INFECTION CONTROL

Feah A. Altura, RN
Infection Prevention and Control
Nurse

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 Question:
How does a
Full Glass
of Water
Weigh?

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 Infection Control Standards
in Blood Transfusion

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 Anne Claire
This is a case of a 25 wks
AOG pregnant patient
who had continuous
contractions and later
prematurely gave birth to
Anne Claire…
Since, she is a PRETERM
Baby she needed
FREQUENT BLOOD
TRANSFUSIONS.

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 In the early 1980s, a number of
hemophiliacs contracted HIV through
blood transfusions. Since then, public
concern about infections transmitted
through blood transfusions has
increased.

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 Infectious Agents identified in the Blood of
Donors:

• Hepatitis A, B, and C
• Malaria
• Syphilis
• Cytomegalovirus
• Herpesviruses
• Epstein-Barr virus
• Creutzfeldt-Jacob virus (which causes the
human form of "mad cow" disease)
• West Nile virus

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 Risk for Allogeneic Blood Transfusion
Transfusion transmitted infections reported to Serious Hazards Of Transmission
Scotland

1995 1996 1997 1998 1999 Total

Hepatitis A - 1 - - - 1
Hepatitis B 1 1 - 2 1 5
Hepatitis C - 1 - 1 1 3
HIV - 3 - - - 3
Bacteria 1 1 3 1 5 11
Malaria - - 1

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 Sources of Blood Transfusion
a. Homologous Donation
b. Autologous Donation
c. Direct Donation
d. Blood Salvage

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 Autologous Donation
• Donation of a client’s own blood for hospitalization.
• Preoperative donation collected 4-6 hours before surgery
• Iron supplements may be ordered
• Benefits:
– Prevention of viral infection from donated blood
– Used for client with history of blood transfusion reaction
– Rare blood type
• Contraindication
– Acute Infection
– Chronic Disease
– Hemoglobin <11g/L, Hematocrit <33%
– Cerebrovascular Disease
– Cardiovascular Disease
• Kaplan, 2006

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 BLOOD TRANSFUSION REACTION:
BACTERIAL REACTION
It is possible for blood, especially platelets, to
become contaminated with bacteria during or
after donation. Transfusion with blood that has
bacteria can result in a systemic bacterial
infection. Because of the precautions taken in
drawing and handling donated blood, this risk is
small. There is a greater risk for bacterial
infection from transfusions with platelets. Unlike
most other blood components, platelets are
stored at room temperature. If any bacteria are
present, they will grow and cause an infection
when the platelets are used for transfusion.

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 BLOOD TRANSFUSION REACTIONS
• Bacterial contamination:
– Rarely, blood becomes contaminated with tiny
amounts of skin bacteria during donation.
– Platelets must be stored at room temperature,
these bacteria can grow rapidly
– This affects about 1 in 1000-3000 units of
platelets
– Patients receiving these platelets may
develop serious illness within minutes or
hours after the transfusion is started

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 Blood Safety
The Precautions taken to ensure that blood-borne
pathogens are not transmitted via donated
blood includes the ff:
2. Rejection of potential donors whose medical
history shows evidence of viral hepatitis, drug
addiction or recent blood transfusion or tattoos
3. Laboratory testing of all donated blood for the
presence of Hepatitis B and C, Syphilis and
the HIV-1 antibody
* www.answers.com

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 Processing of blood prior to transfusion
• Donated blood is sometimes subjected to processing after it is collected,
to make it suitable for use in specific patient populations. Examples
include:
• Leukoreduction, or the removal of stray white blood cells from the blood
product by filtration. Leukoreduced blood is less likely to cause
alloimmunization (development of antibodies against specific blood
types), and less likely to cause febrile transfusion reactions. Also,
leukoreduction greatly reduces the chance of cytomegalovirus (CMV)
transmission. Leukoreduced blood is appropriate for:
– Chronically transfused patients
– Potential transplant recipients
– Patients with previous febrile nonhemolytic transfusion reactions
– CMV seronegative at-risk patients for whom seronegative
components are not available

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 • Irradiation. In patients who are severely
immunosuppressed and at risk for
transfusion-associated
graft-versus-host disease, transfused red
cells may be subjected to irradiation with at
least 25 Gy to prevent the donor T
lymphocytes from dividing in the recipient.
Irradiated blood products are appropriate for:
– Patients with hereditary immune deficiencies
– Patients receiving blood transfusions from relatives in directed-donation
programs
– Patients receiving large doses of chemotherapy, undergoing
stem cell transplantation, or with AIDS (controversial).

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 • CMV screening. Cytomegalovirus, or CMV,
is a virus which infects white blood cells.
Many people are asymptomatic carriers. In
patients with significant immune suppression
(e.g. recipients of stem cell transplants) who
have not previously been exposed to CMV,
blood products that are CMV-negative are
preferred. Leukoreduced blood products can
substitute for CMV-negative products, since
the complete removal of white blood cells
removes the source of CMV transmission.

