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S e c t i o n IThe Clinical

Medical Assistant

3

U n i t O n e

Performing ClinicalDuties

1Medical Asepsis andInfection Control

MICROORGANISMS,PATHOGENS, AND NORMAL FLORAConditions That Favor the Growth

of PathogensThe Infection CycleModes of Transmission

PRINCIPLES OF INFECTIONCONTROLMedical AsepsisLevels of Infection ControlSanitationDisinfection

OCCUPATIONAL SAFETY ANDHEALTH ADMINISTRATIONGUIDELINES FOR THEMEDICAL OFFICEExposure Risk Factors and the

Exposure Control PlanStandard PrecautionsPersonal Protective EquipmentHandling Environmental

ContaminationDisposing of Infectious WasteHepatitis B and Human

Immunodeficiency Viruses

CHAPTER OUTLINE

ROLE DELINEATION COMPONENTS

ADMINISTRATIVE: ADMINISTRATIVEPROCEDURES• Perform basic administrative medical assisting

functions

CLINICAL: FUNDAMENTAL PRINCIPLES• Apply principles of aseptic technique and infection

control• Comply with quality assurance practices

CLINICAL: PATIENT CARE• Prepare and maintain examination and treatment

areas

GENERAL: PROFESSIONALISM• Display a professional manner and image• Demonstrate initiative and responsibility• Work as a member of the health care team

GENERAL: COMMUNICATION SKILLS• Recognize and respond effectively to verbal,

nonverbal, and written communications

GENERAL: LEGAL CONCEPTS• Perform within legal and ethical boundaries• Document accurately• Comply with federal and state health care legislation

and regulations• Comply with established risk management and safety

procedures

GENERAL: INSTRUCTION• Teach methods of health promotion and disease

prevention

GENERAL: OPERATIONAL FUNCTIONS• Perform inventory of supplies and equipment

CHAPTER COMPETENCIES

LEARNING OBJECTIVESUpon successfully completing this chapter, you will be able to:

1. Spell and define key terms.2. Describe conditions that promote the growth of

microorganisms.3. Explain the components of the infectious process

cycle.4. List the various ways microbes are transmitted.5. Compare the effectiveness in reducing or

destroying microorganisms using the four levels ofinfection control.

6. Describe the procedures for cleaning, handling, anddisposing of biohazardous waste in the medical office.

7. Explain the concept of medical asepsis.8. Discuss risk management procedures required by

the Occupational Safety and Health Administrationguidelines for the medical office.

9. List the required components of an exposurecontrol plan.

10. Explain the importance of following StandardPrecautions in the medical office.

11. Identify various personal protective equipment(PPE) items.

12. Describe circumstances when PPE items would beappropriately worn by the medical assistant.

13. Explain the facts pertaining to the transmission andprevention of the Hepatitis B virus and the HumanImmunodeficiency Virus in the medical office.

14. Describe how to avoid becoming infected with theHepatitis B and Human Immunodeficiency viruses.

PERFORMANCE OBJECTIVESUpon successfully completing this chapter, you will be able to:

1. Perform a medical aseptic handwashing procedure(Procedure 19-1).

2. Remove and discard contaminated personal protec-tive equipment appropriately (Procedure 19-2).

3. Clean and decontaminate biohazardous spills(Procedure 19-3).

5

KEY TERMS

aerobeanaerobeasymptomaticbactericidalbiohazardcarrierdiseasedisinfection

exposure control planexposure risk factorsgermicideimmunizationinfectionmedical asepsismicroorganismsnormal flora

OSHApathogenspersonal protective

equipmentpostexposure testingresident floraresistancespore

sanitationsanitizationstandard precautionssterilizationtransient floravectorviablevirulent

MANY PATIENTS ARE SEEN daily in the medical of-fice for a variety of reasons, including physical examina-tions for employment, reassurance about a current healthproblem, and follow-up care for a chronic condition orsurgical procedure. In addition, many patients request ap-pointments because of illness. It is important for you toprotect patients from each other with regard to contagiousdiseases and for you to protect yourself from acquiring themany microorganisms that you will come into contactevery day.

To prevent the spread of disease in the medical office,medical assistants must meet two goals. First, you mustunderstand and practice medical asepsis at all times, usingspecific practices and procedures to prevent disease trans-mission. These practices and procedures also allow you towork with ill patients while reducing the chances that youwill spread disease to other patients or become infectedyourself. Second, you must teach the patients and their fam-ilies about techniques to use at home to prevent the trans-mission of disease. Handwashing, the cornerstone of infec-tion control, is discussed in this chapter and is emphasized inall subsequent chapters wherever contact with infectiousmaterial might be expected. In addition, this chapter de-scribes how disease is transmitted and most important, howto prevent the spread of disease.

MICROORGANISMS, PATHOGENS,AND NORMAL FLORA

Microorganisms, living organisms that can be seen onlywith a microscope, are part of our normal environment. Inaddition to our physical environment, many microorgan-isms can be found on your skin and throughout your gas-trointestinal, genitourinary, and respiratory systems, andsome of these are required for good health. These microor-ganisms are normal and are referred to as normal flora orresident flora. Some microorganisms, however, are notpart of the normal flora and may cause disease or infection.Disease-producing microorganisms are referred to aspathogens and are classified as bacteria, viruses, fungi, orprotozoa. (See Chapter 24 for a more detailed discussion ofmicroorganisms.)

When normal flora become too many in number or aretransmitted to an area of the body in which they are not nor-mally found, they are referred to as transient flora, whichcan become pathogens under the right conditions. For exam-ple, Staphylococcus aureus, a microorganism commonlyfound on the skin, may get into underlying tissue if the skinis broken. In this situation, the normal flora of the skin hasbecome transient flora and may cause disease. Decreasedresistance in the host is one condition that may allow tran-sient flora to become pathogenic. Individuals who are el-derly, receiving certain drugs to treat cancer, or under un-usual stress may have a lowered resistance and beparticularly susceptible to infections.

Although the body is protected by many nonspecific de-fenses against disease, infection or illness may occur if thenatural barriers are overpowered or breached. These aresome of the body’s natural defenses that may prevent the in-vasion of pathogens into various body organs:

• Skin. As long as the skin is kept clean and remains in-tact or unbroken, staphylococcal (Staph) bacteria arenot considered dangerous. Washing the skin frequentlywill flush away many of these bacteria along with anyother microorganisms.

• Eyes. The eyelashes act as a barrier by trapping dustthat may carry microorganisms before they have anopportunity to enter the eye. If any microorganisms doenter the eye, the enzyme lysozyme normally found intears will destroy some microorganisms, includingbacteria.

• Mouth. The greatest variety of microorganisms in thebody are in the mouth. Saliva is slightly bactericidal,and good oral hygiene will remove or prevent thegrowth of many of the pathogens in the mouth.

• Gastrointestinal tract. Hydrochloric acid normallyfound in the stomach destroys most of the disease-producing pathogens that enter the gastrointestinalsystem. One bacterium, Escherichia coli (E. coli), isresident flora found in the large intestine and isnecessary for digestion. It does not usually causedisease as long it remains within the gastrointestinaltract. Helicobacter pylori also resides in the diges-tive tract of some individuals and may cause gastriculcers.

