The ABCs of Infection Control
By Melba Rhodes, RN, BSN
Practicing aseptic technique, good body hygiene and developing a caring attitude comprise the ABCs of infection control. In this article, we will discuss the three major components of Asepsis -- handwashing, disinfection and sterilization -- Body Hygiene -- personal hygiene and dress code -- and a Caring Attitude -- a good sense of right and wrong essential to the practice of the ABCs of infection control. The ABCs of infection control are fundamental in preventing adverse events.
Infectious diseases may become a major health hazard to healthcare workers and patients. Knowing the hazards and following established guidelines and policies can reduce your and the patient's risk of transmission of infection. Safety guidelines are established for a reason -- to protect you, the employee and the patient. Even though at times some policies may seem to take too much time, if you consider the risks of not following these guidelines, you will realize the importance of the measures to help protect you and provide a safe and healthy workplace.
A person entering the hospital or clinic with an infectious disease, such as AIDS or hepatitis B, does not always have this condition diagnosed at the time of admission. The diagnosis may not be made until 2-3 days after admission, after several visits, until the patient is discharged or not at all (if the person is an asymptomatic carrier). To protect yourself, you must consider all patients to have an infectious disease or, in other words, universally apply the same precautions to all body substances regardless of the source patient.
The first letter in our ABCs of infection control is "A", or asepsis. Practicing asepsis is a vital part of infection control practices. Handwashing, disinfection and sterilization are key parts of asepsis.
Definition: Aseptic technique can be defined as all the measures we take to purposefully reduce the number of microorganisms (germs) to an irreducible number for the purpose of preventing transmission of infection. These include handwashing, disinfection and sterilization.
There Are Many Levels of Asepsis
The strictness (or level) of aseptic technique increases as you perform more invasive procedures. For example, taking a blood pressure requires only clean technique, while starting an IV requires sterile technique. The most invasive procedures (entering a sterile body cavity) require sterile technique.
Disinfection: Removal of most pathogens (or disease-causing organisms) by the use of friction (cleaning) and a use of a disinfectant.
- Clean high-touch items with a disinfectant frequently (bed rails, door knobs, over-the-bed tables, faucet handles, phones, etc.).
- Use warm (not hot) water for mopping; hot water may burn someone if splashed and may strip the wax on floors when a "quat" is used.
- Do not use a phenol in food preparation areas or on an infant crib/bassinet. Phenols are toxic if ingested and may harm an infant. Use a sanitizer in food preparation areas.
- Check the label for "contact time," the amount of time the item must remain wet with the disinfectant to "kill" most of the pathogens, usually 10 to 20 minutes.
- Dirt and soil inactivate disinfectants, so clean the area first. Then reapply a fresh layer of disinfectant and allow the area to remain wet for the contact time.
Sterilization: The highest level of asepsis is defined by the removal of all microorganisms. It is achieved by autoclaving or by another sterilization process. Items must be thoroughly cleaned before sterilization can occur.
- Reserved for instruments and other objects that enter sterile parts of the body.
- When entering a sterile body cavity, skin antisepsis is needed with a skin antiseptic such as CHG or Betadine.
- When opening sterile packets, make sure the sterilization indicators are changed. If not, report to Central Supply and do not use the item(s). All packages in that load need to be recalled.
- Sterile items should remain sterile; protect the sterile field.
Microorganisms Live in And on Our Bodies
Transient: Transient microorganisms are easily picked up on hands, clothing, inanimate objects, etc., and are easily removed by handwashing and cleaning (physical removal of "germs"), antisepsis and disinfection. Antisepsis (or handwashing and pre-op skin preparation) is the removal of transient microorganisms from the skin with a reduction in the resident flora.
Resident or Normal Flora: Those microorganisms that are constantly present on our bodies; no amount of scrubbing will totally remove them (the skin cannot be made sterile). These organisms cause "trouble" when introduced into normally sterile areas (like the bladder or bloodstream).
Pathogens: Microorganisms that nearly always produce disease. For example: Salmonella and Shigella cause diarrheal illness upon ingestion of enough organisms. Normal flora can become pathogens when introduced into areas where they don't belong, for example, through insertion of a catheter or through surgery. Staph epidermis, normal flora of the skin, causes most central line infections and hip implants.
The Seven Keys of Asepsis
1. Know what is clean
2. Know what is contaminated
3. Know what is sterile
4. Keep clean, contaminated and sterile items separated
5. Keep sterile sites sterile
6. Resolve contamination immediately
7. Train yourself to realize when you have broken technique
Know what is clean: Clean techniques are any procedures that involve contact with intact skin or mucous membranes only. For example, when you are taking blood pressure or temperature, these articles need to be clean only.
