Transcription
Hello, my name is Shannon Stanley, and I'm going to be taking you through a lecture today on infection control. So, to start off with, we'll have a look at the contents that we're going to cover in this next section.
Firstly, we will talk about the different types of infectious agents that are out there that lead to somebody obtaining a disease, how disease is transmitted from one person to another, and this occurs through the chain of infection. Understanding that chain of infection is highly important for the work that we do, especially when it comes to procedures of infection control, because through these infection control procedures, this is how we can stop infection spreading from one person to another.
Infectious agents are biological agents that can cause infection and disease. Organisms are said to be pathogenic, and what that means is that they are considered to be the origin of most diseases. The different types of infectious agents are bacteria, viruses, fungi, and parasites.
So, bacteria are the first pathogenic agent that we're going to be having a look at, and you can see there's a picture of what bacteria look like underneath a microscope done in the right-hand corner. From the picture, you can see that they're quite simple in structure, and there are only one cell large, or what they call unicellular organisms. And they are spread right throughout our environments. They have the ability of living independently of other organisms, and what that means is that bacteria do not need a human or animal host to survive. They're quite happy to survive and breed and replicate on any kind of object. So that could be something like a disc, or the shower floor, or a mobile phone, or money, for example. And so they do not need a human or animal host to survive or live off.
Bacteria are treated by antibiotics, or bacterial infections are treated with antibiotics. And there's a very big misconception in the community of why antibiotics are used to treat certain things and not most people believe that antibiotics are there to treat any type of infection and that a human gets, and that's not true. Only for bacterial infections. Most bacteria are actually very useful, and only some are said to be pathogenic. So we have millions of bacteria living on our skin and the whole way through our digestive tract, and they're very, very helpful for a number of different reasons. And using an example here is we have quite a lot of bacteria right through our gastrointestinal tract, and they're very important for aiding in digestion. But if they move out of the digestive tract into another cavity or into another place such as the peritoneum, they can cause a very serious infection. And this is exactly the same like we have bacteria inside of our mouths or our oral cavity, and the bacteria has a very important set and function there. But if that bacteria goes to another area such as your lungs, that can cause things like bacterial pneumonia, and which are pretty severe.
So, a couple of examples of different types of bacterial infections is E. coli, Salmonella, Streptococcus, TB or tuberculosis, tetanus, syphilis, and thrush. And you'll notice that with a lot of medical conditions or diseases, you might have a bacterial infection of that and a viral infection, so caused by different things. Example of this is meningitis. So meningitis, which is inflammation of the meninges running around the brain and spinal cord, is a very serious condition, and it can be caused by a bacterial infection and a viral infection, and then will be defined as bacterial meningitis or viral meningitis.
Viruses are very different to bacteria in their shape, structure, and functions. Unlike bacteria, a virus cannot survive without a susceptible host, and it cannot live independently from the host. Viruses are known to be intracellular parasites, and this is due to the nature of how they function. So once they've invaded an organism, they actually use the organism's cell to hide away from the natural defenses of that organism and to multiply. This makes them incredibly difficult to treat because once a virus invades the cell, it can only be killed by destroying the whole cell. And this has resulted to all current treatments of any type of viral infection is solely aimed at treating the symptoms of that virus and not about destroying the virus itself. Viruses can mutate, and so they become very resistant to drugs and medications, and so the main defense against our viruses are actually vaccinations and inoculations. Common different types of viruses are things like the common cold, chickenpox, measles, mumps, rubella, certain types of pneumonia, the Ebola virus, which has been very big in the news as of late, and the AIDS or HIV virus.
Finding a very different type of infectious agent and that again is different to viruses and bacteria and its shape, structure, and its nature, and finding out organisms that are more like plants and animals, and these include yeasts and molds. Fungi can be present in soil, air, and water. So fungi are very different to bacteria and viruses in the sense that they are very happy living independently of any kind of human or animal host. But when they do come into contact with a human or an animal host, they're a pathogen that causes a very slow development of a disease, and they're usually more mildly irritating compared to being fatal. And the only cases where fungi can cause more severe effects is in patients that have very low or impaired immune systems. For example, in an HIV patient with a very low immune system, fungi can invade the lungs, the blood, and several organs and have detrimental effects on those types of patients. Examples of different kinds of fungi infections are things like ringworm, athlete's foot, and thrush.
