Safety and Infection Control Nosocomial/ Healthcare Acquired Infections

 Nosocomial Infection: used to designate an

infection acquired by a patient during hospital
Definition of Terms
stay
Biological Hazards: substance that poses a threat o Common Nosocomial Infections
to the health of living organisms, primarily humans  Urinary Tract Infections: catheter associated
 Respiratory Pneumonia: ventilator associated
Infection Control: procedures to control and o Common Pathogens Associated in N.I.
monitor infections occurring within their facilities  Staphylococcus aureus, Pseudomonas
aeruginosa, Escherichia coli, Acinetobacter
Chain of Infection: requires a continuous link baumanii, C. difficile and coagulase-negative
between 6 components staphylococcus
 Healthcare-acquired Infection: an infection
Six Components of Chain of Infection acquired by a patient as a result of healthcare
procedure that may or may not require a hospital
 Infectious Agent stay
o bacteria, fungi, parasites and viruses
o breaking the chain: early detection and Transmission Prevention Procedures
treatment of infectious agents
 Reservoir preventing transmission of microorganisms from
o a place where infectious agents can live and infected reservoirs to susceptible hosts is critical
possibly multiply like humans, animals, in controlling the spread of infection
equipment and soiled objects
Procedures used to prevent transmission
o breaking the chain: disinfecting work
 hand hygiene
areas
 wearing of PPE
 Portal of Exit  isolation of highly infective or highly susceptible
o phlebotomist provides a portal of exit when they patients
collect blood
 proper disposal of contaminated materials
o breaking the chain: disposing of needles and
 strict adherence to the guidelines published by
lancets in sealed, sharp containers and other
Center for Disease Control and the
contaminated materials in biohazard containers
Occupational Safety and Health Administration
and keeping tubes and sample containers
sealed Hand Hygiene
 Means of transmission
o infectious agent has a way to reach a  includes both hand washing and the use of
susceptible host through: alcohol-based cleansers
 direct contact: unprotected host is touched  alcohol-based cleansers are recommended
by the reservoir after contact with spore-forming bacteria
 droplet: host inhales material from reservoir including Clostridum difficle (major cause of
such as aerosol droplets from infected person HAI) and Bacillus sp.
 airborne: inhalation of dried aerosol nuclei
circulating on air currents or attached to dust
particles
 vehicle: ingestion of contaminated food or
water
 vector: parasites such as malaria transmitted
by a mosquito bite
o breaking the chain: hand washing, Standard
Precautions and Transmission-based
Precautions
 Portal of Entry
o portal entry can be the same as portal of exit
(mouth, mucous membranes, and open
wounds)
o breaking the chain: disinfection and
sterilization, and strict adherence to Standard
Precautions and Transmission-based
Precautions
 Susceptible Host
o can be the patient or the health care provider
o may be: patients undergoing chemotherapy,
immunocompromised patients, newborns (0-2
months old), infants (2 months- 1 year old),
senior citizens  Best time to do Hand Washing?
o breaking the chain: observation of special o before patient contact
precautions when working in the nursery and in o when gloves are removed
isolation rooms (ICU patients or oncology dept.) o before leaving the work area
o at any time when they have been knowingly
contaminated
o before going to designated break areas
o before and after using bathroom facilities
 Handwashing Technique
o antimicrobial soap, paper towels, running water,
and waste container
o (1) Wet hands with warm water; don’t touch the
sink
o (2) Apply soap
o (3) Rub hands. Thoroughly clean between
fingers and under fingernails at least 20 secs;
include thumbs and wrists in cleaning
o (4) Rinse hands with water in a downward
position
o (5) Dry hands thoroughly with a single use
towel
o (6) Turn off faucet using used towel
Personal Protective Equipment
 Gloves: worn to protect hands from
contamination
o Latex Allergy: reaction to latex include irritant
contact dermatitis (dry, itchy irritation on
hands); replace with nitrile or vinyl gloves
 Delayed Hypersensitivity: resembles poison
ivy
 True Immediate Hypersensitivity: often
characterized by respiratory difficulty
 Gowns: worn to protect clothing and skin;
fluid-resistant gowns should be worn when
the possibility of encountering splashes is
anticipated
 Masks: worn to protect against inhalation of
droplets containing microorganisms from
infective patients
 Goggles: worn to protect mucous
membranes of mouth, nose, and eyes
 Face Shields: protect mucous membranes
from splashes; additional layer of protection
 Respirators: required when collecting blood
from patients who have airborne diseases
Donning PPE
 (1) Handwashing/Hand rubbing
 (2) Put on inner gloves
 (3) Put on the gown, first tied at the neck and
waist.
 (4) Put on mask
 (5) Put on face shield
 (6) Put on outer gloves
Doffing PPE
 (1) Hand hygiene
 (2) Remove outer gloves
 (3) Hand hygiene
 (4) Untie and remove gown
 (5) Hand hygiene
 (6) Remove face shield
 (7) Hand hygiene
 (8) Remove inner gloves
 (9) Hand hygiene
 (10) Remove mask
 (11) Hand hygiene
 (12) Wear new mask
Standard Precautions
 developed by CDC by combining the
recommendations of Universal Precautions and
Body Substance Isolation procedures
 assume that every person in the healthcare
setting is potentially infected
Transmission-Based Precautions
 guidelines for isolation practices and have been
periodically revised
 can find these guidelines regarding PPE posted
on the outside doors to isolation rooms
 Classifications
 Airborne precautions: when microorganisms
can remain infective while being carried through
the air on the dried residue of a droplet or on a
dust particle
 Droplet precautions: for persons infected with
microorganisms that can be transmitted on moist
particles (coughing and sneezing)
 Contact precautions: for infections that can be
transmitted by direct skin-skin contact or by
indirect contact
Phlebotomy Procedures in Isolation
 samples taken from the room should be cleaned
of any blood contamination and placed in plastic
bags located near or just outside the door
Protective/ Reverse Isolation
 may be required for severely burned patients,
patients receiving chemotherapy, and organ and
bone marrow transplant patients and in the
nursery
 PPE worn by phlebotomists: gowns, gloves, and
masks
Biohazard
 expose an unprotected individual to bacteria,
viruses, parasites, or other biological entities that
can result in injury
 exposure occurs from ingestion, inoculation,
tactile contamination, or inhalation of infectious
material
 contaminated equipment and supplies must be
disposed in containers clearly marked with the
biohazard symbol or red or yellow color coding
 urine can be poured out in the lab sink; disinfect
nondisposable equipment with 1:10 dilution of
sodium hypochlorite prepared weekly in a plastic
bottle
Chemical Hazards
 may come in contact while accessioning or
processing samples in the lab and preparing
containers for urie samples
 chemicals should never be mixed together unless
specified and must be added in the order
specified (acid into water)
 all chemicals and reagents containing hazardous
ingredients in concentration >1% are required to
have a Material Safety Data Sheet on file
Sharp Hazards
 exposure to bloodborne pathogen due to
accidental puncture
 never recap a needle
 Bloodborne Pathogens: HIV, HBV, HCV,
syphilis, malaria, other viral diseases
 o HIV: attacks human immune system by infecting  the National Fire Protection Association (NFPA)
and destroying the T-lymphocyte subset CD4; classifies fire according to type of burning
can progress from HIV to AIDS material and the fire extinguisher used to control
o HBV: attacks the liver causing mild to severe them
chronic disorders; may develop jaundice  Multipurpose ABC fire extinguishers: most
o HCV: also attacks the liver and now the leading common but label should always be checked
bloodborne pathogen cause of chronic liver before using
disease progressing to cirrhosis and liver o PASS: Pull, Aim, Squeeze, Sweep
cancer
 Enforcement Procedure for the Occupational Types of fire and Fire Extinguishers
Exposure to Bloodborne Pathogen Standard:
placed emphasis on the use of engineering
controls to prevent accidental exposure to
bloodborne pathogens
 Postexposure Prophylaxis: initiated within 24
hours of accidental exposure to blood

