Unit 3 Infectious control 1.0.docx

 1  1. **Define some basic definitions** 1. Define basic terms related to microbiology, infection control, and occupational health. 2. **Describe what is a biological hazards** 2. Define biological hazards and their potential risks...

 1  1. **Define some basic definitions** 1. Define basic terms related to microbiology, infection control, and occupational health. 2. **Describe what is a biological hazards** 2. Define biological hazards and their potential risks in laboratory and healthcare settings 3. Define the types of biological hazards. 4. Explain the different exposure routes 3. **Define what an infection is** 1. Provide a precise definition of infection and its implications on health, including modes of transmission and symptoms. 4. **Define what is a disease**. 1. Provide a precise definition a disease 5. **How are diseases spread.** 2. Describe the different ways diseases are spread  6. **Define what is a nosocomial infection or an HAI (hospital acquired infection)** 3. Provide a precise definition what is a nosocomial infections or HAIs (hospital-acquired infections) 7. **Define what is are fomites** 4. Define fomites as inanimate objects capable of transmitting infectious agents. 8. **Define what are TLV -- Threshold limit values** 5. Explain TLV (Threshold Limit Values) and their significance in occupational health. 9. **Examples of drug resistant bacteria** 6. Give examples of the most common drug resistant bacteria 10. **Examples of viral infectious agents**. 7. Give examples of common viral infectious agents. 11. **Describe what are the conditions for microorganisms to grow** 8. Describe the conditions necessary for microorganisms to  12. **Describe the describe the infection cycle.** 9. Explain the infection cycle, such as airborne transmission, direct contact, and vector-borne transmission. 13. **Describe the 2 most common occupational exposure** 10. Describe the two most common types of occupational exposures in healthcare settings and laboratory environments. 14. **Describe the correct steps in handwashing** 11. Describe the step by step in te correct proceduce in handwashing 15. **How does the immune system work in fighting disease.** 12. Describe the mechanisms by which the immune system defends the body against disease-causing pathogens. 16. **Define standard practices** 1. Define standard practices in infection control and their importance in preventing the spread of infectious diseases. 17. **Describe the different types of precautions** 1. Describe different types of precautions, including standard precautions, contact precautions, and airborne precautions.  18. **How to put on and take off personnel protective equipment.** 1. Provide step-by-step instructions on properly donning 19. **Describe the different classification of labs** 1. Describe the classification of laboratories based on 20. **Define the different international hospital codes** 2. Define different international hospital codes used for - **Microorganism**s -- living things so small that they can only be seen through a microscope - **Pathogens** -- disease causing microorganisms - **Bacteria** -- microorganisms that may or may not be pathogens - **Normal Flora** -- bacteria normally found in the body.  - **Infection** -- condition in body tissue in which pathogens have multiplied and destroyed many cells - **Clean** -- uncontaminated by harmful microorganisms - **Dirty** -- contaminated by harmful microorganisms - **Asepsis** -- free of disease -- causing organisms - **Medical Asepsis** - preventing the conditions that allow pathogens to live, multiply and spread - also called *clean technique* - **Surgical Asepsis** -- a technique that destroys more pathogens than medical asepsis - also called *sterile technique*  - **Normal flora** (resident bacteria) - Bacteria in the gut helps to digest food - However if this bacteria in the gut are present in feces it can be carried to the urinary tract and cause an infection - Normal flora on your hands can cause an infection if it gets inside your body - Definition - ------------  1. Biological Agents 2. Biotoxins 3. Human Blood, Blood Products, and Sharps Blood isn\'t inherently dangerous to human life or health, but it can contain a biological agent 4. Other Human Bodily Matter - Blood isn\'t the only bodily material or fluid that can transmit disease -- other bodily substances can also be hazardous to human health.  