mucous membrane exposure: flush with water or saline for at least 10 minutes, for the eyes, irrigate with water or saline for at least 15 minutes
• Infection


  • Primarily occurs after large and multiple exposures
• Exposure occurs when

  1. Contaminated needle or sharp object pierces skin

  2. Body fluid or blood splashes in eyes, nose or mouth

  3. Cut, scratch or abrasion contacts blood or body fluid

  4. Human bite cuts the skin
• Procedure when there is BBP exposure

  1. Needle stick or other sharp injury:

  2. Carefully remove shards or foreign object

  3. Wash site thoroughly with soap and water for at least 30 seconds

  4. Mucous membrane:

  5. Flush with water or saline for at least 10 minutes

  6. For eyes, use eyewash station

  7. Report incident to supervisor and provider
• Biohazard


  Any material that could be harmful to health
• Biohazard exposure routes


  • Airborne - from splashes and aerosols
  • Ingestion - did not sanitize hands before handling food
  • Non-intact skin - contamination through breaks or cuts
  • Percutaneous - exposure through skin due to needle sticks and sharp objects
  • Permucosal - infection through mucous membranes
• Actions to take if electric shock occurs

  1. Remove source of electricity using non-conductive object or turn off

  2. Ask for medical assistance, start CPR if necessary, keep victim warm
• Five classes of fire

  • Class A - ordinary combustible materials
  • Class B - flammable liquids and vapors
  • Class C - electrical equipment
  • Class D - combustible and reactive metals
  • Class K - cooking oil, grease or fats
• Radiation exposure

  Depends on distance, shielding and time
• Chemicals


  Used as cleaning reagents, preservatives, delivering specimens
• General rule: always wear PPE when working with chemicals
• Never store chemicals above eye level, never add water to acid, never mix chemicals indiscriminately, never store in unlabeled containers, never pour into used/dirty containers, never use for unintended purposes