Chapter 9

Infection Prevention and Control

1. Instead of calling it infection contro, what is called now?
Infection prevention and control.
MICROBIOLOGY INFECTIONS
What are microorganisms?
Organisms that are too small to be seen without the aid of a microscope
What are the 4 categories of microorganisms?
1.
2.
3.
4.

Bacteria
Viruses
Fungi
Protozoa

Which microorganisms are related to bacteria?

1. Rickettsiae
2. Chlamydiae
3. Mycoplasmas
Bacteria
What are some different types of bacteria?
Cocci = speherical
Bacilli = rod shaped
Spirochetes = corkscrew
Vibrios = comma shaped (s shape when 2 of these come together)

How does bacteria reproduce and how long does it take?

By cell division and it takes about 20 minutes

Some bacteria cells have the ability to turn into what highly resistant form?

Endospore
In what state are bacteria in when they are in the endospore form?
Resting, inactive state

What are bacteria cells resistant to when they are in the endospore state?
Chemical and physical disruption of their environment
What are some bacteria capable of producing that is toxic to mammals?
Endotoxins (cause fever)
Viruses
What is perhaps the simplest form of life?
Viruses
Can viruses live outside a host cell?
No
What do viruses need from their host cells?
Organelles and metabolic functions

What happens when the reproduction phase of the virus is complete in the host
cell?
Viral particles are released from the host cell, often bursting the cell (killing the
cell).
How does a virus initially bind to a host cell?
It binds to a specific, compatible, receptor site.
Why does cold sore (herpes simplex) occur only in the lips, face and genital mucosa
and not the bones mucosa?
Because the bones mucosa do not have a specific , compatible, receptor site to
herpes simplex.
What are 2 major medical concerns when it comes to viruses?

1. There are not too many pharmaceutical drugs available to treat diseases
caused by viruses
2. Viruses mutate

What does themedical field depend on to fight viral infections?

The patients own immune system
Protozoa
What are protozoa?
Unicellular and colonial organisms with characteristics similar to animal life.
Do all classes of protozoa have a species that causes harm to humans?
Yes
How are diseseases caused by protozoa transmitted?
1. Through contact with contaminated feces via direct contact or via mechanical
transmission (e.g. flies).
2. Insect bites (e.g. malaria from mosquitoes)
3. Person to person (trichomoniasis, which is a protozoan that causes STD)
How are protozoa classified?
According to their motility (amoeba-like, flagellate, ciliar, or non-motile)
Are some protozoan able to form their own environment?
Yes
What is this environment called?
Cyst
Why do protozoans form their own environment (cysts)?
To become resistant to chemical and physical changes and survive outside the host
organism.

Fingi
What us another name for fungi?
Eumycetes

What are some examples of fungi?

Lichen, mushrooms, toadstools, puffballs, molds, and yeasts.

Are all fungi pathogenic?

No
Are the nonpathogenic fungi still dangerous and if so, why?
Yes, because they can cause allergic reactions.
What are fungal diseases called?
Mycoses
What is an antifungal agent drug?
Mycostatin (nystatin)
Where do fungi live?
Dead or decaying matter; moist, room temperature and oxygen rich environment.
Where do fungi thrive best?
Warm, moist, slightly acidic and sugary environments.
How do fungi reproduce?
Through spore formation (more like seed production)
Do fungi have some benefits for humans?
Yes because they can be used in the production of antibiotics, cheese, bread, etc.
What are the microorganisms capable of causing disease called?
Pathogens
Which bacterial pathogen is found on the skin?
Staphylococci
What are some of the places bacteria live in the human body?
Skin, saliva, mucous, and feces.
Is the presence of bacteria the only component for causing disease?

No, there are other components in the chain leading to disease.

FUNDAMENTALS OF INFECTION
Besides the presence of a pathogen, what else is necessary in order for the
pathogen to cause disease?
1.
2.
3.
4.
5.
6.

