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

rubella. Infection control • Aims at controlling exposure to vehicles and restricting routes of transmission • Standard precautions – All bodily fluids (except sweat). Strep. cold viruses.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. Mycobacterium • Inoculation – HIV. pyogenes. HBV. HCV. scalpels. influenza. 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 . needles. nonintact skin and mucous membranes are treated as infectious – Routes of transmission of vehicles are contained (asepsis) How • Inhalation – CMV. mumps. gauze. measles. etc. Neisseria • Ingestion – Oral/faecal bacteria.

• Radiation – UV. bacteria and their spores • Prions? Sterilization • Limiting factor is often penetration – Limit the size/load – Get the crap off first • Presterilization cleaning • Scrubbing. gamma rays Your friend the autoclave • High pressure steam allows you to heat material to over 100°C • Typical operating conditions are 121°C for 15 minutes – FOLLOW THE MANUAL • Excellent penetration • Kills viruses. ultrasonics • Packaging – Material must be packaged such that it does not become contaminated before reaching patient • Bags. etc. trays. bleach.Sterilization • Moist heat – Autoclave • Dry heat – Oven • Chemicals – Ethylene oxide. . 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. toxic . electronics • 50% of commercial materials are EO sterilized – Flammable. fabrics.

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 (BI’s) – Spores of indicator bacteria (ex. Bacillus subtilis) • Test strip is treated and set for analysis of viability (efficacy of procedure) • Chemical indicators (CI’s) – 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% .