Medical Asepsis and

1
Chapter 19

• Medical Asepsis and
• Infection Control

2
Introduction

• Two goals to prevent spread of disease in medical
  offices
• 1. Understand and practice medical asepsis at
  all times
• 2. Educate patients and their families about
  techniques to use at home

3
Microorganisms, Pathogens, and Normal Flora

• Microorganisms
• Very small living organisms seen only with a
  microscope
• Normal flora
• Part of normal environment
• Also found on skin and throughout
  gastrointestinal, genitourinary, and respiratory
  systems
• Some required for good health

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Pathogens and Normal Flora

• Pathogens
• Disease-producing microorganisms
• Bacteria, viruses, fungi, protozoa
• Transient flora
• Too many normal flora
• Normal flora transmitted to another area of the
  body
• Can become pathogens under the right conditions

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Bodys Natural Defenses

• Skin
• Eyes
• Mouth
• Gastrointestinal tract
• Respiratory tract
• Genitourinary tract

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Checkpoint Question 1

• What are pathogenic microorganisms? How does the
  body prevent an invasion and subsequent infection
  naturally?

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Answer

• Pathogenic microorganisms are microscopic
  organisms that cause disease. Natural ways that
  the body stops an invasion or destroys pathogens
  include tears (wash microbes away from the eyes
  and contain lysozyme, an effective disinfectant)

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Answer (continued)

• Hydrochloric acid in the stomach (produces a pH
  that kills many microbes that may get into the
  stomach) unbroken or intact skin (provides a
  barrier to invading microorganism) mucous
  membranes and cilia lining the respiratory tract
  (trap microorganisms that may be inhaled).

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Conditions that Favor the Growth of Pathogens

• Moisture
• Nutrients
• Temperature
• Darkness
• Neutral pH
• Oxygen

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Checkpoint Question 2

• Given the six conditions that favor the growth of
  pathogens, explain how you can alter the growth
  and reproduction of microorganisms by changing
  these factors.

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Answer

• The conditions that favor the growth of
  microorganisms include moisture, nutrients, a
  warm temperature, darkness, a neutral or slightly
  alkaline pH, and oxygen. To prevent the growth of
  microbes, remove any moisture or sources of
  nutrition, use heat higher than 98.6F, expose
  the area to light, or use chemicals to clean with
  that have a pH higher or lower than 7.0 (neutral).

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The Infection Cycle

• A series of specific links of a chain involving a
  causative agent or invading microorganisms
• Reservoir host
• Modes of transmission
• Pathogen spreads
• Portal of entry
• Susceptible host

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Checkpoint Question 3

• How are the first and fifth links of the
  infection cycle related?

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Answer

• The first link in the infection cycle (the
  reservoir host) provides nutrients and an
  incubation site for the pathogen. The fifth link
  (the susceptible host) allows the pathogen to
  enter and begin growing thus becoming the new
  reservoir host, repeating the cycle.

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Modes of Transmission

• Direct transmission
• Indirect transmission
• Sources of transmission

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Checkpoint Question 4

• The medical office where you work has a policy
  about not opening windows that do not have
  screens in examination rooms and the reception
  area. Why do you think this policy is or is not
  important?

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Answer

• Opening windows that do not have screens would
  allow insects to come into the office. Insects
  may be reservoir hosts to certain diseases and
  contaminate items in the medical office.

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Principles of Infection Control

• Most transmission of infectious disease can be
  prevented by strict adherence to guidelines
  issued by OSHA and the CDC

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Medical Asepsis

• Practices that render an object or area free from
  pathogenic microorganisms
• Handwashing is the MOST IMPORTANT medical aseptic
  technique

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Handwashing

• Always wash your hands
• Before and after patient contact
• After contact with any blood or body fluids
• After contact with contaminated material
• After handling specimens
• After coughing, sneezing, or nose blowing
• After using the restroom
• Before and after lunch, breaks, leaving for the
  day

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Other Medical Asepsis Techniques

• Wear gloves
• Wash hands before applying gloves and after
  removing them
• General office cleaning
• Floors should always be considered contaminated

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Checkpoint Question 5

• Explain why wearing exam gloves does not replace
  handwashing.

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Answer

• Gloves are considered a barrier to prevent the
  skin from coming into contact with contaminated
  materials, However, once they are removed,
  standard precautions require that the hands be
  washed as an additional precaution.

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Levels of Infection Control

• Sterilization
• Disinfection
• Sanitation

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Sanitation

• Science of maintaining a healthful, disease-free,
  and hazard-free environment
• Thorough cleaning of instruments and equipment
  with warm soapy water
• Precedes disinfection and sterilization

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Disinfection

• Inactivates virtually all recognized pathogenic
  microorganisms, but not all microbial forms

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Factors that Affect Disinfection

• Prior cleaning of object
• Amount of organic material on object
• Type of microbial contamination
• Concentration of germicide used
• Length of exposure to germicide
• Shape or complexity of object
• Temperature of process

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Levels of Disinfection

• High level
• Destroys most forms of microbial life, but not
  bacterial spores
• Intermediate level
• Destroys many viruses, fungi, and some bacteria
• Low level
• Destroys many bacteria and some viruses

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Checkpoint Question 6

• What level of disinfection would you use to clean
  a nondisposable instrument that comes into
  contact with the vaginal mucosa, such as a
  vaginal speculum? Why?

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Answer

• Items or instruments that come into contact with
  unbroken mucous membranes in areas of the body
  that are not considered sterile (like the vagina)
  may be safely disinfected using a high level
  disinfectant for the specified period of time.

