This document discusses infection control and asepsis procedures in a healthcare setting. It begins by describing the characteristics of pathogenic microorganisms and the chain of infection process. It then discusses the body's immune response mechanisms and types of infections. The document outlines OSHA standards for exposure control plans, potentially infectious materials, and protocols for disposal of biologic waste. It explains principles of asepsis including proper hand hygiene, and differentiates between sanitization, disinfection, and sterilization. The role of the medical assistant in maintaining asepsis to prevent transmission of infection is also summarized.

1. Infection Control
Chapter 19
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1. Describe the characteristics of pathogenic microorganisms.
2. Do the following related to the chain of infection:
• Apply the chain of infection process to the healthcare practice.
• Compare viral and bacterial cell invasion.
• Differentiate between humoral and cell-mediated immunity.
3. Summarize the impact of the inflammatory response on the body’s ability to
defend itself against infection.
4. Analyze the differences among acute, chronic, latent, and opportunistic
infections.

3. Disease
 Any sustained, harmful alteration of the normal
structure, function, or metabolism of an organism or
cell
 Genetic, drug-induced, autoimmune, degenerative,
communicable, or infectious
 An unaffected person (carrier) can transmit infection to
another person
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4. Chain of Infection
 Infectious agent
 Reservoir host
 Portal of exit
 Mode of transmission
 Portal of entry
 Susceptible host
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6. Viruses
 Smallest of all pathogens
 Intracellular parasites that take over DNA or RNA of
invaded cell
 Interferon produced by cells helps protect cells from
viruses
 Treatment is palliative (relief of symptoms)
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7. Bacteria
 Tiny, simple cells that produce disease in a variety of ways
 Classified according to their shape, or morphology
 Cocci (spherical)
 Bacilli (rod shaped)
 Spirilla (spiral shaped)
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8. Antibiotic Resistance
 One of the world’s most significant public health
problems
 Resistance occurs when an antibiotic is used
inappropriately to treat an infection
 Prescribe antibiotic therapy only when it will benefit the
patient
 Treat the patient with an antibiotic that is specific to the
infecting pathogen
 Prescribe the recommended dose and treatment duration
of the medication
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9. Fungi
 Include such organisms as mushrooms, molds, and
yeasts
 Grow best in warm, moist environments
 Treatment with antifungal agents
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10. Protozoa
 Unicellular parasites that can replicate and multiply
rapidly once inside host
 Frequently are seen in tropical climates
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11. Reservoirs
 Second link in chain of infection
 May be people, insects, animals, water, food, or contaminated
instruments
 Must gain entrance into a host or else they will die
 Reservoir host supplies nutrition for organism, allowing it to multiply
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12. Portal of Exit
 How pathogen escapes reservoir host
 Exits include mouth, nose, eyes, ears, intestines,
urinary tract, reproductive tract, and open wounds
 Use Standard Precautions to help control spread of
infection
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13. Transmission
 Direct transmission occurs from contact with infected
person or discharges from infected person
 Indirect transmission occurs from:
 Droplets in air expelled by coughing, speaking, or sneezing
 Vectors that harbor pathogens
 Contaminated food or drink
 Contact with contaminated objects (called fomites)
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14. Portal of Entry
 How transmitted pathogen gains entry into a new host
 May be mouth, nose, eyes, intestines, urinary tract,
reproductive system, or an open wound
 Anatomic defenses include integumentary system,
tears, cilia, mucous membranes, and pH of body fluids
 Second line of defense is immune system and
inflammatory process
 Humoral immunity
 Cell-mediated immunity
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15. Inflammatory Response
 Process results in four classic symptoms of inflammation:
 Erythema (redness)
 Edema (swelling)
 Pain
 Heat
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16. Inflammatory Response
 Inflammation mediators are released and cause three
different responses at cellular level
 Blood vessels at the site dilate
 Release of white blood cells (WBCs) to the site
 Chemotaxis, or release of chemical agents, occurs,
attracting even more WBCs to the site
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17. Acute Infection
 Rapid onset of symptoms but lasts a relatively short
time
 Prodromal period is the time when patient first shows
vague, nonspecific symptoms of disease
 Symptoms appear after the tissue damage begins
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18. Chronic Infection
 Persists for a long period, sometimes for life
 Some chronic infections are asymptomatic, but virus is
transmissible
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19. Latent Infection
 Persistent infection in which symptoms cycle through
periods of relapse and remission
 Examples include cold sores, genital herpes, and varicella
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20. Opportunistic Infections
 Caused by organisms not typically pathogenic but occur in hosts with an
impaired immune system response
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21. OSHA standards
Asepsis
5. Do the following related to the Occupational Safety and Health
Administration (OSHA) standards for the healthcare setting:
• Specify potentially infectious body fluids.