• Respiratory tract. Hairs and cilia on the membrane lin-ing of the nostrils are early defenses against airbornemicroorganisms. If these physical barriers do not stopan invasion, mucus from the membranes lining the res-piratory tract should trap the microorganisms and facil-itate their removal from the respiratory system as theperson swallows, coughs, or sneezes.

• Genitourinary tract. The reproductive and urinary sys-tems provide a less hospitable environment for mi-croorganisms. The slightly acidic environment ofthese body systems reduces the ability of many mi-croorganisms to survive. In addition, frequent urina-tion flushes the urinary tract and removes many tran-sient microorganisms.

While these systems have protective mechanisms to pre-vent infection, any of them may be overpowered by a partic-ularly virulent organism. Transient flora are not usuallypathogenic unless the person’s defenses are compromised bya decrease in resistance.

Checkpoint Question

1. What are pathogenic microorganisms? Howdoes the body prevent an invasion and subsequentinfection naturally?

6 Section I ■ The Clinical Medical Assistant

Conditions That Favor the Growth of Pathogens

All microorganisms require certain conditions to grow andreproduce. To reduce the number of microorganisms and po-tential pathogens in a clinical setting, you must eliminate asmany of their life requirements as possible. These require-ments include the following:

• Moisture. Few microorganisms can survive with littlewater or moisture. However, some microorganismsform spores and remain dormant until moisture isavailable.

• Nutrients. Microorganisms depend on their environ-ment for nourishment. Surfaces (tables, counters,equipment) that are contaminated with organic matter(food products, body fluids, or tissue) promote thegrowth of microorganisms.

• Temperature. Although some microorganisms can sur-vive even in freezing or boiling temperatures, thosethat thrive at a normal body temperature of 98.6°Fare most likely to be pathogenic to humans. Many mi-croorganisms that leave an infected person can survivefor a while at room temperature; therefore, surfacesthat are contaminated with dried organic materialshould be considered possibly pathogenic.

• Darkness. Many pathogenic bacteria are destroyed bybright light, including sunlight.

• Neutral pH. The pH of a solution refers to the mea-surement of its acid-base balance on a scale of 1 to 14,

with 7 being neutral. Many microorganisms are de-stroyed in an environment that is not neutral. The pHof blood, 7.35 to 7.45, is preferred by microorganismsthat thrive in the human body.

• Oxygen. Microorganisms that need oxygen to surviveare called aerobes. A few, however, do not requireoxygen; these are called anaerobes. While mostpathogens are aerobic, the microbes that cause tetanusand botulism are anaerobic.

If any one of these conditions is altered in any way, thegrowth and reproduction of the pathogen will be affected.Your role as a professional medical assistant in a medical of-fice includes using this knowledge of microbial growth to in-hibit the growth and reproduction of microorganisms in theoffice.

Checkpoint Question

2. Given the six conditions that favor the growth ofpathogens, explain how you can alter the growthand reproduction of microorganisms by changingthese factors.

The Infection Cycle

The infection cycle is often thought of as a series of specificlinks of a chain involving a causative agent or invading mi-croorganism (FIG. 1-1). The first link in the chain is the reser-voir host; this is the person who is infected with the mi-

Chapter 1 ■ Asepsis and Infection Control 7

POINT 1

POINT 5 POINT 2

POINT 4 POINT 3

Reservoir:Place on which or in whichorganisms grow and reproduce.Examples include man andanimals.

Susceptible host:Person whose body cannot fightoff organism once it enters thebody and who therefore usuallybecomes ill.

Exit from reservoir:Escape route for organisms.Examples include nose, throat,mouth, ear, intestinal tract, urinarytract, and wounds.

Portal of entry:Part of body where organismsenter. Examples include any breakin skin or mucous membrane,mouth, nose, and genitourinarytract.

Vehicle of transmission:Means by which organisms arecarried about. Examples includehands, equipment (e.g., bedpan),instruments, china and silverware,linens, and droplets.

F I G U R E 1 - 1 . The infectiousprocess cycle. Infections and infectious dis-eases are spread by starting from the reser-voir (point 1) and moving in a circle to thesusceptible host (point 5). Microorganismscan be controlled by interfering at any pointin the cycle.

croorganism. While this person may or may not show signsof infection, his or her body is serving as a source of nutri-ents and an incubator in which the pathogen can grow andreproduce. These persons are also called carriers, or reser-voirs, of disease.

The reservoir host may transmit disease only when thepathogen has a means of exit. The second link in the chain isthe manner in which the pathogen leaves the reservoir host.Means of exit include the mucous membranes of the noseand mouth, the openings of the gastrointestinal system(mouth or rectum), and an open wound.

In addition to the means of exit, the microbe must have avehicle in which to leave the host. This next link in the chain,the means of transmission, involves the vehicle that is usedby the pathogen when it leaves the reservoir host and spreadsthrough the environment. Vehicles include mucus or airdroplets from the oral or nasal cavities and direct contact be-tween an unclean hand and another person or object. Sneez-ing and coughing without covering the nose and mouth areexcellent methods of transmitting microorganisms into theenvironment and potential hosts.

The fourth link in the chain of the infectious process cycleis the portal of entry. This is the route by which the pathogenenters the next host. With inhalation of contaminated airdroplets the respiratory system is the portal of entry. Anotherportal of entry is the gastrointestinal system: the pathogenenters the body in contaminated food or drink. Any break inthe skin or mucous membranes can be a portal of entry forpathogenic microorganisms.

The final link in the infectious process cycle is the sus-ceptible host (Box 1-1). This host is one to whom thepathogen is transmitted after leaving the reservoir host. If theconditions in the susceptible host are conducive to reproduc-tion of the pathogen, the susceptible host becomes a reser-voir host and the cycle repeats.

Checkpoint Question

3. How are the first and fifth links of the infectioncycle related?

Modes of Transmission

In the third link of the infectious process cycle, the vehiclethat spreads the microorganism is often called the mode oftransmission. It is important for you to understand the modeof transmission used by various pathogens so that you canbreak this link in the infectious cycle and prevent the spreadof disease.

Direct Transmission

Direct contact between the infected reservoir host and thesusceptible host produces direct transmission. Direct trans-mission may occur when one touches contaminated blood orbody fluids, shakes hands with someone who has contami-

nated hands, inhales infected air droplets, or has intimatecontact, such as kissing or sexual intercourse.

Indirect Transmission

Indirect transmission may occur through contact with a ve-hicle known as a vector. Vectors include contaminatedfood or water, disease-carrying insects, and inanimate ob-jects such as soil, drinking glasses, wound drainage, and in-fected or improperly disinfected medical instruments.While visible blood and body fluids are obvious sources ofinfection, many infectious organisms remain viable forlong periods on inanimate surfaces that are not visibly con-taminated.