Pathogenic organism in sufficient quantity and virulence

Reservoirs for the pathogen to thrive
Portal of exit (out of the host)
Mode of transport
Portal of entry (into the host)
Susceptible host

Quantity and Virulence

Can a benign microbe become pathogenic?
Yes, given the right circumstances such as in large numbers and in a susceptible
host.
How can the links to infection be broken to prevent disease?
Yes, by breaking one or more of the links stated before. For example, hand-washing,
sterilization, disinfection and using antiseptic techniques can break the mode of
transport link.
Reservoir
When are patients most infectious?
During the time they are asymptomatic
Who are seen as patients?
Individuals who have developed infections or disease from microbes and manifest
clinical symptoms.
Can reservoirs be other than a person?
Yes
What are other types of reservoir?
Water, food, human and animal waste, insect toxins
What can healthcare workers do to break this link?

Housekeeping procedures.
Portal of Exit
What are the most common exit portals?
Body fluids
Mode of Transport
What are the 4 main routes of transmission for infection?
1.
2.
3.
4.

Direct contact (e.g. STD and touching a patient with scabies)

Fomite (indirect contact)
Vector (indirect contact)
Airborne (indirect contact)

What is a fomite?
An object that has been in contact with a pathogenic organism.
What is the worst fomite?
The pillow case not changed after each patient.
What is a vector?
It is an animal or insect that transmits an infectious microorganism to a new host.
What are some common examples of vectors?
1. Malaria (through mosquitoes)
2. Lyme disease (through ticks)
3. West Nile disease (through birds)
How are airborne diseases transmitted?
Through water droplets or dust
Portal of Entry
What are some portals of entry?
Open wounds
What are some body systems susceptible to the entry of pathogens?
Respiratory, gastrointestinal, and reproductive tracts (any mucous membrane).
Susceptible Host
Which hosts are susceptible to pathogens?

Those with reduced resistance or those exposed to a large quantity of pathogens.

What is one of the most life threatening pathogens susceptible hosts may encounter
and acquire in a hospital?
Staphylococcus aureus (a.k.a staph) because they have become resistant to
chemical agents
What are hospital-acquired infections called?
Nosocmial infections
What is the percentage of health care workers that die from hepatitis
B virus infection acquired in the hospital?
2%
Which organization has published regulations requiring health care employers to
provide HBV immunizations to employees?
OSHA
Which strain of hepatitis piggybacks HBV?
HDV
What are some viral diseases that are of concern to health care workers?
HBV, HIV and TB
What has been created to prevent HBV. HIV and TB?
Universal precautions
Which viral disease is surfacing again with increased virulence?
TB
Where can we find information of the prevention and control of HBV, HIV, and TB?
Centers for Disease Control and Prevention (CDC)website.
Viral Hepatitis
How many tyes of viruses are there?
There are 5 types of hepatitis viruses (plus a few unknown strain).
How are these 5 types of hepatits viruses related or categorized?

By their source and route of transmission

What is the primary source of Hepatitis A and E?
Feces (oral-fecal route is the primary route of transmission).
What is Hep A and Hep E course of infection?
Acute
What is used for pre-exposure and post-exposure of Hep A and Hep E?
Immune globulin
What else can be given for Hep A pre-exposure?
Vaccine
What is Hep B, Hep C, and Hep D course of infection?
Chronic

What is Hep B, Hep C, and Hep D primary route of transmission?

Percutaneous and mucosal exposure.
What can be gien to prevent Hep B?
Heb B vaccine
What can be given to someone who had Heb B?
Hep B immune globulin (HBIG) and Hep B vaccine
Can HDV be prevented with HBV vacdine?
Yes
Are there any preventive treatments for HCV and HEV?
No

Human Immunodeficiency Virus

When was the first known case of HIV?
1959

When did the medical community become aware of it?

