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1 Chapter 10 Infection Control Paradigm Publishing Inc 2 Identifying and Controlling the Source of Infection The development of the germ theory of disease Microorganisms and disease Asepsis and sterilization ID: 784681

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Slide1

© Paradigm Publishing, Inc.

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Chapter 10

Infection Control

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Identifying and Controlling the Source of Infection

The development of the germ theory of diseaseMicroorganisms and disease

Asepsis and sterilization

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The Development of the Germ Theory of Disease

The cause of infectious diseases was not fully understood until recently.Disease was attributed to evil influences.

Knowledge of infectious disease progressed slowly over the centuries.

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Terms to Remember

germ theory of disease the idea that microorganisms cause diseases

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The Development of the Germ Theory of Disease

Pasteur developed a heating process to kill bacteria and mold in milk (pasteurization). Pasteur proposed that disease could be prevented by not allowing microorganisms to enter the body.

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Terms to Remember

pasteurization

a sterilization process designed to kill most bacteria and mold in milk and other liquids

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The Development of the Germ Theory of Disease

English surgeon Joseph Lister built on Pasteur’s work:

He knew that carbolic acid killed bacteria, so he used it to disinfect surgical dressings.

He developed other antiseptic methods for surgery.

His sterile surgical techniques reduced post-surgical infections and saved thousands of lives.

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The Development of the Germ Theory of Disease

Robert Koch defined a series of steps (Koch’s Postulates) that could prove that a certain disease was caused by a certain microorganism (1876).

He conducted research on cattle infected with anthrax:

Cultured bacteria in the lab

Infected healthy animals with it

Found the same bacteria in the blood of the infected animals

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Terms to Remember

bacterium a small, single-celled microorganism that can exist in three main forms, depending on type: spherical (cocci), rod-shaped (bacilli), and spiral (spirochetes)

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Microorganisms and Disease

Bacteria cause a variety of illnesses:

Food poisoning

Strep throat

Ear infections

Rheumatic fever

Meningitis

Pneumonia

Tuberculosis

Pinkeye

Acne

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Microorganisms and Disease

Virus – a microorganism consisting of genetic material encased in protein

Needs a living host in order to reproduce

Causes many illnesses

Colds and influenza

Mumps and measles

Chickenpox

Hepatitis

HIV

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Terms to Remember

virus a minute infectious agent that does not have all of the components of a cell and thus can replicate only within a living host cell

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Microorganisms and Disease

Fungus – a parasite that reproduces slowly by means of sporesCan occur as

Molds

Mildews

Mushrooms

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Terms to Remember

fungus a single-celled organism similar to human cells; marked by the absence of chlorophyll, a rigid cell wall, and reproduction by spores; feeds on living organisms (or on dead organic material)

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Microorganisms and Disease

Molds can be beneficial – source of penicillin

Can also cause conditions such as

Athlete’s foot

Ringworm

Vaginal yeast infections

More serious systemic fungal infections in the hospital

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Microorganisms and Disease

Protozoa – a microscopic organism consisting of one cell or a group of identical cells

Live in water or inside other creatures as parasites

Examples include paramecia and amoeba

Can cause dysentery, malaria, and sleeping sickness

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Asepsis and Sterilization

Before scientific control of harmful microorganisms, epidemics and pandemics killed millions of people:

Bubonic plague killed 137 million Europeans.

European diseases such as smallpox decimated Native American populations.

One quarter of delivering mothers died of infections carried by hands and instruments of nurses and physicians.

Influenza epidemic of 1918 killed over 25 million people worldwide.

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Asepsis and Sterilization

Asepsis is the absence of disease-causing microorganisms.

Sterilization is any process that destroys microorganisms.

There are several types of sterilization:

Heat

Dry heat

Mechanical

Gas

Chemical

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Terms to Remember

asepsis the absence of disease-causing microorganisms

sterilization

a process that destroys the microorganisms in a substance, resulting in asepsis

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Asepsis and Sterilization

Boiling kills vegetative forms, many viruses, and fungi in about 10 minutes.More time is needed to kill fungus spores and the hepatitis virus.

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Asepsis and Sterilization

An autoclave sterilizes with heat(270° F) and pressure (15 psi).Most known

organisms are

killed in about

15 minutes.

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Terms to Remember

autoclave a device that generates heat and pressure to sterilize

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Asepsis and Sterilization

Dry heat (such as direct flaming) kills all organisms:Impractical for many substances

Used for disposal of contaminated objects

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Asepsis and Sterilization

Mechanical sterilization is achieved by means of filtration.It is used for heat-sensitive materials:

Culture media

Enzymes

Vaccines

Antibiotic solutions

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Asepsis and Sterilization

Gas sterilization is used for materials subject to destruction by heat:Uses ethylene oxide

Requires special equipment and aeration

Used only in large institutions and manufacturing facilities

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Asepsis and Sterilization

Chemical sterilization usually does not produce complete sterility.

