1978x 00 fm -...

Image not available due to copyright restrictions

Licensed to:

Basic Infection Control for Health Care Providers,Second Edition

Mike Kennamer

Vice President,Health Care Business Unit:William Brottmiller

Director of Learning Solutions:Matthew Kane

Managing Editor:Marah Bellegarde

COPYRIGHT © 2007 Thomson DelmarLearning, a part of the Thomson Corporation.Thomson, the Star logo, and Delmar Learningare trademarks used herein under license.

Printed in the United States of America.1 2 3 4 5 6 7 8 XXX 10 09 08 07 06

For more information, contact ThomsonDelmar Learning, 5 Maxwell Drive, CliftonPark, NY 12065

Or find us on the World Wide Web athttp://www.delmarlearning.com

ALL RIGHTS RESERVED. No part of this workcovered by the copyright hereon may bereproduced or used in any form or by anymeans—graphic, electronic, or mechanical,including photocopying, recording, taping,Web distribution or information storage andretrieval systems—without the writtenpermission of the publisher.

For permission to use material from this textor product, contact us byTel (800) 730-2214Fax (800) 730-2215www.thomsonrights.com

Library of Congress Cataloging-in-PublicationDataKennamer, Mike.

Basic infection control for health careproviders / Mike Kennamer.—[2nd ed.]

p. cm.Includes bibliographical references and index.ISBN 1-4180-1978-X (alk. paper)

1. Nosocomial infections—Prevention.2. Medical personnel—Health and hygiene.3. Health facilities—Sanitation. I. Title.RA969.K46 2006614.4'4—dc22

2006014983

Acquisitions Editor:Matthew Seeley

Marketing Director:Jennifer McAvey

Marketing Manager:Michele McTighe

Production Director:Carolyn Miller

Content Project Manager:Anne Sherman

NOTICE TO THE READER

Publisher does not warrant or guarantee any of the products described herein or perform any independentanalysis in connection with any of the product information contained herein. Publisher does not assume,and expressly disclaims, any obligation to obtain and include information other than that provided to it by themanufacturer.

The reader is expressly warned to consider and adopt all safety precautions that might be indicated by theactivities described herein and to avoid all potential hazards. By following the instructions contained herein,the reader willingly assumes all risks in connection with such instructions.

The publisher makes no representations or warranties of any kind, including but not limited to, the warrantiesof fitness for particular purpose or merchantability, nor are any such representations implied with respect tothe material set forth herein, and the publisher takes no responsibility with respect to such material. The pub-lisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part,from the reader’s use of, or reliance upon, this material.

Scripture taken from THE MESSAGE. Copyright © 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used bypermission of NavPress Publishing Group.

1978x_00_fm.qxd 06/28/06 03:18 PM Page iv

Copyright 2007 Cengage Learning. All Rights Reserved.May not be copied, scanned, or duplicated, in whole or in part.

Licensed to:

1

C H A P T E R 1

Introduction to InfectionControl

LEARNING OBJECTIVES

After completing this chapter, the reader should be able to:• discuss the history of infectious disease.• discuss the history of infection control.• recognize and discuss modern infection control

threats.• list three key figures in the development of modern

infection control.• recognize and discuss infection control as a rapidly

changing field.

KEY TERMS

• acquired immunodeficiency syndrome (AIDS)• Centers for Disease Control and Prevention (CDC)• chronically infected• hepatitis B (HBV)• hepatitis C (HCV)• hygiene• occupational exposure• tuberculosis (TB)• virulence

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 1


Licensed to:

2 C H A P T E R 1

I F E A T U R E D C A S E S T U D Y KDate: November 13, 1738Patient: Miss MusgravePhysician: Dr. William Brownrigg

Miss Musgrave, a spotty, delicate girl, suffers from aserious fever. Her face is puffy and swollen, the puffi-ness having first appeared on her forehead and spreaddownward to her nose, upper lips, and cheeks. Shereports severe pain in her face and her urine is pale.

Complicating the fact that Miss Musgrave has a deli-cate constitution, the weather has been excessivelywet and rainy and moist and cold with Westerlywinds. This has caused the patient’s humours [f luids]to become corrupted and imbalanced.

She was bled seven times within six days. A largequantity was obtained each time, causing the patientto feel faint. Local plasters of nitrous powders andtartar were applied to the back of the neck and lowerlegs and she was given a suitable cooling diet.

1. Based on the notes provided in Dr. Brownrigg’scasebook, we can begin to form a clinical opinionof his patient’s condition. What do you expectthat Miss Musgrave’s diagnosis would be today?

