1 Infection Control

INFECTION CONTROL

A MODULE

PURPOSE

This module is designed to provide health care professionals with education on

accepted infection control practices.

OBJECTIVES

After completing the Infection Control module, you will be able to:

· Describe how infections spread

· Explain Standard Precautions

· Name common infections transmitted by blood and other body fluids

· List types of protective work practices

· Explain and list the types of Personal Protective Equipment

· Explain the steps involved in exposure reporting and follow up

· Name other types of precautions apart from Standard Precautions

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GENERAL INFECTION CONTROL PRACTICES

Because of viruses such as HIV and the new drug-resistant super bacteria, such as
MRSA and VRE, the risk of acquiring an infection in healthcare facilities has increased
in recent years for both patients and staff. As a healthcare worker, you must recognize
that these threats underscore the fundamental truth that using proper infection control
practices is one of your most important job responsibilities.
Infection control practices are easy to ignore because they can be so elementary.
Researchers at one hospital found that only 48 percent of staff in the intensive care
units washed their hands before examining patients even though they knew they were
being watched as part of a research project.
You must take time and make the effort required to consistently adhere to infection
control procedures – because these procedures are crucial for protecting your patients
and yourself from infection.

I. HOW INFECTION SPREADS

For infection to spread, three elements are required:
 A source of infectious microorganisms (germs)
 A susceptible host
 A means of transmission for the microorganism.

A. SOURCES
Unfortunately, healthcare facilities have several sources of infectious microorganisms
including:
 People
 Contaminated objects
People, including patients, staff members and visitors, can harbor a variety of
infectious microorganisms such as bacteria, viruses, parasites, yeasts and fungi.
Although invisible, these microorganisms may be present in blood and other
body fluids and secretions such as saliva, sputum, nasal and vaginal discharge,
and wound drainage. They are also present in excrement and are often on the
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skin’s surface, especially the hands. A person doesn’t have to look or feel sick to
be a source of infection. Patients can even infect themselves when
microorganisms within their body multiply out of control.
Contaminated objects can also be sources of infection. Some objects especially
prone to contamination include floors, bedpans, trash cans, medical equipment,
invasive medical devices and dirty laundry.

B. HOST
To become a host, a person must be susceptible to the infectious organism. A
person exposed to an infectious organism will not necessarily become a host
because some people are immune to or able to resist the infection.
Unfortunately, healthcare facilities have many different kind of patients that can
become hosts. People particularly susceptible to infection include:
 Elderly patients
 Newborns
 Persons with weak or undeveloped immune systems
 Persons with cancer, multiple health problems or chronic diseases that
require steroid therapy
 Patients with surgical incisions, catheters, breathing tubes and other
medically induced pathways into the body that can allow infections to
enter.
The longer a patient is in the hospital, the greater is his or her chance of
acquiring an infection.

C. TRANSMISSION
To be transmitted, microorganisms must enter the host’s body. Entrance may be
gained through:
 Inhalation
 The mouth, eyes, nose or other opening into the body
 A break in the host’s skin caused by cuts, nicks, skin abrasions or
dermatitis
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There are five main routes of transmission:

 Contact
 Droplet
 Airborne
 Common vehicle
 Vectorborne.

1. Contact Transmission—the most common route, can be either direct or

indirect.
Direct contact transmission—occurs when microorganisms are physically
transferred from the source person’s body surface to the host’s body surface.
This can happen when a healthcare worker turns or bathes a patient, or
performs other patient care activities that required direct personal contact.
Direct contact transmission can also occur between two patients.
Indirect contact transmission—is when a source of infection contaminates an
intermediate object, which then contacts a susceptible host. This can happen
when contaminated gloves are not changed between patients or when a
healthcare worker is stuck with a contaminated needle.
2. Droplet Transmission
Occurs when a source person produces tiny droplets containing infectious
microorganisms. The droplets may be generated when the source person
coughs, sneezes or talks, or during the performance of certain procedures
such as bronchoscopy. The infectious droplets are propelled a short distance
through the air and land in the host’s eyes, nose or mouth. Droplets do not
remain suspended in the air.
3. Airborne Transmission—can occur over greater distances than droplet
transmission. The infectious microorganisms are carried by microscopic
droplet nuclei or even dust particles that remain suspended in the air for long
periods of time. The microorganisms can then be inhaled by a susceptible
host in the same room, or they may be carried by air currents and infect
people further away.
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4. Common Vehicle Transmission —occurs when microorganisms are

transmitted by contaminated items such as food, water, medications and
equipment.
5. Vectorborne Transmission—occurs when mosquitoes, flies, rats and other
vermin transmit microorganisms.
Common vehicle transmission and vectorborne transmission are both rare in
U.S. healthcare facilities.

II. METHODS OF INFECTION CONTROL

According to the Centers for Disease Control, effective infection control
programs have two levels: Standard Precautions and Transmission-Based
Precautions.