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Occupational Safety and Health Administration
Guidelines for the Medical Office

• Federal agency responsible for ensuring safety of
  all workers
• Mandates federal regulations or laws that must be
  followed by all medical offices
• Other office policies must be in a manual

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Exposure Risk Factors and the Exposure Control
Plan

• Medical offices must provide clear instructions
  in the policy manual for preventing employee
  exposure or reducing the danger of exposure to
  biohazardous materials

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Exposure Risk Factors

• Exposure risk factor for each worker must be
  calculated
• Clinical medical assistants
• Have high exposure risk
• Require access to PPE
• Require immunization against hepatitis B

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Exposure Control Plan

• Policy required by OSHA for offices with ten or
  more employees
• Plan of action for all who might become exposed
  to biohazardous material
• Office must provide appropriate equipment and
  supplies

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In the Event of Exposure

• 1. Apply the principles of first aid and notify
  your supervisor
• 2. Physician or supervisor provides guidance for
  postexposure testing and follow-up procedures
• 3. Complete and file an incident report
• 4. Employer must record exposure on an OSHA 300
  log

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Checkpoint Question 7

• Explain the difference between exposure risk
  factors and the exposure control plan.

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Answer

• Exposure risk factors include risk factors
  associated with specific jobs in terms of
  exposure to biohazardous or contaminated
  materials. The exposure control plan is a written
  document outlining the procedure that an employee
  or visitor should take to prevent exposure to
  biohazardous material.

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Standard Precautions

• Set of procedures recognized by the CDC to reduce
  chance of transmitting infectious microorganisms
• Pertain to contact with blood, all body fluids
  (except sweat), nonintact skin, and mucous
  membranes

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Standard Precautions

• Wash hands after touching contaminated items
• Or use alcohol-based hand rub
• Wear clean, nonsterile exam gloves
• Change gloves between procedures
• Wear PPE
• Take precautions to avoid injury
• Place used sharps in puncture-resistant
  containers
• Use barrier devices instead of mouth-to-mouth
  resuscitation

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Checkpoint Question 8

• How will following standard precautions help to
  protect you against contracting an infection or
  communicable disease?

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Answer

• Following the standard precaution guidelines will
  help to protect you against contracting a
  possible infection or disease by preventing the
  possible or potential entrance of the pathogenic
  microorganisms into your body, thereby preventing
  you from becoming a susceptible host.

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Personal Protective Equipment

• Must be available and used by all health care
  workers
• Employees responsible for using PPE correctly
• Remove all PPE before removing gloves
• After removing gloves, wash hands

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Checkpoint Question 9

• What PPE would you need to wear when assisting
  the physician with a wound irrigation?

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Answer

• A wound irrigation would require the wearing of
  gloves and a facial mask covering not only the
  mouth and nose but shielding the eyes as well.
  This procedure would have the potential of
  causing microorganisms to be splashed into the
  environment.

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Handling Environmental Contamination

• All equipment and areas must be clean
• Any surface contaminated with biohazardous
  materials should be promptly cleaned
• Use an approved germicide or a dilute bleach
  solution
• Spill kits or appropriate supplies must be
  available

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Spill Kits

• Spill kits include
• Clean gloves
• Eye protection
• Gel to absorb biohazardous material
• Scoop
• Towels
• Biohazard waste container

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Soiled Linens

• Handling soiled linens
• Wear gloves
• Handle as little as possible
• Fold carefully with contaminated surface inward
• Place in biohazard bag

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Checkpoint Question 10

• How would you respond to an employee in the
  medical office who is unsure about how to clean
  up a spilled urine specimen? Is this biohazardous?

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Answer

• Urine is a potential biohazardous material and
  should be cleaned by applying clean exam gloves,
  using paper towels or absorbent powder to absorb
  the urine, and placing all items used for
  cleaning up the spill into a biohazardous waste
  container. Once the urine is absorbed and
  discarded appropriately, the area or floor should
  be disinfected.

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Disposing of Infectious Waste

• EPA and OSHA set policies
• Individual states determine local policies
• Large generators are certified and maintain
  records
• Medical offices are usually small generators

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Infectious Waste Service

• Supplies office with appropriate waste containers
  and picks up filled containers regularly
• Disposes waste according to EPA and OSHA
  guidelines
• Maintains records
• Medical office retains records for 3 years

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Guidelines to Keep Costs Down

• Use separate containers for each type of waste
• Fill sharps containers only to fill lines
• Use approved biohazard containers
• Secure containers before moving them

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Checkpoint Question 11

• After drawing a blood specimen from a patient,
  you notice that the tube of blood is leaking onto
  the examination table where you temporarily put
  it while finishing the procedure. How would you
  clean up the blood spill?

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Answer

• Again, all blood should be considered a
  contaminated, biohazardous material and should be
  cleaned using the commercially prepared spill kit
  or with items assembled from the office. The
  broken blood tube should be placed into a sharps
  container, and once the blood has been wiped up,
  the table should be disinfected.

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The Hepatitis B and Human Immunodeficiency Viruses

• Persistent health care concern

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Hepatitis B Virus

• More viable than HIV
• Easily killed with dilute bleach solution
• Transmitted via contaminated blood or body fluids
• Vaccine must be provided to employees at no cost
• Postexposure plan required

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Human Immunodeficiency Virus

• Transmitted via contaminated blood or body fluids
• No vaccine available
• Postexposure plan is required

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Checkpoint Question 12

• Which virus is more of a threat to the clinical
  medical assistant HIV or HBV?

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Answer

• The virus that is actually more of a threat to
  the medical assistant is HBV. This virus is more
  likely to live in dried body secretions on an
  inanimate surface for up to 2 weeks. Under the
  right circumstances, contact with these dried
  secretions may cause infection in the exposed
  individual.

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Answer (continued)

• Hepatitis B is a serious disease and may cause
  scarring and destruction of the liver tissue
  (leading to liver failure), an increased risk for
  developing liver cancer, and death.