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INFECTION CONTROL PRACTICES

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Information about INFECTION CONTROL PRACTICES
Education

Published on June 25, 2010

Author: rajhrv

Source: authorstream.com

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INFECTION CONTROL PRACTICES : INFECTION CONTROL PRACTICES Dr.H.R.V.RAJKUMAR M.D. MICROBIOLOGIST What are blood borne pathogens? : What are blood borne pathogens? Microorganisms carried by human blood and body fluids Can be spread through contact with infected blood Cause infections and illness Where are blood borne pathogens found? : Where are blood borne pathogens found? Body fluids containing visible blood Semen and vaginal secretions Torn or loose skin Blood borne pathogens can cause infection by entering your body through: : Blood borne pathogens can cause infection by entering your body through: Open cuts and nicks Skin abrasions Dermatitis Acne Mucous membranes of your mouth, eyes or nose Standard Precautions : Standard Precautions Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious Recommends PERSONAL PROTECTIVE EQUIPMENT (PPE) and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings Objective of Universal Precautions : Objective of Universal Precautions Universal precautions are intended to prevent parenteral, mucous membrane, and non intact skin exposures of health-care workers to blood borne pathogens . Immunization with HBV vaccine is an important adjunct to universal precautions for health-care workers who have exposures to blood Procedures that carry risk to HCW : Procedures that carry risk to HCW Examination of patient using common O.P.D. procedures e.g. P/R, P/V Invasive diagnostic & therapeutic procedures Wound dressing Operation theatre procedures Various ward activities Handling of blood/serum/body fluids & tissues Cleaning of hospital/clinic & disposal of waste Faulty sterilization Laundry; C.S.S.D. & kitchen Post mortem/embalming Relative risk of transmission for HIV/HBV/HCV : Relative risk of transmission for HIV/HBV/HCV After per-cutaneous exposure HIV- 0.2- 0.3% HBV- 9 – 30% HCV- 3 - 10% Risk of transmission of HIV after muco-cutaneous exposure is – 0.05% Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings : Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings Personal Protective Equipment Definition : Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings Types of PPE Used in Healthcare Settings : Types of PPE Used in Healthcare Settings Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose Respirators – protect respiratory tract from airborne infectious agents Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings Gloves : Gloves Purpose – patient care, environmental services, other Glove material – vinyl, latex, nitrile, other Sterile or non-sterile One or two pair Single use or reusable PPE Use in Healthcare Settings Do’s and Don’ts of Glove Use : Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment Don’t touch your face or adjust PPE with contaminated gloves Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings Do’s and Don’ts of Glove Use (cont’d) : Do’s and Don’ts of Glove Use (cont’d) Change gloves During use if torn and when heavily soiled (even during use on the same patient) After use on each patient Discard in appropriate receptacle Never wash or reuse disposable gloves PPE Use in Healthcare Settings Gloves : Gloves You should always inspect your gloves for tears or punctures before putting them on. If a glove is damaged, don't use it! Gowns or Aprons : Gowns or Aprons Purpose of use Material – Natural or man-made Reusable or disposable Resistance to fluid penetration Clean or sterile PPE Use in Healthcare Settings Face Protection : Face Protection Masks – protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration Goggles – protect eyes Should fit snuggly over and around eyes Personal glasses not a substitute for goggles Antifog feature improves clarity PPE Use in Healthcare Settings Face Protection : Face Protection Face shields – protect face, nose, mouth, and eyes Should cover forehead, extend below chin and wrap around side of face PPE Use in Healthcare Settings Respiratory Protection : Respiratory Protection Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) PPE types for respiratory protection Particulate respirators Half- or full-face elastomeric respirators Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings Key Points About PPE : Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene PPE Use in Healthcare Settings Sequence* for Donning PPE : Sequence* for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings How to Don a Gown : How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back PPE Use in Healthcare Settings How to Don a Mask : How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit PPE Use in Healthcare Settings How to Don a Particulate Respirator : How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – Inhale – respirator should collapse Exhale – check for leakage around face PPE Use in Healthcare Settings How to Don Eye and Face Protection : How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably PPE Use in Healthcare Settings How to Don Gloves : How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings “Contaminated” and “Clean” Areas of PPE : “Contaminated” and “Clean” Areas of PPE Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings Sequence for Removing PPE : Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator PPE Use in Healthcare Settings Where to Remove PPE : Where to Remove PPE At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings How to Remove Gloves (1) : How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand PPE Use in Healthcare Settings How to Remove Gloves (2) : How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard PPE Use in Healthcare Settings Remove Goggles or Face Shield : Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal PPE Use in Healthcare Settings Removing Isolation Gown : Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard PPE Use in Healthcare Settings Removing a Mask : Removing a Mask Untie the bottom, then top, tie Remove from face Discard PPE Use in Healthcare Settings Removing a Particulate Respirator : Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard PPE Use in Healthcare Settings What Type of PPE Would You Wear? : What Type of PPE Would You Wear? PPE Use in Healthcare Settings What Type of PPE Would You Wear? : What Type of PPE Would You Wear? PPE Use in Healthcare Settings Hand Hygiene : Hand Hygiene Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE. Wash hands with soap and water or use an alcohol-based hand rub. PPE Use in Healthcare Settings * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub Hand washing is the key to Control of Infection : Hand washing is the key to Control of Infection Ignaz Phillip Semmelweiss1818-65 : Ignaz Phillip Semmelweiss1818-65 first assistant in the maternity hospital in Vienna noted a higher mortality in the wards open to students than in the wards to which the midwives only were admitted the patients had also noticed this... ……. then his chum, Kolletschka died of a dissection wound The Tragedy of Semmelweiss : The Tragedy of Semmelweiss noted that the lesions of his friend’s wound were similar to those found at post-mortem on those who had died of puerperal fever “Puerperal fever is caused by conveyance to the pregnant woman of putrid particles derived from living organisms, through the agency of the examining fingers” The Tragedy of Semmelweiss : The Tragedy of Semmelweiss insisted that the hands of students coming from the dissecting rooms washed their hands in a solution of chloride of lime mortality immediately fell from 18% to 3%, eventually to 1% unable convince his fellow obstetricians, who persecuted him and he was forced to resign eventually he went mad and died…... of a septic finger Preparation for Handwashing : Preparation for Handwashing Nails short & clean No false nails No nail polish No jewellery, especially stone settings Roll up your sleeves Before Decontaminating Hands : Before Decontaminating Hands Cuts and Abrasions must be covered with a waterproof dressing Remove all jewellery and watches. Fingernails should be kept short and clean. Nail art and nail varnish should not be worn. What to Wash your Hands with. : What to Wash your Hands with. Hands which are visibly soiled or potentially grossly contaminated. Liquid soap and water Dried thoroughly with a good quality paper towel. Hands which are contaminated. Alcohol hand gel. Alcohol Hand rubs : Alcohol Hand rubs Quick, easy and convenient method to rapidly disinfect physically clean hands. Decontaminate hands where hand-washing facilities do not exist or are inappropriate. The disinfectant used is alcohol also include a moisturiser. Hand Hygiene : Hand Hygiene HANDWASHING IS THE SINGLE MOST IMPORTANT MEASURE FOR PREVENTING INFECTION. Less frequently missed Least frequently missed Most frequently missed Effective Handwashing : Effective Handwashing Wet hands: Tepid water: Apply soap: Cover all surfaces of the hands: Rub for 10-15 secs: Rinse thoroughly and dry with good quality paper towels Decontamination and Sterilization : Decontamination and Sterilization All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible. Decontamination and Sterilization : Decontamination and Sterilization Equipment and tools must be cleaned and decontaminated before servicing or being put back to use. Decontamination and Sterilization : Decontamination and Sterilization Decontamination should be accomplished by using A solution of 5.25% sodium hypochlorite (household bleach / Clorox) diluted between 1:10 and 1:100 with water. The standard recommendation is to use at least a quarter cup of bleach per one gallon of water. Lysol or some other EPA-registered tuberculocidal disinfectant. Check the label of all disinfectants to make sure they meet this requirement. Safe handling & disposal of sharps (1) : Disposal of Sharps Use syringe or needle once only Avoid recapping, bending, or breaking needles Use puncture-proof container for disposal, Place puncture proof container as close to point of use as possible. Clearly label container “SHARPS” Never overfill or reuse sharps containers Dispose of sharps so people cannot access them Safe handling & disposal of sharps (1) Safe handling & disposal of sharps (2) : Safe handling & disposal of sharps (2) Never Recap needle Prevent Reuse of Needles by using needle destructor Safe decontamination of instruments and equipments (1) : Cleaning—removing all foreign material (i.e., dirt, body fluids, lubricants) from objects by using water and detergents or soaps and washing or scrubbing the object. Disinfection—a process that eliminates many or all microorganisms except spores, and is done with liquid chemicals or by pasteurizing objects. Sterilization—a process that completely eliminates or kills all microorganisms, and is done by using sterilizers that provide steam under pressure, dry heat, ethylene oxide (ETO) and other gases, or by using some liquid chemicals for prolonged soaking times. Safe decontamination of instruments and equipments (1) Safe decontamination of instruments and equipments (2) : Critical