It reduces microbial numbers to safe levels.

Chemicals used for sterilization are known

as disinfectants

.

Commonly used topical disinfectants include

Iodine

Isopropyl alcohol (IPA)

Chlorinated bleach

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Terms to Remember

disinfectant a chemical applied to an object or topically to the body for sterilization purposes, such as rubbing alcohol

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Contamination

Prevention of contamination in the preparation of IV products is crucial.

Contaminated IV solution can cause serious infection or death.

Contamination can occur by

Touch

Air

Water

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Touch

Millions of bacteria live on the skin and hair and under the nails.Touching is the most common means of contamination and the easiest to prevent.

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Touch

Hand washing and use of gloves and head coverings minimize touch contamination.

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Air

Microorganisms are found in the air, dust particles, and moisture droplets.Sterile materials should be prepared in an area designed to keep contaminants to a minimum.

Special equipment is used to control airflow and minimize contamination.

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Water

Tap water contains microorganisms.Moisture droplets (especially from a sneeze or cough) contain harmful microbes.

Sterile materials must not be exposed to contaminated water.

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The Centers for Disease Control and Prevention

CDC is a federal agency that provides guidelines and recommendations on infection control.A major focus of the CDC has been to prevent transmission of infectious diseases in the hospital.

CDC updates and publishes guidelines to protect patients and healthcare workers from infectious diseases.

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Hand Hygiene

Hand washing and hand hygiene are the most important practices to prevent touch contamination.

Hand washing involves using plain or antiseptic soap and water.

Hand hygiene involves using special alcohol-based rinses, gels, or foams that do not require water.

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Terms to Remember

hand washing the use of plain or antiseptic soap and water with appropriate time and technique

hand hygiene

the use of special dry, alcohol-based rinses, gels, or foams that do not require water

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Hand Hygiene

Effectiveness of hand hygiene depends onTechnique Presence of artificial fingernails and jewelry (both can harbor microorganisms)

Proper hand hygiene technique is used only about 40% of the time.

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Gloves

CDC recommends the use of gloves for workers in the IV area.

Gloves are important because hand washing alone may not prevent the transmission of microorganisms.

Gloves are usually made of latex or vinyl, but because some people are sensitive to latex, an alternative should always be available.

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Vaccination

CDC recommends that healthcare workers get an annual flu shot.

Flu shots protect the workers, their families, and the patients.

Flu shots are between 70% and 90% effective.

Only about 40% of healthcare workers get a flu shot each year.

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USP Chapter 797 Standards

USP developed first official and enforceable requirements for sterile preparation compounding (2004).Requirements were updated and approved in 2008.

USP Chapter 797 focuses on sterility and stability.

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Terms to Remember

compounded sterile preparation (CSP) a sterile product that is prepared outside the pharmaceutical manufacturer’s facility, typically in a hospital or compounding pharmacy

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USP Chapter 797 Standards

Standards for sterile compounding are more stringent than for nonsterile compounding:Must work in a defined clean-room environment

Additional rules for garbing

Personnel training and testing in aseptic techniques

Specifications for environmental quality

Rules for disinfection of gloves and surfaces

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Environmental Qualityand Standards

Compounding facilities are designed and controlled to minimize airborne contaminants.

797 standards use the ISO classification system for defining the amount of particulate matter allowed in room air.

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Environmental Qualityand Standards

Sterile compounding area is divided into three main parts:

Ante area

Buffer area

Direct

compounding

area (DCA)

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Terms to Remember

ante area (ante means before)

the area of the IV room used for hand washing and donning protective garments, among other high-particulate-generating

activities

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Terms to Remember

buffer area the area of the IV room used for the storage of components and supplies (such as IV bags and administration sets) that are used for compounding CSPs; also area for hand hygiene and donning protective gloves

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Terms to Remember

direct compounding area (DCA) the sterile, compounding area of the IV room, in which the concentration of airborne particles is controlled with a HEPA filter providing ISO Class 5 air quality

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Environmental Qualityand Standards

Ante area activitiesPersonnel hand washing and garbing

Staging of components

Order entry

CSP labeling

Ante area air quality should be at ISO Class 7 or 8.

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Environmental Qualityand Standards

Buffer area is where CSP supplies are stored.

Buffer area air quality should be no more than ISO Class 7.

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Environmental Qualityand Standards

Staging area outside the compounding workbenches should have an air quality of ISO Class 5.

Compounding is performed in the most sterile area (the DCA) under laminar airflow workbenches (LAFW).

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Environmental Qualityand Standards

The buffer area and the direct compounding area together comprise the clean room.