Sources of Transmission

Most reservoir hosts are humans, animals, and insects. Hu-man hosts include people who are ill with an infectious dis-ease, people who are carriers of an infectious disease, andpeople who are incubating an infectious disease but are notexhibiting symptoms. This last group can transmit diseaseeven though they are ambulatory and asymptomatic (haveno symptoms). Animal sources, which are less common,include infected dogs, cats, birds, cattle, rodents, and ani-mals that live in the wild. Diseases that may be transmittedto humans from infected animals include anthrax andrabies.

In addition to flies and roaches, which carry many diseases,other insect sources feed on the blood of an infected reservoir


THE SUSCEPTIBLE HOSTThe susceptible host is unable to resist the invadingpathogens for a variety of reasons:• Age. As the body ages, defense mechanisms begin

to lose their effectiveness. The immune system isno longer as active or as efficient as in youth. Theimmune system may also not be fully functional inthe very young.

• Existing disease. The stress of an existing illnessmay deplete the immune system and allow microor-ganisms to cause illness in someone who mightotherwise be able to fight it naturally.

• Poor nutrition. A diet deficient in nutrients such asproteins, carbohydrates, fats, vitamins, or mineralswill not allow cells of the body to repair or repro-duce as they are weakened by disease.

• Poor hygiene. Although multitudes of microbesexist on our skin, keeping the numbers down bypracticing good hygiene will reduce the numbers ofpathogens.

B o x 1 - 1

host and then pass the disease to another victim or suscepti-ble host. Ticks and mosquitoes may transmit diseases, in-cluding Lyme disease (ticks) and malaria (mosquitoes).TABLE 1-1 lists some common diseases and their methods oftransmission.

Checkpoint Question

4. The medical office where you work has a policyof not opening screenless windows in examinationrooms and the reception area. Why do you thinkthis policy is or is not important?

PRINCIPLES OF INFECTIONCONTROL

Most transmission of infectious disease in the medical of-fice can be prevented by strict adherence to guidelines is-sued by the Occupational Safety and Heath Administration(OSHA) and the Centers for Disease Control and Preven-tion (CDC). While most medical assistants take extraordi-

nary precautions when dealing with patients who areknown carriers of infectious microorganisms, you may alsotreat an estimated five unknown carriers for each patientknown to be infectious. Therefore, knowledge and use ofeffective infection control in relation to all patients isessential.

Medical Asepsis

Medical asepsis does not mean that an object or area isfree from all microorganisms. It refers to practices thatrender an object or area free from pathogenic microorgan-isms. Commonly known as clean technique, medical asep-sis prevents the transmission of microorganisms fromone person or area to any other within the medical office(Box 1-2).


Disease Method of Transmission

AIDS Contact, or contact with contaminated sharps

Diphtheria Airborne droplets, infected carriers

Rubella Airborne droplets, infected carriers(Germanmeasles)

Influenza Airborne droplets, infected carriers or directcontact with contaminated articles such asused tissues

Measles Airborne droplets, infected carriers(rubeola)

Mumps Airborne droplets, infected carriers or directcontact with materials contaminated withinfected saliva

Mononucleosis Airborne droplets or contact with infectedsaliva.

Pneumonia Airborne droplets or direct contact withinfected mucus

Tuberculosis Airborne droplets, infected carriers

Tetanus Direct contact with spores or contaminatedanimal feces

Rabies Direct contact with saliva of infected animalsuch as an animal bite

Cholera Ingestion of contaminated food or water.

Chicken pox Direct contact or droplets(varicella)

Meningitis Airborne droplets

Hepatitis B Direct contact with infectious body fluid

T a b l e 1 - 1 COMMON COMMUNICABLEDISEASES

PATIENT EDUCATION

BASIC ASEPTIC TECHNIQUE

While performing procedures, take the opportunity toinstruct your patients in basic aseptic techniques theycan use at home to reduce the spread of disease.

• Handwashing. This routine aseptic technique is par-ticularly important for patients and families in pre-venting the spread of disease. Instruct patients towash their hands before and after eating meals, aftersneezing, coughing, or blowing the nose, after usingthe bathroom, before and after changing a dressing,and after changing diapers.

• Use tissue. Explain to patients with respiratorysymptoms that using a disposable tissue to cover themouth and nose when coughing and sneezing de-creases the potential to transmit the illness through-out the household. In addition, immediate andproper disposal of the used tissue is essential to pre-vent the spread of infection.

• Changing bandages. Patients and family memberswho change dressings on wounds should be in-structed in the proper procedure for using steriledressings and clean bandages. Always demonstratethe procedure for the patient and have the patient orfamily member return the demonstration to ensuretheir understanding.

• Sanitation. Explain the proper techniques for dis-posing of waste from members of the householdwith communicable diseases. If in doubt, consultthe local public health department for guidelines.

Handwashing is the MOST IMPORTANT medical aseptictechnique to prevent the transmission of pathogens. Theproper procedure for washing your hands is detailed inProcedure 1-1. Always wash your hands:

• Before and after every patient contact• After coming into contact with any blood or body fluids• After coming into contact with contaminated material• After handling specimens• After coughing, sneezing, or blowing your nose• After using the restroom• Before and after going to lunch, taking breaks, and

leaving for the day

Because you should always assume that blood and bodyfluids are contaminated with pathogens, you should weargloves when handling any specimens or when contact withcontaminated material is anticipated. However, wearinggloves does not replace handwashing! In fact, your handsshould be washed BEFORE you apply gloves and AFTER

you remove them in all situations to prevent disease trans-mission.

Other medical aseptic techniques include general cleaningof the office, including the examination and treatmentrooms, waiting or reception area, and clinical work areas.Floors are always considered contaminated, and dust and dirtare vehicles for transmission of microorganisms and shouldbe regularly cleaned from all surfaces, including the floor. Inaddition, you should teach patients and their caregiversproper medical aseptic techniques for use in the home to pre-vent the spread of disease.

Checkpoint Question

5. Explain why wearing examination gloves doesnot replace handwashing.

Levels of Infection Control

Sterilization, the highest level of infection control, destroysall forms of microorganisms, including spores, on an inani-mate surfaces. Sterilization methods include exposing the ar-ticles to various conditions, including steam under pressurein an autoclave; specific gases, such as ethylene oxide; dryheat ovens; and immersion in an approved chemical steriliz-ing agent (see Chapter 5 for a more complete discussion ofsterilization techniques). Instruments or devices that pene-trate the skin or come into contact with areas of the bodyconsidered sterile, such as the urinary bladder, must be ster-ilized using one of these methods. To save time, many med-ical offices use disposable sterile supplies and equipment toeliminate the need for manual sterilization (FIG. 1-2).

The next highest level of infection control is disinfection.Disinfectants or germicides inactivate virtually all recog-nized pathogenic microorganisms except spores on inani-mate objects. There are three levels of disinfection, high, in-termediate, and low. Each is described in more detail in thefollowing section.

The lowest level of infection control is sanitization,which is cleaning any visible contaminants from the item us-ing soap or detergent, water, and manual friction.

Sanitation

Most instruments, equipment, and supplies used in medicaloffices must be sanitized regularly according the recommen-


GUIDELINES FORMAINTAINING MEDICALASEPSIS• Avoid touching your clothing with soiled linen,

table paper, supplies, or instruments. Roll used tablepaper or linens inward with the clean surface out-ward.

