MICROORGANISMS AND MEDICAL ASEPSIS

1. Define a microorganism and give examples of types of microorganisms.

A microorganism is a living thing that is too small to be seen with the naked eye. Examples of
microorganisms include: bacteria, virus, fungi, archaea, algae, protozoa, and microscopic animals such as
the dust mite.
2. Explain the difference between a nonpathogen and a pathogen.
A pathogen is an organism which is capable of causing diseases in a host, while nonpathogen does not
cause a disease.
3. Define medical asepsis.
Practices used to reduce the number and prevent the transmission of pathogens. Clean and free from
infection or pathogens.
4. List the six basic requirements for growth and multiplication of microorganisms
Proper nutrition, oxygen, optimum temperature, darkness, moisture, pH.
5. Outline the infection process and cycle, including the following:
Reservoir Host (infection source) > Means of Exit > Means of Transmission > Means of Entry >
Susceptible Host
● Give examples of the means of entry of microorganisms into the body
Mouth, nose, throat, ears, eyes, intestinal tract, reproductive tract, open wounds, mucous membrane
● Give examples of the means of transmission of microorganisms from one person to another
There are 2 ways of transmission:
➢ Direct (direct contact with infected person or animal)
➢ Indirect contact (droplet infection or through contaminated objects)
• Inhalation - of aerosols from splashes, centrifugation,
• Ingestion - by handling objects with contaminated hands,
• Absorption by skin contact through cuts, abrasions, bites, burns etc.,
• Percutaneous exposure - needle stick and injuries by sharp objects,
• Permucosal contact - through mucous membranes of the mouth, nose and eyes caused by
splashes, aerosols etc.
● Give examples of the means of exit of microorganisms from the body
Mouth, nose, throat, ears, eyes, intestinal tract, reproductive tract, open wounds, mucous membrane
● List and explain the protective mechanisms the body uses to prevent the entrance of
microorganisms.
Skin barrier protects against entrance of microorganisms, mucous membrane, cilia in the nose and
respiratory tract, coughing and sneezing force pathogens out of body, stomach acid, tears, sweat, urine
and vaginal secretions are acidic.
6. Explain the difference between resident flora and transient flora.
• Resident flora is the normal, harmless flora that resides on the skin (epidermis and dermis - hard to
remove).
• Transient flora is usually picked up during daily activities and is often pathogenic (superficial in
epidermis therefore easy to remove with proper handwashing technique).
7. State when each of the following is performed: hand washing, antiseptic handwashing, and
alcohol-based hand rub.
• Handwashing is performed when hands are visibly soiled with dirt or body fluids.
• Antiseptic handwashing with antimicrobial soap should be performed before surgical procedures.
• Alcohol-based hand rubs should be used when hands are not visibly soiled.
 8. Identify medical aseptic practices that should be followed in the medical office.
• Follow OSHA Bloodborne Pathogens Standard,
• keep office free from dirt and dust,
• keep reception and examining rooms well-ventilated and bright,
• eliminate insects,
• properly dispose wastes that contain pathogens,
• don’t let soiled items touch clothing,
• avoid coughs and sneezes of patients,
• wear minimal jewelry or no jewelry at all,
• teach patients how to prevent spread of infection.
9. Explain how proper handwashing helps prevent the transmission of microorganisms.
Proper handwashing helps remove transient flora and reduces the risk of pathogen transmission.
10. List examples of when to wear clean disposable gloves.
Clean disposable gloves should be worn when you are likely to come in contact with any body substance
(blood, urine, feces, nonintact skin, mucous membranes); for example: when administering an injection,
performing a venipuncture or performing a urinalysis.

