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Colette Schrank
Lecture #1
Learning Objectives
• 1.1. Define the following terms/abbreviations: OSHA,
biohazard, universal precautions, nosocomial infection,
pathologist, medical technologist, medical laboratory
technician, phlebotomist, basal state, “Patient’s Bill of
Rights”.
……combustibility, instability
health…………
• Dispose of sharps
• Dispose of biohazardous materials
• Dispose of non-biohazardous waste
• Wash hands
Waste Removal
• Biohazardous sharps
– lancets, needles, butterfly needles,
syringes, glass slides
– anything that can tear plastic
• Biohazardous material
– Contaminated with blood/body fluid
• Non-biohazardous waste
– Routine non-contaminated waste
Personal Protective Equipment
(PPE)
• Protection from parenteral, mucous
membrane and non-intact skin contact
exposure to BBP
• Examples:
Needlestick Safety and
Prevention Act
• 2001
– Safer needle devices
– Employees to participate in choosing
equipment
Accidental Exposure follow-up
• Flush site (mucus membrane 10 min.)
• Decontaminate area (iodine for 30sec.)
• Report incident
Be directed to employee health (medical
treatment, evaluation, and counseling)
Employee tested for HIV/HBV
Source tested for HIV, HBV, HCV
If source is positive for HIV or HBV,
evaluation takes place at following intervals: 6
weeks, 12 weeks, 6 months
ZT administration & HBIG (there is
no HCV prophylaxis)
If source is positive for HCV, baseline
Universal Precautions
• Mandated by OSHA for HCW
• Assumes that blood and certain body
fluids of all patients are contaminated
• HBV, HCV, HIV – infections of
greatest concern to HCW
• Disease transmission through contact
with blood and certain body fluids
Bloodborne Pathogens
• HBV, HCV, HDV (hepatitis)
• HIV (AIDS)
• Cytomegalovirus (CMV)
• Creutzfeldt Jacob (CJ) virus
• Treponema pallidum (syphillis)
• Plasmodium (malaria)
Body Substance Isolation
• Assumption that ANY body fluid is
contaminated
• Focuses on moist substances
– Blood, urine, saliva, feces, sputum, wound
drainage and other body fluids
• More encompassing than UP
• STOP sign outside patient’s door
Standard Precautions
• Apply to blood and all body fluids,
fluids
except sweat
• Apply to non-intact skin
• Apply to mucous membranes
Transmission-based Precautions
• Adjunct to Standard Precautions
• Category specific
– Airborne
– Droplet
– Contact
Transmission-based: Airborne
Transmission-based: Droplet
Transmission-based: Contact
Infection
• Invasion of a body by a foreign
substance causing injury or disease
staff infection
yeast
infection
HPV infection
What constitutes “Infection”
• Invasion of a body by a microorganism,
usually a pathogen, resulting in injury or
disease
• Micro-organisms include: bacteria, viruses,
fungi, protozoa
• Could be caused by non-pathogen if
systemic conditions are favorable to infection
• Could be local:
local restricted to a small area of
the body
• Could be systemic:
systemic entire body is affected
Infection
• Source: pathogen or infectious microbe
• Mode of transmission: a way for the microbe
to get from one place to another
• Susceptible host
– Infants
– Elderly
– Immunocompromised
– Overmedicated
– Undernourished
Source
• Escherichia coli, E. coli
Mode of transmission
• Fecal/oral (unwashed fruit)
Susceptible Host
• Most at risk: infants, children and
elderly
• Immunocompromised patients
– Surgical pts
– Debilitated pts
• Overmedicated patients
Infection dependent on:
• Amount of contamination
• Viability of organism
• Virulence
• Time lapse between contact and
contamination of host
Break chain of infection by:
• Eliminate the source
• Disrupt the means of transmission
• Reduce susceptibility (stay healthy, eat
right)
Nosocomial Infection
• Where acquired? in a healthcare facility
• How Many? infecting ~10% of hospital
patients
• Deaths - 20,000 patients/year
• Sites: Urinary tract, surgical, respiratory
• Etiologic agents:
– Enterococcus
– E. coli
– Pseudomonas sp.
– Staph aureus
Staphylococcus aureus
• Normal skin flora
• Can cause serious infection
• Surgical wounds, respiratory infections
Methicillin Resistant Staphylococcus aureus:
MRSA
• “super staph”
• commonly on skin
• pathogenic when it becomes systemic
• more virulent strains in places of poor
hygiene
• Tx: vancomycin, teicoplanin and Rifampin
Vancomycin-intermediate Staphylococcus aureus:
VISA
• Uncommon but emerging nosocomial
problem
• Treatment varies; may be susceptible to
gentamicin, tetracycline, and
quinupristin-dalfopristin
Vancomycin resistant staphylococcus aureus:
VRSA
• Specific type of antimicrobial staph
• Not successfully treated with
vancomycin
• VISA and VRSA uncommon – rare at
this time
• Best prevention: handwashing
• Tx: trimethoprim/sulphmethoxazole,
minocycline, linezolid, quinupristin-
Clostridium difficile: C diff
• Disease specific
• Patient is unconscious:
– Ask for help and explain purpose, patient
may still move.
Special situations
• Patient is with doctor or clergy:
– plan to come back later since time with
these individuals is limited unless a timed
test or stat then ask permission to obtain
sample.
Special situations
• Patient not in room:
– Attempt to find the patient, especially timed
tests or stat must be searched out if possible
or document.
• Patient refusal:
– even though the patient has the right to
refuse, gentle persuasion may possibly achieve
cooperation; explain importance of the lab
order, ask a nurse or doctor explain; if unable
to obtain specimen, document and let nurse
Special situations
• Handling family or visitors
– ask family to be of assistance, it will keep
patient more at ease unless they are not
willing to cooperative or be helpful
Preparation for testing
• Bedside manner- gain patient trust and
respect
• Handling difficult patient- remain calm
and professional, treat patient w/ care
and respect
• Explain procedure- give brief
explanation. If language barrier exist,
find translator or use sign language
• Handling inquiries- refer patient to
doctor.
• Refusal, see above, try to convince
patient but never force them.
• Verify restrictions, diet, movement,
requirements for med (i.e. Digoxin-6hrs
post dose).
• Proceed with collection.
Patient’s Bill of Rights
• passed in 1973 by American Hospital
Association
• A patient has the right to know your
name and purpose of visit. You can
answer simple questions but must refer
complex specific questions to their
physician.
Patient’s Bill of Rights
• Have the right to be treated with
RESPECT.
RESPECT
• Have the right to their test RESULTS.
RESULTS
• Have the right to REFUSE treatment.
• Have the right to CONFIDENTIALITY.
CONFIDENTIALITY