A. STANDARD PRECAUTIONS
The Occupational Safety and Health Administration (OSHA) requires that
employers protect employees with exposure to blood and body fluids from
potential infection by organisms such as HIV, Hepatitis B (HBV), Hepatitis C
(HCV) and syphilis, among others. University Hospital has an Exposure
Control Plan which outlines the methods that are in place to minimize
employee risk. These methods include the use of standard precautions,
exposure reporting and follow up and offering of the Hepatitis B vaccine. The
Exposure Control Plan is located in the Infection Control Policy and
Procedure Manual.
Since there is no quick, surefire method of determining which patients may be
carrying an infectious disease, Standard Precautions require that you treat all
patients as though they may be infected. Standard Precautions combine the
major features of:
 Universal Precautions—which reduce the risk of transmitting
bloodborne pathogens.
 Body Substance Isolation—which reduces the risk of transmitting
pathogens from moist body substances.
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In other words, you must use Standard Precautions every time you anticipate
contact with blood, all body fluids, secretions and excretions, nonintact skin
and mucous membranes. Standard Precautions cover all healthcare workers
whether they give direct patient care or work in support areas, like
maintenance and housekeeping.
Standard Precautions outline a system of safeguards to help you protect
yourself from infections such as hepatitis B, hepatitis C and HIV, while also
protecting your patients from infectious organisms that are often transmitted
from patient to patient by healthcare workers. University Hospital has
developed policies using Standard Precautions, including:
 Protective work practices
 Use of personal protective equipment
 Protective Housekeeping
 Protection through the hepatitis B vaccination
 Exposure reporting.

B. PROTECTIVE WORK PRACTICES

You can decrease the spread of infection by using common sense and by
practicing good hygiene.

1. Wash Your Hands

Handwashing is the single most important precaution for preventing the
spread of infection. The sooner you wash infectious material off you hands,
the less likely your chance of infection. Handwashing keeps you from
transferring contamination from your hands to other areas of your body or
other surfaces you may contact later. Hands should be washed for 10-15
seconds.
Always wash your hands:
 After touching blood, all body fluids, secretions and excretions, non-intact
skin, mucous membranes and contaminated items – whether or not gloves
are worn
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 Immediately after gloves are removed and between patient contacts

 Before eating, drinking, smoking, applying makeup, handling contact
lenses or using the restroom
 After you eat, smoke, cough, sneeze or use the toilet.
Use hand lotion after washing hands to prevent drying and chapping.
However, in some situations, lotions may promoted the growth of harmful
microorganisms. Petroleum-based lubricants may deteriorate latex gloves
and some tubing. Be sure to wash your hands thoroughly before you apply
lotion. Never top-off lotion or soap containers because this can promote the
growth of harmful bacteria. Clean containers before refilling or use
disposables.

2. Practice Good Hygiene

 Minimize splashing, spraying or spattering when performing
procedures involving blood or other potentially infectious materials
 Do not eat, drink, smoke, apply cosmetics or lip balms, or handle
contact lenses where there is a reasonable chance you might be
exposed to blood or body fluids
 Do not keep food and drink in places where blood or other potentially
infectious materials are present.
3. Handle Sharps With Care
Be careful to prevent injuries from needles and other sharp instruments when
using them, cleaning them or disposing of them.
 Never bend, recap or break needles after use
 Dispose of contaminated sharps in appropriate puncture-resistant
containers immediately after use.
 Always activate safety mechanism on sharp devices after use and
before discarding.
4. Personal Protective Equipment
When worn properly, personal protective equipment (PPE) protects you from
infectious hazards. PPE includes gloves, fluid-resistant gowns or aprons,
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faceshields, protective eyewear and masks, resuscitation bags or other

ventilation devices.
PPE must be appropriate for the task you are doing. You should wear as
much or as little PPE needed to keep blood or other potentially infectious
materials from getting on your clothing, skin or mucous membranes.
For example: If you anticipate skin exposure only to your hands, you only
need to wear gloves.
Types of PPE:
a. Gloves
Gloves are the most common type of PPE: You should use disposable
gloves for medical procedures and heavy duty utility gloves for some
housekeeping activities.
 Before putting on gloves, wash your hands thoroughly. Cover any
hand cuts with bandages in case a glove leaks or tears.
 Use disposable gloves only once on a single patient—and then
discard.
 Remove disposable gloves as soon as possible if they are
contaminated, torn, punctured or damaged in any way, and then
discard. Never wash or decontaminate them for reuse.
 Utility gloves may be cleaned or decontaminated for reuse only if
they are not damaged. It damaged in any way—throw them out.
 Be careful when removing contaminated gloves, to not touch the
outside of the glove. Always wash your hands after removing
gloves. No glove offers 100 percent effective protection.
If you have dermatitis that is caused or aggravated by wearing gloves, or if
you are allergic to disposable gloves, you should wear cotton glove liners,
powderless gloves or hypoallergenic gloves – consult your manager or
supervisor.
b. Face Protection
Fluid resistant masks and eye protection (splash guards or goggles)
are to be worn if splashing to the face, mouth or nose is likely.
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N95 Respirators are required for protection against tuberculosis