2. Eighteenth-century physicians were convincedthat an imbalance of fluids (blood, phlegm, bile,urine, and sweat) caused illness and that the onlyway to cure the patient was to rid the body ofnoxious fluids. How would Miss Musgrave’s treat-ment differ today from that in 1738?

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 2


Licensed to:

NTRODUCTION

Infection control is a rapidly changing field. This book isan overview of how the health care provider who is at riskof occupational exposure to blood and/or body fluidmay be protected from contracting a communicabledisease. Persons reading this book should realize thatbecause changes occur rapidly, the instructor of thiscourse is an important resource for the most up-to-dateinformation.

ISTORY OF INFECTIOUS DISEASE

Although the cause of infections was not well understooduntil later, people have known of and studied infectionsfor many years. Ancient texts written as early as 1450 BC

describe signs of infections.

When someone has a swelling or a blister or a shiny spot onthe skin that might signal a serious skin disease on the body,bring him to Aaron the priest or to one of his priest sons. Thepriest will examine the sore on the skin. If the hair in the sorehas turned white and the sore appears more than skin deep, itis a serious skin disease and infectious.

Leviticus 13:2-3aThe Message

Approximately one thousand years later, around 450 BC,early scholars recorded the life of King Asa of Judahincluding his suffering and dying from a foot infection.

A full account of Asa is written in The Chronicles of the Kingsof Judah. In the thirty-ninth year of his reign Asa came downwith a severe case of foot infection. He didn’t ask GOD forhelp, but went instead to the doctors. Then Asa died; he diedin the forty-first year of his reign.

2 Chronicles 16:11-13The Message

Greek physician Hippocrates indicated that the ancientGreeks studied and sought the origins of infectious

H

I

Introduction to Infection Control 3

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 3


Licensed to:

diseases as early as 400 BC. Hippocrates wrote of the dan-gers posed by stagnant pools of water and expressed theimportance of good hygiene in promoting good health.

From these things he must proceed to investigate everythingelse. For if one knows all these things well, or at least the greaterpart of them, he cannot miss knowing, when he comes into astrange city, either the diseases peculiar to the place, or the par-ticular nature of common diseases, so that he will not be indoubt as to the treatment of the diseases, or commit mistakes, asis likely to be the case provided one had not previously consid-ered these matters.

Hippocrates, inAirs, Waters, and Places

The ancient Romans built elaborate systems of aqueducts,which helped to promote health and sanitation. By 97 AD

the Romans had constructed nine aqueducts, mainly toprovide water for bathing and drinking. By 226 AD Romanaqueducts were discharging nearly 300 million gallons ofwater each day.

As a result of the survival of reports of the FrenchInquisition, evidence of hygienic practices among 13th-century medieval peasants exists. In Montaillou, a villagein the mountains of southern France, reports indicatethat hardly anyone, rich or poor, ever had a bath. Onlythe hands and mouth—those parts of the body involvedin preparing, blessing, or consuming food—were keptrelatively clean. It was not until the mid-17th century thattheories regarding germs and disease became accurate.

ISTORY OF MODERN INFECTION CONTROL

Modern infection control ideas originated in Vienna,Austria, in the mid-1800s when a physician, IgnazSemmelweis, discovered that hand washing seemed todecrease the incidence of death due to infection follow-ing childbirth. By observing simple hand washing proce-dures, the death rate related to infection decreased from

H

4 C H A P T E R 1

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 4


Licensed to:

18% to 1% in Semmelweis’s hospital. Although Semmel-weis was excited with his discovery, the concept of wash-ing hands before and after medical procedures was notroutinely practiced until much later.

Unfortunately, Semmelweis’s colleagues were not asenthusiastic about his discovery. His hospital censuredhim and reduced his privileges. When he reported hisfindings to the Medical Society of Vienna, he metenough resistance to lead him to his native Budapest.There he was committed to an insane asylum, where hedied of an infection similar to those he had tried to pre-vent in Austria.

During about the same period, French scientist LouisPasteur created his germ theory. A background in physicsand chemistry led Pasteur to approach the study ofmicrobial life in a different way. Pasteur believed thatmicrobes can bring about significant transformations inorganic matter—transformations that are very selectiveand specific in their activities. Pasteur also discoveredanaerobic life when practical application of his germ the-ory proved that, in the absence of air, sugar was convert-ed to butyric acid. Not only did his different approachopen new doors in the field of microbiology, it also led tothe development of the process of pasteurization—atechnique of controlled heating for the preservation ofvarious food products.

