Infection Control
OBJECTIVES
After studying this chapter, the student will be able to:
1. Define the basic terminology used in the practice of infection control.
2. List and describe the known microorganisms that may cause infection.
3. Explain the rise in antibiotic-resistant diseases and the emergence of previously unknown or unrecognized diseases.
4. Describe and demonstrate the methods of controlling infection in health care settings.
5. Discuss the modes of transmission of HIV, all forms of viral hepatitis, methicillin-resistant Staphylococcus aureus, vancomycin-resistant S. aureus, vancomycin-resistant Enterococcus, multiple drug-resistant organisms, Clostridium difficile, extended-spectrum β-lactamase, and tuberculosis, and the methods of preventing their spread in health care settings.
6. List the regulatory agencies that set and maintain the guidelines for safety in health care and the community at large.
7. Explain the actions the radiographer should take if exposed to blood or body substances or other potentially infectious material, or if a sharp injury occurs in the course of work.
KEY TERMS
Antibiotics: Soluble substances derived from a mold or bacterium that kills or inhibits growth of other microorganisms
Antifungal: Kills or inhibits fungi or their growth or reproduction
Antimicrobial drugs: Drugs that tend to destroy microbes or prevent their multiplication
Attenuated vaccine: A weakened or dilute solution of microbes
Bacteria: Colorless, minute, one-celled organisms with a typical nucleus
Broad-spectrum antimicrobial drug: A drug effective against a wide variety of microorganisms
Carrier: A person or an animal that harbors a particular infectious agent and does not have clinical disease but is able to transmit the disease to others
Cilia: Mobile extensions of a cell surface
Cytomegalovirus infections: A group of viruses in the Herpesviridae family
Encephalopathy: A disorder of the brain
Enterotoxigenic: Referring to an organism that produces toxins specific for cells in the intestinal tract
Eucarya or Eukaryote: A cell containing a membrane-bound nucleus and chromosomes of DNA, RNA, and proteins
Fecal-oral route: Disease passed from one person who has poor handwashing hygiene to another person through food touched by the former following stool elimination
Fungi: Cells that require an oxygenated environment to live; may be either yeasts or molds
Genetic predisposition: Inherited potential through the genetic transmission for a particular illness or characteristic
Helminths: Parasitic worms that may live in the human intestinal tract for long periods if not treated
Immune: Free from acquiring a particular infectious disease
Immunosuppressed: Persons whose immunity is prohibited for physiologic reasons
Infectious disease: A disease capable of being passed from one person to another
Nucleoid: A part of a nucleolus (a nuclear inclusion body)
Parasite: An organism that lives in or on another and draws its nourishment from that on which it lives
Pathogenicity: The ability to cause disease
Percutaneous injection: Passage through the skin by needle puncture, including introduction of wires and catheters
Personal protective equipment (PPE): A variety of barriers used alone or in combination to protect mucous membranes, skin, and clothing from contact with infectious agents
Prion: An infectious particle of non-nucleic acid composition; must mutate to become infectious
Prokaryotes: An organism consisting of a single cell
Pseudomembranous colitis: (SYN pseudomembranous enterocolitis) formation and passage of pseudomembranous material due to infection by Clostridium difficile
Retention urinary catheters: Tubes that are placed in the urinary bladder and fixed in place for a period of time
Sepsis: The presence of pus-forming and other pathogenic organisms
Standard Precaution: A group of infection prevention practices that apply to all patients, regardless of suspected or confirmed diagnosis
Sterile: Free of all living microorganisms
Vascular access devices: Catheters or needles that are able to enter the blood vessels
Virulent: Extremely toxic
Viruses: Minute microbes that cannot be visualized under an ordinary microscope; the smallest microorganism known to produce disease
All health care workers must be more vigilant in the practice of infection control to protect themselves and others from acquiring infectious diseases. The practice of infection control measures is a necessity for all who are working in, being treated in, or visiting health care settings.
The radiographer must understand the methods of isolating body substances (called Standard Precautions) and be able to correctly perform all transmission-based precautions as he or she works with patients. Correct cleaning of equipment, correct hand hygiene, and correct disposal of contaminated waste must be part of every procedure in imaging to guard against the spread of infection.
