BHHSC

Department of Pharmacy
Module Title: Apply Infection Prevention Techniques

By: Amha Teklu (BPharm, MSc)

2017 E.C.
1
 Learning Module
 TVET-Programme Title: PHS Level III

 Module Title :Applying IPT and OHS

 Module Code : HLT PHS3 03 1121

 Nominal Duration : 96 Hours

 Module Scope

✓ Knowledge, skills and attitude required for workers to

comply with infection control policies and procedures
✓All procedures must be carried out with current infection

control guidelines

3
 Objectives
➢At the end of this module the learner will be able to:

 Apply infection prevention techniques

 Establish and maintain participative arrangements

 Assess and control risks and hazards

 Limit contamination

 Clean environmental surfaces

4
 Module Contents

➢Apply infection prevention techniques

 Basic components of disease transmission

 Essential elements of infection prevention

 Applying universal and standard precaution

 Demonstrating additional precautions measures

5
  Minimizing Contamination of materials, equipment and

instruments
 Performing instrumental processing

 Disposing infectious/hazardous waste materials

 Personal protective equipment (PPE)

 Applying proper hand washing techniques

6
 ➢Establish and maintain participative arrangements

 Participative processes in accordance with OHS legislation

 Dealing with Issues of participation and consultation

 Providing Information about the outcomes of participation

and consultation
 Establishing and monitoring Systems for OHS records
7
 ➢ Assess and control risks and hazard
 Developing organizational procedures for hazard identification
 Assessment and control of risks.
 Identification of all hazards at the planning
 Design and evaluation stages

 Developing and maintaining hazard risk control measures

 Identifying inadequacies in existing risk control measures
 Protocols for care following exposure to blood or other body fluids
8
 ➢Limit contamination

 Demarcating and maintaining clean and contaminated zones

 Keeping records, materials and medicaments in a clean zone

 Confining contaminated instruments and equipment in a

well designated zone

9
 ➢ Clean environmental surfaces

 Wearing Personal protective equipment (PPE)

 Removing dust, dirt and physical debris from work surfaces

 Cleaning work surfaces

 Drying work surfaces

 Replacing surface covers where applicable

10  Maintaining and storing equipment

 ➢Learning methods:

 Lecture

 Demonstration

 Exercise

 Individual assignment

11
 1. Follow infection control guidelines
1.1 Terminologies related to infection prevention(IP)
 Microorganism: the causative agents of infection which
includes bacteria, virus, fungi and parasites

 Infection: invasion and multiplication of microorganism in

body tissues clinically apparent or result in local cellular injury.

12
  Disease: any interruption of the normal structure or function of

any body part, organ, or system that is manifested by

characteristic set of symptoms and signs and whose etiology,
pathology, and prognosis may be known or unknown
 Colonization: presence and multiplication of a microorganisms

without tissue invasion or damage

13
  Contagious disease: a disease that is transmitted through
contact
 Communicable Disease: an illness due to a specific
infectious agent or toxic product that arises through
transmission from a reservoir to a susceptible host either
directly or indirectly
 Infestation: development and reproduction of arthropods on
the surface body and cloth

14
  Host: the person or animal that affords subsistence to an

infectious agent
 Incubation period: the time interval between invasion by

infectious agent and appearance of first sign or symptom.

 Communicable period: time for an infectious agent to be

transferred from infected to others.

15
  Secondary attack rate: the number of persons developing

diseases within the incubation period following exposure to

primary case
 Micro-Organisms: A microorganism is any living organism

like bacteria, protozoa, or even fungi that cannot be seen with

the naked eye

16
  Infectious microorganism: MIO capable of producing disease in
appropriate host
 Infection prevention: placing barriers between a susceptible host
(person lacking effective natural or acquired protection) and the
microorganism
 Patient safety: the reduction and mitigation of unsafe acts within the
health care system as well as through the use of best practice shown to
lead to optimal patient outcome

17
 ▪ Protective barriers: are physical, mechanical or chemical

processes that help prevent the spread of infectious MIO from

person to person (patient, healthcare client or health workers)
and/or equipments and environment surfaces to people
▪ Host Susceptibility: Individuals who are likely to develop a

communicable disease after exposure to the infectious agents

are called susceptible hosts
18
  Nosocomial infections: Infection arising > 48 hours after

admission and the interchangeable with

 Healthcare facility acquiring infection

 Healthcare associated infections

 It is an infection acquired in healthcare facility by a patient

who was admitted for a reason other than that infection

19
  Asepsis and aseptic technique: combination of effort

made to prevent entry of MIO into any area of the body where
they are likely to cause infection
 Antisepsis: process of reducing the number of MIO on skin,

mucous membranes or other body tissue by applying an

antimicrobial (antiseptic) agents

20
 ▪ Decontamination: process that makes inanimate objects safer to be

handled by staff before cleaning (inactivate viruses and reduces, but

does not eliminate, the number of other contaminating MIOs)
 Cleaning: process that physically removes all visible dusts, soil blood

or other body fluid from inanimate object as well as removing sufficient

number of MIO to reduce risks for those who touch the skin or handle
the object

21
▪ High level disinfection (HLD): the process that eliminates all

microorganisms except some bacterial endospores from inanimate

objects by boiling, steaming or the use of chemical disinfectants
 Sterilization: process that eliminate all MIOs (bacteria, virus,

fungi and parasites) including bacterial endospores from inanimate

objects by high pressure steams (autoclave), dry heat (oven),
chemical sterilization or radiation
22
 ➢Features of Microorganisms

 Microscopic size

 Rapid rate of reproduction

 Tendency to spread from one place to another

 Ability to resist eradication

23
 ➢Sources of Microorganisms in the health care facilities

 The patient (endogenous):

 Another person (exogenous cross-infection)

 The health care environment

24
 ➢Chx. of MIO with Health Care-Associated Infections

 Are able to survive on the hands of HCWs

 Can survive dryness, heat, and disinfectants

 Live in blood and body fluids

 Thrive in damp areas

25
 Preventing spread of infection
 To prevent the transmission of infection, the diseases
transmission cycle need to be broken at some point
Transmission requires Three elements:
 A source of infecting microorganisms
• Human source - patients/hospital personnel/visitors
• Other sources - contaminated objects/medical instruments
26
  A susceptible host

Patients/hospital personnel/visitors

 A mode of transmission

Three main routes

Airborne/Droplet/Contact

27
➢ Disease Transmission Cycle
 Most microorganisms can cause infection
 All humans are susceptible to most infectious agents unless immune
(naturally or by vaccination)

 Risk of infection is related to the number and virulence of organisms

 Number of organisms needed to cause infection varies with location
(blood stream—least; intact skin— greatest number of organisms)
28
29
➢ Agent – pathogen or infectious microorganism