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 BLOODBORNE PATHOGEN
HEPATITIS B VIRUS
• Hepatitis B Virus (HBV) causes serious
liver disease
• Half of the people infected with Hepatitis B
have no symptoms.
• Those with symptoms may experience
jaundice, fatigue, abdominal pain, loss of
appetite, occasional nausea or vomiting

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 BLOODBORNE PATHOGEN
HEPATITIS C VIRUS
• Hepatitis C Virus (HBC) causes serious liver disease
• While 85% of people infected with HCv have chronic
infections, only about 10% of those infected with HBV
are chronically infected.
• People chronically infected with Hepatitis C may have
no symptoms for up to 30 years, yet during that time
the infection may be slowly damaging the liver
• HEPATITIS C IS THE LEADING INDICATOR FOR
LIVER TRANSPLANT
• THERE IS NO VACCINE TO PREVENT HEPATITIS C

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 BLOODBORNE PATHOGEN
HUMAN IMMUNODEFICIENCY VIRUS
(HIV)
• HIV attacks a person’s immune system and causes it to
break down
• Like HCV, HIV can live in a person for years with no
obvious symptoms
• Damage can be observed in blood test – lowered T-cell
counts before actual symptoms are experienced.
• If T-cell count drops below 200, the infected person is
diagnosed with AIDS
• Transmission: Primarily through SEXUAL CONTACT
WITH AN INFECTED PARTNER OR SHARING
CONTAMINATED NEEDLES AND/OR SYRINGES

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 Transmission
• Hepatitis B, Hepatitis C and HIV spread most easily
through contact with blood
• Contact with Other Potentially Infected Materials (OPIM)
– Semen
– Vaginal Fluid
– Other body fluid or tissue containing visible blood
– CSF
– Synovial fluid
– Pleural Fluid
– Peritoneal Fluid
– Pericardial Fluid
– Amniotic Fluid
– Saliva in Dental Procedures

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 Means of Transmission
• An accidental injury by a sharp object
contaminated with infectious material
• Open cuts, nicks and skin abrasions, even
dermatitis and acne, as well as the
mucous membranes of your mouth, eyes
or nose
• Indirect Transmission

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 Work Practice Control
• HANDWASHING
• STANDARD PRECAUTIONS
• SHARPS SAFETY
• PERSONAL PROTECTIVE EQUIPMENT
• GOOD HOUSEKEEPING

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 STANDARD PRECAUTIONS

Treat all blood and body fluids, excretions

and secretions, non-intact skin and
mucous membranes as if infectious

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 PERSONAL PROTECTIVE
EQUIPMENTS
• Use protective barriers
• Use gloves to protect hands from
contamination
• Use gowns to protect skin and clothing
from exposure
• Use fluid-resistant gowns when exposed
to large amounts of blood and body fluids

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 HAND HYGIENE
• Wash with soap and running water when
hands are visibly soiled or contaminated
by blood or other body substances
• To wash, wet hands and apply soap,
rubbing vigourously for at least fifteen
seconds over all surfaces
• Rinse thouroughly and dry with a
disposable towel, then use a dry towel to
turn off the faucet

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 HOUSEKEEPING
• Keep work surfaces and equipment clean
• Do not allow equipment contaminated with blood
or body fluids to touch skin or mucous
membranes of a client or a staff member
• Discard single-use equipment
• Clean and disinfect contaminated, non-
disposable equipment immediately
• Place blood and other medical waste in closed,
leakproof containers, labeled with colored
warning signs to alert others to the contents

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 SHARPS SAFETY
• Dispose of needles and other sharp instruments
immediately in specially labeled, puncture resistant
containers located close to the area where sharps are
used and mounted slightly below eye level
• Never reach into a container of contaminated sharps
• Replace sharps containers before they overfill, or when
¾ full
• Use a broom or dustpan, or forceps or tongs to pick up
broken glass – NOT HANDS
• Transport specimens or other potentially infectious
materials in closed, leakproof containers and watch your
step

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 Bloodless Medicine

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 Reminders
• Blood must be hung within 30 minutes of arriving at the
unit
• Maintain Standard Precautions when handling blood or
Intravenous equipment; Assure client that risk for AIDS
is minimal because blood is screened
• Clean IV Port with Alcohol Swab or 70% Isopropyl
Alcohol before Piggyback of BT
• Strict Vital Signs Monitoring
– Hemolytic Reaction within first 10-15 minutes
– Febrile Reaction within 30 minutes
– Allergic Reaction anytime during or after transfusion
• Mosby, 1999

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 QUIZ: DEAL OR NO DEAL
You are covered by the
standard precaution only if you
are a surgical doctor or nurse?

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 NO DEAL
AS LONG AS U R WORKING
IN THE HOSPITAL U
SHOULD USE STANDARD
PRECAUTIONS

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 QUIZ: DEAL OR NO DEAL
HIV and HBV are the only
bloodborne pathogens you
face

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 NO DEAL
THERE ARE NUMEROUS
INFECTIONS ASSOCIATED
WITH BLOOD INCLUDING
HEPATITIS C

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 QUIZ: DEAL OR NO DEAL
Standard precautions means
treating all blood and body
fluids as potentially
infectious?

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 OF COURSE

DEAL

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 QUIZ: DEAL OR NO DEAL
YOU SHOULD BEND ALL UR
NEEDLES BEFORE PUTTING
THEM IN THE SHARPS
CONTAINER?

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 NO DEAL
CGE! ITRY NINYO! AY SHA!
MADADAGDAGAN ANG
STATISTICS KO NITO!!!

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