AIDS	Acquired immunodeficiency syndrome
CDC	Centers for Disease Control and Prevention
cm	Centimeter
EPA	Environmental Protection Agency
GI	Gastro-intestinal
HAI	Healthcare-associated infection
HBV	Hepatitis B virus
HIV	Human immunodeficiency virus
MDRO	Multidrug-resistant organism
MRSA	Methicillin-resistant Staphylococcus aureus
OPIM	Other potentially infectious materials
OSHA	Occupational Safety and Health Administration
PPE	Personal protective equipment
TB	Tuberculosis
VRE	Vancomycin-resistant Enterococci

An infection is a disease state resulting from the invasion and growth of microbes in the body. Infection is a major safety and health hazard. Minor infections are short-term. Some infections are serious and can cause death. Infants, older persons, and disabled persons are at risk. The health team follows certain practices and procedures to prevent the spread of infection (infection control). The goal is to protect patients, residents, visitors, and staff from infection.

This chapter includes measures of antisepsis. Antisepsis is the processes, procedures, and chemical treatments that kill microbes or prevent them from causing an infection. (Anti means against. Sepsis means infection.)

Microorganisms

A microorganism (microbe) is a small (micro) living thing (organism). It is seen only with a microscope. Microbes, commonly called germs, are everywhere—mouth, nose, respiratory tract, stomach, and intestines. They are on the skin and in the air, soil, water, and food. They are on animals, clothing, and furniture.

Microbes that are harmful and can cause infections are called pathogens. Non-pathogens are microbes that do not usually cause an infection.

Types of Microbes

There are 5 types of microbes.

• Bacteria—are 1-celled organisms that multiply rapidly. They can cause an infection in any body system.

• Fungi—are plant-like organisms that live on other plants or animals. Mushrooms, yeasts, and mold are common fungi. Fungi can infect the mouth, vagina, skin, feet, and other body areas.

• Protozoa—are 1-celled animals. They can infect the blood, brain, intestines, and other body areas.

• Rickettsiae—are found in fleas, lice, ticks, and other insects. They are spread to humans by insect bites. Rocky Mountain spotted fever is an example. The person has fever, chills, headache, and rash.

• Viruses—grow in living cells. They cause many diseases. The common cold, herpes, acquired immunodeficiency syndrome (AIDS), and hepatitis are examples.

Requirements of Microbes

Microbes need a reservoir to live and grow. The reservoir (host) is the environment in which a microbe lives and grows. People, plants, animals, the soil, food, and water are common reservoirs. Microbes need water and nourishment from the reservoir. Most need oxygen to live. A warm and dark environment is needed. Most grow best at body temperature. They are destroyed by heat and light.

Normal Flora

Normal flora are microbes that live and grow in a certain area. Certain microbes are in the respiratory tract, in the intestines, and on the skin. They are non-pathogens when in or on a natural reservoir. When a non-pathogen is transmitted from its natural site to another site or host, it becomes a pathogen. For example, Escherichia coli (E. coli) is normally in the colon. If it enters the urinary system, it can cause an infection.

Multidrug-Resistant Organisms

Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics. Antibiotics are drugs that kill certain microbes that cause infections. Some microbes can change their structures, making them harder to kill. They can survive in the presence of antibiotics. Therefore the infections they cause are hard to treat.

MDROs are caused by prescribing antibiotics when not needed (over-prescribing). Not taking antibiotics for the length of time prescribed is another cause. Two common MDROs are:

• Methicillin-resistant Staphylococcus aureus (MRSA). Staphylococcus aureus (“staph”) is found in the nose and on the skin. MRSA is resistant to antibiotics often used for “staph” infections. MRSA can cause serious wound and bloodstream infections and pneumonia.

• Vancomycin-resistant Enterococci (VRE). Enterococcus is found in the intestines and in feces. It can be transmitted to others by contaminated hands, toilet seats, care equipment, and other items that the hands touch. When not in the intestines, enterococci can cause urinary tract, wound, pelvic, and other infections. Vancomycin is an antibiotic used to treat such infections. Enterococci resistant to vancomycin are called vancomycin-resistant Enterococci (VRE).

Infection

A local infection is in a body part. A systemic infection involves the whole body. (Systemic means entire.) The person has some or all of the signs and symptoms listed in Box 16-1.

