Bài giảng Clinical procedures - Chapter 2: Infection Control Techniques

2Infection Control Techniques2-*Learning Outcomes2.1 Describe the medical assistant’s role in infection control.2.2 Describe methods of infection control.2.3 Compare and contrast medical and surgical asepsis.2.4 Describe how to perform aseptic hand washing.2.5 Compare and contrast the procedures for sanitization, disinfection, and sterilization. 2-*Learning Outcomes (cont.)2.6 Describe measures used in sanitization.2.7 List various methods used in disinfection and the advantages and disadvantages of each.2.8 Discuss the goal of surgical asepsis.2.9 Explain what an autoclave is and how it operates.2.10 List the steps in the general autoclave procedures. 2-*Learning Outcomes (cont.)2.11 Explain how to wrap and label items for sterilization in an autoclave.2.12 Describe how to complete the sterilization procedure using an autoclave.2.13 Define the Blood-Borne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA).2-*Learning Outcomes (cont.)2.14 Explain the role of Universal Precautions in the duties of a medical assistant.2.15 List the procedures and legal requirements for disposing of hazardous waste.2.16 Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease.2.17 Discuss the need for specific guidelines for isolating patients in health-care settings. 2-*Learning Outcomes (cont.)2.18 Describe the appropriate use of personal protective equipment in various situations.2.19 Explain the purpose of immunization.2.20 Describe your role in educating patients about immunizations.2.21 Explain how to educate patients in preventing disease transmission. 2-*Introduction Patients coming to the office for treatment may be more susceptible to infectionsImmunizations and patient education are important methods of infection control You will be introduced to Occupational Safety and Health Administration (OSHA) guidelines, the Blood-Borne Pathogen Standard, reporting guidelines, and isolation procedures.2-*MA’s Role in Infection ControlTo control infectious diseases, the cycle of infection must be brokenApply principles of infection control in office setting2-*MA’s Role in Infection Control (cont.)Follow correct sanitization, disinfection, and sterilization proceduresHelp patients understand basic disease preventionEducate patients about immunizationsAdminister immunizations2-*Apply Your KnowledgeWhat is your role as a medical assistant in controlling infection in the medical office?ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures.Correct!2-*Infection Control MethodsEliminate elements needed for disease to occurKnowledge of Medical asepsis Based on cleanlinessAs few microorganisms as possibleSurgical asepsisSterile environmentNo microorganisms2-*Medical AsepsisKeep office clean:Reception area: sick vs. well patientsReception room clean, well lit, and ventilated Keep furniture in good repairStrict “no food or drink” policyEmpty trash as necessary2-*Medical Asepsis (cont.)During medical assistant proceduresPrevent cross-contaminationHand washingBeginning of dayAfter breaks Before and after each patientBefore and after handling equipment or specimensAfter blowing your nose or coughing2-*Medical Asepsis (cont.)Other precautionsAvoid leaning against sinks, supplies, equipmentAvoid touching your face and mouthUse tissues when you cough or sneeze, and always wash your hands afterwardAvoid working directly with patients when you have a cold; wear gloves and mask if you mustStay home if you have a fever2-*Apply Your KnowledgeDescribe the difference between medical and surgical asepsis.ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms.Good Answer!2-*SanitizationScrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can growFor cleaning items that touch only healthy, intact skinORFirst step in disinfection and sterilization for other equipment2-*Sanitization (cont.)Collect items for sanitizationPlace in water and special detergent solutionUse utility glovesSeparate sharps from other equipmentScrub itemsFollow manufacturers’ guidelinesDry thoroughlyExamine carefully2-*Sanitization (cont.)Rubber and plastic items Syringes and needles – use disposable whenever possibleUltrasonic cleaning For delicate instruments and those with moving partsSound waves generated through a cleaning solution to loosen contaminants2-*Apply Your KnowledgeWhat is sanitation, and what types of items is it adequate for cleaning?ANSWER: Sanitation is scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. It is adequate for cleaning items that touch only healthy, intact skin.Nice Job!2-*DisinfectionAdequate for instruments that do not penetrate skin or mucous membranes and surfaces not considered sterileORSecond step in infection control prior to sterilizationWill