Chapter 03

Objectives
1. Define the key terms and abbreviations listed at the

beginning of this chapter.
2. Identify the components of the chain of infection and
Chapter 3: Infection Control, give examples of each, describe infection-control
Safety, First Aid, and Personal procedures used to break the chain, and identify four
functions of infection-control programs.
Wellness
3. Describe proper procedures for hand hygiene, putting
on and removing protective clothing, and entering the
nursery or neonatal ICU.
4. Describe standard and transmission-based precautions
and identify the organizations that developed them.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objectives (cont’d) Objectives (cont’d)

5. State safety rules to follow when working in the 8. Describe hazards, identify warning symbols, list actions
laboratory and in patient areas. to take if incidents occur, and specify rules to follow for
proper biological, electrical, fire, radiation, and chemical
6. List examples of blood-borne pathogens and describe safety.
their means of transmission in a healthcare setting.
9. Identify symptoms of shock, state first aid procedures
7. Discuss the major points of the blood-borne pathogens for treating external hemorrhage and shock, identify the
(BBP) standard, including changes required by the main points of the international CPR and ECC guidelines,
Needlestick Safety and Prevention Act, and identify key and identify the links in the American Heart Association
elements of a BBP exposure control plan. chain of survival.
10.Describe the role of personal hygiene, proper nutrition,
rest, exercise, back protection, and stress management
in personal wellness.
1
Infection Control Infection Control (cont’d)
• Infection: Definition • Types of Infection
– When a microorganism invades body, multiplies, & causes injury – Communicable
or disease
• Able to be spread from person to person
– Microbes include:
• CDC investigates & controls communicable diseases &
• Bacteria epidemics
• Fungi – Nosocomial & healthcare-associated infections (HAIs)
• Protozoa • Infections acquired in hospitals & other healthcare settings
• Viruses • 1.7 million HAIs & 99,000 associated deaths occur each year
– Pathogen: a microbe capable of causing disease • Caused by infected personnel, patients, visitors, food, drugs,
or equipment
Infection Control (cont’d) Infection Control (cont’d)

• Chain of Infection • Chain of Infection
1. Infectious (causative) agent 4. Means of transmission
– Pathogenic microbe responsible for causing an infection – Airborne
2. Reservoir – Contact
– Source of infectious agent – Direct (touching, kissing)
– Place where microbe can survive & grow or multiply – Indirect (contaminated objects)
– Includes: humans, animals, food, water, soil, equipment – Droplet (coughing, sneezing)
3. Exit pathway – Vector (insect, arthropod, animal)
– A way an infectious agent is able to leave a reservoir host – Vehicle (food, water, drugs)
– Secretions & exudates, tissue specimens, blood, feces, urine
2
• Chain of Infection • Breaking the Chain of Infection
5. Entry pathway – Hand Washing!!!!!!!
– Way an infectious agent enters a susceptible host – Nutrition, rest, stress reduction
– Includes: body orifices, mucous membranes, & breaks in – Immunization
skin
– Insect & rodent control
6. Susceptible host
– Isolation procedures
– Someone with a decreased ability to resist infection
– Decontamination of surfaces & instruments
– Factors: age, health, immune status
– Disposal of sharps & infectious waste
– Use of gloves, gowns, masks, & respirators
– Needle safety devices

• Infection-Control Program • Infection-Control Methods
– To protect patients, employees, visitors, & others – Hand hygiene
– To break chain of infection • Use of alcohol-based antiseptic hand cleaners
– Monitors & collects data on all infections occurring in institution • Hand washing
– Institutes special precautions in event of outbreaks – Personal protective equipment
– Components • Gloves
• Employee screening & immunization • Gowns
• Evaluation & treatment • Lab coats
• Surveillance • Masks, face shields, & goggles
• Respirators
3
• Glove removal • Respirator

• Order for donning PPE • Order for removing PPE • Isolation Procedures: Overview
1. Gown 1. Gloves – Keep patients with communicable infections separate from others
2. Mask (make sure it covers 2. Gown – Prevent spread of infection
nose & mouth)
3. Mask (touch only strings) – Protect patients with compromised immune system
3. Gloves
Wash hands after – Isolation requires doctor’s order
removing PPE – Infected patient is confined to private room
4
• Isolation Procedures • Guideline for Isolation Procedures
– Protective/reverse isolation – Standard precautions
• For patients highly susceptible to infections • Used for all patients
– Traditional isolation systems • #1 strategy for control of nosocomial infection
• Category-specific system • Covers blood, all body fluids, skin breaks, mucous membranes
• Disease-specific system – Transmission-based precautions
– Universal precautions (UP) • Used for patients known/suspected to have certain infections
• Blood & body fluids of all people are potentially infectious • Three types: 1. airborne, 2. droplet, 3. contact
– Body substance isolation
• Goes beyond UP: gloves for contacting moist body substances
Biosafety Biosafety (cont’d)