• Always consider the floor to be contaminated. Anyitem dropped onto the floor must be considereddirty and be discarded or cleaned to its former levelof asepsis before being used.

• Clean tables, counters, and other surfaces frequentlyand immediately after contamination. Clean areasare less likely than dirty ones to harbor microorgan-isms or encourage their growth.

• Always presume that blood and body fluids fromany source are contaminated. Follow the guidelinespublished by OSHA and the CDC to protect your-self and to prevent the transmission of disease.

B o x 1 - 2 .

F I G U R E 1 - 2 . Equipment that must be sterile includes itemsthat will penetrate the skin or come into contact with surgical inci-sions, such as surgical instruments. These items are disposable forone-time use only.

F I G U R E 1 - 3 . These products destroy many pathogenic mi-croorganisms if used correctly.


dations of the manufacturer. Sanitation maintenance of ahealthful, disease-free, and hazard-free environment. Sanita-tion often involves sanitization procedures that reduce thenumber of microorganisms on an inanimate object to a safeor relatively safe level. This is accomplished by thoroughlycleaning items such as instruments and equipment withwarm, soapy water with mechanical action to remove or-ganic matter and other residue. Cleaning or sanitizing mustprecede disinfection and sterilization.

Disinfection

Disinfectants, or germicides, inactivate virtually all recog-nized pathogenic microorganisms but not necessarily all mi-crobial forms, including spores, on inanimate objects. Thesefactors may affect disinfection:

• Prior cleaning of the object. Equipment and supplies thathave been sanitized first are more effectively disinfected.

• The amount of organic material on the object. Themore organic matter, such as blood or body tissues, onthe item, the more disinfectant agent you must use.

• The type of microbial contamination. All blood andbody fluids should be considered contaminated withblood-borne pathogens such as hepatitis B and HIV.

• The concentration of the germicide or chemical disin-fectant that kills pathogens. Disinfectants diluted withwater are relatively ineffective at killing microbes.

• The length of exposure to the germicide. The longer thedisinfectant comes into contact with the contaminatedobject, the more thorough disinfection is likely to be.

• The shape or complexity of the object being disin-fected. Objects that have rough edges, corners, or oth-erwise difficult-to-clean areas may require specialtechniques to disinfect all surfaces.

• The temperature of the process. Most disinfectantswork adequately at room temperature.

Disinfection is categorized into three levels, high, inter-mediate, and low. High-level disinfection destroys mostforms of microbial life except certain bacterial spores. Thislevel of infection control, which is slightly less effective thansterilization, is commonly used to clean reusable instrumentsthat come into contact with mucous membrane–lined bodycavities that are not considered sterile, such as the vagina andthe rectum. Methods of high-level disinfection include im-mersion in boiling water for 30 minutes (rarely used in themedical office) and immersion in an approved disinfectingchemical, such as glutaraldehyde or isopropyl alcohol for45 minutes or according to the guidelines in the disinfectantlabel.

Intermediate-level disinfection destroys many viruses,fungi, and some bacteria, including Mycobacterium tubercu-losis (M. tuberculosis), the bacterium that causes tuberculo-sis. However, intermediate disinfection does not kill bacte-rial spores. Intermediate disinfection is used for surfaces andinstruments that come into contact with unbroken skin sur-

faces, including stethoscopes, blood pressure cuffs, andsplints. Commercial chemical germicides that kill M. tuber-culosis and solutions containing a 1:10 dilution of householdbleach (2 oz of chlorine bleach per quart of tap water) are ef-fective intermediate disinfectants.

Low-level disinfection destroys many bacteria and someviruses, but not M. tuberculosis or bacterial spores. Thistype of disinfection is adequate in the medical office forroutine cleaning and removing surface debris when no vis-ible blood or body fluids are on the items being disinfected.Disinfectants without tuberculocidal properties are usedfor low-level disinfection (FIG. 1-3). TABLE 1-2 describesdisinfection methods, uses, and precautions of variouschemicals.

Checkpoint Question

6. What level of disinfection would you use toclean a reusable instrument that comes into contact

with the vaginal mucosa, such as a vaginal speculum?Why?

OCCUPATIONAL SAFETY ANDHEALTH ADMINISTRATIONGUIDELINES FOR THE MEDICALOFFICE

OSHA is the federal agency responsible for ensuring thesafety of all workers, including those in health care. OSHApromulgates and enforces federal regulations that must befollowed by all medical offices. The practices of individualoffices regarding employees’ health and safety must be putinto either a policy and procedure manual or compiled sepa-rately as an infection control manual. Regardless of wherethe office policies are kept, however, they must be readily

available to both employees of the medical office and OSHArepresentatives.

Exposure Risk Factors and theExposure Control Plan

Medical offices must provide clear instructions in the policyor infection control manual for preventing employee expo-sure and reducing the danger of exposure to biohazardousmaterials. The exposure risk factor for each worker by jobdescription must be included in the written policy. It is basedon the employee’s risk of exposure to communicable dis-ease. Administrative medical assistants have a low exposurerisk and require only minimal protection to perform the du-ties associated with that position. However, clinical medicalassistants have a higher exposure risk and require access to avariety of personal protective equipment (PPE), such asgloves, goggles, and/or face shields, depending on the task athand, and immunization against hepatitis B at no charge tothe employee. The medical office must provide the appro-priate equipment and supplies as outlined in this office pol-icy according to OSHA.

Another written policy required by OSHA for offices with10 or more employees is the exposure control plan. The


Method Uses and Precautions

Alcohol (70% isopropyl)

Chlorine (sodium hypochlorite or bleach)

Iodine or iodophors

Phenols (tuberculocidal)

Formaldehyde

Hydrogen peroxide

Glutaraldehyde

DNA, deoxyribonucleic acid; OSHA, Occupational Safety and Health Administration.

T a b l e 1 - 2 DISINFECTION METHODS

Used for noncritical items (countertops, glass thermometers, stethoscopes)FlammableDamages some rubber, plastic, and lensesDilute 1:10 (1 part bleach to 10 parts water)Used for a broad spectrum of microbesInexpensive and fast actingCorrosive, inactivated by organic matter, relatively unstableBacteriostatic agentNot to be used on instrumentsMay cause stainingUsed for environmental items and equipmentRequires gloves and eye protectionCan cause skin irritation and burnsDisinfectant and sterilantRegulated by OSHAWarnings must be marked on all containers and storage areasStable and effective when used on inanimate objects.Attacks membrane lipids, DNA, and other essential cell components.Can damage plastic, rubber, and some metals.Alkaline or acidEffective against bacteria, viruses, fungi, and some sporesOSHA regulated; requires adequate ventilation, covered pans, gloves,

masksMust display biohazard or chemical label.