 Bacteria

 Viruses

 Mold

 Fungi

➢ Reservoir – Place where pathogen lives

➢Lungs

 Blood

 Digestive tract, etc

30
➢ Portal of Exit – Any body opening on infected person

 Nose

 Mouth

 Eyes

 Cut in Skin

 Urethra/Anus

➢ Mode of Transmission – How the Pathogen travels from one person to the next

 Air

 Hands

 Other Surfaces
31
 ➢Portal of Entry – Any body opening on uninfected person
 Nose
 Mouth
 Eyes
 Cut in Skin
 Urethra/Anus
➢Susceptible Host – an uninfected person

32
 ➢Transmission of HBV and HIV from Patients to Healthcare Workers

 Most injuries can be prevented by: Safe work practice

• Eliminating unsafe and unnecessary injections
• Immediately disposing of needles and syringes in sharps containers
• Placing sharps containers within “arm’s reach”
• Using “Safe Zones” for passing sharps in the OR
• Decontaminating instruments and other items before reprocessing

33
34
 ➢In health care facility the proper IP and patient safety

practice such as
 Reduce the number of MIO present (e.g hand washing, cleaning

of instruments)
 Killing, inhibiting or inactivating MIO (e.g hand washing with a

waterless alcohol preparation, decontamination, sterilization or

HLD)
35
  Creating barriers to prevent infectious agent from spreading

(e.g wearing gloves or PPE)

 Reducing or eliminating risky practices (e.g by using hand free

technique in using disposable gloves and syrings)

 Making sure that people, especially health care workers, are

immune or vaccinated

36
Apply infection prevention techniques

 Elements of infection prevention

 Standard precaution

 Transmission based precaution

 Instrument processing

 Infectious waste management

 Personal protective equipment

 Hand washing

37
 ❖ Elements of infection prevention

 According the 1991 New York city legislation there are seven elements of elements of
infection prevention.
Element I: Scientifically Accepted Principles
Element II: Mechanism of Transmission
Element III Engineering and Work Practice Controls
Element IV: Personal Protective Equipment
Element V: Cleaning, Disinfection, and Sterilization
Element VI: Protecting Healthcare Workers
Element VII: Sepsis Awareness and Education

38
➢Actions to prevent infection

✓Cover coughs and sneezes (everyone, always)

✓ Distancing / separation (everyone, always)

✓Hand hygiene (everyone, always)

✓Personal protective equipment (PPE) for essential staff(according

to risk assessment by what procedures or duties you are doing)

39
➢The 3 main preventive measures for transmition of infection

▪ Social distancing /separation of At least 1m between people/

separation of well and sick individuals

▪ Cough/respiratory etiquette

❖Wear masks if available

❖Sneeze/cough into your sleeve or cover with tissue or scarf or mask.

❖If you have coughed/sneezed into your hands, wash hands

immediately with soap and water

40
➢ Hand washing
 Before eating or feeding others, after coughing/sneezing, after
touching patients or their bed sheets, clothes and utensils, before
and after preparing food, after going to the toilet, after removing
masks or gloves
▪ PPE (personal protective equipment) such as masks or eye
protection must be worn
41
 Standard precautions
 Guidelines designed to create a physical, mechanical, or chemical barrier
between microorganisms and a person to prevent the spread of infection
(i.e., the barrier serves to break the disease transmission cycle)
 Barriers

• Physical: Personal protective equipment

(gloves, face masks, goggles, gowns, plastic or rubber aprons, and
drapes)

42
 • Mechanical: High-level disinfection (HLD) by boiling or

steaming and sterilization by autoclaving or dry heat ovens

• Chemical: Antiseptics (alcohol-based antiseptic agents) and high-

level disinfectants (chlorine and glutaraldehydes)

43
 ➢Designed of standard precautions

Purpose
 To prevent nosocomial infections in all hospitalized patients and
clients attending healthcare facilities. It is a primary strategy in this
regard
 It reduces risk of transmitting microorganisms from known or
unknown sources of infection
 It also provides rationale for appropriate use of limited infection

44 prevention resources in caring for all clients and patients

▪ Apply to care of all clients and patients attending healthcare facilities
Reason: Most people with HIV or other life-threatening blood-
borne diseases do not have symptoms
 Apply to all blood, body fluids, secretions and excretions (except sweat),

non-intact skin and mucous membranes.

Reason: Increased risk of exposure by touching, accidental injury
(needle-stick), or contact (splashing or spraying of potentially
contaminated blood or body fluids)
45
Standard precautions…
Key principle
 Consider every person (patient or staff) as potentially infectious and
susceptible to infection.
Key components
 Wash hands (or use an antiseptic hand rub) before and after touching
blood or body fluids, after removing gloves, and between patient
contacts.
 Wear gloves (both hands) before touching anything wet—broken skin,
mucous membranes, blood or body fluids, soiled instruments .or
contaminated waste materials and before performing invasive
procedures.
46
Standard precautions…
Key components…
 Physical barriers (protective goggles, face masks and Use aprons) if
splashes and spills of blood or body fluids (secretions and
excretions) are likely
 Use antiseptic agents for cleansing the skin or mucous membrane
prior to surgery, cleaning wounds, or doing hand-rubs or surgical
hand-scrubs with an alcohol-based antiseptic product.

47
Key components…
 Use safe work practices such as not recapping or bending
needles, safely passing sharp instruments, and suturing, when
appropriate, with blunt needles
 Safely dispose of infectious waste materials to protect those who
handle them and prevent injury or spread of infection to the
community
 Process instruments, gloves, and other items after use by first
decontaminating and thoroughly cleaning and then either
sterilizing or high-level disinfecting them using recommended
48procedures.
Standard precautions include:
❖ Hand Hygiene

❖ Personal Protective Equipment (PPE) appropriate for the level of

care being given or the potential infection risk associated with an

activity, even when there is no known risk of infection
❖ Respiratory hygiene and cough etiquette

49
Standard precautions include:….
❖ Injection and phlebotomy safety and sharps injury prevention

❖ Safe decontamination and sterilization of medical equipment

❖ Safe handling of Linen and laundry

❖ Environmental decontamination

❖ Healthcare waste management

50
 LO2. Identify and respond to infection risks
2.1 identification of Infection risks
 Risk: The likelihood, or possibility, that harm (injury, illness,

death, damage etc.) may occur from exposure to a hazard.

51
  Risk Assessment: is defined as the process of assessing the risks
associated with each of the hazards identified so the nature of the risk
can be understood
 Risk Control: Taking actions to eliminate health and safety risks so far
as is reasonably practicable
 Where risks cannot be eliminated, then implementation of control
measures is required, to minimise risks so far as is reasonably
practicable
52
▪ Employers have the responsibility of

 Providing a safe workplace

 Follow recommended procedures

 Take adequate precautions to protect yourself from injury and

infection

53
  Risk management is the process of making health care safer for the

patient, staff and visitors by

 Identifying hazards in the workplace

 Taking action to minimize their harm wherever possible

54
 ▪ There are a number of steps in the risk management process:

 Identifying the hazard

 Assessing the risks

 Using control measures

▪Identifying a hazard

 A hazard is anything with the potential to cause harm to you, the

patients, your co-workers or visitors to the work area.
55
 In the sterilization setting this includes chemicals, sharps such as

needles, soiled instruments, power, water, steam, noise, and heat

 All employees, patients, volunteers and visitors that enter the

work place have a responsibility to behave in a safe and

responsible manner and report any hazards or near accidents

56
 ➢The steps in the risk management process:

 Identifying the hazard

 Assessing the risks

 Using control measures

57
 Assessing the risks

 It is important to assess the risks associated with each hazard to

determine how it can be eliminated

 Is there a high risk of injury or is the hazard a result of a

combination of unusual circumstances that may never re-occur?