The last type of pathogenic agent we're going to have a look at are parasites. So parasites need to live and to feed off other organisms. They don't live very well independently of organisms, only for very short periods of time. They can cause mildly annoying to very fatal diseases. Most worm infections are spread via feces, and that contaminates food and water sources. And the most common places that practitioners will see this is in developing countries where there's inadequate supply of fresh and clean water sources and of good sanitation practices. Different types of examples of parasites are things like roundworms, pinworms, hookworms, flatworms, and tapeworms, and flukes. Now, these will be causing more minor infections in an individual, but you can get very severe infections such as hydatice infections with our treatment, and that can be fatal.
In this next section, we'll be having a look at disease transmission and control. So first off, we'll discuss the different modes of transmission and the chain of infection, and then we'll have a look at different infection control methods and the importance of using things such as personal protective equipment, how to dispose of contaminated waste products, and managing needlestick injuries.
In order for disease or pathogen to be spread from one person to another, or from an animal to another, it needs to have a mode of transmission. The first type of mode of transmission is through direct or physical contact. Now, this is one of the easiest ways for a pathogen to enter into the human body because it bypasses a lot of the body's natural defense mechanisms. So examples of this would be through oral contact, through contact through the eye, intravascular injections, fecal contamination, and through sexual contact.
Another mode of transmission is through what's called indirect contact. So this is where something has not immediately been passed from one body source to another. An example of this would be if somebody was to sneeze onto a table surface, or somebody was to cough an infectious agent onto a table surface, and the infectious agent could live outside that host for a while. Another person would come along and touch that surface and maybe wipe their nose, or rub their eye, or even touch their mouth, and this would be a portal then for an infectious agent to enter into their body. So this is not direct contact. The organism needs to survive on an animate or inanimate object for a time without a human host.
The next and very effective mode of transmission is through droplet transmission. So all those people who don't cover their mouths or cover up their noses when they sneeze or cough have the ability to spread infection through the droplets that they cast or sneeze out of their bodies, and somebody else would breathe that in, and that would cause transmission of the disease.
Infections and diseases can only spread when the conditions are right. So we call these set of conditions the chain of infection. There are six links to the chain of infection, and all of these need to be intact in order for the spread of infection to occur from one organism to another. The first is the pathogenic agent. So examples of this is a bacteria, virus, fungi, or parasite. So this needs to be present in order for an infection to take place. The next is the reservoir. This reservoir source is where the infectious agent can normally live and multiply. And examples of this can be a human, animal, insect, in the soil, or any kind of contaminated food or water source. They need to be a portal of exit. So this organism needs to move, and so this pathogenic agent needs to move from one reservoir source or organism to another. So it can exit via things like the respiratory tract, intestinal tract, through sexual contact, open wounds, blood, or bodily fluids. There needs to be an environment conducive for the mode of transmission. So this can be either through direct, indirect contact, or through droplet transmission. Then there needs to be a portal of entry into the new organism. And an infectious agent can enter into the new organism via things like the respiratory tract, intestinal tract, through sexual contact, open wounds, and mucous membranes such as the eye or mouth. The last link in the chain of infection is the host susceptibility. So this determines whether or not somebody will get infected by this pathogenic agent that has been passed from one individual to another. Things that can affect the host susceptibility are age. So with a very young and very old or debilitated, they would have generally lower immune systems and a low ability to fight infections. Those who are immunocompromised due to poor nutrition or health, drug abuse, alcohol abuse, and different types of medical conditions would naturally have a lower immune system and find it harder to fight or cease infectious agents. So again, all of these elements need to be intact in order for infection to spread from one individual or one source to another.
Infection control practices are very important for breaking the chain in the spread of disease. Some important infection control practices include effective hand-washing, personal hygiene, and cleaning and disinfecting of our equipment.
The first infection control procedure we'll have a look at is effective hand-washing. Now, as medical practitioners, we're going to be coming into contact with many different types of patients. Some patients may be highly infectious and have infective agents on their skin or in the atmosphere around them, and other patients might be very immunocompromised. And it's important that we, as medical practitioners, are not aiding the transmission of disease. So we need to follow procedures like effective hand-washing. So very important, we wash our hands before and after contact with every single patient. We need to make sure that we have soap and running water, and as well as some disposable towels at the end to dry our hands.
I'm going to give you a few seconds to have a look at the chart in front of you. Read through all the instructions carefully, and then we'll move on to the next slide.