not kill spores, certain viruses2-*Disinfection (cont.)Using disinfectantsCleaning products applied to inanimate materials to reduce or eliminate infectious organisms Antiseptics are anti-infective cleaning agents used on human tissueFollow manufacturers’ guidelines2-*Disinfection (cont.)Factors impacting effectiveness of disinfectantsNumber of times solution is usedWet items – surface moisture may dilute solutionTraces of soap left from sanitization – alters chemical compositionEvaporation 2-*Disinfection (cont.)Choose the correct disinfectantGermicidal soap productsAlcoholAcid productsFormaldehydeGlutaraldehyde – “cold disinfection”BleachIodine and iodine compounds2-*Disinfection (cont.)Handling disinfected suppliesPrevent contamination with other surfacesUse sterile transfer forcepsWear glovesStore in clean, moisture-free environment2-*Apply Your KnowledgeWhat is the difference between a disinfectant and an antiseptic?ANSWER: Disinfectants are cleaning products applied to inanimate materials to reduce or eliminate infectious organisms. Antiseptics are anti-infective cleaning agents used on human tissue.Excellent!2-*Surgical AsepsisGoal is to keep the surgical environment completely free of all microorganismsUsed for even minor operations and injectionsThe more extensive the procedure, the greater the risk of infection2-*SterilizationRequired for all instruments or supplies thatPenetrate the skinContact normally sterile areas of the bodyObject is either sterile or not sterileIf unsure of sterility, consider it not sterilePrior to sterilizationSanitizeDisinfect2-*The AutoclavePrimary method of sterilizationPressurized steamOperates at lower temperatures than dry heat sterilizationMoisture causes coagulation of proteins in microorganisms at lower temperaturesCell walls burst when cell cools, killing the microorganism2-*The Autoclave (cont.)Wrap sanitized and disinfected itemsSpecial porous fabric, paper, or plasticItems should not touchLabel Check water level – distilled water onlyPreheat, but do not overheat2-*The Autoclave (cont.)Load, choose correct setting, run cycleTemperature 250°to 270°FPressure 15 to 30 poundsUnloadStore items properlyClean, dry locationShelf life based on packaging, but generally 30 days2-*The Autoclave (cont.)Clean autoclave and areaQuality control checksSterilization indicators – confirm that items have been exposed to correct volume of steam at the correct temperature for the correct length of timeBiological indicators – contain bacterial spores and confirm that sterilization occurs2-*The Autoclave (cont.)Prevent incomplete sterilizationCorrect timingAdequate temperatureProperly wrapped packsAdequate steam levelsTimingPreset for load typesUse sterilization indicators2-*The Autoclave (cont.)Temperature Too high – steam too little moistureToo low – steam too much moistureDo not overcrowd autoclaveSteam level If incorrect, items will not be sterile at end of cycle 2-*Sterile Technique2-*Surgical AsepsisDuring surgical proceduresDo not touch sterile items without sterile gloves or transfer forcepsAseptic techniqueThroughout surgical proceduresCaring for surgical wounds2-*Surgical Asepsis (cont.)After proceduresSanitize, disinfect, and sterilize reusable itemsDisinfect surfacesWaste disposalBiohazard waste containersLeak-proof containers either color-coded red or labeled with biohazard symbolBiohazardous materialsBiological agents that can spread disease to living things2-*Apply Your KnowledgeANSWER: Sterilization is required for all instruments or supplies that penetrate the skin or come in contact with normally sterile areas of the body.1. What items need to be sterilized?2-*Apply Your KnowledgeANSWER: Use medical asepsis while preparing the patient, and then use surgical asepsis during the procedure. 2. The physician is going to remove a small growth from your patient’s back. In order to prepare for this procedure, what steps would you take to prevent the spread of infection?Right!2-*OSHA GuidelinesBlood-Borne Pathogen StandardsProtect health-care workers from health hazards on the jobAlso protect patients and others who come to medical facilitiesDictate how to handle infectious or potentially infectious wastesDiscarded Held for processing2-*OSHA Guidelines (cont.)Blood-Borne Pathogen Standards Measures to prevent the spread of infectionProvide a margin of safety by ensuring that medical facilities meet minimal standards for asepsisRequirements for training, keeping records, housekeeping, and personal protective gear2-*OSHA Guidelines (cont.)2-*OSHA Guidelines (cont.)2-*OSHA Guidelines (cont.)Categories of tasksTasks that expose a worker to blood, body fluids, or tissues and require specific protective measuresTasks that usually do not involve risk of exposure but