The Chain of Infection and Standard Precautions

This is Unit Seven of Medical Assistant Prep. Unit Six ended with a medication recorded at once, so no one gives it twice. This unit turns to a risk present at every visit, the spread of infection, and to the precautions used with every patient. Carry one idea through this lecture. Infection spreads through a chain of links, every precaution breaks at least one of them, and standard precautions work because they do not wait for a diagnosis. A constructed scene at the end follows one coughing patient through the office. By the end you will be able to name the links in the chain. To list what standard precautions include. To clean your hands and use gloves correctly. And to handle masks, sharps, surfaces and asepsis.

Five entries on the chain: why infection control matters, the six links, how habits break them, and the host.

Infections picked up during care.

MAS 151 Infection Control Protects Everyone

An infection a patient picks up while receiving medical care is called a healthcare-associated infection. Germs travel on hands, equipment and surfaces from one patient to the next, so every visit to a practice carries some risk unless the staff work to prevent it. Infection control protects you and your family as well as your patients.

Agent to host.

MAS 152 The Chain of Infection

Infection spreads through a chain of six links, and breaking any one stops it. The infectious agent may be a bacterium, virus, fungus or parasite. The reservoir is where it grows, such as blood or a wound. The portal of exit is how it leaves, through secretions, blood, urine or feces. The mode of transmission is how it travels, by touch, a cough or a needle. The portal of entry is how it enters the next person, through a mucous membrane or broken skin. The susceptible host is the person who cannot fight it off. You rarely see the germ. What you control is transmission and the portals, so most daily habits target those links.

Every habit targets a link.

MAS 153 Breaking the Chain

Every infection-control habit breaks one or more links in the chain. Hand hygiene and personal protective equipment block transmission; covering coughs blocks a portal of exit; disinfecting surfaces and sterilizing instruments remove reservoirs. A single skipped link-breaker, such as unwashed hands, can undo all the others.

Helpful in one place, harmful in another.

MAS 154 Normal Flora Can Protect or Harm

Normal flora are the harmless microbes that live on and in the body, and they help defend it. They crowd out invaders, but a microbe harmless in one place, such as E. coli in the gut, can cause infection if it reaches another body system. Antibiotics can deplete normal flora, which is one reason patients on them get other infections.

You cannot tell by looking.

MAS 155 The Susceptible Host

Whether exposure leads to infection depends partly on the person exposed. Someone with a weakened immune system, or whose natural defenses cannot fight the germ off, becomes infected more easily; broken skin and mucous membranes are open doors. You cannot tell who is susceptible by looking. Protect every patient as if they were.

Two entries on standard precautions: what they assume, and the eight practices federal guidance groups under them.

Known infection or not.

MAS 156 Standard Precautions for Every Patient

Standard precautions are the minimum infection-prevention practices used for every patient, whether or not an infection is known or suspected. They assume that blood, body fluids, broken skin and mucous membranes may carry infection, so the same protections apply to every person you care for. Skipping precautions because a patient seems healthy is the mistake they exist to prevent.

One routine, not a menu.

MAS 157 What Standard Precautions Include

Federal guidance groups standard precautions into eight everyday practices: hand hygiene; protective equipment wherever exposure may occur; placement and care under extra transmission-based precautions when needed; respiratory hygiene and cough etiquette; cleaning of the environment, equipment and devices; safe handling of laundry; sharps safety; and aseptic technique for invasive procedures such as injections. They support each other. Protective equipment without hand hygiene carries germs out of the room on your hands when the gloves come off. Follow the list as one routine with every patient, not a menu.

Six entries on hands and gloves: why hand hygiene comes first, when, by which method, and gloves on and off.

The single most important practice.

MAS 158 Hand Hygiene Comes First

Hand hygiene is the single most important practice for reducing the spread of infection in health care. Hands touch patients, equipment, records and doorknobs all day, so clean hands at the right moments break the most common route of transmission. Gloves do not replace hand hygiene. Clean your hands before putting gloves on and after taking them off.

Before and after.

MAS 159 When to Clean Your Hands

Clean your hands at specific moments in every encounter. Clean them before touching a patient, before an aseptic task, and before moving from a soiled body site to a clean one; clean them after touching a patient or their surroundings, after contact with body fluids, and right after removing gloves. The moment after glove removal is the most often missed.

Rub or soap and water.

MAS 160 Alcohol Rub or Soap and Water

Hands may be cleaned with an alcohol-based rub containing at least sixty percent alcohol, or with soap and water. Unless hands are visibly soiled, alcohol rub is preferred; rub every surface of hands and wrists for about twenty seconds, until dry. When hands are visibly dirty, or the patient has C. difficile, use soap and water instead.

Handwashing in sequence.