Box 16-1

Infection—Signs and Symptoms

• Fever (elevated body temperature)

• Chills

• Pulse rate: increased

• Respiratory rate: increased

• Pain or tenderness

• Fatigue and loss of energy

• Appetite: loss of (anorexia)

• Sores on mucous membranes

• Redness and swelling of a body part

• Discharge or drainage from the infected area

• Heat or warmth in a body part

• Limited use of a body part

See Focus on Children and Older Persons: Infection.

See Focus on Surveys: Infection.

Focus on Children and Older Persons

Infection

Older Persons

The immune system protects the body from disease and infection (Chapter 10). Changes occur in this system with aging. Therefore older persons are at risk for infection.

An older person may not show the signs and symptoms listed in Box 16-1. The person may have only a slight fever or no fever at all. Redness and swelling may be very slight. The person may not complain of pain. Confusion and delirium may occur (Chapter 49).

An infection can become life-threatening before the older person has obvious signs and symptoms. Report minor changes in the person’s behavior or condition at once.

Healing takes longer in older persons. Therefore an infection can prolong the rehabilitation process. Independence and quality of life are affected.

Focus on Surveys

Infection

Infection control practices are a major focus of surveys. You may be asked:

• What do you do when you observe signs and symptoms of an infection?

• Who do you tell when you observe signs and symptoms of an infection?

The Chain of Infection

The chain of infection (Fig. 16-1) is a process involving the following.

• Source—A pathogen.

• Reservoir—The pathogen needs a place where it can grow and multiply. A carrier is a human or animal that is a reservoir for microbes but does not develop the infection. Carriers can pass pathogens to others. A vector is a carrier (animal, insect) that transmits disease. Common vectors are:

• Dogs—carry rabies

• Mosquitoes—carry malaria

• Ticks—carry Rocky Mountain spotted fever

• Mites—cause scabies (Chapter 22)

• Portal of exit—The pathogen needs a way to leave the reservoir. Exits are the respiratory, gastro-intestinal (GI), urinary, and reproductive tracts; breaks in the skin; and blood.

• Method of transmission—The pathogen is transmitted to another host (Fig. 16-2, p. 220). A vehicle is any substance that transmits microbes.

• Portal of entry—The pathogen enters the body. Portals of entry and exit are the same—the respiratory, GI, urinary, and reproductive tracts; breaks in the skin; and blood.

• Susceptible host—The transmitted microbe needs a host where it can grow and multiply. Susceptible hosts are persons at risk for infection.

FIGURE 16-1 The chain of infection. (Redrawn from Potter PA, Perry AG, Stockert PA, Hall AM: Fundamentals of nursing: concepts, process, and practice, ed 8, St Louis, 2013, Mosby.)

FIGURE 16-2 Methods of transmitting microbes.

Susceptible Hosts.

Susceptible hosts include persons who:

• Are very young or who are older.

• Are ill.

• Were exposed to the pathogen.

• Do not follow practices to prevent infection.

The ability to resist infection relates to age, nutrition, stress, fatigue, and health. Drugs, disease, and injury also are factors. Severe infection can be deadly for:

• Burn patients. When burns destroy the skin, the wound is a portal of entry for microbes. Microbes are from the person’s normal flora (p. 218), the health care setting, and the health team. MRSA and VRE are great concerns. Burns affect the immune system (Chapter 10) and the ability to fight infection.

• Transplant patients. A transplant involves transferring an organ or tissue from 1 person to another person or from 1 body part to another body part. Kidney, liver, heart, lung, bone, and skin transplants are examples. To the immune system, the new organ or tissue is a foreign object. The normal immune response is to attack (reject) the new organ or tissue. Drugs given to prevent rejection suppress (prevent) the immune system from producing antibodies. Antibodies are needed to fight infection.

• Chemotherapy patients. Some chemotherapy drugs affect the ability to produce white blood cells (WBCs). WBCs are needed to fight infection.

Healthcare-Associated Infections

A healthcare-associated infection (HAI) is an infection that develops in a person cared for in any setting where health care is given (Box 16-2). The infection is related to receiving health care. Hospitals, nursing centers, clinics, and home care settings are examples. HAIs also are called nosocomial infections. (Nosocomial comes from the Greek word for hospital.)