require precautions in certain situationsTasks that have no risk of exposure, so no special protection is required2-*Respiratory Hygiene/Cough EtiquetteGuidelines established by CDC EducationPosting signsControlling source or transmissionProper hand hygieneSeparating patients with respiratory infections from other patients2-*Personal Protective EquipmentProtective gear worn to protect against physical hazardsEmployers must provide PPE at no charge to the employeeDisposable, sterile exam and utility glovesMasks and protective eyewear or face shieldsProtective clothing2-*Postprocedure CleanupDecontaminate all exposed surfacesReplace protective coverings on surfaces or equipmentDecontaminate receptaclesPick up any broken glass with tongsDiscard all potentially infectious waste materials2-*OSHA Guidelines (cont.)Apply guidelines daily on the jobExposure incidentsContact with infectious substanceRules apply to all serious infections – HIV, HBVHBV vaccineTransmission to patientsNosocomial infection – an infection acquired by a patient in a health-care facility2-*Apply Your KnowledgeANSWER: There are three categories of risk:Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measuresCategory 2: Usually do not involve risk of exposure, but precautions are required in certain situationsCategory 3: No risk of exposure, so no special protection is requiredOSHA divides medical tasks by level of risk. What are these risk categories? 2-*Reporting GuidelinesCertain diseases must be reported to state or county health departmentInformation is forwarded to the CDC – control of the spread of infection 2-*Reporting Guidelines (cont.)National Notifiable Disease Surveillance System (Table 2-2)Examples HIV/AIDS  CholeraRubella  HepatitisLegionellosis  Lyme diseaseMumps  SmallpoxTetanus  Tuberculosis2-*Apply Your KnowledgeHow is the information on reportable diseases used by the CDC?ANSWER: The CDC uses the information reported to them to help control the spread of infection. Good Answer!2-*Isolation Guidelines CDC guidelines Types of precautions neededPatients requiring precautionsCreate an environment that protects against pathogensStandard Precautions2-*Isolation Guidelines (cont.)Select appropriate PPEGlovesMasks, face shields, respiratorsGowns Table 2-32-*Apply Your KnowledgeMrs. Findley brings her child with chickenpox into the medical office. What type of personal protective equipment should you use when caring for this child?ANSWER: Chickenpox requires airborne and contact precautions, so you should use gloves and a mask and goggles or a respirator.Nice!2-*ImmunizationsImmunizationAdministration of a vaccine or toxoid to protect susceptible individuals from infectious diseasesReduces risk of infection spreadDecreases the susceptibility of the host2-*Immunization Recommendations Immunization schedules for childrenAdvisory Committee on Immunization PracticesAmerican Academy of PediatricsAmerican Academy of Family Physicians Immunization schedules for adultsThe National Coalition of Adult Immunization (NCAI)2-*Immunizations (cont.)When administering, you must explainThe need for immunizationSide effectsSoreness at siteLow-grade feverGeneral malaise2-*Immunizations (cont.)ConcernsPediatric patientsDo not give if child has feverInformed consent – explain benefits and risksContraindications – symptoms that render the use of a remedy or procedure inadvisable because of the risk Immunization recordsNational Childhood Vaccine Injury Act of 1988Instruct parents keep record as proof of immunization2-* Immunizations (cont.)Pregnant patientsAvoid live virus vaccinesFDA categories A, B, C, D, and XElderlyDispel common misconception and cost concernsMore likely to develop side effects2-*Immunizations (cont.)Immunocompromised patientsMay experience minimal to dangerous effectsAdjust dosage or delay administrationMust also consider immunization status of family and caregiversHealth-care workersHepatitis B vaccinationoffered by employer at nocost to employee2-*Apply Your KnowledgeWhat is an immunization?ANSWER: An immunization is the administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases.Great!2-*Preventing Disease Transmission Patient educationHealth promotion Disease preventionDisease treatmentMedical assistant role in patient educationShare responsibilityReinforce and explain instructions2-*Preventing Disease Transmission (cont.)Educate patient on Nutrition and dietExercise and weight controlPrevention of STDsSmoking cessationAlcohol and drug abuse prevention and treatmentProper use of medications and prescribed treatmentsStress-reduction techniques2-*Preventing Disease Transmission (cont.)Goal of patient educationHelp patients take care of themselvesEncourage patients to participate actively in their own health