Cross Infection

Cross Infection
Infection Control
11/17/08

Introduction of a pathogen from one

person to another in a clinical environment
Patient to staff
Patient to patient

Human to human
Animal sources
Inanimate sources

Cross Infection
Source
Person with the infection
Index case
Vehicle or mode
Physical carrier of pathogen
Bodily fluids, fomites
Route
Portal of entry
Inhalation, ingestion, inoculation

Source
Patients with overt symptoms
Easy to spot

Patients in the prodromal stage

Contagious but hard to define

Healthy carriers
Asymptomatic
Convalescent

When and where

Secretion/deposition
Distribution of fluids/tissue during
procedures in operatory

Generation of contaminated droplets by highspeed instruments

Contamination of equipment/fomites
Probes, scalpels, needles, gauze, etc.

Infection control
Aims at controlling exposure to vehicles
and restricting routes of transmission
Standard precautions
All bodily fluids (except sweat), nonintact skin and mucous membranes are
treated as infectious
Routes of transmission of vehicles are
contained (asepsis)

How
Inhalation

CMV, measles, mumps, rubella, influenza, cold

viruses, Strep. pyogenes, Mycobacterium

Inoculation

HIV, HBV, HCV, Neisseria

Ingestion

Oral/faecal bacteria, HAV

Getting things clean

Sterilization
A process that kills or removes all
organisms
Disinfection
A process that kills or removes all
pathogens EXCEPT BACTERIAL SPORES
Antisepsis
Application of chemicals to live tissue to
kill or inhibit pathogens

Sterilization
Moist heat
Autoclave
Dry heat
Oven
Chemicals
Ethylene oxide, bleach, etc.
Radiation
UV, gamma rays

Your friend the autoclave

High pressure steam allows you to heat material to
over 100C
Typical operating conditions are 121C for 15
minutes
FOLLOW THE MANUAL
Excellent penetration
Kills viruses, bacteria and their spores
Prions?

Sterilization
Limiting factor is often penetration
Limit the size/load
Get the crap off first
Presterilization cleaning
Scrubbing, ultrasonics
Packaging
Material must be packaged such that it does
not become contaminated before reaching
patient
Bags, trays, etc.

Dry heat sterilization

Hot air oven
160 C for 2 hours
Great for metal hardware
Bad for many plastics
Most plastics are disposable

Chemical sterilization
Ethylene oxide
Works at lower temperatures
Good for plastics, fabrics,
electronics

50% of commercial materials are EO

sterilized

Flammable, toxic

Radiation sterilization
UV light
Low penetration
Surgical suites
Gamma radiation (X-ray)
Excellent penetration
Very specialized equipment

Is it working?
Monitoring is crucial for successful infection
control
Biological indicators (BIs)
Spores of indicator bacteria (ex. Bacillus
subtilis)
Test strip is treated and set for analysis of
viability (efficacy of procedure)
Chemical indicators (CIs)
Test strips for autoclaves/oven
Colour change indicates effective treatment

Disinfection

Antiseptic

Bleach

Ethanol

Hydrogen peroxide
Ozone

Chlorhexadine

Sodium hypochlorite

70% is better than 90%