58
 Identification of Infection
 There are a number of steps in the risk management process:

 Identifying the hazard

 Assessing the risks

 Using control measures

59
 Control measures
 The more serious the consequence, the more urgent it is for

the risk to be dealt with and eliminated immediately

 If the risk cannot be eliminated it may be possible to

circumvent the risk of injury by changing practice

60
  When deciding on control measures this should be a team

effort so that management and staff work together

 The control measures should not impose another risk

61
 Reporting incidents
 Every occupational incident and injury must be reported and

investigated immediately
 Especially applies to any injury from sharp items such as

needles or scalpel blades. HIV, Hepatitis B and C are

significant blood borne pathogen risks to health care workers

62
  Blood is usually obtained from the source patient, if known, and

tested for blood borne viruses

 The person injured may be offered counselling as this can be a

very stressful time. Blood from the person with the injury may
also be collected

63
 Reporting incidents
 When completing an incident form, include the following
information to assist with follow up:
 Date and time of exposure

 How the incident occurred

 Name of the source person (if known)

 Site of injury
64
Infection risk control
 Infection control policies established and followed in a health care

organisation should provide the foundation for a safe environment

for patients, staff and visitors
 Policies and procedures should be based on local regulations and

national Standards

65
Follow procedures for risk control and risk containment for specific
risks
 All patient care items require cleaning after use on, or by a patient

 In 1968 in the USA, Earle Spaulding developed some rules to make this decision-
making process easy, called Spaulding’s classification. It is a simple system and is
used daily in most clinical settings. There are three rules governing situations of:
 Non critical

 Semi critical

 Critical
66
 Non-critical: If used instruments are to come into contact with

intact skin they need to be cleaned with detergent and water

 Semi critical: For instruments that come in contact with intact

non-sterile mucosa or non intact skin, sterilization is always

preferred and disinfection or high level disinfection is required
 Critical: For items that enter sterile tissue, other body cavities or

the blood stream, sterilization is the only option

67
Follow protocols for care following exposure to blood
or other body fluids as required
 Environmental surfaces in the health care settings can become

contaminated wit blood and body fluids, possibly containing

harmful micro-organisms

68
  It is possible to receive heavily soiled instruments in the

decontamination area. If these items are accidentally dropped onto

an environmental surface it is important to know how to clean the
spill safely
 In general these spills will be small and should also be cleaned

immediately

69
 Procedures for the accidental exposure to body fluids
 Immediate care of the exposed health care worker
 After exposure to blood or other body substances you should as
soon as possible do the following:
 Encourage bleeding if exposure involves a cut or puncture, then
wash with soap and water
 Wash with soap and water where the exposure does not involve
a cut or puncture

70
  If eyes are contaminated then rinse them, while they are open,
gently but thoroughly with water or normal saline
 If blood or other body substances get in the mouth, spit it out
and then rinse the mouth with water several times
 If clothing is contaminated remove clothing and shower if
necessary
 Inform an appropriate person to ensure that necessary further
action is taken

71
 Factors which need to be documented:
 Nature and extent of the injury
 Nature of the item which caused the injury e.g. gauge of needle
 Nature of body substance involved
 Volume of blood and body substances to which HCW was exposed
 All occupational exposures must be fully documented to meet legal
requirements to ensure that workers are able to obtain the support
to which they are entitled

72
 Process following a sharps injury
 'Sharps' is the terminology used for the items that can cut or
penetrate the skin, and in doing so, potentially cause cross-
infection of micro-organisms
Sharps
scalpels
 These include syringes, razors, scalpels
 Sharps must NOT be passed by hand between people, but in a
puncture resistant tray
 Syringes should not be re-sheathed

razors
73
Remove spills in accordance with the policies and
procedures of the organisation
 Management of blood and body substance spills
 Put on protective apparel including gloves
 Confine and contain the spill
 Cover the spill with paper towels to absorb the bulk of the blood
or body substances
 Treat debris as clinical waste
 Clean the spill with a neutral detergent and water
 If mop is used it must be stored dry
74
Spills kit
 You should have a dedicated 'spills kit' readily available in a bucket
with a fitted lid
 Protective equipment eye protection, plastic apron, disposable
rubber gloves, respiratory protection (for high-risk spills)
 Containers (such as leak proof bags) for disposing of the material
spilt
 A 'pooper scooper' – type scraper and pan
 Sachets of granular chlorine

'pooper scooper
75 plastic apron
Non-hazardous spills
 For small spills, wipe immediately with paper towel. Clean with
water and detergent. Use the following steps when cleaning up
a small spill
 Collect cleaning materials and equipment (eg spills kit)
 Wear disposable gloves. Eyewear and a plastic apron should be
worn where there is a risk of splashing occurring.

76
  Wipe up the spill immediately with absorbent material (eg
paper hand toweling). Place any contaminated absorbent
material into an impervious container or plastic bag for
disposal
 Clean the area with warm water and detergent using a
disposable cleaning cloth or sponge

77
Non-hazardous spills…
 Where contact with bare skin is likely, disinfect the area by wiping
with sodium hypochlorite and allow to dry.
 Discard contaminated materials (absorbent toweling, cleaning cloths,
disposable gloves and plastic apron)
 Wash hands
 Clean and disinfect reusable eyewear before reuse

absorbent toweling

78
 For larger spills, scrape the bulk of the spill into a pan for
disposal, then clean the residue
 When cleaning up a large spill each step of instructions specific
to the size of spill are shown in bold
1. Collect cleaning materials and equipment (eg spills kit)
2. Wear disposable gloves, eyewear, mask and a plastic apron
3. Cover the area of the spill with granular chlorine releasing
agent (1,000 ppm available chlorine) or other equivalent
acting granular disinfectant and leave for three to ten
minutes, depending on formulation and labelling
instructions
79
pan
 For larger spills, scrape the bulk of the spill into a pan for
disposal, then clean the residue.
4. Use a disposable scraper (e g cardboard) and pan to scoop up
granular disinfectant and any unabsorbed blood or body
substances
5. Place all contaminated items into impervious container or
plastic bag for disposal
6. Wipe the area with absorbent paper toweling to remove any
remaining blood and other body fluids place in container for
disposal
80
4. Use ward cleaning materials to mop up with water and detergent
5. Discard contaminated materials (absorbent toweling, cleaning
cloths, disposable gloves and plastic apron) in accordance with
state/territory Regulations
6. Wash hands
7. Wash the mop and bucket with detergent and hot water. Rinse and
allow to dry