OSHA BLOODBORNE PATHOGENS STANDARD AND REGULATED MEDICAL WASTE

11. Explain the purpose of OSHA.

The purpose of OSHA is to provide a safe working environment for health care workers by reducing the risk
of exposure to infectious diseases.
12. Describe the purpose of the Needlestick Safety and Prevention Act.
Includes stronger measures to reduce needlestick and other sharps injuries by using safer medical devices.
13. List and describe the elements that must be included in the OSHA exposure control plan.
• An exposure determination (to identify employees who must follow OSHA bloodborne pathogen
standard),
• The method of compliance (must document the specific health and safety control measures that
are taken to eliminate or minimize risk of occupational exposure),
• Postexposure evaluation and follow-up procedures (specify the procedures to follow in the event of
an exposure incident - inculdes method of documenting and investigating an exposure incident,
postexposure evaluation, medical treatment and follow-up)
14. Explain the purpose of each of the following OSHA requirements: labeling requirements and
sharps injury log.
• Labeling requirements - purpose is to alert employees to possible exposure.
• Sharps injury log - to keep track of needlestick injuries, identify problem areas that need attention
and identify ineffective devices that need to be replaced
15. Define and give examples of each of the following:
• engineering controls - include all measures and devices that isolate or remove the bloodborne
pathogens hazard from the workplace:
➢ readily accessible handwashing
facilities,
➢ safer medical devices,
➢ biohazard sharps containers and
bags,
➢ autoclaves
• work practice controls - reduce the likelihood of exposure by altering the manner in which the
technique if performed:
➢ Perform all procedures involving blood or OPIM in a manner to minimize splashing, spraying,
spattering, and generation of droplets of these substances,
➢ Observe warning labels on biohazard containers and appliances,
➢ Bandage cuts and other lesions on the hands before gloving,
➢ Sanitize hands after removing gloves whether or not the gloves are visibly contaminated
➢ If hands or other skin surfaces come in contact with blood or OPIM wash with soap and water
as soon as possible
➢ If mucous membranes of eyes, mouth, nose come in contact with blood or OPIM flush with
water as soon as possible
➢ Do not break or shear contaminated needles
➢ Do not remove, recap or bend a contaminated needle except in unusual circumstances when
no other alternative is possible, if must remove use a 1-handed technique using a sharps
container with an unwinder
➢ If must recap must use a one-handed scooping technique, 2-handed technique is strictly
prohibited
➢ Place contaminated sharps in a puncture-resistant leakproof container immediately after use
(contaminated sharps - contaminated objects that can penetrate the skin (needles, lancets,
scalpels, broken glass, capillary tubes)
➢ Do not eat or drink, smoke, apply cosmetics or lip balm, or handle contact lenses in areas
where occupational exposure may occur
➢ Do not store food or drink in refrigerators, freezers, cabinets, shelves, or countertops where
blood or OPIM are present
➢ Place blood specimens or OPIM in leakproof containers during collection, handling,
processing, storage, transportation, or shipping (make sure containers are closed; container
must be labeled and/or color-coded with biohazard warning
➢ Before contaminated equipment is serviced or shipped must be decontaminated if blood or
OPIM are present
➢ If an exposure incident occurs - perform first-aid measures immediately (STAT) – example:
Needlestick injury should be immediately washed with soap and water and report incident to
employer
• personal protective equipment PPE - clothing or equipment that protects an individual from
contact with blood or OPIM (must be used when occupational exposure remains after instituting
engineering and work practice controls) Examples: Gloves, Chin-length face shields, Masks,
Protective eyewear, Laboratory coats, Gowns
• and housekeeping procedures - to ensure the work site is maintained in a clean and sanitary
condition, written schedule must be developed and implemented for cleaning and decontaminating
each area where exposure occurs
➢ Includes: clean and decontaminate equipment and work surfaces after procedures involving
blood or OPIM (cleaning - use a detergent soap, decontamination - use a disinfectant)
➢ Clean and decontaminate equipment and work surfaces as soon as possible after exposure
to blood and OPIM (to decontaminate blood spills OSHA recommends 10% solution of sodium
hypochlorite - household bleach in water)
➢ Inspect and decontaminate all reusable receptacles on a regular basis (e.g., waste
containers)
➢ Do not pick up broken contaminated glassware with hands (use mechanical means - brush
and dustpan)
➢ Protective covering may be used to cover work surfaces/equipment (e.g., plastic wrap - must
be removed or replaced if contamination occurs)
➢ Handle contaminated laundry as little as possible using PPE (place in leakproof bag, must
bear a biohazard label and/or be color-coded red)
 ➢ If outside of biohazard container becomes contaminated place in a second suitable
➢ container
➢ Biohazard sharps containers must be: closable, puncture resistant, leakproof, bear a
biohazard label and/or be color-coded red
➢ Guidelines for biohazard sharps containers - locate as close as possible to area of use, (to
avoid transporting a contaminated needle through workplace), maintain in upright position (to
keep contents inside), do not reach into container, replace on regular basis (3/4 full
recommended - do not allow to overfill)