NOSOCOMIAL INFECTIONS
Despite increasing use of infection control measures and the control or elimination of many diseases, infections in patients while they are receiving health care have increased. This is the result of the increase in organisms becoming resistant to anti-infective drugs. Anti-infective drugs include antimicrobial, antibiotic, and antifungal drugs. Infections acquired in the course of medical care are called nosocomial infections. This term is most often applied to infections contracted in an acute care hospital; however, it also applies to infections patients receive while in extended care facilities, outpatient clinics, and behavioral health institutions. Infections contracted at birth by infants of infected mothers are also classified as nosocomial. A nosocomial infection that results from a particular treatment or therapeutic procedure is called an iatrogenic infection. Although a patient acquires a particular infection while in a health care unit, he or she may not develop symptoms of the illness until leaving the health care environment. This is still considered to be a nosocomial infection. A person who enters a health care facility with an infection is said to have a community-acquired infection.
Everyone has microorganisms in their body at all times. These microorganisms are called normal flora. Infections that are caused by microorganisms that are not normal flora are called exogenous infections. When a person acquires an infection in the health care setting as a result of an overgrowth of normal flora, it is called an endogenous nosocomial infection.
Endogenous infections are often the result of the alteration in the number of normal flora present in the body or the alteration in placement of normal flora into another body cavity. Endogenous infections may also be the result of treatment with a broad-spectrum antimicrobial drug that alters the number of normal flora. Many factors in health care facilities encourage nosocomial infections. Display 5-1 lists these factors.
Factors That Increase the Patient’s Potential for Nosocomial Infection
There are individuals who present themselves for health care come from many social and economic environments. A variety of factors in the social and economic environment may render a person more susceptible to acquiring a nosocomial infection. Display 5-2 describes some of these factors.
The bloodstream and the urinary tract are common sites of nosocomial infections. These are often
the result of long-term use of vascular access devices (VADs) and retention urinary catheters. Infections in wounds following surgical procedures and respiratory tract infections also occur frequently. Early removal of urinary catheters, intravenous catheters, and other types of invasive treatment devices is recommended whenever possible to reduce the incidents of nosocomial infections. Meticulous care of VADs and retention catheters while they are inserted is of great importance, and will be discussed later in Chapter 11.
the result of long-term use of vascular access devices (VADs) and retention urinary catheters. Infections in wounds following surgical procedures and respiratory tract infections also occur frequently. Early removal of urinary catheters, intravenous catheters, and other types of invasive treatment devices is recommended whenever possible to reduce the incidents of nosocomial infections. Meticulous care of VADs and retention catheters while they are inserted is of great importance, and will be discussed later in Chapter 11.
DISPLAY 5-1 Factors That Encourage Nosocomial Infections
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DISPLAY 5-2 Factors That Increase the Potential for Nosocomial Infection
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MICROORGANISMS
Viruses cause many disease, and are discussed in this chapter.
Infectious diseases are caused by both eukaryotic and prokaryotic microorganisms. Microorganisms known to produce diseases are bacteria, fungi, viruses, and prions. If a microorganism is known to produce disease, it is called a pathogenic microorganism or a pathogen. There are also believed to be unidentified pathogens that produce newly recognized disease. Within the known groups of microorganisms, many different species may produce infections in humans, and many are useful or, at least, not harmful. Microorganisms are used in a variety of ways: in food and drug processing to destroy waste and, frequently, as a means of effecting a positive change in the environment.
Some microorganisms that are natural flora in one area of the body produce infection if they are accidentally relocated to a site other than their natural habitat. For example, Escherichia coli, which normally inhabits the human intestinal tract, does not cause disease there; however, if it gains entry to the urinary bladder, it can cause a urinary tract infection. There are certain strains of E. coli that are extremely virulent and are not considered normal flora. This strain of E. coli is called an enterotoxigenic strain and may cause a severe cholera-like infectious disease. This disease has been linked to the E. coli from cattle and is spread by introduction into beef or contamination from irrigation of vegetables with contaminated water.
Often, it is the quantity of microorganisms in an area that produces infection. A small number of a particular bacterium in the body may be harmless; however, if the number increases, it may produce an infection. There are few areas of the human body that are considered sterile. These are the brain, blood, bone, heart, and the vascular system.
