Introduction Patients coming to the office for treatment may be more susceptible to infections Immunizations and patient education are important methods.

Introduction

Patients coming to the office for treatment may be more susceptible to infections

Immunizations and patient education are important methods of infection control

You will be introduced to OSHA guidelines, the Blood-Borne Pathogen Standard, reporting

guidelines, and isolation procedures.

MA’s Role in Infection Control

To control infectious diseases, the cycle of infection must be broken

Apply principles of infection control in office setting

MA’s Role in Infection Control (cont.)

Follow correct sanitization, disinfection, and sterilization procedures

Help patients understand basic disease prevention

Educate patients about immunizations

Administer immunizations

Apply Your Knowledge

What is your role as a medical assistant in control of infection in the medical office?

ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures.

Correct!

Infection Control Measures

Eliminate elements needed for disease to occur

Knowledge of Medical asepsis

Based on cleanliness As few microorganisms as possible

Surgical asepsis Sterile environment No microorganisms

Medical Asepsis

Keep office clean: Reception area: sick vs. well patients Reception room clean, well lit, and

ventilated Keep furniture in good repair Strict “no food or drink” policy Empty trash as necessary

Medical Asepsis (cont.)

During medical assistant procedures Prevent cross-contamination

Hand washing Beginning of day After breaks Before and after each patient Before and after handling equipment or specimens After blowing your nose or coughing

Medical Asepsis (cont.)

Other precautions Avoid leaning against sinks, supplies, equipment Avoid touching your face and mouth Use tissues when you cough or sneeze, and

always wash your hands afterward Avoid working directly with patients when you

have a cold; wear gloves and mask if you must Stay home if you have a fever

Sanitization

Scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow

For cleaning items that touch only healthy, intact skin

OR First step in disinfection and

sterilization for other equipment

Sanitization (cont.)

Collect items for sanitization Place in water and special

detergent solution Use utility gloves Separate sharps from other

equipment

Scrub items Follow manufacturers’ guidelines Dry thoroughly Examine carefully

Sanitization (cont.)

Rubber and plastic items Syringes and needles

Use disposable whenever possible Ultrasonic cleaning

For delicate instruments and those with moving parts

Sound waves generated through a cleaning solution to loosen contaminants

Disinfection

Adequate for instruments that do not penetrate skin or mucus membranes and surfaces not considered sterile

OR Second step in infection control prior to

sterilization Will not kill spores, certain viruses

Disinfection (cont.)

Using disinfectants Cleaning products applied to

inanimate materials to reduce or eliminate infectious organisms

Antiseptics are anti-infective cleaning agents used on human tissue

Follow manufacturers’ guidelines


Factors impacting effectiveness of disinfectants

Number of times solution is used Wet items – surface moisture may

dilute solution Traces of soap left from sanitization

– alters chemical composition Evaporation


Choose the correct disinfectant Germicidal soap products Alcohol Acid products Formaldehyde Glutaraldehyde – “cold disinfection” Bleach Iodine and iodine compounds


Handling disinfected supplies Prevent contamination with other

surfaces

Use sterile transfer forceps

Wear gloves

Store in clean, moisture-free environment

Surgical Asepsis

Goal is to keep the surgical environment completely free of all microorganisms

Used for even minor operations and injections

The more extensive the procedure, the greater the risk of infection

Sterilization

Required for all instruments or supplies that Penetrate the skin Contact normally sterile areas of the body

Object is either sterile or not sterile If unsure of sterility, consider it not sterile

Prior to sterilization Sanitize Disinfect

Sterilization: The Autoclave

Primary method of sterilization Pressurized steam

Operates at lower temperatures than dry heat sterilization

Moisture causes coagulation of proteins in microorganisms at lower temperatures

Cell walls burst when cell cools, killing the microorganism

Sterilization: The Autoclave (cont.)

Wrap sanitized and disinfected items Special porous fabric, paper, or

plastic Items should not touch Label

Check water level – distilled water only

Preheat, but do not overheat


Load, choose correct setting, run cycle Temperature 250° to 270° F

Pressure 15 to 30 pounds

Unload

Store items properly Clean, dry location

Shelf life based on packaging, but generally 30 days


Clean autoclave and area Quality control checks

Sterilization indicators – confirm that items have been exposed to correct volume of steam at the correct temperature for the correct length of time

Biological indicators – contain bacterial spores and confirm that sterilization occurs


Prevent incomplete sterilization Correct timing Adequate temperature Properly wrapped packs Adequate steam levels

Timing Preset for load types Use sterilization indicators


Temperature Too high – steam too little moisture Too low – steam too much moisture

Do not overcrowd autoclave

Steam level If incorrect, items will not be sterile at end of

cycle

Sterilization: Sterile Technique

Surgical scrub

During surgical procedures Do not touch sterile items without

sterile gloves or transfer forceps Aseptic technique

Throughout surgical procedures Caring for surgical wounds

Sterilization: Surgical Asepsis

After procedures Sanitize, disinfect, and sterilize reusable items Disinfect surfaces

Waste disposal Biohazard waste containers

Leak-proof containers either color-coded red or labeled with biohazard symbol

Biohazardous waste Biological agents that can spread disease

to living things

OSHA Guidelines

Blood-Borne Pathogen Standards Protect health-care workers from health hazards

on the job Also protect patients and others who come to

medical facilities Dictate how to handle infectious or potentially

infectious wastes Discarded Held for processing

OSHA Guidelines (cont.)