Box 16-2

Healthcare-Associated Infections—Examples

• Clostridium difficile—Chapter 26

• Gastro-intestinal infections

• Hepatitis A, B, and C—Chapter 46

• Human immunodeficiency virus—Chapter 43

• Influenza—Chapter 45

• Methicillin-resistant Staphylococcus aureus—p. 218

• Vancomycin-resistant Enterococci—p. 218

• Tuberculosis—Chapter 45

Modified from Centers for Disease Control and Prevention: Healthcare-associated infections (HAIs): diseases and organisms in healthcare settings, Atlanta, updated March 26, 2014.

HAIs are caused by normal flora. Or they are caused by microbes transmitted to the person from other sources. For example, E. coli is normally in the colon. Feces contain E. coli. Poor wiping after bowel movements can cause E. coli to enter the urinary system. With poor hand-washing, E. coli spreads to any body part or anything the hands touch. It also can be transmitted to other people.

Microbes can enter the body through care equipment and supplies. Such items must be free of microbes. Staff can transfer microbes from 1 person to another and from themselves to others. Common sites for HAIs are:

• The urinary system

• The respiratory system

• Wounds

• The bloodstream

Patients and residents are weak from disease or injury. Some have wounds or open skin areas. Infants and older persons have a hard time fighting infections. The health team must prevent infection by:

• Medical asepsis. This includes hand hygiene.

• Surgical asepsis, p. 244.

• Standard Precautions, p. 228.

• Transmission-Based Precautions, p. 231.

• The Bloodborne Pathogen Standard, p. 240.

See Focus on Long-Term Care and Home Care: Healthcare-Associated Infections.

Focus on Long-Term Care and Home Care

Healthcare-Associated Infections

Home Care

An HAI does not apply to every infection acquired by a person receiving home care. Rather, it applies to any infection associated with a medical, surgical, or nursing measure. It results from receiving care.

Medical Asepsis

Asepsis is the absence (a) of disease-producing microbes (sepsis means infection). Microbes are everywhere. Measures are needed to achieve asepsis. Medical asepsis (clean technique) is the practices used to:

• Reduce the number of microbes.

• Prevent microbes from spreading from 1 person or place to another person or place.

Microbes cannot be present during surgery or when instruments are inserted into the body. Open wounds (cuts, burns, incisions) require the absence of microbes. They are portals of entry for microbes. Surgical asepsis (sterile technique) is the practices used to remove all microbes. Sterile means the absence of all microbes —pathogens and non-pathogens. Sterilization is the process of destroying all microbes (pathogens and non-pathogens).

Contamination is the process of becoming unclean. In medical asepsis, an item or area is clean when it is free of pathogens. The item or area is contaminated when pathogens are present. A sterile item or area is contaminated when pathogens or non-pathogens are present. Cross-contamination is passing microbes from 1 person to another by contaminated hands, equipment, or supplies (Fig. 16-3). Medical asepsis and surgical asepsis (p. 244) prevent cross-contamination.

FIGURE 16-3 Cross-contamination. A, Microbes on the person’s skin are transmitted to the nursing assistant’s hands. B, Contaminated hands transmit microbes from 1 person to another.

Common Aseptic Practices

Aseptic practices break the chain of infection. To prevent the spread of microbes, wash your hands:

• After elimination.

• After changing tampons or sanitary pads.

• After contact with your own or another person’s blood, body fluids, secretions, or excretions. This includes saliva, vomitus, urine, feces, vaginal discharge, mucus, semen, wound drainage, pus, and respiratory secretions.

• After coughing, sneezing, or blowing your nose.

• Before and after handling, preparing, or eating food.

• After smoking.

Also do the following.

• Provide all persons with their own linens and personal care items.

• Cover your nose and mouth when coughing, sneezing, or blowing your nose. If tissues are not available, cough or sneeze into your upper arm (Fig. 16-4). Do not cough or sneeze into your hands.

FIGURE 16-4 Sneezing into the upper arm.

• Bathe, wash hair, and brush your teeth regularly.

• Wash fruit and raw vegetables before eating or serving them.

• Wash cooking and eating utensils with soap and water after use.

See Focus on Children and Older Persons: Common Aseptic Practices.

See Focus on Long-Term Care and Home Care: Common Aseptic Practices.

Focus on Children and Older Persons

Common Aseptic Practices

Older Persons

Persons with dementia do not understand aseptic practices. The staff must protect them from infection. Assist them with hand-washing:

• After elimination

• After coughing, sneezing, or blowing the nose

• Before or after they eat or handle food

• Any time their hands are soiled

Check and clean their hands and fingernails often. They may not or cannot tell you when soiling occurs.