Another factor that determines the pathogenicity of a microorganism is its ability to find susceptible body tissue to invade. For example, the skin is a normal habitat for staphylococci; however, if this microorganism enters the lungs, it can cause an infection. Some microorganisms are more virulent than others. This means that some microbes are more certain than others to cause disease if they enter the human body.
The human body houses resident flora. This means that there are microbes that live in the body at all times in a quantity that is usually stable. When the quantity of resident flora increases, the flora may become pathogenic. Staphylococci are resident flora on the superficial layers of the skin, and in large numbers, these may cause a serious infection. Resident flora require firm friction, an effective soap, and quantities of water to remove them from the skin.
Flora that are acquired by contact with an object on which they are present are called transient flora. Transient flora are more easily removed from the dermal layers of the skin because they are not firmly adhering to it. For an infection to occur, the microorganism must be able to survive and multiply in the body of the host, whether the host is human, plant, or animal. Moreover, the microorganism must be able to produce a disease, and the host must be unable to mobilize its defenses against the infectious microbes.
Bacteria
Bacteria are colorless, minute, one-celled organisms with a typical nucleus. They contain both DNA and RNA. DNA carries the inherited characteristics of a cell, and RNA constructs cell protein in response to the direction of DNA.
Bacteria may be spherical in shape (cocci), oblong (bacilli), comma shaped (vibrio), spiral (spirilla), or tightly coiled (spirochetes). A small number of bacteria are cuboidal in shape. They may also be classified according to their divisional grouping as diplococcic (groups of two), streptococci (chains), or staphylococci (grapelike bunches) (Fig. 5-1). Bacteria must be stained to be seen under a microscope and are classified according to their reaction to various staining processes in the laboratory.
Gram-positive bacteria are able to form a highly resistant structure called an endospore. This endospore encases the genetic material in the cell and allows the bacteria to survive for many years in most unfavorable conditions. When conditions for survival are again favorable, the endospore germinates and the bacterial cell grows again and replicates. Endospores are more difficult to destroy than vegetating bacteria; therefore, many methods of destroying pathogenic bacteria do not affect endospores.
There are bacteria that survive only in an oxygen environment and are called aerobes. Others are unable to live in the presence of oxygen and are called anaerobes. Many bacteria are opportunists, and learn to adapt or thrive in any environment. They may also
learn to live in the presence of antimicrobial drugs or disinfectants.
learn to live in the presence of antimicrobial drugs or disinfectants.
 FIGURE 5-1 Forms of bacteria. (A) Gram-stained smear of Staphylococcus aureus in grapelike clusters. (B) Gram-stained smear of Streptococcus pneumoniae in elongated pairs. (C) Bacillus anthracis grows as large gram-positive bacilli arranged in chains. (From Winn W Jr, Allen S, Janda W, et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.) |
Some diseases caused by bacteria include tuberculosis, streptococcal infections of the throat, staphylococcal infections in many parts of the body, Salmonella poisoning, gonorrhea, syphilis, and tetanus.
Chlamydia is transferred by direct contact between hosts often during sexual contact. It causes infections of the urethra, bladder, or sexual organs of the host.
Fungi
Fungi are eukaryotic microbes and require an aerobic environment to live and reproduce. Fungi include in their grouping yeasts and molds. Yeasts are one-celled forms of fungi that reproduce by budding. Molds form multicellular colonies and reproduce by spore formation.
Yeasts and molds can be harmful and cause a number of infectious diseases. However, molds are often extremely useful. They are a primary source of material for the production of antibiotic drugs; they produce enzymes for medical use and are used in the production of foods to flavor various cheeses. Yeasts are used commercially to produce beer and wine and to leaven bread. They are also a source of vitamins and minerals; however, some yeasts are pathogens that produce diseases in humans and animals. A commonly seen disease caused by yeast infection is thrush (caused by Candida albicans). Diseases caused by dimorphic fungi are histoplasmosis, blastomycosis, and coccidioidomycosis (Fig. 5-2).
Protists
Protists are a diverse group of eukaryotic microorganisms. They are either one-celled or multicellular without specialized tissues, and can live in most environments as long as water is available. They live either in colonies or as independent cells. This taxonomy is in the throes of change and, at this time, contains algae, protozoa, slime-like molds, and water molds.
Some protists are pathogenic to plants and animals, including humans. Many of the diseases caused by protists that affect humans are prevalent in tropical climates, such as malaria.
