SAFETY IN THE CLINICAL ENVIRONMENT

Cultural Competence is defined as having the set of

behaviors, attitudes, and policies that come together in a
health care system, agency, or individual practicioner in
order to function effectively in cross-cultural interactions.

In the affective domain this includes awareness of the

impact of sociocultural factors, acceptance, of
responsibility for the understanding cultural dimensions
of health and illness, willingness to make clinical settings
more accessible to patients of all cultures.
Appreciation of the heterogeneity that exists within and
across cultural groups, recognition of one's own
personal biases and reactions, and appreciation of how
one's personal cultural values, assumptions, and beliefs
affect clinical care.

The physical therapy profession embraces cultural

competence as a necessary skill to ensure best practice
in providing physical therapist services by responding to
individual and cultural considerations, needs, and values.
Asepsis - Absence of microorganisms that produce
disease.
Pathogens - A microorganism that produces disease.
Sepsis - The presence of pathogenic microorganisms or
toxins in the blood or tissues.
Spores - A hard thick walled capsule formed by some
bacteria that contains only the essential parts of the
protoplasm of the bacterial cell.
Contamination - When something is rendered unclean or
non sterile.
 What You Need to Know
UNDERSTAND HOW THE INFECTION CONTROL WORKS

Define asepsis, medical asepsis, surgical

asepsis, and contamination
Explain the concept, use, and value of
Standard Precautions and Transmission-
Describe and perform proper techniques Based Precautions
of hand hygiene for clean and sterile
situations

Describe and perform the proper application and removal of

personal protective equipment for clean and sterile situations
Microorganisms and
the Infection Cycle
Microorganisms move, or are
transmitted, from place to
place by various means in a
cyclical manner (cycle of
infection)
The interruption of the cycle of
infection means an interruption of
the microorganism's ability to
grow, spread, or cause of
disease.
 The Cycle of Infection
includes six elements:

Infectious Agent Reservoir

Pathogens that cause Microorganisms require a place
communicable disease. where they can grow and reproduce
(ex. a host can be possibly animals
and human beings)
Exit
Microorganisms also require a means by
which they can leave the host. They can
exit thorugh a person's (nose, mouth,
throat, ear, eye, intestinal tract, body
fluids) bloods or wounds.
 Transmission

Microorganisms must pass from one person to another

to spread the infection. Transmission can occur through
air, droplets (from a cough or sneeze) or direct contact
with items such as another peson's skin, equipment, mat
pads, instruments (needles, scalpels, thermometers)
eating utensils, toys, linens, and bodily fluids (blood,
semen, saliva, vaginal secretions).
 Infection
To infect another person, the microorganism
must be able to enter that person. It must
have a portal of entry. (Ex. Such as portals are
break in the person's skin barrier, mouth, nose,
ears, genitourinary tract.

Susceptibility
The person who recieves the microorganisms
must be susceptible to them. (Susceptible
host). A person whose body systems cannot
destroy, repel, remove, or ward off the
microorganisms is a susceptible host.
 Infectious
Agent

Susceptible Reservoir
Host

Cycle of Cross-Contamination
and Infection

Entry Exit

Method of
Transmission
Aseptic Technique
Isolation precautions are used in health care
and residential settings. The two levels of
isolation precautions are Standard Precautions
and Transmission-Based Precautions
Aseptic techniques range from simple practices, such
as using alcohol to sterilize the skin, to full surgical
asepsis, which involves the use of sterile gowns,
gloves, and masks. Healthcare professionals use
aseptic technique practices in hospitals, surgery rooms,
outpatient care clinics, and other healthcare settings.
The primary purpose of Standard Precautions and
Transmission Based Precautions:

To protect persons or objects from becoming

contaminated or infected by pathogenic microorganisms.

It is important that the (Physical Therapist) understand the

three most common means of transmission contact
(Direct or Indirect), droplet, and airborne so that quality
care can be delivered, and therapeutic procedures or
activities can be applied safely.
Medical Asepsis
Techniques of medical asepsis are designed to keep
pathogens confined to a specific area, object, or person.
Medical asepsis may involve isolation of a patient to
protect health care workers, other patients, and other
persons from the pathogenic microorganisms associated
with the patient.
During contact with patient, the (Physical Therapist) must
take precautions. These precautions include refraining
from contact with soiled dressings or articles of clothing
and room surfaces to reduce the possibility of becoming
infected.
The use of PPE by the (Physical Therapist) is
nessesary to protect clinical workers from the
patient. Extreme care must be used when
removing PPE after treating a patient who is in
isolation to reduce contamination. This approach
is reffered to as a ''clean approach''.
Surgical Asepsis
Surgical asepsis (a.k.a. “sterile technique”): practices
that completely kill and eliminate microorganisms
Surgical asepsis techniques are used to exclude all
microorganisms before they can enter a surgical wound or
contaminate a sterile field before or during surgery.
All instruments, surgical and patient drapes, and any other
inert objects that may come in contact with the surgical
site must be streralized.
Hand Hygine
Hand hygine is the most important activity that every
clinical workers and hospials visitor should perform
before and after contact a patient and is an essential
element of standard precautions.