81
Blood and body substance spills
 Protect yourself, wear gloves (and face protection if needed)
 If possible, isolate the area
 For a small spill, wipe immediately with paper towel, then clean
with water and detergent
 In a 'dry' area, use absorbent paper or granular chlorine to absorb
the spill. (This avoids increasing the size of the spill and/or releasing
contaminants into the air)

82
  Then scrape up the absorbed material into a pan and clean the
affected area with water and detergent. Dispose of spilt material,
paper or granules and gloves in a sealed container.
 In a 'wet' area, wash the spill into the sewerage system. Flush area
with water and detergent
 You can use hospital-grade disinfectant on the area after cleaning

83
Equipment needed for cleaning blood and body substance spills
 A mop, a bucket and detergent

 Leak-proof bags and containers for disposal of waste material

 A scraper and pan for spills (similar to a pooper scooper

 Paper towel to wipe up spills

 About five granular disinfectant sachets containing

10,000 ppm available chlorine or equivalent

84 Leak-proof bags
Equipment needed for cleaning blood and body substance spills…
 Disposable rubber gloves that are suitable for cleaning.

 Eye protection (disposable or reusable)

 A plastic apron

 A mask for protection against inhalation of powder from the

disinfection granules or aerosols

 Forceps for picking up glass
85
 LO3. Maintain personal hygiene
Hand hygiene
 Hand hygiene is the single most important infection prevention

procedure
 Appropriate hand hygiene must be carried out

• Before examining (coming in direct contact with) a client/patient

• Before putting on sterile or high-level disinfected surgical gloves,

86 or examination gloves
 • After any situation in which hands may be contaminated, such as:

 Handling contaminated objects, including used instruments

 Touching mucous membranes, blood, body fluids, secretions or

excretions (except sweat)

• After removing gloves

87
 Hand Hygiene Practices
 Routine handwashing with soap and water

 Handwashing with an antiseptic agent and water, also called

hand antisepsis
 Using an antiseptic hand rub with a waterless, alcohol-based

agent
 Performing a surgical scrub using an antiseptic agent

88
Criteria for selcting hand hygiene practice
 Intensity of contact with patients and/or blood and body fluids

 Likelihood of microbial transmission

 Patient’s susceptibility to infections

 Procedures being performed

➢ N.B. The level of hand hygiene will be determined by the activity

or area of practice
89
 Hand washing
 Hands are the principal route of cross infection.

 Hand washing is the single most important measure in reducing the spread of

infection!

Objective:Mechanically
remove soil and debris from the
skin and reduce the number of
transient microorganisms

90
 When do we wash our hands?
➢Wash hands:

 After arriving at work

 Before and after examining any client

 After touching contaminated instruments/items

 After exposure to blood or any body fluids

91
  Before putting on gloves and after removing them

 Whenever our hands become visibly soiled

 After blowing your nose, covering a sneeze

 After visiting the toilet

 Before leaving work

92
 ➢ Step of hand washing
 Thoroughly wet hands.

 Apply plain soap (antiseptic agent is not necessary).

 Vigorously rub all areas of hands and fingers for 10–15 seconds

 Rinse hands thoroughly with clean water.

 Dry hands with a paper towel or a clean, dry personal towel.

 Use a paper towel when turning off water if there is no foot

93
control or automatic shut-off.
  Handwashing technique

94
Hand Antisepsis
➢ The soap or detergent contains an antiseptic agent (often

chlorhexidine, iodophors, or triclosan) instead of plain soap or

detergent
➢When to use hand antisepsis?

 Before examining or caring for highly susceptible patients (e.g.,

premature infants, elderly patients and AIDS patients)

95
 • Performing an invasive procedure (e.g., intravascular device)

• Leaving the room of patients on Contact Precautions (e.g.

hepatitis A or E)
• Objective: Remove soil and debris as well as to reduce both

transient and resident flora

96
Antiseptic Hand rub
 Purpose: is to inhibit or kill transient and resident flora

 Considered to be more effective than antimicrobial hand washing

agents or plain soap and water

 It is quicker and easier to perform,but it should not be used when

the hands are visibly soiled

 Do not rinse hands after applying hand rub
97
 Antiseptic hand rub
Alcohol-based solution for hand rub:
 Add glycerin or sorbitol to alcohol (2 ml. in 100 ml. of 60–90%

ethyl or isopropyl alcohol solution)

Steps:
 Apply enough alcohol-based hand rub to cover the entire surface

of hands and fingers (about a teaspoonful -5ml)

98
  Continue rubbing the solution over hands until they are dry (15-30

seconds)
 Rub the solution vigorously into hands, especially between fingers

and under the nails, until dry

99
 Summary
Alcohol-Based Hand rubs: What benefits do they provide?
Require less time

 More effective for standard handwashing than soap

 More accessible than sinks

 Reduce bacterial counts on hands

100
 Improve skin condition
 ▪ Efficacy of Hand Hygiene Preparations in Killing Bacteria

Good Better Best

Antimicrobial Alcohol-based hand rub

Plain soap soap

101
 Efficacy of Hand Hygiene Preparations in Killing
Bacteria
• Plain soap is good at reducing bacterial counts but anti

microbial soap is better, and alcohol-based hand rubs are the

best
• Plain soap and water do not kill germs

102
 • Almost half of the hand soaps in the market have antibacterial

additives
• The active ingredient in most of the soaps is triclosan

• In the amounts used in the hand soap(0.2 or less) triclosan doesnot

kill many bacteria but may keep bacterial count down due to its
residual effect

103
 Surgical Hand scrub
➢ To mechanically remove soil, debris and transient organisms and

to reduce resident flora for the duration of the surgery

➢procedures

 Remove rings, watches, and bracelets

 Thoroughly wash hands and forearms to the elbow with soap and

water
104
  Clean nails with a nail cleaner

 Rinse hands and forearms with water

 Apply an antiseptic agent (soap)

 Vigorously wash all surfaces of hands, fingers, and forearms for at

least 2 minutes

105
 Surgical Hand-scrub…
 Rinse hands and arms thoroughly with clean water, holding

hands higher than elbows

 Keep hands up and away from the body, do not touch any

surface or article. and dry hands with a clean, dry towel

 Put on sterile or HLD gloves

106
 Why Healthcare Workers Don’t Wash Their Hands?
 Hand washing between every patient encounter is unnecessary

 Hand washing doesn’t affect clinical outcome

 Hand washing is unnecessary when gloves are worn

 Frequent hand washing damages skin and causes cracking,

dryness, irritation and dermatitis

107
  Hand washing damages nails and nail polish

 Hand washing facilities are not conveniently placed or well

designed
 Hand washing takes too much time

108
 ➢Issues Related to Hand Hygiene

 Hand lotions and creams

 Lesions and skin breaks

 Fingernails

 Artificial nails

 Nail polish

 Jewelry
109
 Fingernails
➢The region under fingernails harbors many microbes

➢Long nails can:

 Tear gloves easier

 Cause potential patient injury

 Require additional time to properly wash

➢Artificial or long nails may prevent effective hand washing

➢Keep nails clean and short

110
 How to Improve Hand Hygiene
 Have supplies available and at “point of use.”

 Disseminate and promote guidelines.