16. Identify the guidelines for use of personal protective equipment.

Certain Guidelines must be followed when using protective equipment:
• PPE must not allow blood or OPIM to pass through it and reach - skin, underlying garments (e.g.
work clothes, street clothes, undergarments), eyes, mouth or other mucous membranes under
normal conditions
• Employer must provide PPE at no cost to employee, must be:
➢ available in appropriate sizes
➢ readily accessible
➢ used correctly
• Employer must ensure PPE is:
➢ cleaned
➢ laundered
➢ repaired
➢ replaced
➢ disposed of as necessary
• Alternatives must be provided for employers allergic to regular gloves:
➢ hypoallergenic gloves
➢ powderless gloves
• Replace gloves as soon as practical if they become:
➢ contaminated
➢ torn
➢ punctured
• Eye protection must have solid side shields
Acceptable:
➢ chin-length face shields
➢ goggles
➢ glasses with solid side shields
Not acceptable: prescription eyeglasses
• Remove contaminated garments as soon as possible - place in appropriate container for washing
• Remove all PPE before leaving office
• Place PPE in designated area or container after removal for:
➢ storage
➢ washing
➢ decontamination
➢ disposal
• Utility gloves can be decontaminated and reused if not damaged
• Can briefly or temporarily decline the use of PPE if it:
➢ prevents proper health care
➢ poses an increased hazard to MAs or coworkers safety (circumstances must be investigated
to determine if situation can be prevented in the future)
17. List examples of medical waste and explain how to discard each type of waste.
Medical waste includes:
• Any liquid or semiliquid blood or OPIM
• Items contaminated with blood or OPIM that would release these substances in a liquid or semiliquid
state if compressed
• Items caked with dried blood or OPIM that are capable of releasing these materials during handling
• Contaminated sharps
• Pathological and microbiological wastes that contain blood or OPIM
 Medical waste must be properly discarded to prevent the transfer of disease
• gauze, dressings or any item saturated with blood or OPIM > discard in a biohazard bag
• bandage with a spot of blood, urine test strips, tongue depressors > discard in regular waste
container
• needles, lancets, blood tubes, capillary pipets, broken glassware > biohazard sharps container
• small amounts of blood, urine or sputum > sanitary sewer
18. Explain how to handle and dispose of regulated medical waste.
Must be handled carefully to prevent an exposure incident. Guidelines:
• Place RMW directly into biohazard containers do not mix with regular trash
• Biohazard containers used (includes biohazard bags and sharps containers) must be:
➢ Closable
➢ Leakproof
➢ Suitably constructed to contain contents
• Close lid of sharps container before removal from examining room (to prevent spilling contents)
• Never open, empty or clean a contaminated sharps container
• Securely close and tie biohazard bags before removal from examining room (to provide additional
protection double-bag by placing primary bag inside a second biohazard bag)
• Remove full biohazard containers to a secure area away from general public (use gloves)
• Each state responsible for developing RMW disposal policies
Most offices use commercial medical waste service (must be licensed and have EPA permit)
• Pickup RMW from office
• Transport RMW to a facility for incineration
➢ Destroys pathogens
➢ Renders it harmless
• Disposed of in a landfill
Steps for preparing and storing RMW for pickup
• Place biohazard bags and containers in receptacle provided by service (e.g., cardboard box)
➢ Seal box with tape
➢ Biohazard warning label must appear on two opposite sides of box
• Store boxes
➢ In locked room inside facility
➢ In locked container outside the facility
Storage area should be labeled with one of following: Authorized Personnel Only or Biohazard symbol
Many states require a tracking record:
• Completed when RMW is picked up
• Specifies:
➢ Type of RMW
➢ Quantity of RMW (in pounds)
➢ Where it is being sent
• Signed by RMW service and medical office
• After RMW destroyed record of disposal sent to office
•
Bloodborne Disease

19. Describe postexposure prophylaxis for hepatitis B.

• Treatment is administered after exposure to an infectious disease to prevent the disease
• Administration of a passive and active immunizing agent
• Administer within 24 hours (preferable) but no later than 7 days
• Hepatitis B Immune Globulin (HBIB):
➢ Passive immunizing agent (contains antibodies)
➢ Provides temporary immunity (1 to 3 months)
➢ Gives hepatitis B vaccine a chance to work
 • Hepatitis B vaccine
➢ Active immunizing agent (stimulates the body to produce antibodies)
➢ Brand names: Recombivax HB, Engerix B
➢ Given IM in 3 doses (0, 1, and 6 months)
➢ Mild side effects: soreness at injection site (most common), serious reactions are rare
If an employee has had Hepatitis B vaccine, no treatment is required. Unless antibody level is low: then
booster dose is given
20. Explain the difference between acute and chronic hepatitis B.
Acute hepatitis B:
• Occurs approx 12 weeks after exposure
• Symptoms last 1 to 4 few weeks
• Can take 6 months to fully recover
• Aproximately 1/3 are asymptomatic and unaware they are infected
• Another 1/3 have only mild flulike symptoms: fatigue, headache, loss of appetite, nausea, vomiting,
malaise, muscle and joint pain
• 1/3 have severe symptoms: abdominal pain, dark urine, clay-colored stools, jaundice, liver
enlargement and tenderness
• May require hospitalization
• Small percentage (0.5 to 2) develop fulminant hepatitis which is almost always fatal (sudden onset
of nausea and vomiting, chills, high fever, severe and early jaundice, covulsions, coma, death as a
result of hepatic failure usually withing 10 days)
• Treatment: no medications available
Chronic Hepatitis B:
• If the body doesn’t clear acute viral hepatitis B on its own usually after 6 months, it becomes chronic
• Individuals produce antibodies but not enough to remove the virus
• They may or may not experience symptoms, they become carriers and can transmit disease to
others
• Increased risk of liver damage, cirhosis and liver cancer