Consistent and proper use of recommended hand

hygine techniques reduces the number of pathogenic
microorganisms on one's hand reduces cross-
contamination.
 3 Factors that are involved with the
use of
Transmission Based Precautions

A Source (Reservoir) of A susceptible host with a A mode of transmission

the infectious agent portal of entry receptive for the agent
to the agent
 3 designations of
precautions based on the route of
Transmission

Microorganism are transferred

directly from one infected person to
Contact
another or indirectly when the
transfer of an infectious agent is
through an object, medical equipment,
furniture surface, or a person
 3 designations of
precautions based on the route of
Transmission
Microorganism are transferred by direct or
indirect contact.

Respiratory Droplets - carrying infectious

Droplet
pathogens transmit infection when they travel a
short distance directly from the respiratory
tract of the infected individual to the mouth,
conjunctivae, or nasal mucosa of the recipient.
(may be transmitted through sneezing,
coughing, or talking)
 3 designations of
precautions based on the route of
Transmission

Microorganism are transferred by small

Airborne infectious particles (infective over time and
distance) in the respirable size range.
 Proper Hand hygiene techniques amd wearing of gloves
Use of mask, respiratory protestation, eye protection, and
face shields
Use of personal protective equipment

and protection of laundry
Handling and disposal of linen
personnel
Cleaning or Disposal of eating utensils and dishes
Patient Placement
Protective transportation of an infected patient
Use and care of patient care equipment and articles
Routine and terminal cleaning of the patient's enviroment
is designed to maintain the sterility of objects
contained within the field such as dressings,
bandages, and sterile instruments to prevent
contamination of objects that could
contaminate the patient.

1. Know which item are sterile

2. know which items are not sterile
3. Seperate sterile items from nonsterile
items
4. If a sterile item becomes contaminated,
remedy the situation immediately.
Personal Protective Equipment
Personal protective equipment is protective
clothing, gloves, goggles/faceshield, gown,
mask or respirator or other garments or
equipment designed to protect the wearer's
body from injury or infection. The hazards
addressed by protective equipment include
physical, chemicals, biohazards, and airborne
particulate matter.
Gloves - Disposable examination gloves are usually sized
small, medium, or large and are dispensed singly from a box.
They may be made of latex, vinyl, or nutrile material and can be
powered or non powdered on the inside.
If the clinical worker or patient has a latex allergy, do not use
latex gloves.
Gloves can form an effective barrier between the therapist
hands and the patient.
Sterile gloves are used for surgical asepsis. It should be worn
when applying a new dressing to a wound or debriding a
wound using sterile equipments.
Regardless of the type of gloves you use, be careful when
removing them to avoid any contact between outside of the
gloves and your skin.
Isolation Gowns - Isolation gowns, if indicated, are always
worn with gloves and other PPE.
The gown can be clean, which is usually used for isolation, or
can be sterile, which is nessesary for invasive procedures.
A gown is used to protect the wearer's clothing from becoming
contaminated or soiled by contact with a contaminant.
A gown also provides a barrier to decrease the transmission of
microorganisms from the clinical worker clothing to the patient
or the environtment.
Masks - Masks are designed to reduce the spread of
microorganisms that are transmitted through the air and may
be worn in combination with googles to protect mouth, eyes,
and nose to provide more complete protection to the face.
A faceshield may be used instead of a facemask and
googles.
For diseases with airborne transmission, a fit-tested N-95 or
higher respirator should be worn in place of the mask.
These items protect the wearer from the inhalation of
particles or droplets that may contain pathogens.
Protective Eyewear - Such as googles, face shield, or eye
wear with shields, should be worn to prevent fluids from
entering the eyes.
It is especially important that protective eyewear be worn
when blood splashes or spurts are likely to occur and when
other bodily fluids are likely to be sprayed or splashed onto
the face.
 Disposal of
Instrument and Clothing

Anyone who handles this instruments or

equipment should wear gloves and wash or
hand rub the hands before and after gloves
have been applied and removed.
 Sterilization Ways an item can be sterilized

subjected to steam under pressure

is used to destroy all forms of
to ethylene oxide (a gas)
microbial life, including high numbers
to a dry heat source
of bacterial spores.
immersed in an EPA - approved
chemical sterilant for 6 to 10 hours
(or according to manufacturer's
instruction)
 Disinfection
High level disinfection destroys all Intermediate level disinfection destroy
forms of microbial life except high most viruses, most fungi, vegetative
numbers of bacterial spores. bacteria, and the tuberculosis
bacterium, but does not killvbacterial
spores.

Low level disinfection destroy most Environmental disinfection practices

bacteria, some viruses, and some are used to clean and disinfect solid
surfaces and are performed with any
fungi, but does not kill the tuberculosis cleaner or disinfectant that is intended
bacterium or bacterial spores. for environmental use.
 Decontamination
to remove, inactivate, or destroy blood-borne
pathogens on a surface or item to the point where
they are no longer capable of transmitting
infectious particlesvand surface or item is
rendered safe for handling, use, or disposal
Do you have
any questions?
Reference:
Fairchild, Sheryl L. Pierson, and Fairchild’s Principles
and Techniques of Patient Care 7 th edition
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Reference: Suggested
https://www.physio-
pedia.com/Personal_Protective_Equipment_(PPE)