Scottish surgeon Joseph Lister expanded Pasteur’s germtheory by using cotton wool and bandages treated withcarbolic acid to dress surgical wounds. It was Lister whodiscovered that infection could be prevented by coveringwounds and using antiseptic agents. Like Semmelweis,the efficacy of Lister’s work was demonstrated by a postsurgery mortality rate that decreased from 50% to15%. And like Semmelweis, he initially experiencedgreat resistance from the medical community. Lister,


1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 5


Licensed to:

however, persevered and became famous during his life-time. He performed surgery on Queen Victoria andopened the way for techniques of modern surgery.

Just as Semmelweis had trouble convincing his col-leagues to wash their hands, health care providers asrecently as several years ago were not convinced of thenecessity of observing standard precautions against com-municable disease. What do you think it took to con-vince health care providers to observe precautionsagainst communicable disease? See if you agree with theanalysis in the following section.

NFECTION CONTROL BECOMES AN ISSUE

In the 1980s, a disease called acquired immunodefi-ciency syndrome (AIDS) was introduced to theAmerican public. Although early reports sparked littleinterest, people began to take note when celebrities andsports figures became infected with the disease. As wordof the disease spread throughout the country, personswith occupational exposure to blood started to routinelywear gloves and other protective equipment. At the time,little was known about AIDS and its causative agent,human immunodeficiency virus (HIV).

Organizations set standards and the U.S. governmentbegan work on legislation that would protect America’shealth care workers.

Hepatitis B virus (HBV) emerged as a considerablehealth risk during the late 1980s and early 1990s.Although HIV is a deadly virus, it does not survive welloutside the human body. Conversely, HBV can survivefor hours or even days outside the human body, posing agreater risk to health care professionals. Although avaccine for HBV was developed as early as 1971, it was

I

6 C H A P T E R 1

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 6


Licensed to:


N E W S M A K E RJohnson Infected Retires

L O S A N G E L E S , C A N O V E M B E R 7 , 1 9 9 1

On November 7, 1991, Earvin “Magic”Johnson announced his retirement fromthe Los Angeles Lakers. The 6-ft. 9-in.tall, 32-year-old NBA star was at thepinnacle of his career. He was loved bythe fans and respected by his fellowplayers. Johnson told the reportersgathered at the Great Western Forum inLos Angeles that he had been infectedwith the HIV virus and would “have toretire from the Lakers today.”

The announcement was shocking.“When you look at a big, healthy guy likeMagic Johnson,” said Keven McHale ofthe Boston Celtics, “you think this illnesswouldn’t attack someone like him.” But itdid.

“We think sometimes it can onlyhappen to gay people, it can’t happen to

me,” said Johnson, who, it is believed,contracted HIV through heterosexualcontact. “And here I am saying it canhappen to anybody, even me, MagicJohnson.”

Johnson’s revelation brought the issueof AIDS and infectious diseases in generalto the forefront of popular culture. Onceconsidered a disease that affected onlythose in developing countries, or homo-sexuals, or intravenous drug users, HIVnow had a face in Magic Johnson. Thepart that frightened the public wasthat they could relate to Johnson. Nolonger was HIV an “awful disease”affecting this group or that group. HIVhad hit home.

1. Why do you think media coverage of HIV had been limited untilMagic Johnson’s announcement?

2. How did Magic Johnson’s forthrighness about his condition helpprompt the public to learn more about HIV and AIDS?

3. Do you think that the media coverage given to HIV and AIDShelped increase the public’s awareness of infectious disease in general?

4. What other infectious diseases have been brought to public atten-tion through the media in recent years?

1978x_01_ch1_p001-013.qxd 06/28/06 09:40 PM Page 7


Licensed to:

8 C H A P T E R 1

ALERTDiseases other than hepatitis and human immunodefi-ciency virus (HIV) pose a risk for health care providers.Always protect yourself from all infectious and communi-cable disease.

URRENT PERSPECTIVE

Today communicable disease is taken seriously.Employees take the initiative to better protect themselvesand employers meet stringent standards imposed by thefederal government to ensure a safe workplace.

C

!

UNDER THE MICROSCOPE

– Research Magic Johnson’s life since his Novermber7, 1991, announcement. What is his current status?What has he done to support awareness of HIV andAIDS?

– List and discuss others who have increased publicawareness of communicable diseases.

– As a health care provider you will be seen as anauthority in your own community. Discuss how youcan help increase public awareness of infection control in your own neighborhood.