care2-*Apply Your KnowledgeWhat three areas should patient education focus on? What is the medical assistant’s role in patient education?ANSWER: Patient education should focus on health promotion, disease prevention, and disease treatment.The medical assistant shares responsibility with the physician and other staff members and should reinforce and explain instructions given by others.Bravo!2-*In Summary2.1 It is the medical assistant’s responsibility to apply the principles of infection control by following correct sanitization, disinfection, and sterilization procedures, helping patients understand basic disease prevention, administering immunizations, and teaching patients about the importance of immunizations.2.2 The two basic methods of infection control are medical asepsis (clean technique) and surgical asepsis (sterile technique).2-*In Summary (cont.)2.3 The goal of medical asepsis is to prevent the spread of infection in the medical environment by reducing the number of microorganisms. Surgical asepsis requires that all organisms be eliminated. 2.4 Aseptic hand washing removes accumulated dirt and microorganisms by wetting your hands, applying soap, carefully scrubbing every surface of the hands, rinsing, and carefully drying with clean paper towels. 2-*In Summary (cont.)2.5 Sanitization is the scrubbing of instruments and equipment with special brushes and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. Disinfection uses special cleaning products applied particularly to instruments and equipment to reduce or eliminate infectious organisms. Sterilization is usually accomplished through the use of steam and pressure in an autoclave. 2.6 Sanitize instruments by soaking them in a disinfecting solution, carefully scrubbing every surface of each instrument, rinsing thoroughly, and allowing them to dry. 2-*In Summary (cont.)2.7 There are several types of disinfectants, each with different properties. Choose a disinfectant based on the type of instrument and the level of disinfection required.2.8 The goal of surgical asepsis is to destroy all microorganisms.2.9 An autoclave is a device that uses steam and pressure to sterilize instruments and equipment.2-*In Summary (cont.)2.10 The general steps for using the autoclave include preparing the instruments, checking the water level, preheating the chamber, loading the instruments, choosing the correct settings, running the autoclave, and allowing the instruments to dry at the end of the cycle. 2.11 Instruments should be carefully wrapped in a porous material, bag, or envelope and labeled with the contents of the pack, date, and your initials. 2-*In Summary (cont.)2.12 To ensure that the sterilization procedure is complete, you should make sure you use the correct amount of time, the correct temperature, and adequate levels of steam. In addition, you should avoid overcrowding the chamber.2.13 Laws set forth in the OSHA Blood-Borne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures. According to these rules, any potentially infectious waste materials must be discarded or held for processing in biohazardous waste containers2-*In Summary (cont.)2.14 Standard Precautions prevent health-care workers from exposing themselves and others to infections. Following Standard Precautions means assuming that all blood and body fluids are infected with blood-borne pathogens. 2.15 OSHA requires that all hazardous waste be placed in properly labeled biohazard containers and disposed of in an appropriate manner. 2-*In Summary (cont.)2.16 The CDC requires reporting of certain diseases to the state or county department of health, who then reports the information to the National Notifiable Disease Surveillance System of the CDC. 2.17 The CDC issued the current Guideline for Isolation Precautions in Hospitals to ensure that an environment is created that protects people from disease-causing microorganisms.2-*In Summary (cont.)2.18 There are a number of different types of personal protective equipment, including gloves, gown, masks, and goggles. Choosing the correct type depends on the exposure type. 2.19 Immunizations prevent infection by reducing the susceptibility of the host to infection. 2-*In Summary (cont.)2.20 As a medical assistant, you should educate patients about the importance of getting immunizations and following the immunization schedule. You should also discuss potential hazards and side effects of immunizations. 2.21 You should emphasize the basic principles of hygiene and disease prevention, including frequent hand washing, routine bathing and dental care, covering coughs and sneezes, eating well, and avoiding stress. 2-*Soap and education are not as sudden as a massacre, but they are more deadly in the long run.~ Mark TwainEnd of Chapter 2