 FIGURE 5-2 Colony of the yeast, Candida albicans, after 3 days of incubation. (From Winn W Jr, Allen S, Janda W, et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.) |
Protozoa
Protozoa are more complex one-celled microorganisms. They are often parasitic and are able to move from place to place by pseudopod formation, by the action of flagella, or by cilia.
Many of the diseases in humans caused by protozoa affect the gastrointestinal tract, genitourinary tract, and circulatory system. Some of the common protozoa diseases are amebiasis, giardiasis, trichomoniasis, malaria, and toxoplasmosis.
Helminths
Helminths can be simply described as parasitic worms classified as either Platyhelminthes (flatworms) or Aschelminthes (roundworms). Many of these worms can live in the human intestinal tract for long periods if they are not treated.
Viruses
Viruses are minute microorganisms that cannot be visualized under an ordinary microscope. They are the smallest microorganisms known to produce disease in humans. The genetic material of a virus is either DNA or RNA, but never both. A virion is a complete infectious particle with a central nucleoid. The genetic material is protected by a capsid or protein coat that is composed of minute protein units called capsomeres. The complete nucleocapsid with a nucleic acid core constitutes a complete virus. Some viruses are surrounded by an envelope that is composed of a lipoprotein. Viruses must invade a host cell in order to survive and reproduce.
Whatever its structure, the virus is transported by way of its capsid to a host cell that has receptor sites on its surface that are suitable to a particular virus that it invades. A virus does not invade a cell at will. It must attach itself at a membrane receptor site for which it has a specificity; that is, specific for that particular type of host cell and no others.
Once in the cell, production of new viral particles does not take place with certainty. Other factors in the cell environment must be favorable for the multiplication to take place. There are various theories concerning what makes the environment favorable. These include, but are not limited to, poor nutritional status of the host, poor health related to heart disease or diabetes, increased life stress for the host, or excessive use of drugs and alcohol.
To reproduce, the virus uses the genetic machinery of the host cell. When reproduction is complete, new viruses leave the original host cell. As some types of viruses leave the host cell, they destroy the cell by the rapid release of new viruses. This is called lysis. The second type of viral replication produces viruses that lie dormant, but very much alive and destructive, within the host cell.
Some viruses have the capacity to invade nerve ganglia and leave their genetic material in the ganglia in a latent phase after an acute infective period. The virus remains there until the body is under some type of stress such as an emotional life event or illness or until it is exposed to sunlight for a period of time. This will often induce the virus to take over nearby cells and produce more viruses, as in the case of herpes simplex (fever blisters) or herpes zoster (shingles). Such viral infections may occur repeatedly.
A virus may be classified on the basis of its genetic composition; the shape or size of the capsid; the number of capsomeres or the absence of an envelope; the host it infects; the type of disease it produces; or its target cell and immune properties (Fig. 5-3).
Viruses are capable of infecting plants, animals, and humans. Some common viral diseases that affect humans are influenza, the common cold; mumps; measles; HIV (AIDS); and hepatitis A, B, C, D, and E.
Prions
Prion proteins exist in all mammals and are abundant in brain cells. When they fold in a particular manner, the malformed prion proteins proceed to convert normal proteins to become infectious disease (Yam, 2003). A mutant prion may be present by genetic predisposition or may be the result of infection. Acquiring an infectious prion is the result of transmission from an infected animal or person. The disease most often resulting from a mutant infectious prion is Creutzfeldt-Jakob disease. This disease is transmitted to humans by eating infected meat or meat products, and is known as mad cow disease. Prion diseases are known as transmissible spongiform encephalopathies (TSEs). “When TSE is suspected clinically, elaborate precautions must be taken in the autopsy room and histology laboratory because the agents of these infections survive formalin fixation and are even
demonstrable after tissue is embedded in paraffin blocks” (Koneman, 2006, p. 1367). There is currently research ongoing to determine whether prions are contributory to Alzheimer disease.
demonstrable after tissue is embedded in paraffin blocks” (Koneman, 2006, p. 1367). There is currently research ongoing to determine whether prions are contributory to Alzheimer disease.