21. Explain the possible effects and consequences of chronic hepatitis C.

• Infection of liver caused by HCV
• No preventative vaccine available
• Most likely means of contracting in medical office
• Needlesticks and other sharps injuries
• Chance of health care worker contracting much lower than contracting hepatitis
• Most have no symptoms
• If symptoms occur mild and flulike
• Of individuals infected with acute hepatitis C:
➢ 55% to 85% develop chronic hepatitis C
➢ 20% develop liver disease after 10 to 30 years, cirrhosis or liver cancer
➢ 1% to 5% die from liver failure
• Treatment: Antiviral drugs (40% effective)

22. List and describe the four stages of the AIDS infection cycle.

• Stage 1: Acute HIV infection phase

➢ Occurs 1 to 4 weeks after exposure

➢ Disappears within 1 week to 1 month, often mistaken for other viral infections
➢ Many people don’t develop symptoms - if symptoms occur they include fever, sweats, fatigue,
loss of appetite, diarrhea, pharyngitis, myalgia, arthralgia and adenopathy
 • Stage 2: Asymptomatic period

➢ After early symptoms subside (if occur at all):

➢ Long incubation period usually occurs - may last months or years (depending on individual)
➢ No symptoms are present
➢ Individual looks and feels well, may not realize HIV is present
➢ Only way to detect HIV during this time is a blood tests for antibodies
➢ Danger of accidental transmission is greatest during this period

• Stage 3: Symptomatic period

➢ Series of lesser symptoms may occur before full-blown AIDS develops

➢ Lymph node enlargement for more than 3 months
➢ Progressive generalized lymphadenopathy, lack of energy, unexplained weight loss,
recurrent fever and sweats, persistent skin infections, rashes or flakey skin

• Stage 4: AIDS

➢ CD4+ T-cell count below 200 cells/µL

➢ CD4+ T-cell percentage of total lymphocytes of less than 14% or one of the defining illnesses.
➢ As HIV infection progresses opportunistic infections develop, Pneumocystis carinii (rare type
of pneumonia), unusual cancers: Kaposi’s sarcoma (rare type of cancer), etc.
➢ Body cannot fight back because of severely damaged immune system
➢ Patient eventually succumbs to AIDS-defining conditions

23. List and describe the AIDS-defining conditions.

AIDS-defining illnesses are those being directly associated with advanced HIV infection.
The current list of AIDS-defining illnesses:
• Bacterial infections, multiple or recurrent
• Candidiasis of bronchi, trachea, lungs or esophagus
• Cervical cancer (invasive)
• Coccidioidomycosis (is infection, usually of the lungs, caused by the fungus Coccidioides immitis)
• Cryptococcosis, presenting outside of the lung (potentially fatal fungal disease, caused by one of two
species Cryptococcus neoformans and Cryptococcus gattii
• Cryptosporidiosis chronic intestinal for longer than one month (diarrheal disease caused by parasites)
• Cytomegalovirus disease (other than in the liver, spleen, or lymph nodes)
• Encephalopathy (HIV-related, also known as AIDS dementia complex)
• Herpes simplex virus (HSV), lasting longer than a month or appearing in an area other than the skin
(such as esophagus or lungs)
• Histoplasmosis (caused by inhaling Histoplasma capsulatum fungal spores)
• Kaposi's sarcoma (cancer that causes red or purple patches of abnormal tissue under the skin, in the
lining of the mouth, nose, and throat, in lymph nodes, or in other organs)
• Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
• Burkitt lymphoma (non-Hodgkin's lymphoma/cancer starts in immune cells called B-cells.)
• Immunoblastic lymphoma (malignant disorder of the B cell)
• Primary lymphoma of the brain (cancer in the lymph tissues of the brain or spinal cord)
• Mycobacterium avium complex or Mycobacterium kansasii (nontuberculous opportunistic
mycobacterial infection)
• Mycobacterium tuberculosis of any site in or out of the lungs
• Pneumocystis pneumonia caused by the fungus Pneumocystis jiroveci
• Pneumonia, recurrent
• Progressive multifocal leukoencephalopathy (a rare infection of the brain that is caused by the JC
(John Cunningham) virus)
• Salmonella septicemia, recurrent (salmonella infection enters bloodstream /bacteremia)
• Toxoplasmosis of the brain (T. gondii, the parasite forms cysts in the brain)
• Wasting syndrome (an involuntary loss of more than 10% of body weight (especially muscle mass),
diarrhea or weakness and fever)