 Reinforce guidelines

 Involve everybody

 Give positive feedback

 Reward role modeling

111  Benchmark best practices

 LO4: Use personal protective equipment (PPE)
 Protective barriers and clothing are now commonly to as PPE

 PPE includes: gloves, masks/respirators, eyewear (face shields,

goggles), caps, gowns, aprons, boots and other items

 Wearing PPE is to get physical barrier / protection of healthcare

provider and patient from MIO

 The most effective barriers are made of synthetic materials that

112 do not allow water or other liquids to penetrate them

 Plastic Apron
 PPE that is fluid-resistant (e.g., plastic or rubber aprons) can
protect healthcare workers from exposure to potentially
contaminated blood or other body fluids
Gloves
 Hand hygiene, coupled with the use of protective gloves, is key
component in minimizing the spread of disease and maintaining

113
an infection free environment
 Gloves
➢Healthcare worker wear gloves for the following three reasons

 To reduce the risk of staff acquiring infections from patients

 To prevent staff from transmitting their skin flora to patients

 To reduce contamination of the hands of staff by

microorganisms

114
 Types of gloves
➢There are three types of gloves used in healthcare facilities

A. Surgical glove:

▪ Used when performing invasive medical or surgical

procedure
▪ Made from latex rubber, b/c of rubber natural elasticity,

sensitivity and durability

115 ▪ Provide a comfortable fit

 B. Clean examination glove:
▪ Provide protection to healthcare workers when perform routine

duties
▪ Used when contact with mucous membrane and non-intact skin

C. Utility or heavy duty household gloves:

▪ Worn for process equipment and instruments for handling and

disposing of contaminated waste and cleaning conta. surface

116
 When to Wear Gloves
➢Gloves should be worn when:

 There is a reasonable chance of hand contact with blood or

other body fluids, mucous membranes, or non-intact skin,

 Performing an invasive medical procedures

117
  Before handling soiled instruments, contaminated waste items or

touch contaminated surfaces

 When disposing contaminated waste items

 Handling chemicals or disinfectants

118
 Removing and discarding or reprocessing gloves
 As a general rule, if the risk is to the patient then “Sterile”

gloves are required. If the risk is to the user then “Non-

Sterile” gloves will probably be sufficient
 Gloves should not be worn when it is not required

119
 If gloves are to be discarded, briefly immerse them in 0.5%

chlorine solution
 If gloves are to be processed and reused; soak the gloves in 0.5%

chlorine solution for 10 minutes before cleaning, then sterilize

or HLD (by steaming)

120
 Removing…gloves
 Immediately after autoclaving, gloves are extremely friable and

tear easily.
 Gloves should not be used for 24 to 48 hours to allow their

elasticity to return and to prevent tackiness (stickiness)

 Latex rubber surgical gloves should be discarded after

processing three times because the gloves tear more easily with

121
additional processing
  After steaming; wear “wet” within 30 minutes or allow to dry

for 4 to 6 hours before using.

Remember
 Wearing gloves does not replace the need for hand washing or

use of antiseptic hand rubs,

 Surgical gloves can be reused

122
 Wearing gloves
 Keep nails short

 Select correct type and size

 Insert hands into gloves

 Extend gloves over gown cuffs to protect the wrists

123
Removing Gloves (1)
▪ Grasp outside edge near wrist

▪ Peel away from hand, turning glove inside-out

▪ Hold in opposite gloved hand

124
 Removing Gloves (2)

- Slide ungloved finger under the

wrist

of the remaining glove

- Peel off from inside, creating a

bag

for both gloves

125
 Do’s and Don’ts of Glove Use
❑ Do’s
➢Work from “clean to dirty”
➢Limit opportunities for “touch contamination”
➢Protect yourself, others, and the environment
➢ Change gloves
 During use if torn and when heavily soiled (even during use on
the same patient)
 After use on each patient
126
 Don’ts of Glove Use
❑ Don’ts

➢ Touch your face or adjust PPE with contaminated gloves

➢ Touch environmental surfaces except as necessary during

patient care

127
 Gowns / Aprons

➢Materials

 Natural or man-made

 Reusable or disposable

 Resistance to fluid penetration

➢Clean or sterile
128
 Face Protection(Masks ,Goggles, Face shield) thmbnl

➢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

129
 Face Shield
➢Intended to protect the entire face or potions thereof

➢Can provide protection against power, chemical or heat hazards

➢ Goggles or glasses to provide adequate protection

130
 Shoe and Head Covers
➢Shoe covers

 Wear shoe covers to provide a barrier against possible exposure to

airborne organisms
➢Head covers

 Wear head covers to protect the hair and scalp

131
 Respiratory Protection
➢Respirators filter the air you breathe to help protect you from

microorganisms including bacteria and many viruses.

➢Types of respirators include:

 Particulate respirators (Disposable Respirators) (includes N95, N100)

 Powered Air Purifying Respirator (PAPR)

 Self-Contained Breathing Apparatus (SCBA) Respirators

132
 Factors Influencing PPE Selection

➢Type of exposure anticipated

 Splash/spray versus touch

 Category of isolation precautions

➢Durability and appropriateness for the task

➢Fit

133
 Key Points About PPE

➢Apply before contact with the patient, generally before

entering the room

➢Use carefully – don’t spread contamination

➢Remove and discard carefully, immediately outside patient

room; remove respirator outside room

134
➢Immediately perform hand washing
 Sequence for Donning PPE

➢Gown first

➢Mask or respirator

➢Goggles or face shield

➢Gloves

*Combination of PPE will affect sequence – be practical

135
 How to Don a Gown
➢ Select appropriate type and size

➢ Preferably opening is in the back

but based on type of gown available

➢ Secure at neck and waist

➢ If gown is too small, use two gowns

 Gown #1 ties in front

 Gown #2 ties in back

136
How to Don a Gown Cont’d…
 If the gown is with front opening, make sure to close the gown

with appropriate locker/zipper

 Make sure that the end of sleeves are tight enough with our

hand
 Never folded up the sleeve and let the hand uncover

137
 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

138
 How to Don a Particulate Respirator
❑Its disposable Respirators which includes N95, N99 or N100

➢Select a fit tested respirator

➢Place over nose, mouth and chin

139
 ➢Fit flexible nose piece over nose bridge

➢Secure on head with elastic

➢Adjust to fit and perform a fit check

 Inhale – respirator should collapse

 Exhale – check for leakage around face

140
 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

141
 Sequence for Doffing PPE

1st Remove Glove

2nd Face shield or goggles

3rd Gown

4th Mask or respirator

142
 Where to Remove PPE?

➢At doorway, before leaving Laboratory/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

