The ABCs of Infection Control

May 1, 2003

The ABCs of Infection Control

The ABCs of Infection Control

By Melba Rhodes, RN, BSN

Practicing aseptic technique, good body hygiene and developing a caringattitude comprise the ABCs of infection control. In this article, we willdiscuss the three major components of Asepsis -- handwashing,disinfection and sterilization -- Body Hygiene -- personal hygiene anddress code -- and a Caring Attitude -- a good sense of right and wrongessential to the practice of the ABCs of infection control. The ABCs ofinfection control are fundamental in preventing adverse events.

Infectious diseases may become a major health hazard to healthcare workersand patients. Knowing the hazards and following established guidelines andpolicies can reduce your and the patient's risk of transmission of infection.Safety guidelines are established for a reason -- to protect you, the employeeand the patient. Even though at times some policies may seem to take too muchtime, if you consider the risks of not following these guidelines, you willrealize the importance of the measures to help protect you and provide a safeand healthy workplace.

A person entering the hospital or clinic with an infectious disease, such asAIDS or hepatitis B, does not always have this condition diagnosed at the timeof 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 theperson is an asymptomatic carrier). To protect yourself, you must consider allpatients to have an infectious disease or, in other words, universally apply thesame precautions to all body substances regardless of the source patient.

ASEPSIS

The first letter in our ABCs of infection control is "A", orasepsis. 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 topurposefully reduce the number of microorganisms (germs) to an irreduciblenumber for the purpose of preventing transmission of infection. These includehandwashing, disinfection and sterilization.

There Are Many Levels of Asepsis

The strictness (or level) of aseptic technique increases as you perform moreinvasive procedures. For example, taking a blood pressure requires only cleantechnique, while starting an IV requires sterile technique. The most invasiveprocedures (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 allmicroorganisms. It is achieved by autoclaving or by another sterilizationprocess. 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 transientmicroorganisms from the skin with a reduction in the resident flora.

Resident or Normal Flora: Those microorganisms that are constantly present onour bodies; no amount of scrubbing will totally remove them (the skin cannot bemade sterile). These organisms cause "trouble" when introduced intonormally 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 enoughorganisms. Normal flora can become pathogens when introduced into areas wherethey don't belong, for example, through insertion of a catheter or throughsurgery. Staph epidermis, normal flora of the skin, causes most central lineinfections 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 contactwith intact skin or mucous membranes only. For example, when you are takingblood pressure or temperature, these articles need to be clean only.

Know what is contaminated: Certain procedures like dressing changes producecontaminated materials. These contaminated materials must be disposed ofproperly by incineration or autoclave. Touching non-intact skin is acontaminated procedure; wear clean gloves unless a sterile procedure (like adressing change) is being done.

Know what is sterile: During certain procedures (for example, the insertionof an IV or urinary catheter), sterile technique should be used. The level ofsterile 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 contaminatedarticles from touching clean or sterile items. Store clean and sterile itemsseparately from contaminated areas or items. Keep sterile items from touchinganything but a sterile field or another sterile item.

Keep sterile sites sterile: Once a tube has been inserted into the body, caremust 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'spolicy and procedure.

Resolve contamination immediately: If sterile technique cannot be used(during an emergency) or is broken, resolve contamination when it occurs. Forexample, if an IV is inserted during an emergency, replace the IV as soon aspossible after the code is completed.

Train yourself to realize when you have broken technique. If a technique isbroken, remedy the problem if possible. For example, if during the insertion ofan IV the catheter is contaminated (by dropping on floor, etc.), replace thecatheter before insertion. If contamination cannot be resolved, report it to theproper person. For example, if the bowel is nicked during surgery, the caseclassification will change from clean contaminated to contaminated and extracare 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 orexcretions 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, WestNile virus). Vector is an uncommon means of transmission of nosocomialinfections; in other words, "two-legged rats" (or humans) transmitmore infections in the hospital than those with four legs!

c. Airborne: Transmitted through bacteria contained in dust particlesthat remain airborne for long periods of time (chicken pox and tuberculosis).These diseases are highly infectious. A mask is needed for protection from thesediseases. A special respirator is needed for tuberculosis.