Personal hygiene is another important aspect of infection control, and by practicing good personal hygiene practices, we also help to break the chain of infection. So very important to wear a clean uniform with each and every shift. Ensure that nails are kept short and clean, and this means no artificial nails either. Artificial nails, long nails, and excessive jewelry is a breeding ground for bacteria, and often these areas are not cleaned appropriately when performing the good hand-washing techniques. So it's very important to keep nails short, no artificial nails, and no excessive jewelry. And again, just ensure that you're washing hands before and after contact with every patient.
Cleaning and disinfection is just as important as personal hygiene and hand washing. It's important that you clean all personal and ambulance equipment after use with each patient. The cleaning detergent or disinfection solution will be provided to you and approved of by your service. Ensure that you're also cleaning the inside and the outside of your ambulance after each shift or after you've had a highly infectious patient.
As a medical practitioner or healthcare provider, personal protective equipment makes up part of your uniform. Personal protective equipment, or PPE, consists of gloves, masks, safety glasses, and clothing or your uniform. Gloves make up the most important part of your personal protective equipment when attending to cases. And gloves provide that extra barrier between your skin and the patient, and this helps to ensure that your skin isn't exposed to as many bacteria and viruses as it would be if you were to not be wearing gloves. So we ensure that we use a pair of gloves with every single patient, and this is a single-use only. Now, keep in mind that when we are using gloves, regardless of whether a patient is bleeding, has bodily fluids, is highly infectious, or not, and that you are protecting yourself by using a pair of gloves, but you're also protecting immunocompromised patients from anything that you may be carrying as well. Gloves must meet the government regulations and specifications set up by Australian standards. And whenever you are removing a pair of gloves, it's very important to ensure that you're turning them inside out, and in this way, if your gloves are contaminated with any waste products, you're confining it to a certain area when you're disposing of them. Ensure that you also use gloves when you're cleaning your equipment and your vehicle, and because they have been contaminated, and when you are cleaning your gear, if you just wear a pair of gloves while doing that, you're also just adding that extra protection to yourself. And lastly, just make sure that you are washing your hands after you remove your gloves, every time.
Masks and goggles or safety glasses are very important for providing protection to your eyes and mouth, and it provides protection against things such as saliva, blood spray, vomitus, or any other type of body fluids. The eyes and the mouth are an easy portal of entry for an infection into the body, so it provides a barrier from and stops that from occurring. So very important to keep your safety goggles on you at all times, particularly when you're anticipating any splashes of body fluids or blood.
Immunizations also help protect you against many of the pathogens that you'll come into contact with as a healthcare provider. The different immunizations would help protect you against things such as Hepatitis A and B, tetanus, the flu virus, and you may also get the triple antigen, which is protecting you against diphtheria, tetanus, and whooping cough. Depending on where you work, your organization may require you to have some or all of these, or even more of these, to ensure that you can work safely in your work environment.
Exposure: If blood or body substances gets into contact with the skin, then wash that exposed site with soap and water. Wherever there's no water available, using non-water-based cleansers such as an alcohol solution or an antiseptic solution. If blood or other body substances gets into the eyes, rinse them thoroughly with water or normal saline. Do not use any harsh chemicals on the eyes. If blood or other body substances gets into the mouth, then spit them out and rinse the mouth thoroughly several times with water.
Needlestick injuries have the capacity to spread infections such as hepatitis or HIV or AIDS virus. In the event of a needlestick injury occurring, you need to wash the injured area with copious amounts of soapy water, disinfectant scrub solution, or just water if that's all you have. Ensure you report the incident, document it effectively, and dispose of the sharps safely.
Waste needs to be disposed of appropriately and effectively. Needles and sharps need to go into a sharps container only. Needles and sharps are not allowed or should not go into any normal waste bin or any contaminated waste. Besides a sharps container, other soft contaminated waste needs to be disposed of in contaminated waste bags. This includes any product that has blood or bodily fluid on it. It is important that any scene we attend, we need to clean and make sure there is no waste left on scene.
So, in regard to isolation and reporting, if you have come into contact with an infectious disease case, then report the incident to a senior officer or operations manager immediately. You may need to be isolated or removed from duty, and your vehicle and equipment will need to be cleaned and disinfected appropriately. So it's very important that you are aware of your work health safety policies and procedures in your workplace.
Some take-home points in conclusion to this PowerPoint are: pathogenic agents such as bacteria, fungi, and viruses cause disease. In order for disease to be transmitted from one person to another, the chain of infection needs to be intact. We, as practitioners, are responsible for maintaining and practicing infection control procedures to prevent the spread of disease.