Medical Asepsis and the OSHA Standard



Medical Asepsis and the OSHA Standard




































LEARNING OBJECTIVES PROCEDURES
Microorganisms and Medical Asepsis

Handwashing.

Applying an alcohol-based hand rub.

Application and removal of clean disposable gloves.
OSHA Bloodborne Pathogens Standard

Adhere to the OSHA Bloodborne Pathogens Standard.
Regulated Medical Waste

Prepare regulated waste for pickup by an infectious waste service.
Bloodborne Diseases

 


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Introduction to Medical Asepsis and the OSHA Standard


Medical asepsis and infection control are crucial in preventing the spread of disease. The medical assistant should always practice good medical aseptic techniques to provide a safe and healthy environment in the medical office. The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard is important for infection control. This standard is required by the federal government to reduce the exposure of health care employees to infectious diseases. This chapter presents a thorough discussion of medical asepsis, infection control, and the OSHA Bloodborne Pathogens Standard.



Microorganisms and Medical Asepsis


Microorganisms are tiny living plants or animals that cannot be seen with the naked eye, but instead must be viewed with the aid of a microscope. Common types of microorganisms include bacteria, viruses, protozoa, fungi, and animal parasites. Most microorganisms are harmless and do not cause disease. They are termed nonpathogens. Other microorganisms, known as pathogens, are harmful to the body and can cause disease.


In the medical office, practices must be employed to reduce the number and hinder the transmission of pathogenic microorganisms. These practices are known as medical asepsis. Medical asepsis means that an object or area is clean and free from infection. Nonpathogens would still be present on a clean or medically aseptic substance or surface, but all the pathogens would have been eliminated.



Growth Requirements for Microorganisms


For microorganisms to survive, certain growth requirements must be present in the environment, as follows:



1. Proper nutrition. Microorganisms that use inorganic or nonliving substances as sources of food are known as autotrophs. Microorganisms that use organic or living substances for food are known as heterotrophs.


2. Oxygen. Most microorganisms need oxygen to grow and multiply and are termed aerobes. Other microorganisms, known as anaerobes, grow best in the absence of oxygen.


3. Temperature. Each microorganism has a temperature at which it grows best, known as the optimum growth temperature. Most microorganisms grow best at 98.6° F (37° C), the human body temperature.


4. Darkness. Microorganisms grow best in darkness.


5. Moisture. Microorganisms need moisture for cell metabolism and to carry away wastes.


6. pH. Most microorganisms prefer a neutral pH. If the environment of the microorganisms becomes too acidic or too basic, they die.


    If growth requirements are taken away from the environment of microorganisms, they are unable to survive. Eliminating these conditions is one way to reduce the growth and transmission of pathogens in the medical office.



Infection Process Cycle


For a pathogen to survive and produce disease, a continuous cycle must be followed; this is known as the infection process cycle (Figure 17-1). If the cycle is broken at any point, the pathogen dies. The medical assistant has a responsibility to help break this cycle in the medical office by practicing good techniques of medical asepsis. These techniques are discussed in the next section.




Protective Mechanisms of the Body


The body has protective mechanisms to help prevent the entrance of pathogens, and these help break the infection process cycle. Protective mechanisms of the body are as follows:



1. The skin is the body’s most important defense mechanism; it serves as a protective barrier against the entrance of microorganisms.


2. The mucous membranes of the body, which line the nose and throat and respiratory, gastrointestinal, and genital tracts, help protect the body from invasion by microorganisms.


3. Mucus and cilia in the nose and respiratory tract fight off pathogens. Mucus traps the smaller microorganisms that enter the body, and the hairlike cilia constantly beat toward the outside to remove them from the body.


4. Coughing and sneezing help force pathogens from the body.


5. Tears and sweat are secretions that aid in the removal of pathogens from the body.


6. Urine and vaginal secretions are acidic. Pathogens cannot grow in an acidic environment.


7. The stomach secretes hydrochloric acid, which helps in the process of digestion. This acidic environment discourages the growth of pathogens that enter the stomach.



Medical Asepsis in the Medical Office



Hand Hygiene

Hand hygiene refers to the process of cleansing or sanitizing the hands. Hand hygiene is considered the most important medical aseptic practice in the medical office for preventing the spread of infection. Specific techniques for sanitizing the hands in the medical office include the following:



The Centers for Disease Control and Prevention (CDC) has issued new recommendations for hand hygiene in health care settings. The purpose of these guidelines is to promote improved hand hygiene practices and to reduce transmission of pathogenic microorganisms to patients and employees in health care settings. The CDC guidelines for hand hygiene as they apply to the medical office are outlined in Box 17-1. They are also discussed further in this section.