Devices E.g. Equipments that Enters sterile tissue or vascular system (includes dental instruments) Implants,scalpels, needles,other surgical instruments dental instruments, and endoscopic accessories Sterilization-Steam under pressure , Dry heat, Ethylene oxide (ETO) gas High level disinfection - Glutaraldehyde based formulations (2%) Safe decontamination of instruments and equipments (2) Slide 57: Semi-Critical Devices – Touches mucous membranes or broken skin E.g. Flexible endoscopes, laryngoscopes, endotracheal tubes, respiratory therapy and anesthesia equipment, diaphragm fitting rings, and other similar devices. High-level disinfection( exposure time - 20 minutes) Glutaraldehyde based formulations (2%)- commonly used - Cidex. Safe decontamination of instruments and equipments (3) Safe decontamination of instruments and equipments (4) : Non-Critical Devices - Touches intact skin Stethoscopes, tabletops, floors, bedpans, furniture, etc. Low-level disinfection (exposure time - 10 minutes). Ethyl or isopropyl alcohol (70% to 90%) Phenolic germicidal detergent (dilute per label) Iodophor germicidal detergent (dilute per label) Quaternary ammonium germicidal detergent(dilute per label) Household bleach (sodium hypochlorite 5.25%) Safe decontamination of instruments and equipments (4) Safe decontamination of instruments and equipments (5) : Disinfectants Name of Disinfectant Concentration of use Alcohol( Ethyl/Iso-propyl) - 60- 80% Glutaraldehyde (cidex) - 2% alkaline solution Povidone iodine( Betadine) - 2.5% Sodium hypochlorite - 0.1 -1% Blood spills - 1% (10,000 ppm of chlorine) Surface cleaning - 0.1%(1000 ppm of chlorine) Contaminated instruments - 0.2% Safe decontamination of instruments and equipments (5) Safe decontamination of instruments and equipments (6) : Preparing Sodium Hypochlorite solution from Household bleach (5.25%) Contains 52,500 ppm of available chlorine 1:10 dil contains - 5000 ppm 1:100 dil contains - 50 ppm Organism Chlorine Time for inactivation Mycoplasma - 50 ppm seconds Vegetative bacteria - 5ppm minutes Most bacteria -100 ppm 10 minutes Viruses -200 ppm 10 minutes Hepatitis B Virus -500 ppm 10 minutes HIV - 50 ppm 10 minutes Note: Freshly prepared, no organic matter Safe decontamination of instruments and equipments (6) Safe decontamination of instruments and equipments (7) : Linen Soiled linen should be handled with minimum of agitation. Linen soiled with blood and body fluids should be transported in leak proof bags. Linen should be washed with detergent and hot water ( 70 degrees centigrade) for 25 minutes. Safe decontamination of instruments and equipments (7) Safe decontamination of instruments and equipments (8) : Handling Blood Spills Wear Gloves Avoid direct contact of gloved hand with spill Cover the spill with paper towel/absorbent material Pour hypochlorite 1% (10 gm/litre) Leave for 10 minutes Clean with absorbent material Wipe the surface with disinfectant Sweep broken glass/fractured plastic with dust - pan and brush Safe decontamination of instruments and equipments (8) Segregation & Disposal of hospital waste (1) : Segregation & Disposal of hospital waste (1) Waste should be segregated & suitably disinfected before disposal Classification of Hospital waste: Infectious/Hazardous : Human Anatomical waste: Human tissues, organs, parts, Blood, Blood bags Sharps –Needles, syringes, scalpels, blades, glass etc Soiled –Wound dressings, swabs, mops , bandages Laboratory - Pathology ,Microbiology Non Infectious: General waste - paper, plastic bags , bouquets Kitchen waste Segregation & Disposal of hospital waste (2) : Segregation must be done in colour coded containers Red: All plastics-Disposable syringes,Blood bags,IV tubings,Urine bags etc Yellow: Body parts, Histopathology specimens, human tissue, organs, microbiology waste. soiled waste, swabs, dressings , mops ,bandages etc Green :General waste, Kitchen waste White Puncture proof Containers :Needles,glass ampoules, nails, blades, lancets etc Disinfection methods :1%Sodium hypochlorite, Autoclaving. Segregation & Disposal of hospital waste (2) Collection of blood/body fluids : Collection of blood/body fluids Always wear gloves If there is any cut on hand, put a dressing After collection, cut the needle using needle cutter Flush syringe. Dispose syringe in hypochlorite solution In case gloved hands are contaminated, rinse in hypochlorite solution, wash with soap and water , remove gloves and hang them to dry Change the gloves if contaminated before proceeding further After work is completed, remove gloves and wash hands with soap and water Handling & Disposal of HIV positive dead body (1) : Observe UPs :Avoid direct contact with blood and body fluids. Wear protective gear- gloves, apron. Disinfect with 1% sodium hypochlorite all needle puncture holes, wound drainage and dress with impermeable dressings. Plug all orifices with swabs soaked in 1% sodium hypochlorite solution. Wash and disinfect the body with 1% sodium hypochlorite solution. Handling & Disposal of HIV positive dead body (1) Handling & Disposal of HIV positive dead body (2) : Handling & Disposal of HIV positive dead body (2) Do not embalm the body. Cover the body with robust plastic sheet (150um thick) and cover it tightly with tapes or zipper. Clean the outside plastic sheet with 0.1% sodium hypochlorite if soiled. Soiled linen should be bagged and sent to laundry.It should be disinfected with sodium hypochlorite before washing. Hands should be washed thoroughly after removing gloves and protective clothing : Remember To Use Universal Precautions Thank you : Thank you

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