5. Animal Waste and Products 6. Organic Matter 7. Biting or Stinging Insects  1. **Airborne** -- Splashes , aerosol, fumes 2. **Ingestion** -- neglect of washing your hand, and putting thing in your mouth 3. **Nonintact skin** -- Breaks in skin ( cuts) 4. **Percutaneous** -- accidental puncture into the skin ( needle stick injuries) 5. **Permucosal** -- Exposure of biohazard through the mucous membranes - An infection occurs when a microorganism --- such as bacteria, fungi, or a virus --- enters a person's body and causes harm. - The effects of infections occur due to the immune system's attempt to get rid of the invading organism.  Localized: ========== - means confined to one area - signs are: - Swelling - Redness - Pain at infected site - Loss of function of involved part - Pus - Affected area could be " hot" - SHARP acronym - S - Swelling - H -- Heat - A -- Aching - R -- Redness - P - Pus  - Spread through out the entire body - Signs: - Increased temperature - Lethargy - Generalized pain - Definition - ------------ - A **disease** is a particular abnormal condition that adversely affects  - Infectious diseases are not bond by geography. - Infectious disease at first might be local , then it spreads throughout the community, and globally. - **Endemic** -- an infectious disease that spread thought an area, community or country. - **Outbreak** - This is more serious. The infectious disease has spread to a new area. - **Epidemic** -- The infectious disease has spread rapidly and has infection more people than expected. - **Pandemic** -- This is when the epidemic has spread to multiple countries and has affected a large portion of the population  - When the body is invaded by pathogenic bacteria, viruses, fungi, or parasites, the resulting condition is known as an **[infection.]** - An infection acquired after admission to a health care facility is called a **[Nosocomial] [Infection] or an [HAI ]**(healthcare associated - Objects that can harbour infectious agents and transmit infections are called **[fomites]** - [TLV -- Threshold limit values] ------------------------------------------- - [Due Diligence] ---------------------------  - The ability of microorganisms to develop resistant to specific antibiotics is continuingly to be a problem in healthcare. - Some progress has been made. However, it is one of the major threat in HAI. - Resistant pathogens are; *Clostridium difficle,* Methicillin resistant Staph. aures and *Enterococcus gram negative bacteria, Tb, etc.*  - **[Clostridium difficile-]** C. difficile infection is a growing problem in healthcare facilities. When the bacteria are in a colon in which normal gut flora has been destroyed (usually after a broad- spectrum antibiotic has been used), the gut becomes overrun with C. difficile. The bacteria release toxins that can cause bloating and diarrhea, with abdominal pain, which may become severe. - You cannot use **alcohol based** hand cleaner.\` - Alcohol based hand cleaner does not kill C. difficile ( spores)  - **MRSA -- Methicillin Resistant Staph aureus** - common infection in hospitals and in the community (pneumonia, skin infections) - is resistant to Methicillin and needs Vancomycin  - \- VRSA -- Vancomycin-resistant Staphylococcus aureus. VRSA was first identified in Japan in 1997 and has since been found in hospitals elsewhere in Asia, as well as in the United Kingdom, France, the U.S., and Brazil.   - VRE -- Vancomycin Resistant Enterococci --------------------------------------- - Bacteria normally found in the bowel - Generally does not bother those with a healthy immune system, but may cause infection in an individual with compromised immune system. - Resistant to all antibiotics even vancomycin which is the strongest we have at present - Spread by fecal -- oral route  - Tuberculosis (TB) ----------------- - Respiratory illness - Diagnosed by a Mantoux test and chest x-ray and sputum cultures for AFB ( acid fast bacilli) - Other body sites can be infected. Some examples - skin - lymph nodes  - Drug resistant gram -- negative bacteria. ----------------------------------------- - These bacteria are resistant to almost every available treatment. The major concerns is the resistant to the drug carbapenems. - Carbapenems is consider the last resort when treating gram negative bacteria. - Examples *E. coli , Klebsiella* and  - **Hepatitis** -- infection of the liver - Hep A - Hep B - Hep C - **HIV** -- Human immunodeficiency virus ( AIDS) - Influenza --------- - **Childhood communicable diseases** (chicken pox, Rubella, Measles, Mumps, Whooping Cough, Polio) - These are any infectious agent found in the blood.  - Moisture - Temperature ( warm or RT) - Darkness - Nourishment  - **Direct contact** -- most common mode of infection - touching, rubbing, and body secretions - Indirect contact ================ - clothing, bedding, instruments, specimen containers, etc. ( Fomites) - **Droplet spread -** Droplets are relatively large (\>5 µm) - coughing, sneezing. A sneeze can travel at 100 MPH and spread up to 12 feet away. Bacteria from a sneeze, however, can continue to travel up to 150 feet.   - Common vehicle ============== - water, food, drugs, blood - **Air borne -** airborne particles \ - carried by moisture or dust particles in the air, which are inhaled - Vector borne ============ - intermediate hosts such as insects or animals   - **Everyone is considered infectious** - **This includes all visitors, and all healthcare employees.**  - When an outbreak of an infection occurs in a health care facility the Infection Prevention & Control Program is dedicated to preventing control department takes special precautions to prevent the infection from spreading.  - The most common acquired infection in health care facilities is urinary tract infections( UTI) - The most common bacteria that causes UTI is  1. **Infectious agent** -- any disease causing organism ( pathogen) 2. **Reservoir Host** -- places in which microorganisms can thrive and reproduce 3. **Portal of Exit** - A place of exit for microorganisms to leave the reservoir. ( through the nose, mouths, body fluid)  4. **Route of Transmission** -- direct contact, air, insects, etc. ( how the infectious agent travels to the new host) 5. **Portal of Entry** - respiratory, gastrointestinal, urinary and reproductive tracts. ( how it enters the new host) 6. **Susceptible Host** -- people with suppressed immune systems. ( a person capable of being infected)  - The infection control department of a hospital is particularly concerned in how to interrupt the infection cycle before the infection spreads in the hospital. For each component of the infection cycle, there are methods used to interrupt that part of the cycle - Two serious diseases can cause significant risk to a med lab assistant/phlebotomist: - **Hepatitis** (inflammation of the liver) - **AIDS** (Acquired immune deficiency syndrome)  - The most common form of viral hepatitis - Spread by fecal-oral routes - Clears up in a few weeks with no lasting effects - Spread through infected blood products and sexual contact - There is an effective vaccine against hep B that is made available to all health care workers  - Spread by the same routes as Hep B - No vaccine for this type exists. - Med Lab Assistants should wear gloves at all times and [must wash their hands frequently.] - The infection is contagious and spread through direct contact with - The virus can only be contracted concurrently with Hepatitis B. - Therefore , Hep B vaccination protects from Hepatis D  - Transmitted through blood and sexual contacts. - Virus known as HIV attacks the immune system. 1. Allow the injury to bleed freely 2. Clean the body site with soap and water 3. If mucous membranes are involved use eye wash station. 4. Do not squeeze the site 5. Try to identify the source 6. Report to the supervisor   - Is the most effective method of In reducing the transmission of microorganism - At the very minimum hands should be washed with soap and water or with hand sanitizer - Wearing gloves is another way to protect yourself. Wash your hands before and after you put gloves on. - Before and after taking blood from a patient - After contact with blood or other body fluids - After contact with contaminated items - After removing gloves - Between patients - Before contact with food - After personal use of toilet or wiping your nose - When hands are visibly soiled  - Turn on taps - Wet hands - Apply soap - Lather hands for 15 -- 20 seconds - Rinse hand to remove soap with fingers down - Should wash 2 inches above the wrist - Turn off taps with paper towel --discard - Dry hands with a clean paper towel - discard - Dispense 2 -- 3 ml ( dime sized) of product into palm of hand - Rub hands together covering all surfaces - Cover the palm and back of hands, fingernails, web spaces and fingers - Allow product to dry before