LEGAL TIP: BLOOD-BORNEPATHOGEN STANDARD TRAINING

According to OSHA, health care facilities, includingphysician offices, must provide training to newly hiredemployees who will be exposed to blood or other pos-sibly infectious material while caring for patients. Thistraining must be repeated yearly and include any newissues or policies recommended by OSHA, the CDC,the Department of Health and Human Services, or theU.S. Public Health Service. Items that must be includedin the training:• A description of blood-borne diseases, including the

transmission and symptoms.• Personal protective equipment available to the em-

ployee and the location of the PPE in the medicaloffice.

• Information about the risks of contracting hepatitisB and about the HBV vaccine.

• The exposure control plan and postexposure proce-dures, including follow-up care in the event of anexposure.

• Change gloves between procedures on the same patientafter exposure to potentially infective material.

• Wear equipment to protect your eyes, nose, and mouthand avoid soiling your clothes by wearing a disposablegown or apron when performing procedures that maysplash or spray blood, body fluids, or secretions.

• Dispose of single-use items appropriately; do not dis-infect, sterilize, and reuse.

• Take precautions to avoid injuries before, during, andafter procedures in which needles, scalpels, or othersharp instruments have been used on a patient.

• Do not recap used needles or otherwise manipulatethem by bending or breaking. If recapping is necessaryto carry a used needle to a sharps container, use a one-handed scoop technique or a device for holding theneedle sheath (see Chapter 8).

• Place used disposable syringes and needles and othersharps in a puncture-resistant container (sharps) asclose as possible to the area of use.

• Use barrier devices (e.g., mouthpieces, resuscitationbags) as alternatives to mouth-to-mouth resuscitation(See Chapter 10).

Checkpoint Question

8. How will following standard precautions help toprotect you against contracting an infection orcommunicable disease?

Personal Protective Equipment

In any area of the medical office where exposure to biohaz-ardous materials might occur, PPE must be made availableand used by all health care workers, including medical assis-tants. For instance:

• Gloves must be available and accessible throughoutthe office. If you or a patient is sensitive to the latexfound in regular examination gloves, proper alterna-tives such as vinyl gloves must be available (Box 1-4).

• Disposable gowns, goggles, and face shields must beavailable in areas where splattering or splashing of air-borne particles may occur (FIG.1-5).

• You must wear gloves when performing any procedurethat carries any risk of exposure, such as surgical proce-dures or drawing blood specimens, disposing of biohaz-ardous waste, touching or handling surfaces that havebeen contaminated with biohazardous materials, or ifthere is any chance at all, no matter how remote, thatyou may come into contact with blood or body fluids.

Employers who do not make this equipment available arenot in compliance with OSHA regulations and may face sig-nificant fines. However, employees are responsible for usingthe PPE correctly and appropriately and washing their handsfrequently throughout the day. Remember: pathogens maybe carried home to family members and to other persons who


medical office must have a written plan of action for all em-ployees and visitors who may be exposed to biohazardousmaterial despite all precautions. In the event of an exposure,you must first apply the principles of first aid and notify yourimmediate supervisor, office manager, or the office physi-cian. The physician or supervisor should provide guidanceregarding postexposure testing and follow-up procedures.Next you should complete and file an incident report (or ex-posure report) form explaining the circumstances surround-ing the exposure. This report form not only documents theincident but also allows management to establish a policy toprevent this type of exposure in the future. In addition, theemployer must record the exposure on an OSHA 300 log(FIG. 1-4) and report the exposure to OSHA if one or more ofthe following criteria are present:

• The work-related exposure resulted in loss of con-sciousness or necessitated a transfer to another job.

• The exposure resulted in a recommendation for medi-cal treatment, such as vaccination or medication to pre-vent complications.

• The exposure resulted in the conversion of a negativeblood test for a contagious disease into a positiveblood test in the employee who was exposed.

Box 1-3 describes biohazard and safety equipment com-monly used in medical offices.Checkpoint Question

Checkpoint Question

7. Explain the difference between exposure riskfactors and the exposure control plan.

Standard Precautions

Standard precautions are a set of procedures recognized bythe CDC to reduce the chance of transmitting infectious mi-croorganisms in any health care setting, including medicaloffices. By presuming that all blood and body fluids exceptperspiration are contaminated and by following these pre-cautions, you can protect yourself and prevent the spread ofdisease. Specifically, these precautions pertain to contactwith blood, all body fluids except sweat, damaged skin, andmucous membranes and require that you:

• Wash your hands with soap and water after touchingblood, body fluids, secretions, and other contaminateditems, whether you have worn gloves or not.

• An alcohol-based hand rub (foam, lotion, or gel) is ac-ceptable to decontaminate the hands if the hands arenot visibly dirty or contaminated.

• Wear clean nonsterile examination gloves when con-tact with blood, body fluids, secretions, mucous mem-branes, damaged skin, and contaminated items is antic-ipated.

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equipment and areas must be clean. Sanitization is cleaningor washing equipment or surfaces by removing all visiblesoil. Any detergent or low-level disinfectant can be used toclean and disinfect areas such as floors, examination tables,cabinets, and countertops. Because you may be expected to


BIOHAZARD AND SAFETYEQUIPMENT IN THE MEDICALOFFICE• MSDS binder. Material safety data sheets are forms

prepared by the manufacturer of all chemical sub-stances used in the medical office. The bindershould contain sheets for all chemicals used in theoffice. Each sheet describes how to handle and dis-pose of the chemical and most important, the healthhazards of the chemical and safety equipmentneeded when using it.

• Biohazard waste containers. Only waste contami-nated with blood or body fluids or other potentiallyinfectious material (OPIM) should be placed in bio-hazard waste containers. Sharps containers are usedfor disposal of items that have the potential to punc-ture or cut the skin.

• Personal protective equipment. Employers are re-quired to provide PPE appropriate to the risk of ex-posure. For example, employees who may comeinto contact with blood, such as the clinical medicalassistant giving an injection, need be protected onlyby wearing gloves. However, situations that maycause a splash or splatter of blood require full cov-erage of the skin, eyes, and clothing.

• Eyewash basin. Pressing the lever on the basin andturning on the faucets produces a stream of waterthat forces open the caps of the eyewash basin. Toremove contaminants or chemicals from the eyes,lower your face into the stream and continue towash the area until the eyes are clear or for theamount of time recommended on the MSDS.

• Immunization. Employers are required by OSHA toprovide immunization against blood-bornepathogens if vaccines are available.

B o x 1 - 3

come into contact with you or the patient. When removingPPE after a procedure, remove all protective barriers be-fore removing your gloves. Once you have removed allPPE, including your contaminated gloves (Procedure 1-2),always wash your hands.

Checkpoint Question

9. What PPE should you wear when assisting thephysician with a wound irrigation?

Handling EnvironmentalContamination

Although not all equipment or surfaces in the medical of-fice must be sterile (free from all microorganisms), all

WHAT IF

Your patient is offended that you are wearinggloves when drawing a blood specimen?

Sometimes patients become defensive and make state-ments to the effect that they are “disease free.” If thishappens to you, reassure the patient by saying thatwearing gloves is a standard practice and is used for theprotection of the patient also. Use this occasion to teachthe patient about standard precautions and the impor-tance of following these guidelines.