• Biohazard • Biohazard Exposure Routes
– Any material or substance – Airborne
harmful to health
– Ingestion
– Should be identified by a
biohazard symbol – Nonintact skin
– Percutaneous (through the skin)
– Permucosal (through mucous membranes)
5
Biosafety (cont’d) Biosafety (cont’d)
• Blood-Borne Pathogen • Blood-Borne Pathogen
– Hepatitis B virus (HBV) & hepatitis D virus – Hepatitis C virus (HCV)
• Best defense: HBV vaccination • HCV exposure hazards
• HBV exposure hazards • Present in blood & serum; sometimes saliva
• Present in blood & other body fluids • Infection primarily occurs after large or multiple exposures
• Can survive up to a week on objects • Transmitted via needlesticks, sexual contact
• Transmitted via needlesticks, sexual contact • Symptoms: flu-like, fatigue, loss of appetite, mild fever,
muscle/joint/abdominal pain, nausea, vomiting
• Symptoms: flu-like, fatigue, loss of appetite, mild fever,
muscle/joint/abdominal pain, nausea, vomiting

• OSHA Standard for Blood-Borne Pathogens (BBPs) • Exposure Control Plan
– Enforced by federal law – Must be written
– Intended to reduce/eliminate occupational exposure to BBPs – Must be reviewed & updated at least annually
– Requires: – Nonmanagerial employees with risk of exposure must be
involved in:
• Use of engineering & work practice controls to prevent
exposure incidents • Identification
• Availability & use of PPE • Review
• Special training • Selection
• Medical surveillance
• Availability of vaccination against HBV for all at-risk personnel
6
• BBP Exposure Routes • Exposure Incident Procedure
– Skin is pierced by a contaminated needle or sharp object – Needlestick or other sharps injury:
– Blood or other body fluid splashes in eyes, nose, or mouth • Carefully remove shards of glass or other objects
– Blood or other body fluid contacts cut, scratch, or abrasion • Wash site with soap & water at least 30 seconds
– A human bite breaks the skin – Mucous membrane exposure:
• Flush site w. water or sterile saline at least 10 min
• Use eyewash station if available to flush a splash to eyes
• Remove contact lenses as soon as possible & disinfect them
– Report incident to immediate supervisor
– Report directly to provider for evaluation, treatment, counseling
Biosafety (cont’d) Electrical Safety

• Surface Decontamination (required by OSHA) • Actions to Take if Electrical Shock Occurs
– All surfaces in specimen collection & processing areas – Shut off source of electricity
– 1:10 bleach solution or other disinfectant approved by EPA – Or, use nonconducting item to remove source of electricity from
victim
• Cleanup of Body Fluid Spills
– Call for medical assistance
– EPA-approved chemical solutions & kits
– Start cardiopulmonary resuscitation if indicated
– Gloves must be worn
– Keep the victim warm
– Absorb material without spreading it over wider area
• Biohazard Waste Disposal

– All nonreusable items contaminated w. blood/body fluids go in
biohazard waste containers
7
Fire Safety Fire Safety (cont’d)
• All employees should know: • Components Needed for Fire to Occur
– Procedures to follow in case of fire – Fuel: combustible material
– Location of fire extinguishers & how to use them – Heat: raises temperature of material until ignition
– Location of fire blankets or heavy towels & how to use them – Oxygen: to maintain combustion
– Location of emergency exits & evacuation routes – Chemical reaction: produces fire
• Keep components apart to prevent fire
Fire Safety (cont’d) Fire Safety (cont’d)

• Fire tetrahedron • Classes of Fire
– Class A
• Ordinary combustible materials (wood, paper)
• Require water/water-based solutions to extinguish
– Class B
• Flammable liquids & vapors (paint, oil, grease, gasoline)
• Require blocking oxygen or smothering to extinguish
– Class C
• Electrical equipment
• Require nonconducting agents to extinguish
8
Fire Safety (cont’d) Radiation Safety
• Classes of Fire • Principles of Radiation • Radiation hazard symbol
– Class D
Exposure
• Combustible or reactive metals (sodium, potassium, – Distance
magnesium, lithium) – Shielding
• Require dry powder agents or sand to extinguish – Time
– Class K
• Radiation Present in:
• High-temperature cooking oils, grease, or fats
– Patients injected w.
• Require agents that prevent splashing & cool & smother fire radioactive dyes
– Specimens from radiology
or nuclear medicine
– Radioimmunoassay area
Chemical Safety Chemical Safety (cont’d)

• General Rules – Never • OSHA Hazard Communication (HazCom) Standard
– Always • Store chemicals above – HazCom labeling requirements
eye level
• Wear PPE • Statement of warning (“danger” or “poison”)
• Add water to acid
• Clean up chemical spills • Statement of hazard (toxic, flammable, combustible)
properly • Indiscriminately mix
chemicals together • Precautions to eliminate risk
• Store chemicals in • First aid measures for spills or other exposure
unlabeled containers
– Material Safety Data Sheets
• Pour chemicals into
dirty containers • General, precautionary, & emergency info on product
• Use chemicals in ways

they were not intended
9
Chemical Safety (cont’d) Chemical Safety (cont’d)
• Safety Showers & • Spill cleanup kit
Eyewash Stations
– Phlebotomist should know
location of these
– Used for chemical spill or
splash to eyes/body
– Flush affected part w.
water at least 15 min.
– Visit ER for evaluation
External Hemorrhage Shock