• Integrate OSHA’s requirement for a site-based exposure control plan
into facility management procedures.
• Explain the major areas included in the OSHA Compliance Guidelines.
• Discuss protocols for disposal of biologic chemical materials.
• Remove contaminated gloves while following the principles of Standard
Precautions.
• Summarize the management of post-exposure evaluation and follow-up
and participate in bloodborne pathogen training and a mock exposure
event.
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22. OSHA Standards,
Asepsis, and Sanitization
6. Apply the concepts of medical and surgical asepsis to the
healthcare setting.
7. Discuss proper hand washing and demonstrate the proper
hand washing technique for medical asepsis.
8. Differentiate among sanitization, disinfection, and
sterilization procedures, and select barrier/personal
protective equipment while demonstrating the correct
procedure for sanitizing contaminated instruments.
9. Discuss the role of the medical assistant in asepsis.
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23. OSHA Standards for
the Healthcare Setting
 Universal Precautions: All blood and certain body fluids
must be treated as if known to be infectious for blood-
borne pathogens
 Precautions must be implemented for all patients,
regardless of the information available about person’s
individual health history
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24. Potentially Infectious
Materials Body fluids
 Semen
 Vaginal secretions
 Cerebrospinal fluid (CSF)
 Synovial fluid
 Pleural fluid
 Peritoneal fluid
 Amniotic fluid
 Saliva in dental procedures
 Any body fluid that is visibly contaminated and in situations in which it is
difficult/impossible to differentiate between body fluids
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25. OSHA’s Bloodborne
Pathogens Standard
 Needlestick Safety and Prevention Act
 Employers must keep a confidential sharps injury log that
describes the device involved and details of how and
where incident occurred
 Parenteral exposure includes accidental needlesticks,
occupation-related human bites, and exposure of
nonintact skin
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26. CDC’s Hand Hygiene
Recommendations
 Visibly soiled hands
 Wash a minimum of 15 seconds with antimicrobial soap and warm, running
water
 Alcohol-based hand rubs
 Used before and after contact with each patient, and also after removing
gloves
 To use properly, apply the label-recommended amount to palm of one hand
and rub hands together, covering all surfaces until hands are dry
 Healthcare workers with artificial nails have more
pathogenic microbes under their nails
 Natural nail tips should be no longer than ¼ inch
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27. Barrier Protection
 Barrier protection, or PPE, includes specialized clothing or equipment
that prevents the healthcare worker from coming into contact with
blood or other potentially infectious material
 Disposable gloves, face masks, face shields, protective glasses, shoe covers,
laboratory coats, barrier gowns, mouthpieces, and resuscitation bags
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29. When Gloves Must Be Worn
 Touching a patient’s blood, body fluids, mucous
membranes, or skin that is not intact
 Handling items and surfaces contaminated with blood
and body fluids
 Performing venipuncture, finger sticks, injections, and
other vascular procedures
 Assisting with any surgical procedure
 Handling, processing, and disposing of all specimens of
blood and body fluids
 Cleaning and decontaminating spills of blood or other
body fluids
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30. Using Standard Precautions to
Remove Contaminated Gloves
 The goal is minimize exposure to pathogens by aseptically removing
and discarding contaminated gloves
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31. Environmental Protection
 Refers to minimizing risk of occupational injury by
isolating or removing any physical or mechanical health
hazard in medical workplace
 Read warning labels on biohazard containers and
equipment
 Minimize splashing or spraying of potentially infectious
materials
 Bandage any breaks or lesions on your hands before
gloving
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32. Environmental Protection
 If any body surface is exposed to potentially
infectious material, scrub area with
antimicrobial soap and warm, running
water as soon as possible after exposure
 If your eyes come into contact with body
fluids, continuously flush them with water
as soon as possible for a minimum of 15
minutes using an eye wash unit
 Contaminated needles and other sharps
should never be recapped, bent, broken, or
resheathed
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33. Environmental Protection
 Contaminated sharps should not be processed in a way
that requires employees to reach into containers to
grasp them
 Immediately after use, dispose of syringes and needles,
scalpel blades, and other sharp items in a labeled, leak-
proof, puncture-resistant biohazard container
 All specimens must be placed in a container that
prevents leakage during collection, handling,
processing, storage, transport, and shipping
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34. Environmental Protection
 Equipment requiring repair that has been
contaminated with blood or body fluids should be
decontaminated before being repaired in the office or
transported for repair
 Smoking, eating, drinking, applying cosmetics or lip
balm, and handling contact lenses are prohibited in
work areas where there is reasonable likelihood of
contamination from pathogens
 Food and beverages cannot be kept in refrigerators,
freezers, or cabinets or on countertops where
infectious materials could be present
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35. Housekeeping Controls
 Work surfaces must be immediately