Blood-Borne Pathogen Standards Measures to prevent the spread of

infection Provide a margin of safety by

ensuring that medical facilities meet minimal standards for asepsis

Requirements for training, keeping records, housekeeping, and personal protective gear


Universal Precautions Prevent health-care workers from exposure to

infections Assume that all blood and blood and body

fluids are infected with blood-borne pathogens Standard Precautions

Combination of Universal Precautions and Body Substance Isolation guidelines

Used in hospitals to prevent transmission of disease


Categories of tasksI. Tasks that expose a worker to blood, body

fluids, or tissues and require specific protective measures

II. Tasks that usually do not involve risk of exposure but require precautions in certain situations

III. Tasks that have no risk of exposure, so no special protection is required


Personal Protective Equipment Protective gear worn to protect

against physical hazards Employers must provide PPE at no

charge to the employee Disposable, sterile exam and utility

gloves Masks and protective eyewear or face

shields Protective clothing


Postprocedure Cleanup Decontaminate all

exposed surfaces

Replace protective coverings on surfaces or equipment

Decontaminate receptacles

Pick up any broken glass with tongs

Discard all potentially infectious waste materials


Apply guidelines daily on the job

Exposure incidents Contact with infectious substance Rules apply to all serious infections – HIV, HBV HBV vaccine

Transmission to patients Nosocomial infection – an infection acquired by a

patient in a health-care facility


OSHA divides medical tasks by level of risk. What are these risk categories?

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

20-35

ANSWER: There are three categories of risk: Category 1: Expose a worker to blood, body fluids, or tissues

and require specific protective measures Category 2: Usually do not involve risk of exposure, but

precautions are required in certain situations Category 3: No risk of exposure, so no special protection is

required

Reporting Guidelines

Certain diseases must be reported to state or county health department

Information is forwarded to the CDC – control of the spread of infection

Reporting Guidelines (cont.)

National Notifiable Disease Surveillance System (Table 20-2)

Examples HIV/AIDS Cholera Rubella Hepatitis Legionellosis Lyme disease Mumps Smallpox Tetanus Tuberculosis


How 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.

Isolation Guidelines

CDC guidelines Types of precautions needed Patients requiring precautions

Create an environment that protects against pathogens

Standard Precautions

Isolation Guidelines (cont.)

PPE Select appropriate PPE for mode of

transmission Gloves Masks, face shields,

respirators Gowns

Table 20-3


Mrs. 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!

Immunizations

Immunization Administration of a vaccine or

toxoid to protect susceptible individuals from infectious diseases

Reduces risk of infection spread Decreases the susceptibility of

the host

Immunizations: Recommendations

Immunization schedules for children Advisory Committee on Immunization Practices American Academy of Pediatrics American Academy of Family Physicians

Immunization schedules for adults The National Coalition of Adult Immunization

(NCAI)

Immunizations (cont.)

When administering. you must explain The need for immunization Side effects

Soreness at site Low-grade fever General malaise


Concerns Pediatric patients

Do not give if child has fever

Informed consent Explain benefits and risks

Contraindications Symptoms that render the use of a remedy or

procedure inadvisable because of the risk

Immunization records National Childhood Vaccine Injury Act of 1988 Instruct parents keep record as proof of

immunization

Pregnant patients Avoid live virus vaccines FDA categories A, B, C, D, and X

Elderly More likely to develop side effects



Immunocompromised patients May experience minimal to dangerous effects Adjust dosage or delay administration Must also consider immunization status of family

and caregivers

Health-care workers Hepatitis B vaccination

offered by employer at nocost to employee

Preventing Disease Transmission

Patient education Health promotion Disease prevention Disease treatment

Medical Assistant role in patient education Share responsibility Reinforce and explain instructions

Preventing Disease Transmission (cont.)

Educate patient on Nutrition and diet Exercise and weight control Prevention of STDs Smoking cessation Alcohol and drug abuse prevention and treatment Proper use of medications and prescribed

treatments Stress-reduction techniques

Goal of patient education Help patients take care of

themselves

Encourage patients to participate actively in their own health care

Preventing Disease Transmission (cont.)

In Summary

Medical Assistant Sanitization, disinfection, and sterilization break the cycle of infection by ridding instruments and equipment of pathogens.

The medical assistant plays a vital role in reducing patient vulnerability by encouraging patients to maintain a correct

immunization status and by being aware of special immunization concerns of certain patients.

Introduction Patients coming to the office for treatment may be more susceptible to infections Immunizations and patient education are important methods.

Documents

control of infection

necessary slide

coughing slide

fever slide

infection control measures

office setting slide

medical office

cycle of infection