LATEX ALLERGY ANDPREVENTIONThe incidence among health care workers of allergic re-actions to proteins in latex has increased in recent years.The proteins in latex, a product of the rubber tree that isused to make many products including examinationgloves, may cause allergic reactions, especially with re-peated exposure. The reactions can be mild (skin rednessor rash, itching, or hives) or severe (difficulty breathing,coughing, or wheezing). Respiratory reactions often re-sult when the powder in the gloves becomes airborneand is inhaled as the gloves are removed after use. Toprotect yourself from exposure and allergy to latex, thefollowing guidelines may be useful:• Use gloves that are not latex for tasks that do not in-

volve contact or potential contact with blood orbody fluids.

• When contact with blood or body fluids is possible,wear powder-free latex gloves. Powder-free glovescontain less protein than the powdered ones, reduc-ing the risk of allergy.

• Avoid wearing oil-based lotions or hand creams be-fore applying latex gloves. The oil in these productscan break down the latex, releasing the proteins thatcause the allergic reactions.

• Wash your hands thoroughly after removing latexgloves.

• Recognize the symptoms of latex allergy in your-self, your coworkers, and your patients.

B o x 1 - 4

perform cleaning tasks routinely or when these surfaces be-come soiled with visible blood or body fluids, you shouldunderstand how these procedures are correctly performed.

Any surface contaminated with biohazardous materialsshould be promptly cleaned using an approved germicide ora dilute bleach solution. OSHA requires that spill kits or ap-propriate supplies be available, and commercial kits makecleaning contaminated surfaces relatively safe and easy.Commercial kits include clean gloves, eye protection if thereis a risk of splashing, a gel to absorb the biohazardous mate-rial, a scoop, towels, and a biohazard waste container to dis-card all used items (FIG. 1-6). If your office does not pur-chase commercial kits, you should gather and store thefollowing items together in the event that a biohazardousspill occurs:

• Eye protection, such as goggles• Clean examination gloves• Absorbent powder, crystals, or gel• Paper towels• A disposable scoop• At least one biohazard waste bag• A chemical disinfectant

In some cases, you may need a sharps container (FIG. 1-7)and spill control barriers. If there is a large amount of con-tamination on the floor, you should put on disposable shoecoverings to avoid transmitting microorganisms on yourshoes. All gloves, paper towels, eye protection, and shoecoverings should be discarded in the biohazardous wastebags, which must be disposed of properly. Procedure 1-3outlines the procedure for an area contaminated with bloodor body fluids.

Although most medical offices use disposable patientgowns and drapes, some offices continue to use cloth. Hy-

gienic storage of clean linens is recommended, and properhandling of soiled linens, disposable or not, is required. Af-ter applying clean examination gloves, handle soiled linen,including examination table paper, as little as possible byfolding it carefully so that the most contaminated surface isturned inward to prevent contamination of the air. Contami-nated linen should be placed in a biohazard bag in the exam-ination room where the contamination occurred rather thancarried through the hallways of the medical office. Some of-fices using cloth linens contract with an outside company forthe laundering. If linen materials are laundered at the office,use normal laundry cycles following the recommendationsof the washer, detergent, and fabric.


F I G U R E 1 - 5 . Personal protective equipment that must beprovided for employees who may come into contact with contami-nated materials includes gloves, goggles, face shields, and gowns oraprons to protect clothing.

F I G U R E 1 - 7 . All sharps should be disposed of properly byplacing them in a plastic puncture-resistant sharps container like theone shown here. Note the biohazard symbol on the sharpscontainer.

F I G U R E 1 - 6 . A commercially prepared biohazard spill kitcontains gloves, absorbent material, eye protection, and a biohazardbag for proper disposal.


Checkpoint Question

10. How would you respond to an employee in themedical office who is unsure about how to clean up

a spilled urine specimen? Is this biohazardous?

Disposing of Infectious Waste

Federal regulations from the Environmental ProtectionAgency (EPA) and OSHA set the policies and guidelinesfor disposing of hazardous materials, but individual statesdetermine policies based on these guidelines. As a result,policies vary widely, and you should review your state andlocal regulations before making waste disposal decisions.Most medical offices are considered small generators ofwaste because they produce less than 50 pounds of wasteeach month. Facilities such as hospitals and large clinicsthat generate more than 50 pounds are considered largegenerators and must obtain a certificate of registration fromthe EPA and maintain a record of the quantity of waste anddisposal procedures.

To remain compliant with any state and federal laws, fa-cilities that are considered large generators of infectiouswaste and some smaller medical offices use an infectiouswaste service to dispose of biohazardous waste appropri-ately and safely. These services supply the office with ap-propriate waste containers and pick up filled containers reg-ularly (Box 1-5). Once the filled containers are picked upby the waste service, the infectious waste is disposed of ac-cording to EPA and OSHA guidelines. The service main-tains a tracking record listing the type of waste, its weightin pounds, and the disposal destination. When the waste hasbeen destroyed, a tracking form documenting the disposalis sent to the medical office and should be retained in theoffice records for 3 years. This documentation must be pro-vided to the EPA should an audit be performed to assesscompliance. States impose stiff penalties, including finesand/or imprisonment, for violations of regulations involv-ing biohazardous waste.

Because the fee charged by an infectious waste service isbased on the type and amount of waste generated, you shouldfollow these guidelines to help keep the cost down whilemaintaining safety:

• Use separate containers for each type of waste. Don’tput bandages in sharps containers (puncture-resistantcontainers for needles or other sharp items) or papertowels used for routine handwashing in a biohazardbag.

• Fill sharps containers two-thirds full before disposingof them. Most containers have fill lines that must notbe exceeded.

• Use only approved biohazard containers.• When moving filled biohazard containers, secure the

bag or top with a closure for that specific container.• If the container is contaminated on the outside, wear

clean examination gloves, secure it within another ap-

proved container, and wash your hands thoroughly af-terward.

• Place biohazard waste for pick up by the service in asecure, designated area.

Checkpoint Question

11. After drawing a blood specimen from a patient,you notice that the tube of blood is leaking onto theexamination table where you put it while finishingthe procedure. How do you clean up the blood spill?

Hepatitis B and HumanImmunodeficiency Viruses

One of the most persistent health care concerns in the medi-cal office is the transmission of hepatitis B virus (HBV) andhuman immunodeficiency virus (HIV). Although HIV is themost visible public concern, HBV has been an occupational

Triage BoxThe following three situations occur at the same time inthe office where you are employed:A. You have just finished changing the dressing on a

wound that is draining a moderate amount ofblood. You still have your gloves on, but you needto document the procedure in the patient’s medicalrecord and instruct the patient regarding woundcare.

B. As you are cleaning up the materials used to irrigatethe wound, you spill the basin used to collect the ir-rigating solution and blood obtained from the pro-cedure.

