Transmission Transmission of infectious agents within a healthcare setting requires three elements: ● A source or reservoir of infectious agents. ● A susceptible host with a portal of entry to receive the infectious agent. ● A mode of transmission for the infectious agent. Individual microorganisms normally have a specific mode of transmission and route to enter the body, but some types of infection can spread in multiple ways, such as: ● Contaminated hands, fingers, or objects placed into the mouth, nose, or eyes. ● Instruments or equipment that are inadequately cleaned between patients before disinfection or sterilization or that have manufacturing defects that interfere with the effectiveness of reprocessing may transmit bacterial and viral pathogens. ● Clothing, uniforms, laboratory coats, or personal protective equipment (PPE), may become contaminated with potential pathogens after contact with colonized or infectious agents, including Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus (VRE), and C. difficile. Soiled garments have the potential to transmit infectious agents. ● Inhalation of small droplets of microorganisms can occur without PPE. ● Blood and body fluids may splash into the eye, nose, or mouth for contact with other mucous membranes. ● Breaks in the skin may lead to direct contact with microorganism or contaminated objects. ● Pathogens may enter through any puncture or injury to the skin such as a contaminated needles or sharp objects. According to OSHA guidelines in 2015, the routes of infectious disease transmission in mortuary settings include contact, droplet, and airborne. ● Contact transmission can be classified as direct or indirect contact. Direct contact transmission involves transfer of infectious agents to a susceptible individual through physical contact with an infected individual such as direct skin-to-skin contact. Indirect contact transmission occurs when infectious agents transfer to a susceptible individual when the individual makes physical contact with contaminated items and surfaces, such as doorknobs, instruments, equipment, or examination tables. Two examples of contact transmissible infectious agents include MRSA and VRE. ● Droplets containing infectious agents can spread during certain postmortem preparation, including transport and embalming procedures. Transmission occurs when droplets come into direct contact with the mucosal surfaces of the eyes, nose, or mouth of a susceptible individual. The distance droplets travel depends on the velocity and means by which respiratory droplets are propelled from the source, the density of respiratory secretions, environmental factors such as temperature and humidity, and the ability of the pathogen Epidemiologically important organisms Infectious agents of particular interest for healthcare settings are called epidemiologically important organisms and are targeted for advanced methods of infection control. An “epidemiologically important organism” is identified by the following characteristics: ● Increased potential for transmission within healthcare facilities based on published reports and the occurrence of temporal or geographic clusters of > two patients. A single case of healthcare-associated invasive disease caused by certain pathogens is generally considered a trigger for investigation and enhanced control measures because of the risk of additional cases and severity of illness associated with these infections. ● Antimicrobial resistance to first-line therapies. ● Common and uncommon microorganisms with unusual patterns of resistance.
to remain infectious over that distance. A distance of three feet around the patient is an example of “a short distance from a patient” but should not be used as the sole criterion for deciding when a mask should be donned to protect from droplet exposure. Due to the variables that affect droplet transmission, staff should wear a mask when they are within six to ten feet of the body upon entry into the room, especially when exposure to emerging or highly virulent pathogens is possible. Observations of particle dynamics have shown that a range of droplet sizes, including those with diameters of thirty μm, micrometer or one millionth of a meter, or greater can remain suspended in the air. ● Airborne transmission occurs through very small particles or droplet nuclei that contain infectious agents and remain suspended in the air for extended periods of time. When the susceptible individual inhales the pathogen, it enters the respiratory tract and can cause infection. Airborne transmission only occurs with infectious agents that are capable of surviving and remaining infectious for relatively long periods of time in airborne particles or droplet nuclei. Airborne microorganisms may be dispersed over long distances by air currents and may be inhaled by susceptible individuals who have not had face-to-face contact with or been in the same room as the infectious individual. Preventing the spread of pathogens by airborne routes requires the use of special air handling and ventilation systems, such as an Airborne Infection Isolation Room (AIIR, to contain and safely remove the infectious agent. OSHA standards and directives for protection against transmission of infectious agents must be included in training for all personnel. These include OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) which provides protection of workers from exposures to blood and body fluids that may contain bloodborne infectious agents. OSHA’s Personal Protective Equipment standard (29 CFR 1910.132) and Respiratory Protection standard (29 CFR 1910.134) which provide protection for workers when exposed to contact, droplet, and airborne transmissible infectious agents; and OSHA’s TB compliance directive, which protects workers against exposure to tuberculosis (TB)through enforcement of existing applicable OSHA standards and the General Duty Clause of the OSH Act. In some cases where a specific OSHA standard doesn’t apply, the General Duty Clause (Sec. 5(a)(1) of the Occupational Safety and Health Act requires employers to furnish to each employee a place of employment free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees; each employer shall comply with occupational safety and health standards under this Act. In addition, each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act, which are applicable to his own actions and conduct. ● Difficulty to treat because of resistance to multiple classes of antimicrobial agents. ● Association with serious clinical disease, increased morbidity, and mortality. ● A newly discovered or reemerging pathogen. These epidemiologically important organisms include C. difficile; bioterrorism agents like anthrax, prions, SARS-CoV, monkey pox, noroviruses; and hemorrhagic fever viruses which include Ebola, Marburg, Lassa, Crimean-Congo hemorrhagic fever viruses and other multi-drug resistant organisms. The CDC updated its research on modes of transmission and effective preventive measures in 2015, and these are included in this course.
Page 40
Book Code: FFL1223
EliteLearning.com/Funeral
Powered by FlippingBook