performing another task ( 15 -- 20 seconds)  - Intact skin =========== - is your body's most important defense - **Mucous membranes** -- line the respiratory tract, digestive and reproductive tracts - produce mucous that traps foreign materials that can cause damage  - **Cilia** -- fine microscopic hairs that line the respiratory tract and propel the mucous and trapped foreign materials out of the body - **Coughing and Sneezing** -- remove foreign materials from the respiratory tract - **Hydrochloric acid** -- produced in the stomach and is a strong chemical that is harmful to most microorganisms - **White blood cells** -- specialize in fighting infections - **Tears** -- protect your eyes with a flushing action and special chemicals - **Saliva** -- is an acid that is effective in killing some microorganisms  - Genetics - Level of health - Degree of illness - Amount of stress - Psychological make up - Age -- slows and weakens in elderly  - Keep your body healthy - Good nutrition - Rest and low stress  - Practice medical asepsis - Practice surgical asepsis where there is a high risk of infection - In a sterile environment always ask: - Where do I stand? - Can I touch this?  - Isolation systems were once based on the diagnosis of a transmittable disease. - Now instead the focus has changed from infection control to prevention of patient-to- patient transmission to prevention of patient to personnel transmission. - Universal precautions is now called Standard precautions. - There are 3 types of precautions. 1. Standard precautions 2. Transmissions based precautions 3. Protective precautions  - Routine activities recommended for all individuals at all times to protect health care workers from exposure to pathogens - Not ordered specifically for a patient and not based on the presence of a known infection. - Everyone is treated as infectious. ================================== - **[Hand washing is to be done, always.]** - Standard precautions include proper hand hygiene , and proper PPE depending on type of exposure to body fluids.  1. Contact 2. Airborne 3. Droplet  - **Contact Precaution -** is a precautionary measure taken when there is a risk of an infection being transmitted via direct or indirect contact with surfaces or patient care items. - Example: *Clostridium diffilcile* - **Airborne precautious** in patients that have been or suspected to be infected with a pathogen transmitted by airborne droplet.  - **Droplet precautious** in patients that have been or suspected to be infected with a pathogen transmitted by droplet.  - Patients that are more susceptible to infections -- HIV, chemotherapy, burn and transplant patients - Protective barriers are required to protect them from being infected by health care workers and other - A sign indicating the required barriers will be posted   1. The gown is put on first and tied at the neck and waist. 2. Mask is placed over the mouth and nose. (masks with ties are tied at the top first and then at the neck) 3. Goggles and/or face shields are put on after the mask. 4. Gloves are put on last and securely pulled over the cuffs of the gown.  1. Remove gloves first ( glove to glove and skin to skin) and place in a biohazard bag. 2. Untie the gown by touching only the inside of the gown and place in a biohazard container. 3. Remove goggles and/or face shields and place in 4. Remove the mask touching only the ties or bands. (Untie the lower tie first so the mask will not fall) Dispose of the mask in a biohazard container. - **Containment level 1** -- deals only with biological hazards that are low risk, e.g. bleeding station - **Containment level 2** -- most labs fall into this category. The primary exposure hazards associated with organisms in CL2 is through ingestion, inoculation, mucous membrane  - **Containment Level 3** -- these are labs that handle agents transmitted by airborne route - Often only need a small amount to produce ill effects - Can cause serious or fatal disease - **Code red** -- fire - **Code pink** -- infant abduction - **Code orange** -- major emergency - **Code yellow** -- missing patient - **Code green** -- evacuation - **Code blue** -- cardiac arrest/ emergency - **Code white** -- violent patient  - **Code black** -- bomb threat - **Code purple** -- hostage taking - **Code brown** -- chemical spill - **Code grey** -- external air exclusion - Code silver -- armed intruder - **Code alert** -- severe/significant weather