 FIGURE 5-3 Herpes simplex vesicular lesion; a mature squamous epithelial cell stains pink. (From Winn W Jr, Allen S, Janda W, et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.) |
ELEMENTS NEEDED TO TRANSMIT INFECTION
Infection cannot be transmitted unless the following elements are present (Display 5-3):
1. An infectious agent, which may be a bacterium, fungus, virus, prion, or parasite. Infectious agents vary in their ability to cause disease. These characteristics are pathogenicity, virulence, invasiveness, and specificity.
Pathogenicity refers to the causative organism’s ability to cause disease.
Virulence refers to the causative organism’s ability to grow and multiply with speed.
Invasiveness is the term used to describe the organism’s ability to enter tissues.
Specificity characterizes the organism’s attraction to a particular host.
2. A reservoir or an environment in which the pathogenic microbes can live and multiply. The reservoir can be a human being, an animal, a plant, water, food, earth, or any combination of organic materials that support the life of a particular pathogen. Infection is prevented by removing the causative microbe from the reservoir.
3. A portal from which to exit the reservoir. In the case of a human reservoir, the portals of exit might be the nose, mouth, urinary tract, intestines, or an open wound from which blood or purulent exudate can escape. There can be more than one portal of exit.
4. A means of transmission. Infection is transmitted by direct or indirect contact, droplet, vehicle, vector, or airborne route. Contact is direct when a person or an animal with a disease or blood or body fluids are touched. This contact can be by touching with the hands, by kissing, by percutaneous injection, or by sexual intercourse. A person who transmits disease-causing organisms but has no apparent signs or symptoms of that disease is called a carrier. Particular organisms require specific routes of transmission for infection to occur.
DISPLAY 5-3 Elements Needed to Transmit Infection
An infectious agent and a reservoir of available organisms
An environment in which the pathogenic microbes can live and multiply
A portal of exit from the reservoir
A means of transmission
A portal of entry into a new host
Indirect contact is defined as the transfer of pathogenic microbes by touching objects (called fomites) that have been contaminated by an infected person. These objects include dressings, instruments, clothing, dishes, or anything containing live infectious microorganisms.
Droplet contact involves contact with infectious secretions that come from the conjunctiva, nose, or mouth of a host or disease carrier as the person coughs, sneezes, or talks. Droplets can travel from approximately 3 to 5 ft and should not be equated with the airborne route of transmission, which is described later.
Vehicles may also transport infection. Vehicle route of transmission includes food, water, drugs, or blood contaminated with infectious microorganisms.
The airborne route of transmission indicates that residue from evaporated droplets of diseased microorganisms is suspended in air for long periods. This residue is infectious if inhaled by a susceptible host.
Vectors are insect or animal carriers of disease. They deposit the diseased microbes by stinging or biting the human host.
5. A portal of entry into a new host. Entry of pathogenic microorganisms into a new host can be by ingestion, by inhalation, by injection, across mucous membranes, or, in the case of a pregnant woman, across the placenta.
A human host can be any susceptible person. Persons particularly susceptible to infection are those who are poorly nourished or are fatigued. Those at greater risk are persons with chronic diseases, such as diabetes mellitus or cancer. Immunosuppressed persons are at great risk for acquiring infections. Previous infection with a particular disease or vaccination against a particular disease can render an individual immune to infection.
Socioeconomic status and culture also play a role in host susceptibility. Persons living in poor environments are more likely to contact some diseases because of poor hygienic conditions and the poor diets that they are forced to endure. Some diseases have a strong hereditary aspect, which makes them more likely to occur in particular races or families who are genetic carriers of the disease.
THE BODY’S DEFENSE AGAINST DISEASE
The human body has both mechanical and chemical methods of warding off contamination and infection. The radiographer must be aware of these defenses because this knowledge will play a role in his or her professional work and personal life.
THE IMMUNE SYSTEM
The body has a highly complex immune system that reacts to specific invaders that are able to bypass the nonspecific body defenses by forming antigens. Antigens are foreign or unrecognizable organic substances that invade the body and induce it to produce antibodies. An antibody is a protein substance produced by a particular white blood cell, the lymphocyte, or, more specifically, the B cell. B cells work with other lymphocytes called T cells, macrophages, and neutrophils. Together, the components of this highly complex system attempt to destroy invading antigens. All antibodies are immunoglobulins (Igs), but not all Igs are antibodies. Antibodies in the bloodstream and in other body systems react against specific antigens to produce an immunity to further infection by that particular antigen.