Know what is contaminated: Certain procedures like dressing changes produce contaminated materials. These contaminated materials must be disposed of properly by incineration or autoclave. Touching non-intact skin is a contaminated procedure; wear clean gloves unless a sterile procedure (like a dressing change) is being done.
Know what is sterile: During certain procedures (for example, the insertion of an IV or urinary catheter), sterile technique should be used. The level of sterile procedures increases with the level of invasiveness. For example, surgical procedures require stricter aseptic technique than starting an IV. Sterile gloves are required for sterile procedures.
Keep clean, contaminated and sterile items separated: Keep contaminated articles from touching clean or sterile items. Store clean and sterile items separately from contaminated areas or items. Keep sterile items from touching anything but a sterile field or another sterile item.
Keep sterile sites sterile: Once a tube has been inserted into the body, care must be given to mitigate the travel of microorganisms up the catheter or tube. Give dressing changes or catheter care and replace catheters per your facility's policy and procedure.
Resolve contamination immediately: If sterile technique cannot be used (during an emergency) or is broken, resolve contamination when it occurs. For example, if an IV is inserted during an emergency, replace the IV as soon as possible after the code is completed.
Train yourself to realize when you have broken technique. If a technique is broken, remedy the problem if possible. For example, if during the insertion of an IV the catheter is contaminated (by dropping on floor, etc.), replace the catheter before insertion. If contamination cannot be resolved, report it to the proper person. For example, if the bowel is nicked during surgery, the case classification will change from clean contaminated to contaminated and extra care should be given to prevent infection.
There Are Three Methods of Transmission of Infection
Direct: Contact with a patient's blood and body fluid, secretions or excretions or by contact with items soiled with these substances (example: over-the-bed table, instruments, etc.).
Indirect: Contact with food/drink or vermin.
a. Vehicle: Contaminated food, water or article (VRE, Hepatitis A, Salmonella).
b. Vector: Rats, roaches or insects (malaria, plague, hantavirus, West Nile virus). Vector is an uncommon means of transmission of nosocomial infections; in other words, "two-legged rats" (or humans) transmit more infections in the hospital than those with four legs!
c. Airborne: Transmitted through bacteria contained in dust particles that remain airborne for long periods of time (chicken pox and tuberculosis). These diseases are highly infectious. A mask is needed for protection from these diseases. A special respirator is needed for tuberculosis.
Handwashing is the single most important means of preventing the spread of infection. Handwashing is a critical part of asepsis.
Handwashing is stressed in the following areas: (This is not an all-inclusive list. Use your own conscience when washing hands.)
1) Before and after performing invasive procedures, whether or not sterile gloves are worn.
2) Before and after contact with wounds, whether surgical, accidental, or associated with an invasive device (e.g., an intravenous cannula entrance wound) whether or not sterile gloves are worn.
3) Before contact with particularly susceptible patients.
4) After contact with a source that is likely to be contaminated with virulent microorganisms or hospital pathogens, such as an infected patient or an object or device contaminated with secretions or excretions from patients (e.g., a urinary catheter system).
5) Between giving care to different sites of the body (e.g., measuring urine and giving IV site care).
6) Between direct contacts with different patients.
7) Before and after your shift.
8) Before and after eating, drinking or handling food.
9) After using the toilet, coughing or sneezing.
10) Whenever hands are visibly soiled.
Antiseptics (such as CHG, PCMX, Triclosan, Betadine) should be used when performing invasive procedures, upon entering and leaving isolation rooms and in special care units (i.e., ICU, Nursery, Surgery).
Antiseptic alcohol solutions may be used when handwashing facilities are not convenient, after casual contact with a patient (such as taking a pulse), but not when hands are visibly soiled. Rub hands together in the same manner as when washing hands. Allow to air dry. After approximately 10 applications, you may notice a buildup on hands. Simply remove by washing with soap and water.
Friction is the most important part of handwashing. Rub for 10 to 15 seconds. Be sure to cleanse under and around nails and rings and backs of fingers. Rinse and dry hands adequately. Use a paper towel to turn off the faucet.
1. Rinsing hands thoroughly and carefully drying hands will help to prevent chapping and cracking of hands. Pat hands dry. Roughly drying hands removes the top layer of your protective skin.
2. In patient care areas, use only hospital approved lotion in pump dispensers. Petroleum-based products (such as Vaseline Intensive Care) degrade latex. Most hand lotions inactivate the antimicrobial residue left on hands by agents such as chlorhexidine gluconate (CHG). A pump dispenser helps to protect the lotion from contamination.