Late 1970s or early 1980s.
The virus in HIV, which reduces the hosts resistance to infection, destroys what?
T lymphocytes (infection fighting cells).
How is the term AIDS used now?
When HIV persons have developed illnesses from opportunistic microorganisms.
What was HIV called before in 1982?
HTLV.
How is HIV primarily transmitted?
Through infected blood, blood products, and reproductive fluids.
Tuberculosis
What are the statistics on TB?
8 million new cases worldwide with 3 million deaths; 20% increase in U.S. between
1985 and 1992; 10-15 millions in the U.S. have TB.
Has TB increased as HV has increased?
Yes
What is the greatest threat regarding TB?
The increase in multidrug-resistant outbreaks in hospitals and prisons.
H ow is TB spread?
Via airborne particles known as droplet nuclei.
INFECTION PREVENTION AND CONTROL
What parts of the infection cycle can be used to stop transmission?
From the reservoir to the susceptible host (these are the most predominant factor
that can be controlled)
Universal Precautions
Which CDC publication in 1983 directly addresses the issue of body fluids and bloodborne pathogens?

Guidelines for Isolation Precautions in Hospitals

What is the name of the revised publication in 1987?
Recommendations for Prevention of HIV Transmission in Health-Care Settings
(stating that precautions should be universal and should be used whether a patient
has HIV or not).
What does universal mean?
It refers to universal treatment of blood and certain body fluids, requiring them to
be treated the same, regardless of patients apparent infectious state.
Do Universal Precautions apply to droplet, airborne, and contact diseases? It may
or it may not.
Why was the 1987 CDC document revised in 1988?
To clarify which body fluid should be treated as potentially infectious; to address
HBV immunization among health care workers, to address protective barriers; to
address sharps and waste management.
What do Universal Procedures apply to?
Blood, body fluids that contain visible blood, as well as semen and vaginal
secretions, and tissue fluids such as cerebrospinal, synovial, pleural, peritoneal,
pericardial, and amniotic.
What is not included in the Universal Precautions?
Saliva, vomitus. Feces. Nasal secretions, sputum, tears, sweat, and urine.
For what 2 diseases were the Universal Precautions created?
HIV and HBV
What is the key to effective Universal Protection?
Consistent approach to all contact, to all body fluids, to all patients at all time.
Box 9.1 Universal Precautions
Gloves should be worn when in contact with blood, body fluids with visible blood,
mucous membranes and non-intact skin.
Gloves should be worn when touching surfaces with blood or body fluids.
Gloves should be worn when performing venipuncture.
Gloves should be changed after contacting each patient.

Masks should be used when performing procedures that can generate droplets of
blood and other bodily fluids to prevent exposure to mucous membranes such as
eyes, nose, and mouth.
Gowns should be used when performing procedures that can generate splash of
blood and other body fluids.
Hand should be thoroughly washed after contamination of blood or together body
fluid.
Needles should not be recapped or removed from syringes.
Needles should be disposed in a puncture-resistant container in the immediate area.
Mouth pieces, Ambu bags and ventilation equipment should be used.
Healthcare workers with oozing or open wounds should refrain from contacting
patients and patient care equipment or items.
MEDICAL ASEPSIS
What is the front line of medical asepsis?
Barrier techniques

Sterilization and Disinfection

What are the standard Sterilization and Disinfection good for?
Sterilize or disinfect instruments, devices or other blood-contaminated instruments
from blood borne pathogens such as HIV.
What are high-level disinfection?
A procedure that kills vegetative organisms and viruses, but not necessarily large
numbers of bacterial spores.
What chemicals germicides registered by the EPA may be used for sterilization or for
high level disinfection?
Sterilants
Hand-washing and Gloving
What is a critical step in infection control and the first step og gloving?
Hand-washing

When should you wash your hands?

After sneezing, coughing, blowing nose, touching charts, pencils, patients,
equipment, contaminated barriers (e.g. gown), etc.
For how long should you be washing hands with soap?
20-30 seconds (in a circular motion)
When should gloves be worn?
When touching bllod, body fluids (requiring universal precaution), handling items
soiled with blood or body fluids (requiring universal precaution), non-intact skin, and
mucous membranes.