BOX 17-1


CDC Guidelines for Hand Hygiene in Health Care Settings





General Recommendations




• Keep natural nail tips less than image inch long. Avoid wearing artificial nails.


• Do not add soap to a partially empty liquid soap dispenser. The practice of “topping off” dispensers can lead to bacterial contamination of the soap. The correct procedure is either to dispose of an empty dispenser or to rinse an empty dispenser thoroughly and then refill it.


• Multiple-use cloth towels of the hanging or roll type are not recommended.


• Use hand lotions or creams to minimize the occurrence of dermatitis associated with frequent handwashing.


• Wear gloves if contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could occur.


• Change gloves during patient care if moving from a contaminated body site to a clean body site.


• Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.


From Bonewit-West K: Clinical procedures for medical assistants, ed 8, St Louis, 2011, Saunders.




Resident and Transient Flora

Microorganisms on the hands are classified into the following categories: resident flora and transient flora. Resident flora (also known as normal flora) normally resides and grows in the epidermis and deeper layers of the skin known as the dermis. Resident flora is generally harmless and nonpathogenic. Because resident flora is attached to the deeper skin layers, it is difficult to remove from the skin.


Transient flora lives and grows on the superficial skin layers, or epidermis. It is picked up on the hands in the course of daily activities. In the medical office, this may include contact with an infected patient, contaminated equipment, or contaminated surfaces. Transient flora is often pathogenic, but because it is attached loosely to the skin, it can be removed easily with proper handwashing or by applying an alcohol-based hand rub.




Handwashing

Handwashing refers to washing the hands with a detergent soap and water. Detergent soap (commonly known as plain soap) contains agents that help break down and emulsify dirt and oil present on the skin. Soap is used to sanitize the hands through the physical removal of dirt and transient flora. It is important to use adequate friction during handwashing to ensure the removal of all transient flora. The CDC recommends that the hands be rubbed together for at least 15 seconds, making sure to cover all surfaces and to focus on the fingertips and fingernails. Procedure 17-1 outlines the handwashing procedure.



image Procedure 17-1   Handwashing image



Outcome 


Perform handwashing.



Equipment/Supplies





1. Procedural Step. Remove your watch or push it up on the forearm so that the wrist is clear. Avoid wearing rings. If you wear rings, remove all except a plain wedding band and put them in a safe place.


    Principle. Microorganisms can lodge in the crevices and grooves of rings.


2. Procedural Step. Stand at the sink, making sure clothing does not touch the sink.


    Principle. The sink is considered contaminated, and if the uniform touches the sink, it may pick up microorganisms and transfer them.


3. Procedural Step. Turn on the faucets, using a paper towel.


    Principle. The faucets are considered contaminated because they harbor microorganisms.



4. Procedural Step. Adjust the water temperature. The water should be warm to make the best suds.


    Principle. Water that is too hot or too cold tends to dry the skin, causing chapping and cracking and making it easy for pathogens to enter the body or be transferred to patients.


5. Procedural Step. Discard the paper towel in the waste container.


    Principle. The paper towel is considered contaminated after touching the faucets.


6. Procedural Step. Wet the hands and forearms thoroughly with water. The hands should be held lower than the elbows at all times. Do not touch the inside of the sink because it is also contaminated.


    Principle. When you hold the hands lower than the elbows, bacteria and debris are carried away from the arms and body and into the sink.


7. Procedural Step. Apply soap to the hands. Apply 1 teaspoon of liquid soap (approximately the size of a nickel) to the palm of one hand.



8. Procedural Step. Wash the palms and backs of the hands with 10 circular motions. Use friction along with the circular motions to wash the palm and back of each hand.


    Principle. Friction helps to dislodge and remove microorganisms from the hands.



9. Procedural Step. Wash the fingers with 10 circular motions while focusing on the fingertips and fingernails. Interlace the fingers and thumbs, and use friction and circular motions while rubbing the fingers back and forth.


    Principle. This kind of movement helps remove microorganisms and debris that have accumulated between the fingers.



10. Procedural Step. Rinse well, making sure to hold the hands lower than the elbows.


    Principle. Running water helps to rinse away dirt and microorganisms.



11. Procedural Step. Wash the wrists and forearms, using friction along with circular motions.


    (NOTE: The hands are washed first because they are the most contaminated; microorganisms and dirt are washed away and do not spread to the wrists and forearms.)