3. In clinical areas, keep fingernails short and unpolished. Germs "hide" in the cracks in polish and under long or false nails and have been established as a link to transmission of infection. You can get naturally "polished" nails using a four-step buffing file. A good rule of thumb for nail length is to hold your hands with the palm side to you. If your nails are visible over your fingers, your nails are too long.
BODY HYGIENE AND DRESS CODE
The next letter of the ABCs of infection control is "B," or "Body Hygiene." Body hygiene is an extension of handwashing. Keeping clean and looking great help to form an atmosphere conducive to the practicing of asepsis and the ABCs of infection control.
Scrub Attire Dress Code
Wearing of scrub attire is usually designated as mandatory for the control of infection in the operating room. However, some operating rooms have recently allowed home laundering of scrub attire as a sterile gown is used to cover the uniform during the surgical procedure.
Wearing of scrub attire (as uniforms) is usually permissible in other areas but not necessary for infection control purposes.
Follow Good Habits of Personal Hygiene
- Bathe or shower daily.
- Keep your hair clean.
- Cover, pull back or wear a hairnet for long hair at work.
- Keep nails trimmed and clean.
- Wear clean clothes every day.
- Keep jewelry and cologne to a minimum.
- Wash your uniform separately from household laundry.
- in exposure prone areas: dietary, clinical personal
Scrub Attire "Rules"
Do not enter a restricted area without proper attire.
Shoe covers, masks and head covers are not to be worn outside your work area (usually your department or the isolation room). Dispose of properly before leaving the area.
Know and Follow Your Department Dress Code
- Some departments have special dress codes.
- Wear your identification badge.
- Wear clean lab coats and shoes.
Maintain Good Health
If you maintain good health, you will be less likely to get and transmit infections.
- Eat a balanced diet.
- Get enough sleep.
- Exercise regularly.
- Practice healthy stress reduction measures.
The last letter in our acronym for the ABCs of infection control is "C," or a Caring Attitude. A caring attitude will be reflected in work practices that support sound infection control principles. Work practices that support the maintenance of aseptic technique and embrace responsibility for each individual's role in Infection Control can only come from staff with caring attitudes. This can be accomplished by fostering a team approach through education and support of the clinician as they perform duties that are pivotal in the prevention and control of infection. Focus should be placed on the last of the ABCs of infection control (focusing on the right and wrong of infection control). Our attitudes should mirror the plan of asepsis -- common sense. By using common sense we can safely protect our patients and ourselves. Use common sense and a caring attitude to develop a good aseptic conscious (or a continuous awareness of asepsis). Your "aseptic consciousness" is your set of internal ideals. We have set ideals (in the form of policies and procedures) to protect our patients and ourselves. Set your ideals at the highest level to give care without doing harm.
The ABCs of infection control -- Asepsis, Body Hygiene and Caring Attitude -- comprise what we should do to help protect our patients and ourselves. Your diligence and common sense is key to protecting yourself, your co-workers and the patient. Handwashing and skin preparation, disinfectant and sterilization, vital parts of asepsis and a caring attitude, are essential to the ABCs of infection control. Infection control is a valuable asset to the facility and it is our responsibility to demonstrate this.
1. Discuss the three major components of asepsis.
2. Discuss handwashing, disinfection and sterilization as they apply to asepsis.
3. Discuss body hygiene -- personal hygiene and dress code.
4. Explore developing a caring attitude -- a good sense of right and wrong essential to the practice of the ABCs of infection control.
TEST QUESTIONS: TRUE OR FALSE T F
1. Handwashing is a major part of asepsis.
2. The highest level of asepsis is sterilization.
3. Most infections transmitted in the hospital are vector-borne.
4. These comprise the ABCs of infection control: practicing aseptic technique, good body hygiene and developing a caring attitude.
5. Contact time is the time it takes for a disinfectant to kill what the label claims it will kill.
6. Asepsis is defined as the absence of bacteria.
7. Disinfection is defined as the total removal of all bacteria.
8. Airborne infections are transmitted by airborne dust particles.
9. Clean high-touch areas frequently.
10 If a sterile items indicator has not turned, report it to Central Supply.
11. Do not use a phenol in a food preparation area.
12. Dispose of protective attire when leaving your work area.
13. Infection control measures are not cost-effective.
14. A special respirator is required for tuberculosis.
15. Sterilization, a vital part of asepsis, means the absence of all bacteria.
16. Airborne infections are transmitted through bacteria contained in dust particles that remain airborne for long periods of time (such as chicken pox and tuberculosis).
17. Use warm (not hot) water to mop.
18. Dirt and soil inactivate disinfectants, so clean the area first. Then reapply a fresh layer of disinfectant and allow the area to remain wet for the contact time.
19. If laundering scrubs at home, it's okay to wash them with household laundry.
20. Getting enough sleep and eating healthy will help prevent infections.