Focus on Long-Term Care and Home Care

Common Aseptic Practices

Home Care

You must prevent the spread of microbes in home settings. Also, protect the person from microbes brought into the home. The measures on this page and others (p. 226) are needed. Also protect the person from foodborne illnesses (Chapter 27).

Microbes easily grow and spread in bathrooms. The entire family must help keep the bathroom clean. Aseptic measures are needed when the bathroom is used.

• Flush the toilet after each use.

• Rinse the sink after washing, shaving, or oral hygiene.

• Wipe out the tub or shower after each use.

• Remove and dispose of hair from the sink, tub, or shower.

• Hang towels out to dry. Or place them in a hamper.

• Wipe up spills—water, personal care products, beverages, and so on.

Wear utility gloves to clean bathrooms. Use a disinfectant or water and detergent to clean all surfaces.

• Toilet surfaces—bowl, seat, and all outside areas

• The floor

• The sides, walls, and curtain or door of the shower or tub

• Towel racks

• Toilet tissue holder, toothbrush holder, and soap holders

• The mirror (use a glass cleaner)

• The sink

• Window sills

To clean bathrooms, you also need to:

• Mop uncarpeted floors. Vacuum carpeted floors.

• Empty wastebaskets.

• Put out clean towels and washcloths.

• Open bathroom windows for a short time and use air fresheners. These actions reduce odors and give the bathroom a fresh smell.

• Wash bath mats, the wastebasket, and the laundry hamper weekly.

• Replace toilet and facial tissue as needed.

The care plan and assignment sheet tell you when to clean other areas of the home. For general housekeeping:

• Wipe up spills right away.

• Dust furniture and blinds.

• Vacuum or mop floors. Damp-mop uncarpeted floors at least weekly.

• Use a dust mop to sweep. Use a dustpan to collect dust, crumbs, and other things swept up. Sweep daily or more often if needed.

• Wash clothes and linens.

Hand Hygiene

Hand hygiene is the easiest and most important way to prevent the spread of microbes and infection. You use your hands for almost everything. They are easily contaminated. They can spread microbes to other persons or items (see Fig. 16-3). Practice hand hygiene before and after giving care. See Box 16-3 for the rules of hand hygiene.

Box 16-3

Rules of Hand Hygiene

• Wash your hands (with soap and water) at these times.

• When they are visibly dirty or soiled with blood, body fluids, secretions, or excretions

• Before eating and after using a restroom

• If exposure to the anthrax spore is suspected or proven

• If an alcohol-based hand rub is not available

• Use an alcohol-based hand rub to practice hand hygiene if your hands are not visibly soiled.

• Before direct contact with a person.

• After contact with the person’s intact skin. After taking a pulse or blood pressure or after moving a person are examples.

• After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled.

• When moving from a contaminated body site to a clean body site.

• After contact with items in the person’s care setting.

• After removing gloves.

• Follow these rules for washing your hands with soap and water. See procedure: Hand-Washing, p. 225.

• Wash your hands under warm running water. Do not use hot water.

• Stand away from the sink. Do not let your hands, body, or uniform touch the sink. The sink is contaminated. See Figure 16-5, p. 224.

FIGURE 16-5 The uniform does not touch the sink. Soap and water are within reach. Hands are lower than the elbows. Hands do not touch the inside of the sink.

• Do not touch the inside of the sink at any time.

• Keep your hands and forearms lower than your elbows. Your hands are dirtier than your elbows and forearms. If you hold your hands and forearms up, dirty water runs from your hands to your elbows. Those areas become contaminated.

• Rub your palms together (Fig. 16-6, p. 224) and interlace your fingers (Fig. 16-7, p. 224) to work up a good lather. The rubbing action helps remove microbes and dirt.

FIGURE 16-6 The palms are rubbed together to work up a good lather.

FIGURE 16-7 The fingers are interlaced to clean between the fingers.

• Pay attention to areas often missed during hand-washing—thumbs, knuckles, sides of the hands, little fingers, and under the nails.

• Clean fingernails by rubbing the fingertips against your palms (Fig. 16-8, p. 224).

FIGURE 16-8 The fingertips are rubbed against the palms to clean under the fingernails.

• Use a nail file or orangewood stick to clean under fingernails (Fig. 16-9, p. 224). Microbes grow easily under the fingernails.

FIGURE 16-9 A nail file is used to clean under the fingernails.

• Wash your hands for at least 15 to 20 seconds. Wash your hands longer if they are dirty or soiled with blood, body fluids, secretions, or excretions. Use your judgment and follow agency policy.