12. Procedural Step. Clean the fingernails with a manicure stick. The fingernails should be cleaned at least once daily, preferably during initial handwashing (i.e., handwashing performed just after arriving at the medical office to begin your day).


    Principle. Dirt and microorganisms collect underneath the fingernails.


13. Procedural Step. Rinse the arms and hands.


    Principle. The running water rinses away the dirt and microorganisms.


14. Procedural Step. Repeat the handwashing procedure. For initial handwashing or when the hands come into contact with blood or other potentially infectious materials, the handwashing procedure should be repeated to ensure removal of all pathogens.


15. Procedural Step. Dry the hands gently and thoroughly, and discard the paper towel.


    Principle. Gently drying the hands prevents them from becoming chapped. Microorganisms can lodge in the crevices of chapped hands. Ensure that the hands are dried completely, because wet skin also may cause chapping.



16. Procedural Step. Turn off the water, using a paper towel, and discard the paper towel in a waste container.


    Principle. The faucet is considered contaminated, whereas the hands are medically aseptic or clean.


17. Procedural Step. Do not touch the sink with the bare hands.


    Principle. The hands are now medically aseptic, and the sink is considered contaminated.


The CDC hand hygiene guidelines recommend that handwashing be performed when the hands are visibly soiled with dirt or body fluids, before eating, and after using the restroom (see Box 17-1). If the hands are not visibly soiled, the CDC recommends that an alcohol-based hand rub, rather than handwashing, be used to sanitize the hands. This is because repeated handwashing tends to dry out the hands, leading to irritation, chapping, and dermatitis.



Antiseptic Handwashing

Washing the hands with an antimicrobial soap is termed antiseptic handwashing. Antimicrobial soaps contain an antiseptic, which is an agent that functions to kill or inhibit the growth of microorganisms (Figure 17-2, A). Antiseptic handwashing sanitizes the hands through the mechanical scrubbing action and through the action of the antiseptic. Proper handwashing with an antimicrobial soap removes all soil and transient flora from the hands. Most antimicrobial soaps also deposit an antibacterial film on the skin that discourages bacterial growth. Antiseptic handwashing should be performed by the medical assistant before assisting with minor office surgery. Examples of antiseptics contained in antimicrobial soaps include triclosan, chlorhexidine, hexachlorophene, iodine, and chloroxylenol.




Alcohol-Based Hand Rubs

CDC guidelines recommend the use of an alcohol-based hand rub for sanitizing the hands when they are not visibly soiled (see Box 17-1). Alcohol-based hand rubs, also known as hand sanitizers, consist of 60% to 90% alcohol (ethanol or isopropanol) and come in the forms of gels, lotions, and foams (Figure 17-2, B). Studies have shown that hand rubs are more effective than traditional soap and water handwashing in removing transient flora and reducing bacterial counts on the hands. The advantages that alcohol-based hand rubs offer over traditional handwashing are as follows:



Alcohol-based hand rubs have disadvantages. They are more expensive than plain soap. They also cause a brief stinging sensation if they are applied to broken skin, such as a cut or abrasion on the hand. Procedure 17-2 describes the proper steps for performing an alcohol-based hand rub.



image Procedure 17-2   Applying an Alcohol-Based Hand Rub image



Outcome 


Apply an alcohol-based hand rub.



Equipment/Supplies





1. Procedural Step. Inspect the hands to ensure that they are not visibly soiled. Hands that are visibly soiled must be washed with soap and water.


    Principle. Alcohol-based hand rubs are not intended for the removal of visible soil.


2. Procedural Step. Remove your watch or push it up on the forearm. Avoid wearing rings. If you wear rings, remove all except a plain wedding band and put them in a safe place.


    Principle. Microorganisms can lodge in the crevices and grooves of rings.


3. Procedural Step. Apply the alcohol-based hand rub to the palm of one hand as follows:


    Gel or Lotion. Apply approximately 1 mL of the gel or lotion to the palm of one hand; this amount is approximately equal to the size of a dime.



    Foam. Apply 3 grams of foam to the palm of one hand; this amount is approximately equal to the size of a walnut.



    Principle. Using more than the recommended amount results in a prolonged (and unnecessary) period of time for your hands to dry.


4. Procedural Step. Thoroughly spread the hand rub over all surfaces of both hands (and fingers) up to image inch above the wrist. Spread the hand rub around the fingertips and around and under your fingernails.


    Principle. Failure to cover all surfaces can leave areas of the hands contaminated. Microorganisms tend to collect around and underneath the fingernails.


5. Procedural Step. Rub the hands together until they are dry; this usually takes 10 to 30 seconds. Allow your hands to dry completely before touching anything. The hands are now medically aseptic.


