3.4 Infection Control and Safety

Infection Control and Safety

Infection control is a critical responsibility for every medical assistant. With 15 items on the CCMA exam, this sub-area covers the principles, practices, and regulations that prevent the spread of infection in healthcare settings.

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The Chain of Infection

Infection requires all six links in the chain. Breaking any link prevents the spread of infection:

Types of Microorganisms:

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Standard Precautions

Standard precautions apply to ALL patients, ALL the time, regardless of known or suspected infection status:

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Transmission-Based Precautions

Used IN ADDITION TO standard precautions for specific modes of transmission:

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Hand Hygiene

The #1 most effective method of infection prevention:

Handwashing with Soap and Water (20+ seconds):

1. Wet hands with warm water
2. Apply soap
3. Rub palms together, then between fingers, backs of hands, fingertips, thumbs, and wrists
4. Wash for at least 20 seconds (sing "Happy Birthday" twice)
5. Rinse thoroughly under running water
6. Dry with paper towel
7. Use paper towel to turn off faucet

When to use soap and water (NOT hand sanitizer):

• Hands are visibly soiled or contaminated
• Before and after eating
• After using the restroom
• After caring for patients with C. difficile or norovirus
• After contact with blood or body fluids

Alcohol-Based Hand Sanitizer (ABHS):

• Apply a dime-sized amount to palm
• Rub all surfaces of hands until dry (~20 seconds)
• Use when hands are NOT visibly soiled
• Must be at least 60% alcohol

Personal Protective Equipment (PPE)

PPE Donning Order (putting ON):

1. Gown — Tie at neck and waist
2. Mask/respirator — Secure over nose and mouth
3. Eye protection (goggles or face shield) — Adjust to fit
4. Gloves — Pull over gown cuffs

PPE Doffing Order (taking OFF):

1. Gloves — Remove carefully, touching only outside surfaces; dispose
2. Eye protection — Remove by handle/earpieces (do not touch front)
3. Gown — Untie and pull away from body, rolling contaminated side inward
4. Mask/respirator — Remove by ties/elastic (do not touch front)
5. Perform hand hygiene immediately

Memory aid for doffing order: "Gloves, Goggles, Gown, Mask" — the most contaminated items come off first.

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Sanitization, Disinfection, and Sterilization

Autoclave (Steam Sterilization):

• Standard cycle: 250°F (121°C) at 15 psi for 15-20 minutes (unwrapped) or 30 minutes (wrapped)
• Biological indicator (spore test) is the gold standard for verifying sterilization effectiveness
• Chemical indicators (autoclave tape, strips) show exposure to sterilization conditions but do not confirm sterilization
• Instruments must be sanitized (cleaned) BEFORE sterilization

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OSHA Bloodborne Pathogen Standard

Key Bloodborne Pathogens:

• Hepatitis B (HBV) — Most resilient; vaccine available; survives on surfaces up to 7 days
• Hepatitis C (HCV) — Most common chronic bloodborne infection; no vaccine
• HIV — Least resilient outside the body; no vaccine; manageable with antiretroviral therapy

OSHA Requirements:

• Written Exposure Control Plan — updated annually
• Hepatitis B vaccination offered at no cost to employees with occupational exposure
• Post-exposure evaluation and follow-up for needlestick and exposure incidents
• Engineering controls — sharps containers, safety needles, self-sheathing devices
• Work practice controls — no eating/drinking in clinical areas, no recapping needles
• PPE provided at no cost to employees
• Annual bloodborne pathogen training for all employees with potential exposure

Needlestick/Exposure Incident Protocol:

1. Immediately wash the area with soap and water (mucous membranes: flush with water)
2. Report the incident to your supervisor
3. Document the incident (source patient, circumstances, body fluid involved)
4. Seek medical evaluation — source patient testing, baseline labs, PEP consideration
5. Follow up as directed by occupational health

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Biohazardous Waste Disposal

Never recap needles, bend needles, or remove needles from syringes by hand.