– – –

not widely used. In 1981 the U.S. Food and DrugAdministration (FDA) approved the first commercialHBV vaccine. This vaccine was derived from protectiveantibodies contained in the blood of patients who hadrecovered from a hepatitis B infection. The widespreaduse of this vaccine and its second-generation geneticallyengineered synthetic successor, approved in 1986,helped to quell the increase in numbers of those infectedwith HBV.

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 8


Licensed to:

AIDS remains a formidable disease, for which there is novaccine and no cure. However, other diseases, such astuberculosis (TB), hepatitis B (HBV), and hepatitis C(HCV) continue to affect health care providers andremain considerable health risks. Although the numberof new HBV infections has declined from 260,000 peryear in the 1980s to about 73,000 per year in 2003, anestimated 1.25 million Americans remain chronicallyinfected with HBV.

It is estimated that 3.9 million Americans have beeninfected with HCV, 2.7 million of whom are chronicallyinfected, which means that they will always be infected.Because of the virulence, or the degree of its ability tocause a disease, of hepatitis and its ability to survive out-side the confines of the human body, health careproviders are at risk of occupational exposure.

TATISTICS

The United Nations estimates that nearly 38 millionpeople worldwide are infected with HIV, the virus thatcauses AIDS. An estimated 950,000 of these are U.S. res-idents and, according to the Centers for DiseaseControl and Prevention (CDC), the component of theU.S. Department of Health and Human Services instru-mental in setting infection control standards, 180,000 to280,000 are unaware that they are infected.

Hepatitis B emerged as a significant health risk in the1980s. Although public education and an effective vac-cine have contributed to decreasing numbers of personsinfected with hepatitis B virus (HBV), the CDC esti-mates that 78,000 U.S. residents become infected eachyear. Hepatitis B is very environmentally resistantand can survive for long periods of time, even outsidethe body.

S


1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 9


Licensed to:

Currently, hepatitis C is the most common chronicbloodborne infection in the United States. An estimated3.9 million Americans have been infected with HCV.Worldwide, it is estimated that 350 million have beeninfected. According to the CDC, most of these personsmay not be aware of their infection because they are notclinically ill.

Work on an HCV vaccine is ongoing; however, develop-ment has been difficult. Traditional means of vaccinedevelopment have been unsuccessful, since unlike hep-atitis A or B, antibodies to hepatitis C even at high levelsdo not lead to recovery and fail to prevent current or sub-sequent infection. Research continues in this importantquest.

Other diseases may pose a risk to the health careprovider. Tuberculosis (TB), which was once the lead-ing cause of death in the United States, was thought tobe a disease of the past until 1984, when it began to makea comeback. Many attribute the comeback of tuberculo-sis to public apathy and failure to vaccinate.

NFECTED HEALTH CARE WORKERS

Although health care providers are at risk of occupa-tional exposure to blood and body fluids, their risk ofactually contracting an infection is fairly low. Forinstance, the annual number of occupational HBVinfections was fewer than 400 in 2001. This is a signifi-cant decrease from the more than 10,000 new casesinvolving occupational exposure in health care in1983. Today, health care personnel who have receivedHBV vaccine and in whom immunity has developedare at virtually no risk for infection. Although there is arisk for infection from exposures of mucous membranesor nonintact skin, there is no known risk from exposureof intact skin. The risk from a single needlestick or

I

10 C H A P T E R 1

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 10


Licensed to:

cut exposure to HBV-infected blood ranges from 6 to30%, depending on the antigen status of the sourceindividual.

No exact estimates on the number of occupationalexposures to HCV in the health care industry are avail-able; however, studies have shown that 1% of hospitalhealth care personnel have evidence of HCV infection,compared with 3% of the overall U.S. population.Studies also reveal that 2% of health care workers willbecome infected with HCV after an exposure to HCV-infected blood or a needlestick involving HCV-infectedblood.

Occupational exposure to HIV is rare. However, HIVcontinues to be an international concern, especially indeveloping countries. From 1985 to 2001, the CDCreported 57 documented cases and 138 possible casesof occupationally acquired HIV infection amonghealth care personnel in the United States. The aver-age risk of HIV infection after a needlestick or cutexposure to HIV-infected blood is 0.3% (1 in 300).Stated another way, 99.7% of needlestick/cut expo-sures to HIV-infected blood do not lead to infection.The risk after exposure of the eye, mouth, or nose toHIV-infected blood is estimated to be 1 in 1000 (0.1%).The risk after short-term exposure to intact skin is nil,whereas the risk after exposure to nonintact skin is lessthan 0.1%.