143
 ➢ Inoculating sputum for culturing TB ➢ Drawing blood from a vein?
• Gloves, Gown and N95 mask • Gloves
➢ Suctioning oral secretions? ➢ Cleaning lab work bench
• Gloves and mask/goggles or a face • Gloves & Gown
shield – sometimes gown
➢ Login in registration log book or
➢ Transporting lab specimen using cold box
Occurrence log book
• Generally none required
• Generally none
➢ Responding to an emergency where blood
is spurting? ➢ Posting safety signage?
• Gloves, fluid-resistant gown, • Generally none
mask/goggles or a face shield

144
 LO5 Limit contamination

5.1 Demarcating of clean and contaminated zones

145
 Instrument Processing

Decontaminate

High-Level
Clean Disinfect
Sterilize
Chemical Boil
High-pressure steam Steam
Dry heat Chemical

146 Dry/Cool and Store

147
 ➢ Decontamination is the process of making inanimate objects safer to handled by

staff before cleaning. It is done by making the equipments in 0.5% chlorine solution

Principles decontamination

 Inactivates HBV and HIV

 Makes items safer to handle

 Must be done before cleaning

148
 ➢ Decontamination practices

 Place instruments and reusable gloves in 0.5% chlorine solution after use

 Soak for 10 minutes and rinse immediately

 Wipe surfaces (exam tables) with chlorine solution

 Flush syringe and needles with 0.5% chlorine solution

149
 Cleaning
 Cleaning: Process that physically removes all visible dust, soil, blood or other body

fluids from inanimate objects as well as removing sufficient numbers of microorganisms

to reduce risks for those who touch the skin or handle the object

Principles of cleaning

 Removes organic material that:

• Protects microorganisms against sterilization and HLD

• Can inactivate disinfectants

 Must be done for sterilization and HLD to be effective

 Method of mechanically reducing the number of microorganisms, especially endospores

150
 Cleaning Spills of Blood and Other Body Fluids

 Clean spills of blood, body fluids and other potentially infectious fluids immediately:

 For small spills, while wearing utility or examination gloves, remove visible

materials using a cloth soaked in 0.5% chlorine solution

 For large spills, flood the area with a 0.5% chlorine solution, mop up the

solution and then clean as usual with detergent and water.

151
 Cleaning soiled and contaminated cleaning equipment

 Decontaminate cleaning equipment that has been contaminated with blood and body

fluids

 Wash cleaning buckets, cloths, brushes and mops with detergent and water daily, or

sooner if visibly dirty

 Rinse in clean water

 Dry completely before reuse

152
 Sterilization and disinfection

▪ Sterilization: A physical or chemical process that completely destroys or removes all

microbial life, including bacterial spores

▪ Disinfection: it is a process which reduces the number of viable microorganisms to

an acceptable level (no longer cause disease) but may not inactive some viruses and
bacterial spores

153
 Sterilization
❑ To achieve and maintain sterilization of any instrument, three definite stages are to be

completed

➢Pre sterilization cleaning: Manual or mechanical removal of the organic

matters (blood, saliva, feces, debris, etc) which provide protective barrier for
microorganisms and prevents its destruction
➢Sterilization process: method and efficiency used for / while sterilization

➢Aseptic storage: maintenance of sterility during transportation and storage

is of utmost importance.
154
 Factors which influence the effectiveness of Sterilization
❑ Number of Microbes:

▪ The more microbes present, the more time it takes to eliminate population

❑ Type of Microbes:

▪ Endospores are very difficult to destroy. Vegetative pathogens vary widely in

susceptibility to different methods of microbial control.

155
 ❑ Environmental influences:

▪ Presence of organic material (blood, feces, saliva, pH etc.) tends to inhibit antimicrobials.

❑ Time of Exposure:

▪ Chemicals and radiation are more effective at longer times. In heat treatments, longer

exposure compensates for lower temperatures

156
 Methods of Sterilization

I. Physical methods

1) Heat (Dry , Moist)

2) Filtration
3) Radiation (ionizing and non-ionizing)
II. Chemical methods (Ethylene Oxide and Glutaraldehyde)

157
 1) Heat Sterilization

❑ Most common and one of the most effective methods of sterilization

❑ Factors influencing sterilization by heat are:-

✓ Nature of the heat (Dry, Moist)

✓ Temperature and time

✓ No. of organism present

✓ Presence or absence of bacterial spore (a dormant, non-dividing form of a bacterial

cell that protects the bacteria from harsh environments).

✓Type of material from which organism is to be eradicated

158
Heat sterilization ….Cont’d

❑ There are two types of Heat Sterilization

A. Dry heat sterilization

B. Moist Heat
A. Dry heat sterilization

❑ killing is due to :

➢ Dehydration and oxidation of organisms

➢ Protein denaturation and toxic effects of elevated levels of electrolytes

N.B; Electrolytes are minerals in your blood and other body fluids that carry an electric charge.
Electrolytes affect how your body functions in many ways, including: The amount of water in your
159body. The acidity of your blood (pH) Your nerve and muscle function.
 A. Dry heat sterilization flasks

❑ Kinds of Dry Heat sterilization

i. Hot air oven : is used to sterilize items, which do not get damaged by high
temperature, such as laboratory glass, flasks, instruments with sharp cutting
edges

➢Holding temperature and time of exposure are crucial

 Holding temperature refers to the temperature at which food is kept to prevent

bacterial growth and foodborne illnesses.

160
 ii. Flaming (Red Heat) : It is used to sterilize metallic objects by holding them in
a flame like bunsen burner till they are red hot

➢Example : inoculating wires, needles, forceps

iii. Incineration:- is an excellent method of destroying materials such as

contaminated cloth, animal carcasses, pathological materials and etc which are no
more needed.

Incineration

161
 B. Moist heat sterilization

 Causes denaturation and coagulation of proteins for killing.

Kinds of moist Heat sterilization

1. Pasteurization: Heating at temperatures sufficient to inactivate harmful organism in

milk and other liquids. Does not achieve sterilization.

➢ The temperature employed is either 630C for 30mins (Holder method) or

720C for 15-20 seconds (Flash method) followed by cooling.

162
 B. Moist heat sterilization…

2. Boiling…

Tyndallisation or intermittent sterilization: named after John Tyndall.

➢ Exposure of 1000C for 20 min for 3 successive days.

➢ The process involves boiling for a period (typically 20 minutes) at atmospheric

pressure (100oC), cooling and incubating for a day and repeating for a 3 successive days
and finally boiling again

163
➢ Principle: 1st exposure kills all vegetative bacteria and spores, since they are in a favorable
medium, will germinate and be killed on subsequent occasions
➢ The procedure was historically used for media preparation

➢ Is used for heat sensitive liquids, milk and pharmaceutical products

2. Boiling: Heating to 100oC or more.

➢ Kills vegetative forms of the pathogens within 10 minutes or less.