Handwashing

Handwashing is the single most important means of preventing the spread ofinfection. Handwashing is a critical part of asepsis.

Handwashing is stressed in the following areas: (This is not an all-inclusivelist. Use your own conscience when washing hands.)

1) Before and after performing invasive procedures, whether or not sterilegloves are worn.

2) Before and after contact with wounds, whether surgical, accidental, orassociated 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 withvirulent microorganisms or hospital pathogens, such as an infected patient or anobject 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 urineand 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 whenperforming invasive procedures, upon entering and leaving isolation rooms and inspecial care units (i.e., ICU, Nursery, Surgery).

Antiseptic alcohol solutions may be used when handwashing facilities are notconvenient, after casual contact with a patient (such as taking a pulse), butnot when hands are visibly soiled. Rub hands together in the same manner as whenwashing hands. Allow to air dry. After approximately 10 applications, you maynotice 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. Rinseand dry hands adequately. Use a paper towel to turn off the faucet.

Key Points:

1. Rinsing hands thoroughly and carefully drying hands will help to preventchapping and cracking of hands. Pat hands dry. Roughly drying hands removes thetop layer of your protective skin.

2. In patient care areas, use only hospital approved lotion in pumpdispensers. Petroleum-based products (such as Vaseline Intensive Care) degradelatex. Most hand lotions inactivate the antimicrobial residue left on hands byagents such as chlorhexidine gluconate (CHG). A pump dispenser helps to protectthe 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 havebeen established as a link to transmission of infection. You can get naturally"polished" nails using a four-step buffing file. A good rule of thumbfor nail length is to hold your hands with the palm side to you. If your nailsare 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. Keepingclean and looking great help to form an atmosphere conducive to the practicingof asepsis and the ABCs of infection control.

Scrub Attire Dress Code

Wearing of scrub attire is usually designated as mandatory for the control ofinfection in the operating room. However, some operating rooms have recentlyallowed home laundering of scrub attire as a sterile gown is used to cover theuniform during the surgical procedure.

Wearing of scrub attire (as uniforms) is usually permissible in other areasbut 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 beforeleaving 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 transmitinfections.

  • Eat a balanced diet.

  • Get enough sleep.

  • Exercise regularly.

  • Practice healthy stress reduction measures.

CARING ATTITUDE

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 workpractices that support sound infection control principles. Work practices thatsupport the maintenance of aseptic technique and embrace responsibility for eachindividual's role in Infection Control can only come from staff with caringattitudes. This can be accomplished by fostering a team approach througheducation and support of the clinician as they perform duties that are pivotalin the prevention and control of infection. Focus should be placed on the lastof the ABCs of infection control (focusing on the right and wrong of infectioncontrol). Our attitudes should mirror the plan of asepsis -- common sense. Byusing common sense we can safely protect our patients and ourselves. Use commonsense and a caring attitude to develop a good aseptic conscious (or a continuousawareness of asepsis). Your "aseptic consciousness" is your set ofinternal ideals. We have set ideals (in the form of policies and procedures) toprotect our patients and ourselves. Set your ideals at the highest level to givecare without doing harm.

Conclusion

The ABCs of infection control -- Asepsis, Body Hygiene and Caring Attitude --comprise what we should do to help protect our patients and ourselves. Yourdiligence and common sense is key to protecting yourself, your co-workers andthe patient. Handwashing and skin preparation, disinfectant and sterilization,vital parts of asepsis and a caring attitude, are essential to the ABCs ofinfection control. Infection control is a valuable asset to the facility and itis our responsibility to demonstrate this.

OBJECTIVES:

1. Discuss the three major components of asepsis.

2. Discuss handwashing, disinfection and sterilization as they apply toasepsis.

3. Discuss body hygiene -- personal hygiene and dress code.

4. Explore developing a caring attitude -- a good sense of right and wrongessential to the practice of the ABCs of infection control.

TEST QUESTIONS: TRUE OR FALSETF
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.  

ANSWERS

1. T
2. T
3. F
4. T
5. T
6. F
7. F
8. T
9. T
10. T
11. T
12. T
13.F
14. T
15. T
16. T
17. T
18. T
19. F
20. T