decontaminated with a disinfectant after
accidental spills of blood or body fluids, at end
of each procedure, and at end of each shift
 Disinfection and decontamination of all
reusable containers must be done on a routine
basis
 Sharps containers must be as close as possible
to work area
 Never pick up spilled material or broken
glassware with the hands
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36. Housekeeping Controls
 Handle soiled linen as little as possible and always wear
gloves or other protective equipment during disposal
 Contaminated materials and/or infectious waste must
be handled with extreme caution to prevent exposure
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37. Protocols for Disposal of
Biologic Chemical Materials
 Biomedical waste should be collected in containers that are leakproof and
strong
 Workers who handle biomedical waste should observe Standard Precautions
 Biologic waste containers/boxes should not be held in healthcare facilities
for more than 30 days
 Sharps are instruments intended to cut or penetrate the skin
 Boxes for disposal of chemicals should be labeled with the chemicals’
names and any other pertinent data
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38. Hepatitis B Vaccination
 Must be available free of charge to all employees at risk
for exposure
 Intramuscular injection in three doses
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39. Postexposure Follow-Up
 Wash or flush exposed area and receive confidential
medical evaluation
 File incident report and screen and test person for HBV,
HCV, and HIV
 Receive copy of physician’s written opinion within 15
days of evaluation
 Receive health counseling about risks and adverse
outcomes
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40. Aseptic Techniques
 Asepsis
 Free from infection or infectious material
 Medical asepsis
 Destruction of disease-causing organisms after they leave
the body
 Surgical asepsis
 Destruction of organisms before they enter the body
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41. Bacteria on the Skin
 Transient bacteria
 Surface bacteria introduced by fomites
 Resident bacteria
 Found under fingernails, in hair follicles, openings of
sebaceous glands, and deeper layers of skin
 Most effective barrier against infection is unbroken skin
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42. Hand Hygiene
 Wash correctly before and after every patient
 Warm water, antimicrobial soap, friction
 Alcohol-based hand rubs may substitute unless hands
are visibly contaminated
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43. Sanitization
 Cleansing process that reduces number of
microorganisms to a safe level
 Removes debris such as blood and other body fluids
from instruments or equipment
 Wear gloves while performing sanitization
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44. Ultrasonic Sanitization
 Sound waves can be used to sanitize instruments
 Instruments are placed in an ultrasonic bath of cleaner
and water
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45. Disinfection
 Process of killing pathogenic organisms or of rendering
them inactive
 Disinfecting agents vary in effectiveness and must be
used according to instructions
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46. Levels of Disinfectants
 CDC defines three levels of disinfectants:
 Low-level disinfectants can kill most vegetative bacteria,
some fungi, and some viruses
 Intermediate-level disinfectants can kill mycobacteria,
vegetative bacteria, most viruses, and most fungi, but
they do not kill spores
 High-level disinfectants will kill all microorganisms except
large numbers of bacterial spores
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47. Common Errors in
Disinfection
 Instruments are not thoroughly sanitized; attached organic
matter inhibits or prevents action of disinfectant
 Sanitized instruments are not dried
 Disinfectant solution is left in an open container;
evaporation changes its concentration
 Solutions are not changed after the recommended period
 Solutions are not prepared properly or are not mixed
properly
 Manufacturer’s recommended temperature for use and
storage are not maintained
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48. Sterilization
 Destruction of all microorganisms
 Essential for surgical asepsis
 Area should be set aside in each office for sterilization
 Clear, clean plastic bags in which to store sterile packs
may be kept in sterile area
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49. Role of the Medical
Assistant in Asepsis
 Spread of pathogens can be controlled only through
application of the Bloodborne Pathogens Standard and
by proper sanitization, disinfection, and sterilization of
supplies, equipment, and work surfaces
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50. Patient Coaching
 While washing your hands, explain to the
patient that this routine is part of daily
hygiene
 Advise patient to carry an alcohol-based hand
rub and use it throughout the day
 Explain the use of disposable tissues or bent
elbow to cover nose and mouth when coughing
or sneezing
 Discuss proper ways of discarding used tissues
 Instruct patient in the differences between
sterile and clean dressings and bandages
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51. Suggestions for Asepsis and
Infection Control Education
 Set up an information table in the waiting room with
take-home pamphlets and literature
 Mail, e-mail, or post a periodic newsletter to patients
about infection control
 Demonstrate and explain aseptic procedures to patients
and family members
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52. Legal and Ethical Issues
 It is imperative that disinfection and sterilization are performed precisely
and effectively
 Carelessness can cause nosocomial infections in patients
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