    Note: After cleaning your hands 5 to 10 times with a hand rub, a buildup of emollients may occur on your hands. The emollients can be easily removed by washing your hands with soap and water.


    Principle. If you have applied a sufficient amount of hand rub, it should take at least 10 to 30 seconds for your hands to feel dry. Your hands will still feel a little wet at first. Let them dry completely before touching anything.




Infection Control

In addition to hand hygiene, other good aseptic practices in the medical office include the following:



1. Follow the OSHA Bloodborne Pathogens Standard (presented in this chapter).


2. Keep the medical office free from dirt and dust, which can collect and carry microorganisms.


3. Ensure that the reception area and examining rooms are well ventilated. Stuffy rooms encourage microorganisms to settle on objects.


4. Keep the reception area and examining rooms bright and airy. Light discourages the growth of microorganisms.


5. Eliminate insects by the use of insecticides or window screens. Insects are a means of transmission of microorganisms.


6. Carefully dispose of wastes, such as urine, feces, and respiratory secretions; all wastes should be handled as though they contained pathogens.


7. Do not let soiled items touch clothing.


8. Avoid coughs and sneezes of patients. Moisture droplets expelled from the lungs with coughing and sneezing may contain pathogens.


9. Use discretion in the amount of jewelry worn; wear minimal jewelry or no jewelry at all. Microorganisms can become lodged in the grooves and crevices of jewelry and serve as a means of transmission of pathogens.


10. Teach patients aseptic practices to control the spread of infection at home.



Gloves

Gloves reduce hand contamination by 70% to 80%, reduce cross-contamination between patients, and protect patients and health care workers from infection. The CDC recommends that clean disposable gloves be worn when the medical assistant is likely to come in contact with any body substance, such as blood, urine, feces, mucous membranes, and nonintact skin. Clean disposable gloves should be worn when administering an injection, performing a venipuncture, or performing a urinalysis. Clean disposable gloves come in the following sizes: small, medium, large, and extra large, and sometimes extra small. Procedure 17-3 presents the proper method for applying and removing clean disposable gloves.



image Procedure 17-3   Application and Removal of Clean Disposable Gloves image image




Applying Clean Disposable Gloves


No special technique is required when clean disposable gloves are applied. This is because the hands are clean and the gloves are clean; the medical assistant can touch any part of the gloves during application without contaminating them.



1. Procedural Step. Remove all rings, and sanitize your hands. Handwashing should be performed if the hands are visibly soiled. If this is not the case, use an alcohol-based hand rub to sanitize the hands. Ensure that your hands are completely dry.


    Principle. Rings may cause the gloves to tear. The warm, moist environment inside gloves provides ideal growing conditions for the multiplication of transient microorganisms present on the hands. Sanitizing the hands removes these microorganisms and prevents the transmission of pathogens. Moisture encourages the growth of microorganisms.


2. Procedural Step. Choose the appropriate size of gloves; they should not be too small or too large. The gloves should fit snugly but not be too tight. Apply the gloves, and adjust them so they fit comfortably.


    Principle. If your gloves are too small, they may rip as you are applying them or may become uncomfortable to wear. If they are too large, you may find it difficult to perform your tasks.



3. Procedural Step. Inspect the gloves for tears. If a tear is present, a new pair of gloves must be applied.



Removing Clean Disposable Gloves


Gloves must be removed in a manner that protects the medical assistant from contaminating his or her clean hands with pathogens that may be present on the outsides of the gloves. This is accomplished by not allowing the bare hands to come in contact with the outsides of the gloves.



1. Procedural Step. Grasp the outside of the left glove 1 to 2 inches from the top with your gloved right hand.


    (NOTE: It does not matter which glove is removed first. You may start with the right glove if you prefer.)



2. Procedural Step. Slowly pull the left glove off the hand. It will turn inside out as it is removed from your hand.


3. Procedural Step. Pull the left glove free, and scrunch it into a ball with your gloved right hand.



4. Procedural Step. Place the index and middle fingers of the left hand on the inside of the right glove. Do not allow your clean hand to touch the outside of the glove.



5. Procedural Step. Pull the glove off the right hand. It will turn inside out as it is removed from your hand, enclosing the balled-up left glove. Discard both gloves in an appropriate container. If your gloves are visibly contaminated with blood or other potentially infectious materials, discard them in a biohazard waste container. Otherwise, they can be discarded in a regular waste container.


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Apr 16, 2017 | Posted by in NURSING | Comments Off on Medical Asepsis and the OSHA Standard

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