➢ Endospores and some viruses are not destroyed this quickly; may not attain sterilization as such.

 vegetative forms of pathogens refers to the actively growing and reproducing stage of a pathogen

 Endospores are dormant, tough structures produced by some bacteria to survive in harsh

conditions.
164
 B. Moist heat sterilization…

3. Autoclaving (Stem under pressure)

➢ Uses an autoclave: a tough double walled chamber in which air is replaced by pure
saturated steam under pressure which was invented by Charles Chamberland in1879.
➢ Steam is the most effective means of sterilization and more effective than dry heat in
general
➢ High penetrating capacity and large amount of heat to a surface with which it comes in
contact.
➢ Denaturation and coagulation ability of microbial proteins

➢ To achieve sterility, a holding time of 15 minutes at 121 °C

165
 Autoclave

 Used to sterilize solid and fluid culture media, gowns, medical and surgical equipment

 Time-Temperature-Pressure Level Relationship in moist heat sterilization (Autoclaving)

Temperature Time Pressure level

1210c 15 minutes 15 Ib/inch2

1260c 10 minutes 20 Ib/inch2

1340c 3 minutes 30 Ib/inch2

166
 ➢ Steam sterilization requires four conditions:

• Adequate contact

• Sufficiently high temperature

• Correct time

• Sufficient moisture

167
 Steam sterilization requires four conditions…
Advantages
 Most commonly used effective method of sterilization

 Sterilization cycle time is shorter

Disadvantages
 Requires a continuous source of heat

 Requires equipment

 Requires strict adherence to time, temperature and pressure settings

 Repeated sterilization cycles can cause pitting and dulling of cutting edges

 Plastic items cannot withstand high temperatures

168
 ❑ Control of the moist heat Sterilization

➢ Physical Indicator: an alloy designed to melt only after being subjected to relevant

holding time

➢ Chemical indicator: Strips or tapes that change color once the correct sterilization

conditions have been met

➢ Biological indicator: Spores of Bacillus stearothermophilus are used as the test

organisms as it is toughest organism for an autoclave to destroy. Its spores require an

exposure of 15 mins at 121oc to be destroyed

169
 II) Sterilization by Chemical Methods
Chemical method

 Chemical agents destroy any type of microbes without showing any form of

selectivity

 Classification of chemical mean’s of sterilization and disinfection

1. Chemical agents that damage the cell membrane

 Surface Active Agents

 Phenols

 Organic solvents ( Alcohol e.g. Ethyl alcohol, Isopropyl alcohol)

170
 2. Chemical agents that denature proteins
 Acids and alkalizes Acids like benzoic acid, citric acid and acetic acid

3. Chemical agents that modify functional groups of proteins and nucleic acids

 Heavy metals

 Oxidizing agents

 Alkylating agents

171
 Disinfection
 Disinfection is the elimination of many or all pathogenic microorganisms, with the

exception of bacterial spores using antiseptics and disinfectants.

 There are three levels of disinfection

1. High level disinfection (HLD)

 Eliminates bacteria, viruses, fungi and parasites but does not reliably kill all

bacterial endospores
 The only acceptable alternative to sterilization and can be achieved by boiling,

chemical HLD and steaming

172
 1. Intermediate level disinfection (ILD)

 Inactivates vegetative bacteria, Mycobacterium and most fungi and viruses, but

do not necessarily kill spore-forming bacteria

2. Low level disinfection (LLD)

 kills most vegetative bacteria and some enveloped, medium sized viruses and

fungi but not the most resistant microorganisms such as M. tuberculosis or

bacterial spores.

173
 Disinfection…….Cont’d
❑ Level of Resistance of Microorganisms to disinfection

Mechanism of disinfecting or killing

Spores
In increasing order of resistance Sterilization
bacterial, fungal

Mycobacteria, TB bacilli High Level Disinfection

Hydrophilic viruses Intermediate Disinfection

Vegetative fungi & bacteria Low Disinfection

Lipophilic viruses
174
 ❑Factors influencing activity of Disinfectants:

➢ Temperature: activity is directly proportional

➢ Concentration of the disinfectant: directly proportional up to an

optimum concentration point. After this level, no advantage in further

increase in concentration.

➢ Time: Disinfectants need time to work.

175
 ➢ Range or span of action : Disinfectants are not equally effective against

the whole spectrum of microbes. e.g. Chlorhexidine is less active against

GNB than Gram Positive Cocci.

➢ Nature of the organism (microbe) to be disinfected: susceptible,

resistant or sporulation.

➢ Level of cleanliness /microbial load to be disinfected.

176
 Types of Disinfectants

1. Phenol and Phenolics:

❑ Phenol (carbolic acid) was first used by Lister as a disinfectant.

➢ Rarely used today because it is a skin irritant and has strong odor.
❑ Phenolic are chemical derivatives of phenol

➢ Cresols (Lysol): Derived from coal tar.

➢ Biphenols: Effective against gram-positive staphylococci and streptococci. Excessive
use in infants may cause neurological damage.
Biphenols

▪ Destroy plasma membranes and denature proteins

177
 Types of Disinfectants…….Cont’d
▪ Advantages: Stable, persist for long times after applied, and remain active in the
presence of organic compounds.
2. Halogens: are effective alone or in compounds.
A. Iodine:
u Iodine tincture (alcohol solution) was one of first antiseptics used.
B. Chlorine:
u When mixed in water forms hypochlorous acid:
Cl2 + H2O ------> H+ + Cl- + HOCl
Hypochlorous acid
▪ Used to disinfect drinking water, pools, and sewage.

178
 Types of Disinfectants…….Cont’d
3. Alcohols:
➢ Kill bacteria, fungi, but not endospores or naked viruses.
➢ Act by denaturing proteins and disrupting cell membranes.
➢ Used to mechanically wipe microbes off skin before injections or blood drawing.
➢ Not good for open wounds, because cause proteins to coagulate.
➢ Ethanol (drinking alcohol): Optimum concentration is 70%.
➢ Isopropanol (Rubbing alcohol): Better disinfectant than ethanol. Also cheaper
and less volatile.
179
 Types of Disinfectants…….Cont’d

4. Heavy Metals:

➢ Include copper, selenium, mercury, silver, and zinc.

➢ Very tiny amounts are effective.

A. Silver:

➢ 1% silver nitrate used to protect infants against gonorrheal eye infections, now has
been replaced by erythromycin.

180
 B. Mercury

➢ Organic mercury compounds like merthiolate and mercurochrome are used to

disinfect skin wounds.

C. Copper

➢ Copper sulfate is used to kill algae in pools and fish tanks.

181
 Types of Disinfectants…….Cont’d
5. Quaternary Ammonium Compounds (Quats):

➢ Cationic (positively charge) detergents.