Masks, Protective Eyewear, and Gowns

When should masks, eyewear and gowns be worn?
Arteriogram, cardiac catherization, severe trauma, and orthopedic surgical
procedures
Good Housekeeping
What are some of the technologists primary duties?
Clean table, couch, or cart between examinations.
What is similar to chemical germicides and are effective in inactivation HIV?
Embalming fluids
What should be followed when sterilizing and disinfection medical equipment or
instruments and the type of chemical germicides for a particular medical device?
Manufacturers instructions.
What is more diluted, 500ppm (1:100) or 5,000ppm (1:10)?
500ppm (1:100)
What are some general principles to follow?
1.
2.
3.
4.

Clean from least contaminated to most contaminated area

Use most effective, but surface-appropriate disinfectant.
Use bleach (sodium hypochlorite) in metal (not cloth, vinyl, cassette, or film).
Use barriers where disinfectant chemicals are inappropriate.

Handling Linens and Uniforms

To protect all who must handle contaminated linens, what must be done?
Contaminated material must be paced in a clearly labeled bag or box and taped or
tied shut.
What kind of bags do most hospitals provide?
Bags labeled Biohazard
What should be done if an object is dropped on the floor in the hospital or clinic?
Dispose of if disposable or resterilized if non-disposable.

Contaminated Waste Disposal

Which organizations regulate policies regarding waste disposal?
OSHA and EPA
What must be done to objects contaminated with blood and/or body fluids?
Discarded in proper container with the Biohazard symbol.
What should be done with bandages and dressings?
Be placed in waterproof bags, sealed before discarding.
Handling Sharps
What is the primary mode of occupational transmission of HIV and HBV?
Needles, scalpels, and other sharps.
What is the primary mode of occupational transmission of HIV?
Needlesticks and sharps
Bloodborne Virus Transmission to Health Care Personnel
How many pathogens are associated with needle and other sharp devices injuries
used in health care and laboratory settings?
20
What are the most commonly transmitted pathogens transmitted during patient
care?
HBV. HCV, and HIV

Which infections are transmitted by Sharps during patient care?

HIV, HBV, HCV, Herpes, TB, and Malaria
What must be done if a healthcare worker has a parenteral or mucous-membrane
exposure to blood or other body fluids or prolonged cutaneous contact with blood?
Source patient should be informed of the incident and tested for serologic evidence
of HIV infection after consent is obtained.
When should the health care worker be counseled and tested serologically for HIV?
When source patient has AIDS, tested positive for HIV, or source patient has denied
testing.
Should the source patient denied any testing, what should the health worker do?
Get tested for serological evidence of HIV and report any febrile illness, rash, or
lymphadenopathy within 12 weeks of exposure.
If healthcare worker tests negative, what should he/she do next?
Get retested 6 weeks later, then periodically thereafter (e.g. 12 weeks later and 6
months later.
When are people expected to seroconvert after HIV exposure?
6-12 weeks after exposure.
What should HIV workers follow to prevent HIV transmission?
Public Health Services (PHS) recommendations.
If the source patient tests negative for HIV, should the health care worker follow-up?
No, unless source patient is at risk for HIV infection. In such case, health care worker
should get tested 12 weeks after exposure.
Should the same procedures be followed for long blood or body fluid skin exposure
or mucous membrane exposure to blood or other body fluid?
Yes
EMPLYER RESPONSABILITIES
Implementation of Recommended Precautions
What should employers of helath-care workers insure?
1. Initial orientation and continuing education

2. Provision of equipment and supplies necessary to minimize HIV infection and

other blood-borne pathogens.
3. Monitoring adherence to recommended protective measures.
Conclusion
What does the 1996 CDC standard precautions synthesize?
Body Substance Isolation (BSI) and universal precautions to prevent transmission
of a variety of organisms.