• Use clean, dry paper towels to dry your hands.

• Dry your hands starting at the fingertips. Work up to your forearms (Fig. 16-10, p. 224). You will dry the cleanest area first.

FIGURE 16-10 Hands are dried starting at the fingertips and working up to the forearms.

• Use a clean, dry paper towel for each faucet to turn the water off (Fig. 16-11, p. 225). Faucets are contaminated. The paper towels prevent you from contaminating your clean hands.

FIGURE 16-11 A paper towel is used to turn off each faucet.

• Follow these rules when decontaminating your hands with an alcohol-based hand rub. See procedure: Using an Alcohol-Based Hand Rub, p. 225.

• Apply the product to the palm of 1 hand. Follow the manufacturer’s instructions for the amount to use.

• Rub your hands together.

• Cover all surfaces of your hands and fingers.

• Continue rubbing your hands together until your hands are dry.

• Apply hand lotion or cream after hand hygiene. This prevents the skin from chapping and drying. Skin breaks can occur in chapped and dry skin. Skin breaks are portals of entry for microbes.

Modified from Centers for Disease Control and Prevention: Guidelines for hand hygiene in health-care settings, Morbidity and Mortality Weekly, Report 51 (RR-16), October 2002.

See Focus on Surveys: Hand Hygiene.

See Promoting Safety and Comfort: Hand Hygiene.

See procedure: Hand-Washing, p. 225.

See procedure: Using an Alcohol-Based Hand Rub, p. 225.

Promoting Safety and Comfort

Hand Hygiene

Safety

You use your hands for almost every task. They can pick up microbes from a person, place, or thing. Your hands transfer them to other people, places, or things. That is why hand hygiene is so very important. Always practice hand hygiene before and after giving care.

Comfort

You will practice hand hygiene very often during your shift. Hand lotions and hand creams help prevent chapping and dry skin.

Focus on Surveys

Hand Hygiene

Hand hygiene is a focus of surveys. A surveyor may:

Hand-Washing

Procedure

1. See Promoting Safety and Comfort: Hand Hygiene, p. 223.

2. Make sure you have soap, paper towels, an orangewood stick or nail file, and a wastebasket. Collect missing items.

3. Push your watch up your arm 4 to 5 inches. Push long uniform sleeves up too.

4. Stand away from the sink so your clothes do not touch the sink. Stand so the soap and faucet are easy to reach (see Fig. 16-5). Do not touch the inside of the sink at any time.

5. Turn on and adjust the water until it feels warm.

6. Wet your wrists and hands. Keep your hands lower than your elbows. Be sure to wet the area 3 to 4 inches above your wrists.

7. Apply about 1 teaspoon of soap to your hands.

8. Rub your palms together and interlace your fingers to work up a good lather (see Fig. 16-6). Lather your wrists, hands, and fingers. Keep your hands lower than your elbows. This step should last at least 15 to 20 seconds.

9. Wash each hand and wrist thoroughly. Clean the back of your fingers and between your fingers (see Fig. 16-7).

10. Clean under the fingernails. Rub your fingertips against your palms (see Fig. 16-8).

11. Clean under the fingernails with a nail file or orangewood stick (see Fig. 16-9). Do this for the first hand-washing of the day and when your hands are highly soiled.

12. Rinse your wrists, hands, and fingers well. Water flows from above the wrists to your fingertips.

13. Repeat steps 7 through 12, if needed.

14. Dry your wrists and hands with clean, dry paper towels. Pat dry starting at your fingertips (see Fig. 16-10).

15. Discard the paper towels into the wastebasket.

16. Turn off faucets with clean, dry paper towels. This prevents you from contaminating your hands (see Fig. 16-11). Use a clean paper towel for each faucet. Or use knee or foot controls to turn off the faucet.

17. Discard the paper towels into the wastebasket.

Using an Alcohol-Based Hand Rub

Procedure

1. See Promoting Safety and Comfort: Hand Hygiene, p. 223.

2. Apply a palmful of an alcohol-based hand rub into a cupped hand (Fig. 16-12, A, p. 226).

FIGURE 16-12 Using an alcohol-based hand rub. A, A palmful of an alcohol-based hand rub is applied into a cupped hand. B, The palms are rubbed together. C, The palm of 1 hand is rubbed over the back of the other. D, The palms are rubbed together with the fingers interlaced. E, The fingers are interlocked and rubbed back and forth. F, The thumb of 1 hand is rubbed in the palm of the other. G, The fingers of 1 hand are rubbed into the palm of the other hand with circular motions.