C. Another staff member knocks on the door of the ex-amination room and informs you that you have aphone call.

How do you sort these tasks? What do you do first?Second? Third?Tell the staff member in situation C that you cannottake a phone call now and ask him or her to take a mes-sage or refer the call to another medical assistant. Thespill in situation B is a biohazardous spill and should becleaned up and the area decontaminated immediately.You should be familiar with the policy and procedureof the medical office and clean the spill accordingly.Once the spill is cleaned and decontaminated, removeyour gloves and wash your hands. Document thewound irrigation, dressing change, and patient educa-tion in situation A only after removing your gloves andwashing your hands. To prevent the spread of microor-ganisms to the medical record, you should never han-dle the medical record while wearing contaminatedgloves.

sult even with careful handling. Bags should not befilled to capacity. When the plastic bag is abouttwo-thirds full, it should be removed from the wastecan, the top edges brought together and secured bytying or with a twist tie. Remove the bag from thearea and follow the office policy and procedure fordisposal. Put a fresh plastic bag into the waste can.

Biohazard Waste Container

The biohazard waste container is reserved for thedisposal of waste contaminated with blood or bodyfluids, including soiled dressings and bandages,soiled examination gloves, soiled examinationtable paper and cotton balls and applicators thathave been used on or in the body.

hazard for health care professionals for many years. HBV ismore viable than HIV and may survive in a dried state onclinical equipment and counter surfaces at room temperaturefor more than a week. In this dried state, HBV may be passedthrough the medical setting by way of contact with contami-nated hands, gloves, or other means of direct transmission.Fortunately, HBV can be contained by the proper use ofstandard precautions, and it can be killed easily by cleaningwith a dilute bleach solution.

HBV and HIV are both transmitted through exposure tocontaminated blood and body fluids. Accidental punctureswith sharp objects contaminated with blood are one way tobecome infected, but the viruses may also enter the bodythrough broken skin. Disorders of the skin, including drycracked skin, dermatitis, eczema, and psoriasis, also allowentrance into the body if contact with contaminated surfacesor equipment occurs.

While there is no vaccine to prevent infection with HIV,employers whose workers, including clinical medical assis-tants, are at risk for HBV exposure are mandated by OSHA toprovide the vaccine to prevent HBV at no cost to the em-ployee. This vaccine is given in a series of three injections that


B o x 1 - 5

PROPER WASTE DISPOSALRegular Waste Container

A regular waste container should be used only for dis-posal of waste that is not biohazardous, such as paper,plastic, disposable tray wrappers, packaging material,unused gauze, and examination table paper. To preventleakage and mess, liquids should be discarded in a sinkor other washbasin, not in the plastic bag inside thewaste can. NEVER discard sharps of any kind in plasticbags; these are not puncture resistant, and injury may re-

SA regular waste container.

A biohazard waste container.

normally produce immunity to the disease. It is recommendedthat a blood sample be drawn 6 months after the third injec-tion of HBV vaccine to determine whether the person has de-veloped immunity. The blood test can detect the presence, ortiter, of antibodies against hepatitis B. The series is repeatedif HBV immunity is not found, but the vaccine has been foundto be very effective. The immunity may last as long as 10years. Employees who choose not to receive the vaccine mustsign a waiver or release form stating that they are aware of therisks associated with HBV. Individuals who contract hepati-tis B may develop cirrhosis (destruction of the cells of theliver) and are at increased risk for developing liver cancer.

In the event of exposure to blood or body fluids infectedwith HBV, the postexposure plan should include an imme-diate blood test of the employee. Repeat blood titers shouldbe obtained at specific intervals, usually 6 weeks, 3 months,6 months, 9 months, and 1 year, as a comparison. If you havebeen immunized against HBV, usually no further treatmentis required. However, if you waive the HBV series, hepatitisB immunoglobulin can be given by injection for immediateshort-term protection, and the general series of three immu-nizations should be started.

B o x 1 - 5 ( c o n t i n u e d )


Procedure 1-1

Handwashing for Medical AsepsisPurpose: To prevent the growth and spread of pathogen

Equipment: Liquid soap, disposable paper towels, an orangewood manicure stick, a waste can

Standard: This task should take 2 to 3 minutes.

Steps

1. Remove all rings and your wristwatch if it cannot bepushed up onto the forearm.

2. Stand close to the sink without touching it.

3. Turn on the faucet and adjust the temperature of thewater to warm.

4. Wet your hands and wrists under the warm runningwater, apply liquid soap, and work the soap into alather by rubbing your palms together and rubbingthe soap between your fingers at least 10 times.

Reason

Rings and watches may harbor pathogens that maynot be easily washed away. Ideally, rings shouldnot be worn when working with material that maybe infectious.

The sink is considered contaminated, and standingtoo close may contaminate your clothing.

Water that is too hot or too cold will crack or chapthe skin on the hands, which will break the naturalprotective barrier that prevents infection.

This motion dislodges microorganisms from betweenthe fingers and removes transient and someresident organisms.

Step 4. Wet hands and wrists.

(continues)

The same schedule of evaluation is required after HIV exposure. Again, there is no vaccine to prevent HIV, butother HIV treatments for preventing transmission are beingtested.

Checkpoint Question

12. Which virus is more of a threat to the clinicalmedical assistant: HIV or HBV? Why?


Procedure 1-1 (continued)

Handwashing for Medical Asepsis

Steps

5. Scrub the palm of one hand with the fingertips of theother hand to work the soap under the nails of thathand; then reverse the procedure and scrub the otherhand. Also scrub each wrist.

6. Rinse hands and wrists thoroughly under runningwarm water, holding hands lower than elbows; do nottouch the inside of the sink.

7. Using the orangewood stick, clean under each nail onboth hands.

Reason

Friction helps remove microorganisms.

Holding the hands lower than the elbows and wristsallows microorganisms to flow off the hands andfingers rather than back up the arms.

Nails may harbor microorganisms. Metal files andpointed instruments may break the skin and makean opening for microorganisms. This may be doneat the beginning of the day, before leaving for theday, or after coming into contact with potentiallyinfectious material.

Step 5. Wash hands and wrists with firm rubbing and cir-cular motions.

Step 6. Rinse hands thoroughly

(continues)



Handwashing for Medical Asepsis

Steps

8. Reapply liquid soap and rewash hands and wrists.

9. Rinse hands thoroughly again while holding handslower than wrists and elbows.

10. Gently dry hands with a paper towel. Discard thepaper towel and the used orangewood stick whenfinished.

11. Use a dry paper towel to turn off the faucets anddiscard the paper towel.

Reason

Rewashing the hands after using the orangewoodstick washes away any microorganisms that mayhave been removed with the orangewood stick.

Hands must be dried thoroughly and completely toprevent drying and cracking.

Your hands are clean and should not touch thecontaminated faucet handles.

Step 10. Dry hands gently with a paper towel.


Procedure 1-2

Removing Contaminated GlovesPurpose: To remove contaminated gloves to prevent the spread of pathogenic microorganisms

Equipment: Clean examination gloves; biohazard waste container

Standards: This task should take 1 to 2 minutes.

Steps

1. Choose the appropriate size gloves for your handsand put them on.

2. To remove gloves, grasp the glove of yournondominant hand at the palm and pull the gloveaway.

Reason

Gloves should fit comfortably, not too loose and nottoo tight.

To avoid transferring contaminants to the wrist, besure not to grasp the glove at the wrist.

Step 2. Grasp the palm of the glove on your nondomi-nant gloved hand.