DISPLAY 5-4 Methods of Acquiring Immunity
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Antibodies are also found in human tears, saliva, and colostrum. Colostrum is the fluid initially secreted by the mammary glands of the new mother. If given to the infant during breastfeeding, it protects the infant, because the infant’s body is not capable of producing antibodies for itself. There are several types of immunity and various methods of acquiring immunity, as described in Display 5-4.
Vaccines are administered to produce artificial immunity to a number of diseases that have been extremely pathogenic in times past. These vaccines may be made from living or dead (inactivated) microorganisms. If made from living microbes, the pathogenic microbe is rendered less pathogenic and is called an attenuated vaccine. A third
type of vaccine called a toxoid is made from inactivated, nontoxic exotoxin of a pathogenic microbe.
type of vaccine called a toxoid is made from inactivated, nontoxic exotoxin of a pathogenic microbe.
Occasionally, antibodies function as antigens and produce diseases called autoimmune diseases. This occurs when substances identical with one’s own tissues stimulate antibody production, and these substances react with the host’s tissues in an adverse manner. In other words, one’s own antibodies destroy healthy tissue. Some diseases believed to be autoimmune diseases are rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis.
There is ongoing research using stem cells to restore the immune systems of persons with autoimmune diseases. Stem cells are found in the bone marrow and peripheral blood. The stem cell is also called a precursor cell because it furnishes a continuous supply of red and white cells.
THE PROCESS OF INFECTION
Infection invades the body in a progressive manner, that is, “in stages.” Although some diseases are considered to be infectious (contagious or communicable) during only one or two of their stages, in the radiographer’s practice, he or she must deal with all diseases as if they are highly infectious at all stages, because it is difficult to be certain of the period of infectivity. Display 5-5 outlines the process of infection.
Hereditary Diseases
Some diseases are the result of alterations in a person’s genetic makeup and are inherited from his or her parents or grandparents. The environment may also play a role in influencing the course of these diseases. They may result from aberrations in chromosomal makeup, monogenic (Mendelian) alterations, or other multifactorial errors as the fetus develops. Monogenic disorders are defined as a mutation of one gene that produces disease. It is not possible in this text to fully discuss these problems; however, you must be aware that such problems are seen relatively often and are diagnosed as hemophilia, diabetes mellitus, sickle cell disease, and congenital heart anomalies.
DISPLAY 5-5 The Process of Infection
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Immune Deficiency
A person whose body does not adequately defend itself against disease is said to be immunodepressed or immunocompromised. This condition may be present at birth, the result of malnutrition, or the result of medical treatment, disease, injury, or an unknown cause later in life. An immunocompromised person is unable to neutralize, destroy, or eliminate invading antigens from his or her body systems. These conditions are often chronic and untreatable. Immune deficiency results in frequent, sometimes life-threatening infections. HIV, which causes AIDS, is an example of an infection that can have disastrous consequences for the body’s immune system.
INFECTIOUS DISEASES
There are an increasing number of infectious diseases that may be acquired or transmitted by health care workers. The radiographer must be aware of these and understand the precautions that must be taken to prevent the spread of these in the workplace and refrain from acquiring them him- or herself as he or she cares for patients. The most
common of those the radiographer will need to be aware of are briefly described, and the methods of infection control needed to prevent their spread are listed as well. The radiographer must understand that there are new diseases and constantly emerging problems, and those discussed are only a small number. It is not within the scope of this textbook to list and describe all diseases that are communicable.
common of those the radiographer will need to be aware of are briefly described, and the methods of infection control needed to prevent their spread are listed as well. The radiographer must understand that there are new diseases and constantly emerging problems, and those discussed are only a small number. It is not within the scope of this textbook to list and describe all diseases that are communicable.
HIV and AIDS
Because HIV and AIDS are critical health conditions that have a huge impact on health care workers, it is necessary for the radiographer to understand the underlying disease process. A person infected with HIV may develop AIDS, a disease that is currently incurable and has a high mortality rate. Before it was understood how the spread of HIV could be controlled, health care workers were insecure and, in some cases, frightened when caring for persons known to be infected with HIV or who had symptoms of AIDS. They were also concerned when caring for potential HIV-positive carriers who had not yet been identified as being infected with this virus.
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