c. Fluid-Resistant Gowns
 Are to be worn if splashing or soiling of clothing is likely
 Remove clothing as soon as possible if soiled with blood or body
fluids
d. Protection During Resuscitation
Since a patient may expel saliva, blood or other fluids which could contain
infectious materials, avoid unprotected mouth-to-mouth resuscitation.
Instead, use mechanical emergency respiratory devices and pocket
masks designed to isolate you from contact with potentially infectious
substances.
5. General Rules For PPE Use
 Always inspect your protective equipment before, during and after use
 Clean and maintain PPE properly
 Repair or discard any equipment that is flawed or damaged
 Replace PPE as soon as possible if it becomes penetrated by blood or
other potentially infectious materials
 Always remove PPE before leaving the work area and place it in a
designated receptacle for disposal, laundering or processing
 Remove PPE carefully to avoid contamination of clothing and skin.
 Remove PPE in the proper order i.e. gloves before other PPE. Wash
hands after PPE removed.
Hospitals also provides equipment necessary to eliminate infectious
hazards at their source, such as autoclaves, sharps disposal containers
and needles with safety mechanisms attached.

C. PROTECTIVE HOUSEKEEPING
Good housekeeping protects everyone and is everyone’s responsibility. Carefully
follow University Hospital’s policies and procedures regarding housekeeping.
Follow these general rules:
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 Handle used patient care equipment soiled with blood or other potentially
infectious materials with care. Do not let the equipment touch your skin,
mucous membrane, clothing, other patients or items in the environment.
 Clean reusable equipment appropriately before using it for the care of
another patient. Single-use items must be discarded.
 Do not let sharps container overfill
 To prevent contamination, handle soiled linen as little as possible and with
minimum agitation. Without sorting or rinsing, place soiled linen in
leakproof bags in the area where it was used. Do not place linen on the
floor, furniture, windowsill, etc.
 Keep clean linen carts covered when not in use.
 Transport specimens in closed containers. Wear gloves and handle the
containers carefully.
 Shake down waste containers and carry waste bags by the top, away from
your body.
 Promptly contact Environmental Services to clean major blood and body
fluid spills.

D. REGULATED MEDICAL WASTE

All items contaminated with blood or body fluids are characterized as regulated
medical waste and are to be disposed of in red bags.
Waste from patients on isolation must also be deposited into red bags.
Note: Items that are not contaminated with blood or body fluids are to be disposed of in
clear bags.
Contamination of body or clothing with blood and body fluid is likely. In the event that
clothing should become contaminated, it should be removed promptly. REMEMBER:
Hepatitis B virus can become active again even after existing dry on surfaces for
between seven to thirty days.Sharp objects are to be disposed of into sharp containers.
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COMMON BLOODBORNE PATHOGENS

1. HUMAN IMMUNODEFICIENCY VIRUS (HIV) the virus that causes AIDS is

transmitted by:
 Sexual contact with an infected partner
 Sharing needles with an infected person
 Perinatally from mother to baby
 Occupationally through mucous membrane (eye, nose, mouth) splashes,
cuts, needlestick and contamination of nonintact skin (burns, acne lesions,
wounds, etc).
2. HEPATITIS B (HBV) is transmitted by:
 Sexual contact with an infected partner
 Sharing needles with an infected person
 Perinatally from mother to baby
 Occupationally through mucous membrane (eyes, nose, mouth) splashes, cuts,
needlestick and contamination of nonintact skin (burns, acne lesions, wounds,
etc).
3. HEPATITIS C (HCV) is transmitted via:
 Sexual contact with a infected partner
 Nonsexual household contact
 Needle sharing
 Blood transfusion (now very rare)
 Perinatally
 Occupational exposure as described above

OTHER TYPES OF PRECAUTIONS

To prevent the spread of certain highly infectious or drug-resistant organisms, a
second level of precautions, Transmission-Based Precautions, must be used in
addition to Standard Precautions. Categories of Transmission-Based Precautions
include:
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 Airborne ( TB, measles, chickenpox, rubella etc.)

 Droplet (RSV, Meningitis etc.)
 Contact (MRSA, VRE, C.difficile, Rotavirus, Hepatitis A etc.)
Sometimes several of these special categories are combined or one category is
individualized to meet the needs of the particular patient.
Depending upon the particular category, Transmission-Based Precautions may
involve some of the following special infection control measures:
 Placing the patient in a private room or cohorting patients by grouping those
who are actively infected with the same microorganisms
 Keeping the patient’s room door closed
 Wearing masks when entering the patient’s room
 Moving the patient from the room only for essential purposes
 Having the patient wear a mask outside the room
 Wearing gloves when entering the patient’s room
 Placing patients with infectious TB in rooms with proper ventilation, such as
negative air-pressure rooms, and requiring anyone enter these rooms to wear
appropriate respiratory protection.