3. Slide your hand out of the glove, rolling the gloveinto the palm of the gloved dominant hand.

You should avoid touching either glove with yourungloved hand.

Step 3A. Carefully remove the glove and avoid con-taminating your bare skin.

continues



Removing Contaminated Gloves

Steps Reason

Step 3B. Grasp the soiled glove with your gloved domi-nant hand.

4. Holding the soiled glove in the palm of your glovedhand, slip your ungloved fingers under the cuff of theglove you are still wearing, being careful not to touchthe outside of the glove.

Skin should touch skin but never the soiled part of theglove.

Step 4. Slip your free hand under the cuff of the remain-ing glove.

continues



Removing Contaminated Gloves

Steps

5. Stretch the glove of the dominant hand up and awayfrom your hand while turning it inside out, with thealready removed glove balled up inside.

Reason

Turning it inside out ensures that the soiled surfacesof the gloves are enclosed.

Step 5. Remove the glove by turning it inside out over thepreviously removed glove.

6. Both gloves should now be removed, with the firstglove inside the second glove and the second gloveinside out.

7. Discard both gloves as one unit into a biohazardwaste receptacle.

8. Wash your hands. Wearing gloves is NOT a substitute for washing yourhands!


Procedure 1-3

Cleaning Biohazardous SpillsPurpose: To clean contaminated surfaces

Equipment: Commercially prepared germicide OR 1:10 bleach solution

Gloves

Disposable towels

Chemical absorbent

Biohazardous waste bag

Protective eye wear (goggles or mask and face shield)

Disposable shoe coverings

Disposable gown or apron made of plastic or other material that is impervious to soaking up contaminatedfluids.

Standard: This task should take 3 to 5 minutes.

Steps

1. Put on gloves. Wear protective eyewear, gown orapron, and shoe coverings if you anticipate anysplashing.

2. Apply chemical absorbent material to the spill asindicated by office policy. Clean up the spill withdisposable paper towels, being careful not to splash.

3. Dispose of paper towels and absorbent material in abiohazard waste bag.

4. Spray the area with commercial germicide or bleachsolution and wipe with disposable paper towels.Discard towels in a biohazard bag.

5. With your gloves on, remove the protective eyewearand discard or disinfect per office policy. Remove thegown or apron and shoe coverings and put in thebiohazard bag if disposable or the biohazard laundrybag for reusable linens.

6. Place the biohazard bag in an appropriate wastereceptacle for removal according to your facility’spolicy.

7. Remove your gloves and wash your handsthoroughly.

Reason

A plastic gown or apron will protect your clothingfrom contaminants.

The bag will alert anyone handling the waste that itcontains biohazardous material.

Wearing gloves does not replace proper handwashing.


Answers to Checkpoint Questions

1. Pathogenic microorganisms are microscopic organ-isms that cause disease. Natural ways that the bodystops an invasion or destroys pathogens include tears(wash microbes away from the eyes and containlysozyme, an effective disinfectant); hydrochloricacid in the stomach (produces a pH that kills manymicrobes that may get into the stomach); unbroken orintact skin (provides a barrier to invading microorgan-ism); mucous membranes and cilia lining the respira-tory tract (trap microorganisms that may be inhaled).

2. The conditions that favor the growth of microorgan-isms include moisture, nutrients, a warm temperature,darkness, a neutral or slightly alkaline pH, and oxy-gen. To prevent the growth of microbes, remove anymoisture or sources of nutrition, use heat higher than98.6°F, expose the area to light, or clean with acidicor alkaline chemicals.

3. The first link in the infection cycle (the reservoir host)provides nutrients and an incubation site for thepathogen. The fifth link (the susceptible host) allowsthe pathogen to enter and begin growing thus becom-ing the new reservoir host, repeating the cycle.

4. Opening screenless windows allows insects to comeinto the office. Insects may be reservoir hosts to cer-tain diseases and contaminate items in the medicaloffice.

5. Gloves are a barrier to prevent the skin from cominginto contact with contaminated materials. However,

once they are removed, standard precautions requiresthat the hands be washed as an additional precaution.

6. Items or instruments that come into contact with un-broken mucous membranes in areas of the body thatare not considered sterile (like the vagina) may besafely disinfected using a high-level disinfectant forthe specified period.

7. Exposure risk factors are associated with specific jobsin terms of exposure to biohazardous or contaminatedmaterials. The exposure control plan is a writtendocument outlining the procedure that an employee orvisitor should take to prevent contact with biohaz-ardous material.

8. Following the standard precautions will help to pro-tect you against contracting an infection or disease bypreventing entrance of the pathogenic microorgan-isms into your body.

9. A wound irrigation requires wearing gloves and cov-ering the eyes, nose, and mouth. This procedure hasthe potential to splash microorganisms into the envi-ronment.

10. Urine may be biohazardous and should be cleaned upby applying clean examination gloves, using papertowels or absorbent powder to absorb the urine, andplacing all items used for cleaning up the spill into abiohazardous waste container. Once the urine is ab-sorbed and discarded appropriately, the area or floorshould be disinfected.

11. Again, all blood should be considered contaminatedand should be cleaned up using the commercially pre-pared spill kit or with items assembled from the of-fice. The broken blood tube should be placed in asharps container, and once the blood has been wipedup, the table should be disinfected.

12. The virus that is actually more of a threat to the medi-cal assistant is HBV. HBV may live in dried body se-cretions on an inanimate surface for up to 2 weeks. Inthe “right” circumstances, contact with these dried se-cretions may cause infection in the exposed individ-ual. Hepatitis B is a serious disease and may causescarring and destruction of the liver tissue (leading toliver failure), an increased risk for developing livercancer, and death.

Critical Thinking Challenges

1. Review Table 1-1 on common communicable dis-eases. Create a patient education brochure that fo-cuses on the spread of these diseases.

2. A patient who comes into your office has a leg woundthat must be cared for at home. When asked aboutcaring for the wound, he tells you that he knows howto do it, but you think he may be confused about theimportance of using medical asepsis. How do youhandle this situation?

CHAPTER SUMMARYFollowing the principles of medical asepsis and infec-tion control help ensure a safe environment for patientsand health care providers in the medical office.

If you fail to follow these principles consistently, youwill place yourself and others at risk for infection thatmay impair patients’ recovery and affect health careworkers’ performance. Although avoiding contact withmicroorganisms in the environment is impossible, sani-tation and disinfection will reduce the numbers of mi-croorganisms and potential pathogens, making the envi-ronment clean and as disease free as possible. Inaddition, OSHA and the CDC issue regulations andstandards for health care workers who work with bloodand body fluids, and you must always follow them, in-cluding wearing PPE. In case of exposure, your officemust have an exposure control plan and a postexposureplan to assist you in receiving appropriate medical at-tention and follow-up care.

Remember: Handwashing is the single most effectivemeasure to prevent the spread of infection.


Web Sites

www.osha.gov OSHAhttp://www.cdc.gov/niosh/98-113.html Latex allergy

prevention

the clinical medical assistant€¦ · many patients are seen daily in the medical of- fice for a...

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