INTERESTING FACTS

7 There is no known risk of HBV, HCV, or HIV fromexposure of intact skin.

7 Only 1% of hospital health care personnel haveevidence of HCV infection, versus 3% of the generalU.S. population.

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 11


Licensed to:

12 C H A P T E R 1

7 98% of those exposed to HCV-infected bloodthrough a needlestick or cut exposure will notbecome infected.

7 99.7% of those exposed to HIV-infected bloodthrough a needlestick or cut exposure will notbecome infected.

7 99.9% of those exposed to HIV-infected bloodthrough exposure of nonintact skin or mucousmembranes of the mouth, eye, or nose will notbecome infected.

CONCLUSION

All health care providers have an obligation to learnabout infectious disease in an effort to protect themselvesand their patients. The remainder of this book will serveas a basis for that knowledge.

QUESTIONS FOR DISCUSSION

1. What diseases have increased public awareness ofinfection control over the past few years?

2. What simple infection control procedure helped Dr.Ignaz Semmelweis save a number of lives in the 1800s?

3. List three pioneers in the field of infection control.4. List at least three diseases that should concern health

care workers today.5. Explain how we know that ancient civilizations knew

of and were concerned about infectious diseases.

WORTH THINKING ABOUT

• Try to recall the first time you heard about AIDS.Have you experienced prejudices against those withAIDS or other communicable diseases? Why?

INTERESTING FACTS (continued)

1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 12


Licensed to:

• Have you ever cared for a person with AIDS? Didyou take more precautions with this patient than younormally do? Why?

WEB RESOURCES

Centers for Disease Control and Prevention—This siteprovides a wealth of information on infectious disease,infection control, and statistics. Click on MMWR (Morbidityand Mortality Weekly Report) for detailed trends andstatistics. http://www.cdc.gov.

Association for Professionals in Infection Control andEpidemiology (APIC)—This is the official site of the premierorganization for infection-control professionals.http://www.apic.org.

BIBLIOGRAPHY

Centers for Disease Control and Prevention. (2003). Exposure to blood: Whathealthcare personnel need to know. Atlanta: Author.

Centers for Disease Control and Prevention. (2006). Hepatitis B fact sheet.Atlanta: Author.

Centers for Disease Control and Prevention. (2003). Hepatitis C fact sheet.Atlanta: Author.

Dubos, R. J., & Hirsch, J. G. (1965). Bacterial and mycotic infections of man.Philadelphia: Lippincott.

Hippocrates. (400 BC). On airs, waters, and places. Accessed April 15, 2006,from http://www.4literature.net.

Hoofnagle, J. H. (2004). Testimony before the Committee on GovernmentReform of the United States House of Representatives. Washington, DC:U.S. Department of Health and Human Services.

Joint United Nations Programme on HIV/AIDS. (2004). 2004 Report on theglobal AIDS epidemic. Geneva, Switzerland: Author.

Peterson, E. (2002) The message: The Bible in contemporary language.Colorado Springs: NavPress Publishing.

Shimeld, L. A., & Rodgers, A. T. (1999). Essentials of diagnostic microbiology.Clifton Park, NY: Thomson Delmar Learning.

Waller, J. (2002). The discovery of the germ. Cambridge, U.K.: Icon Books.


1978x_01_ch1_p001-013.qxd 06/28/06 11:17 AM Page 13


Licensed to:

186

A P P E N D I X B

Answers to Questions for Discussion

The answers provided are intended to stimulate further discussionand are not intended as a definitive answer to the questions present-ed. The answers should, however, assist the reader in understandingthe concepts presented.

CHAPTER 11. What diseases have increased public awareness of infection

control over the past few years?Several diseases have been highlighted in the media, includingSARS, avian flu, anthrax, and others.

2. What simple infection control procedure helped Dr. IgnazSemmelweis save a number of lives in the 1800s? The simple procedure of hand washing helped Dr. Semmelweisreduce the death rate due to infection at his hospital.

3. List three pioneers in the field of infection control. Ignaz Semmelweis proved that hand washing could prevent thespread of infection. Louis Pasteur’s background in physics andchemistry led him to discover some of the basic principles ofmicrobiology as we know it today. Joseph Lister applied Pasteur’sprinciples and initiated the use of antiseptics.

4. List at least three diseases that should concern health care workerstoday.Many diseases should be of concern. Hepatitis C is certainly athreat to health care providers and should warrant concern. Otherdiseases such as hepatitis B, hepatitis non-ABC, HIV, and othersshould be of concern as well.

1978x_10_appB_p186-193.qxd 06/28/06 11:46 AM Page 186


This page contains answers for this chapter only.

1978x 00 fm -...

Documents

Transcript of 1978x 00 fm -...