• Definition • Definition
– Abnormal or profuse bleeding – Condition involving insufficient return of blood to heart
• Treatment – Results in inadequate supply of oxygen to body organs/tissues
– Firm, direct pressure to wound using cloth or gauze – Caused by hemorrhage, heart attack, trauma, & drug reactions
– Elastic bandage can be used to hold compress in place • Symptoms

– Only use tourniquet as last resort – Pale, cold, clammy skin
– Rapid, weak pulse
– Increased, shallow breathing rate
– Expressionless face & staring eyes
10
Shock (cont’d) CPR and Emergency Cardiovascular Care
• First Aid for Shock • Training Recommended by AHA for Healthcare Pros
– 6- to 8-hour Basic Lifesaving Healthcare Provider Course
1. Maintain an open airway for victim
– Includes CPR, use of AED, removing airway obstruction
2. Call for assistance
– Certification good for 2 years
3. Keep victim lying down w. head lower than rest of body
• AHA CPR and ECC Guideline Updates
4. Control bleeding or other cause of shock
– Hands-only CPR for lay rescuers
5. Keep victim warm until help arrives – 100/min compression rate
– Infant & child compression depth of ½ anterior-posterior chest
diameter
– Allow complete chest recoil between compressions
CPR and Emergency Cardiovascular Care

(cont’d) Personal Wellness
• AHA CPR and ECC Guideline Updates (cont’d) • Personal Hygiene
– Minimize interruptions in chest compressions (try to limit to less
than 10 seconds) – Shower/bathe regularly & use deodorant
– Avoid excessive ventilation (BLS single rescuer compression-to- – Brush teeth & use mouthwash several times per day
ventilation ratio stays at 30:2)
– Hair clean & neat
• AHA Chain of Survival
– Fingernails clean, short, neatly trimmed
1. Early access to care
– No heavily scented lotions or colognes
2. Early CPR
3. Early defibrillation • Proper Nutrition
4. Advanced care – Plant-based diet rich in variety of vegetables, fruits, & legumes
– Avoid processed, starchy staple foods
– Balance of carbohydrate, fat, protein, vitamins, minerals, fiber
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Personal Wellness (cont’d) Chapter 3 Test info: Infection Control, Safety, First aid
• Rest and Exercise • External bleeding controlled how?

• Class of fires
– Lack of rest & sleep can lead to fatigue & other medical problems
• Know how HBV vaccines are given
– Stay fit to be healthier & live longer
• OSHA HAZCOM standard is also called what?
– Focus on strength, flexibility, & endurance
• Proper order for putting on protective clothing
• Back Protection • Principles of radiation exposure
– Use proper lifting techniques • Parental transmission
• Know chain of infection: What is.. Infectious agent (causative agent),
• Stress Management Reservoir, Exit pathway (portal of exit), Means of transmission (mode of
transmission), Entry pathway (portal of entry), Susceptible host.
Cont. Chap 3 Test info
• Know: Permucosal, percutaneous, medical asepsis, biohazard, universal and

standard precautions, body substance isolation (BSI), PPE, N95
• Fomites: Inanimate objects that can harbor material containing infectious
agent.
• Needle Safety and Prevention Act (pg. 85)
• Hazards: electrical, sharps, chemical, radiation, physical, fire/explosive,
biologic, allergic
• Nosocomial infection: Infection acquired in a healthcare facility
• The most effective way to prevent the spread if infection is “HANDWASHING”
• Symptoms and first aid for shock
• Know all study questions
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Objectives

1. Define the key terms and abbreviations listed at the

Objectives (cont’d) Objectives (cont’d)

Infection Control (cont’d) Infection Control (cont’d)

Infection Control (cont’d) Infection Control (cont’d)

Infection Control (cont’d) Infection Control (cont’d)

Biosafety Biosafety (cont’d)

Biosafety (cont’d) Biosafety (cont’d)

Biosafety (cont’d) Electrical Safety

• Biohazard Waste Disposal

• Keep components apart to prevent fire

Fire Safety (cont’d) Fire Safety (cont’d)

Chemical Safety Chemical Safety (cont’d)

• Use chemicals in ways

External Hemorrhage Shock

• Treatment – Results in inadequate supply of oxygen to body organs/tissues

– Elastic bandage can be used to hold compress in place • Symptoms

CPR and Emergency Cardiovascular Care

• Rest and Exercise • External bleeding controlled how?

Cont. Chap 3 Test info

• Know: Permucosal, percutaneous, medical asepsis, biohazard, universal and

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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