MAS 161 Washing Hands With Soap and Water

Handwashing follows a set sequence so every surface is cleaned. Wet your hands under running water and apply the approved soap. Lather by rubbing them together. Scrub palms, between the fingers, the backs of hands and fingers, the fingertips and thumbs, for at least twenty seconds. Rinse well under clean running water. Dry with a clean disposable towel. Then turn off the faucet with a clean paper towel. Closing it with bare hands puts the germs from the handle straight back on them, so the paper towel is part of the procedure.

Contact with fluids and broken skin.

MAS 162 When to Wear Gloves

Gloves protect both you and the patient from germs carried on hands. Wear them when you expect contact with blood, body fluids, mucous membranes or broken skin, and when handling contaminated equipment or surfaces. When gloves are worn with other protective equipment, they go on last, over the cuffs of the gown.

Dirty side never on skin.

MAS 163 Removing Gloves Safely

Remove gloves so that the dirty outer surface never touches your skin. Grasp one glove at the wrist and peel it off inside out, holding it in the gloved hand; slide clean fingers inside the second glove at the wrist and peel it off over the first. Discard both gloves at once, never reuse them, and clean your hands right away.

Nine entries on the remaining practices: coughs, masks, sharps, exposure, cleaning, linen, the two kinds of asepsis, and a constructed scene.

Tissues, masks and distance.

MAS 164 Respiratory Hygiene and Cough Etiquette

Respiratory hygiene keeps coughing patients from spreading infection in shared spaces. Post signs; offer tissues and a mask to anyone coughing; encourage hand hygiene after coughing; and, when possible, seat people with respiratory symptoms more than three feet from others. Staff with respiratory infections should avoid direct patient care, following the practice's policy.

Different risks.

MAS 165 Masks and Respirators

A face mask and a respirator are different pieces of equipment for different risks. A face mask protects against sprays and large droplets and is placed on coughing patients; a fitted respirator, rated N ninety-five or higher, protects against tiny airborne particles. A face mask is not a substitute for a respirator when airborne precautions apply.

Into the container.

MAS 166 Sharps Safety

Needles and other sharps can transmit bloodborne infections, including hepatitis B, hepatitis C and HIV. Preventing sharps injuries is part of standard precautions: use the safety devices provided, do not recap used needles, and place used sharps straight into a sharps container. A sharp stays dangerous until it is in the container, so keep your attention on it through cleanup.

Act at once.

MAS 167 If You Are Exposed

If a needle sticks you, or blood splashes into your eyes, nose, mouth or broken skin, act at once. Flood the area with water, clean any wound with soap and water, and report the incident immediately so follow-up care can begin. Do not wait until the end of the day; unit ten covers the full post-exposure steps.

Between every patient.

MAS 168 Cleaning Surfaces and Equipment

Routine cleaning and disinfecting of patient-care areas is part of standard precautions. Focus on frequently touched surfaces nearest the patient, and clean shared equipment between patients; a stethoscope, for example, is cleaned before and after each use. Equipment that goes from patient to patient carries germs from patient to patient unless it is cleaned in between.

Never shaken.

MAS 169 Handling Soiled Linen

Soiled linen and gowns carry little risk when they are handled safely. Do not shake soiled items, keep them away from your own clothing, and bag them in the room before carrying them anywhere. Shaking linen throws germs into the air you and others breathe.

Fewer germs.

MAS 170 Medical Asepsis

Medical asepsis, also called aseptic technique, deliberately reduces germs to prevent their transfer from one person or object to another. It is used for procedures such as injections, where the goal is to keep germ numbers low and keep them out of the body. Medical asepsis reduces germs but does not remove all of them; that is the job of sterile technique.

No germs.

MAS 171 Surgical Asepsis

Surgical asepsis, also called sterile technique, aims to eliminate every microorganism in and around a sterile field. It is required whenever skin is deliberately cut or punctured for a procedure, when a body cavity is entered, or when broken skin may be contacted. In surgical asepsis, if you doubt whether something is sterile, treat it as contaminated.

One cough, many links.

MAS 172 A Cough in the Waiting Room

A constructed scene pays off the opening idea. A man coughing hard sits near an older woman holding a baby. Before checking his insurance, the front desk assistant offers a tissue and mask, points him to the alcohol rub, seats him at the far end, and cleans her own hands after the clipboard he touched. The clinical assistant wears a mask for his signs of respiratory infection, cleans her hands before and after his vital signs, then wipes the table, chair arm, cuff and clipboard. Each act broke a link: the mask covered a portal of exit, distance and hand hygiene interrupted transmission, cleaning removed reservoirs, and two susceptible hosts were shielded. None of it needed a diagnosis. Waiting for one would have been too late for the baby.

Look at what you can now do. You can name the six links in the chain of infection and the habit that breaks each. You can explain why standard precautions apply to every patient, and list the eight practices they include. You can clean your hands at the right moments with rub or soap and water, and take gloves off without touching the dirty side. And you can apply respiratory hygiene, masks, sharps safety, cleaning and asepsis. Unit Eight adds the extra precautions for known or suspected infections, and the protective equipment they call for.