3. Rub your palms together (Fig. 16-12, B, p. 226).

4. Rub the palm of 1 hand over the back of the other (Fig. 16-12, C, p. 226). Do the same for the other hand.

5. Rub your palms together with your fingers interlaced (Fig. 16-12, D, p. 226).

6. Interlock your fingers as in Figure 16-12, E, p. 226. Rub your fingers back and forth.

7. Rub the thumb of 1 hand in the palm of the other (Fig. 16-12, F, p. 226). Do the same for the other thumb.

8. Rub the fingers of 1 hand into the palm of the other hand (Fig. 16-12, G, p. 226). Use a circular motion. Do the same for the fingers of the other hand.

9. Continue rubbing your hands until they are dry.

Supplies and Equipment

Disposable supplies and equipment help prevent the spread of infection. Discard single-use items after use. A person uses multi-use items many times. They include bedpans, urinals, wash basins, and water mugs. Label such items with the person’s room and bed number. Do not “borrow” them for another person.

Non-disposable items are cleaned and then disinfected. Then they are sterilized by the supply department.

Cleaning.

Cleaning reduces the number of microbes present. It also removes organic matter. Organic matter comes from living plants and animals and is able to decay. Blood, body fluids, secretions, and excretions are organic matter. So is food.

To clean equipment:

• Wear personal protective equipment (PPE) to clean items contaminated with blood, body fluids, secretions, or excretions. PPE includes gloves, a mask, a gown, and goggles or a face shield.

• Work from clean to dirty areas. If you work from a dirty to clean area, the clean area becomes contaminated (dirty).

• Rinse the item in cold water to remove organic matter. Heat makes organic matter thick, sticky, and hard to remove.

• Wash the item with soap and hot water.

• Scrub thoroughly. Use a brush if necessary.

• Rinse the item in warm water. Dry the item.

• Disinfect the item. Or send it to the supply department to be sterilized.

• Disinfect equipment used and the sink.

• Discard PPE.

• Practice hand hygiene.

Agencies have clean and dirty utility rooms. Equipment is cleaned in the dirty utility room. Then it is disinfected or sterilized in the clean utility room.

Disinfection.

Disinfection is the process of killing pathogens. Spores are not destroyed. Spores are bacteria protected by a hard shell. Spores are killed by very high temperatures.

Disinfectants are used to clean objects and surfaces. A disinfectant is a liquid chemical that can kill many or all pathogens except spores. Disinfectants are used to clean counters, tubs, showers, and re-usable items. Such items include:

• Blood pressure cuffs

• Commodes and metal bedpans

• Wheelchairs and stretchers

• Furniture

See Focus on Long-Term Care and Home Care: Disinfection.

See Promoting Safety and Comfort: Disinfection.

Focus on Long-Term Care and Home Care

Disinfection

Home Care

Detergent and hot water are used to clean cooking, eating, and drinking utensils and linens. Household disinfectants are used for surfaces—floors, toilets, tubs, and showers. Use the products the family prefers or as the nurse instructs.

White vinegar and water is a good, cheap disinfectant. You can use it to clean bedpans, urinals, commodes, toilets, mirrors, bathroom tiles, and so on. To make a vinegar solution:

• Mix 1 cup of white vinegar with 3 cups of water.

• Label the container as a “vinegar solution: 1 cup white vinegar, 3 cups water.”

• Write the date, time, and your name on the label.

Promoting Safety and Comfort

Disinfection

Safety

Disinfectants can burn and irritate the skin. Wear utility gloves or rubber household gloves to prevent skin irritation. These gloves are waterproof. Do not wear disposable gloves.

Some disinfectants have special measures for use and storage. Check the safety data sheet (SDS) before handling a disinfectant. See Chapter 13.

Sterilization.

Sterilizing destroys all non-pathogens, pathogens, and spores. Very high temperatures are used. Heat destroys microbes.

Boiling water, radiation, liquid or gas chemicals, dry heat, and steam under pressure are sterilization methods. An autoclave (Fig. 16-13) is a pressure steam sterilizer. Glass, surgical items, and metal objects are autoclaved. High temperatures destroy plastic and rubber items. They are not autoclaved. Steam under pressure sterilizes objects in 30 to 45 minutes.