Air quality is controlled with a high-efficiency particulate air (HEPA) filter system.

The clean room is physically segregated from the rest of the pharmacy.

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Terms to Remember

clean room an area that includes the buffer and staging areas and the sterile, direct compounding area (DCA) of the IV compounding lab

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Terms to Remember

high-efficiency particulate air (HEPA) filter a device used with laminar flow hoods to filter out most particulate matter to prepare parenteral products safely and aseptically

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Environmental Qualityand Standards

No food, drink, or chewing gum is permitted in the compounding lab.

No long-term storage is permitted in the clean room.

Only specific items needed for sterile compounding can be taken into the DCA.

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Special Equipment

Laminar airflow workbenches (LAFW) are crucial for maintaining air quality in the clean room.Horizontal laminar airflow workbench is used to prepare nonhazardous CSPs.

Vertical laminar airflow workbench is use to prepare hazardous CSPs.

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Special Equipment

In a horizontal LAFW, air flows from the back of the hood, across the work surface, and out into the room.

Air is filtered with

a HEPA filter,

which removes

99.97% of particles

0.3 microns

or larger.

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Terms to Remember

horizontal laminar airflow workbench (LAFW) a special biological safety cabinet used to prepare IV drug admixtures, nutrition solutions, and other parenteral products aseptically

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Special Equipment

In a vertical LAFW, air flows from the top of the hood down through a prefilter and a HEPA filter, onto the work

surface, and is

then circulated

through another

HEPA filter and

vented outside.

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Terms to Remember

vertical laminar airflow workbench (LAFW) a special biological safety cabinet used to prepare hazardous drugs, such as cancer chemotherapy drugs, aseptically

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Special Equipment

Coughing and talking should be directed away from the hood and workbench.

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Special Equipment

Technicians using a vertical LAFW should wear eye protection, a mask, and proper apparel.

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Special Equipment

Routine cleaning of LAFWs is an important responsibility of the IV technician.The entire LAFW should be cleaned with 70% IPA daily.

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Special Equipment

The technician should wear full protective clothing while cleaning LAFWs.

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Personnel Cleansingand Garb

Personnel must remove all outerwear before entering the ante area.Cleansing process starts with hand washing and putting on protective garb.

Process continues with hand hygiene in the buffer area.

Gloves are the last step.

For hazardous materials, extra protection includes eye protection and double gloving.

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Contamination Risk Levels

Risk levels are assigned to each CSP based on the probability of microbial, chemical, or physical contamination.Risk level can be

Low

Medium

High

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Contamination Risk Levels

Low-risk CSPs include sterile products that have been handled using aseptic techniques.Low-risk CSPs also include the transfer, measuring, and mixing of CSPs containing three or fewer ingredients.

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Contamination Risk Levels

Medium-risk CSPs include multiple sterile products combined using automated devices or transferred from multiple sterile containers into one final sterile container.Examples include TPN solutions containing more than three electrolytes or vitamins.

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Contamination Risk Levels

High-risk CSPs include

Products that have been compounded from nonsterile ingredients

Sterile products without preservatives

Sterile products exposed to inferior air quality

All high-risk CSPs must be sterilized by using

A 0.22 micron filter

Autoclaving

Dry heat

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Terms to Remember

expiration date the date after which a manufacturer’s product should not be used

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Training Requiredto Work with CSPs

Extensive skills and training are necessary to practice in a clean room.

Written tests and skill assessments must be passed.

The technician may be encouraged or required to acquire additional certifications for sterile compounding.

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Terms to Remember

infection control committee (ICC) a committee of the hospital that provides leadership in relation to infection control policies

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Terms to Remember

nosocomial infection an infection caused by bacteria found in the hospital from any source that causes a patient to develop an infectious disease; also called healthcare-associated infection (HAI)

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Infection Control Committee

Primary role is to prevent, identify, and control nosocomial infections as well as infections brought into the hospital from the community.

Committee plays a major role in ensuring that the hospital is in compliance with Joint Commission, CDC, and USP Chapter 797 standards.

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Infection Control Committee

Sets infection control policy and is involved in planning, monitoring, evaluating, updating and educating

Surveillance of nosocomial infections

Antibiotic and other product evaluations

Investigation of infection outbreaks and infection clusters

Development of infection control procedures

Patient education regarding medical waste management

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Infection Control Committee

Hospital is also responsible for protecting workers from contracting infectious diseases from patients.

ICC educates all hospital employees about the importance of following procedures to minimize employee exposure.

Universal precautions are procedures followed in all healthcare settings to prevent infection.

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Terms to Remember

sharp a used needle, which can be a source of infection

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Terms to Remember

universal precautions procedures followed in healthcare settings to prevent infection as a result of exposure to blood or other bodily fluids