Components of the OSHA Bloodborne

Pathogen Standard

Engineering Controls: sharp disposal containers;

discarding of needles w/ activated safety device
and holder attached; proper labelling

Work Practice Controls: practice Standard

Precautions; no eating, drinking, smoking, etc.;
daily disinfection

PPE: provide PPE for employees

Medical: immunizations; medical follow-up to

employees

Documentation: annual training in safety

standards; evaluation & implementation of safety
devices; involve employees in selection &
evaluation of new devices; maintain sharps injury
log
Radioactive Hazards
 while drawing blood from patients in the radiology
dept. or from patients receiving radioactive
treatments and, in the lab
 exposure to radiation is dependent on the
combination of time, distance and shielding
 persons working in a radioactive environment
wear measuring devices to determine amount of
radiation they are accumulating; they also wear
LED gown/aprons
Physical Hazards
 agent, factor or circumstance that can cause
harm with contact
 classified as type of occupational hazard or
environmental hazard
 Avoid running in rooms and hallways
 Be alert for wet floors
 Bend the knees when lifting heavy objects or
patients
 Keep long hair tied back and removed dangling
jewelry
 Wear comfortable, closed-toes shoes with
nonskid soles
 Maintain a clean, organized work area.

Electrical Hazards

 healthcare setting contains a large amount of

electrica
 l equipment with which phlebotomists are in
contact
 electrical equipment are closely monitored by
designated hospital personnel but phlebotomist
should always be observant for any dangers

Fire/Explosive Hazards

 Joint Commission requires that all healthcare

institutions have posted evacuation routes and
detailed plans to follow
 Initial Steps to follow
o Rescue anyone in immediate danger
o Alarm: activate institutional fire alarm system
o Contain: close all doors to potentially affected
areas
o Extinguish/ Evacuate: extinguish fire if
possible, or evacuate, closing the door