➢ Effective against gram positive bacteria, less effective against gram-negative

bacteria.

6. Aldehydes:

➢ Include some of the most effective antimicrobials.

➢ Inactivate proteins by forming covalent crosslinks with several functional groups.

182
 Types of Disinfectants…….Cont’d
A. Formaldehyde:
➢ Excellent disinfectant, 2% aqueous solution.
➢ Commonly used as formalin, a 37% aqueous solution.
➢ Formalin was used extensively to preserve biological specimens and inactivate viruses
and bacteria in vaccines.
➢ Irritates mucous membranes, strong odor.
B. Glutaraldehyde:
➢ Less irritating and more effective than formaldehyde. Glutaraldehyde

➢ Commonly used to disinfect hospital instruments

183
 Types of Disinfectants…….Cont’d
7. Gaseous Disinfectant/Sterilizers:

➢ Chemicals that sterilize in a chamber similar to an autoclave.

➢ Denature proteins, by replacing functional groups with alkyl groups.

E g: Ethylene Oxide:
➢ Kills all microbes and endospores, but requires exposure of 4 to 18 hours.

184
 8. Oxidizing Agents:

➢Oxidize cellular components of treated microbes.

➢ Disrupt membranes and proteins.
A. Ozone:

➢ Used along with chlorine to disinfect water.

➢ Helps neutralize unpleasant tastes and odors.

➢ More effective killing agent than chlorine, but less stable and more expensive.
➢ Highly reactive form of oxygen.
➢ Made by exposing oxygen to electricity or UV light
185
 Types of Disinfectants…….Cont’d
B. Hydrogen Peroxide:

➢ Not good for open wounds because quickly broken down by catalase present in
human cells.
➢ Effective in disinfection of inanimate objects

186
 Aseptic storage of sterilized items

❑Instruments should be kept wrapped until used; preferably in a lockable drums.

❑To reduce the risk of contamination, sterile packs should be handled as little as

possible.

❑Sterilized packs should be allowed to cool before storage; otherwise, condensation

may occur inside the packs.

187
 Aseptic storage of sterilized items….Cont’d

• To prevent contamination from rodents, ants, and cockroaches, the store must be

subjected to adequate pest control .

• Materials should be stored at least 8 inches off the floor and 18 inches from the

ceiling

• Sterile packs must be issued in correct date order.

• Preset trays & cassettes are useful since instruments can be organized as per the

procedure
188
 LO6 Handle, package, label, store, transport and dispose of clinical and
other waste

➢Health Care Waste Management

Purpose of Waste Management

 Protect people who handle waste items from injuries,

 Prevent the spread of infections to HCWs who handle waste,

 Prevent the spread of infection to the community,

189
 Types of Waste
Non-Contaminated
Hazardous

Contaminated

190
 Approximately 85% of the general waste produced by
hospitals and clinics is non-contaminated waste and
poses no infection risk to persons who handle it and to
the environment.

191
 Categories of healthcare waste
High Risk Wastes Low risk waste
 Infectious waste
 Communal wastes
 Anatomical waste

 Sharps wastes (used or unused)

 Chemical waste

 Pharmaceutical waste

 Radioactive wastes

 Pressurized containers

192
 Segregation
Production of
waste Segregation at
point of use

~ 85% regular waste ~ 15% contaminated

or hazardous waste

193
 Risks and hazards of healthcare waste
 Needle stick injuries

 Transmission of infection

 Re-use of some type of waste e.g., syringe

 Environmental pollution e.g., air, water

 Exposure to radiation

 Fires

 Public nuisance ( offensive smalls, unsightly debris)

194
 Open site of waste should be avoided because they:
 Are a risk to those who scavenge and unknowingly reuse contaminated items

 Allow persons to accidentally step on sharp items and injure themselves,

 Produce foul odors,

 Attract insects and animals,

 Are unsightly and wind will scatter the waste,

195
 Principles of Waste Management

 All healthcare facility and settings staff have a responsibility to dispose of

waste in a manner that poses minimal hazard to patients, visitors,

other healthcare workers, and the community.

 Infectious waste materials shall be treated properly to eliminate the

potential hazard that, these wastes pose to human health and
environment.

196
 Principles Cont’d…

 Sharps shall be contained in a puncture-resistant container.

 All waste handlers shall wear protective equipment appropriate to the

risk

197
 PPE During Waste Handling
and Disposal

198
 Key steps in waste management
 Waste Minimization

 This is the first and best way to reduce health care waste quantities, cost and environmental impacts.

 Segregation/ Separation

 Separating waste by type at the place where it is generated.

 Handling, i.e. collecting, storing…

 Treatment

 Methods used to render the waste non-hazardous

 Transporting

 Disposal
199
 Contaminated Waste Disposal Includes (1)

 Pouring liquids or wet waste directly in to a safe sewerage system,

 Incinerating (burning) items,

 Burying

 Use plastic or galvanized metal containers with tight-fitting covers,

 Use puncture resistant sharps containers for all disposable sharps,

 Place waste containers close to where the waste is generated,

200
 Contaminated Waste Disposal Includes (2)
 Use PPE when handling wastes,

 Wash hands after handling wastes,

 Equipment that is used to hold and transport wastes must not be used for any

other purpose,

 Wash all waste containers with a disinfectant cleaning solution (0.5% Chlorine

solution plus soap) and rinse with water regularly.

201
 Treatment of Healthcare Waste

Types of Waste Recommended Recommended

treatment procedures
Microbiological waste Autoclave As per instruction with the
machine
Pathological waste Liming Dig pit, place lime, add
waste, more lime, add soil

Infectious fluid Chemical 1% hypochlorite solution

Let sit for 10-15 min.

202
 How to Dispose Sharps

Sharps:
 Segregation at point of use,

 Burn, encapsulate or bury sharps container when it is three-quarters full.

203
 Safety Boxes (Sharps Container)

 Made of puncture and liquid resistant cardboard

 5L safety boxes hold up to 100 used syringes and needles

204
 Safety Boxes
Advantages Disadvantages
Reduce occupational risk to Requires on-going supply
waste handlers and
scavengers
Prevent reuse of syringes Requires final treatment

Reduce community Needs transportation to final

exposure treatment site

205
 Storage
 Storage:- placing waste in a secure place until it can be disposed

 Ideal storage area should be:

• designed, secure, kept clean, dry and pest free

• Healthcare waste should be stored no longer than one week

• Organic waste should be disposed daily

• Segregation must be maintained throughout until final disposal

206
 Waste Disposal
 Disposal:- eliminating or transporting healthcare waste from the facility

 Methods:-

• Bury-waste - is placed into a pit and covered with earth

• Burn - waste is placed into pit and burned on a regular base ( weekly )

• Incineration:- is high temperature burning

207
 Open Burning
 Generally is not recommended.

 If open burning must be done:

 Burn in a small, designated area,

 Transport waste to the site just before burning, and

 Remain with the fire until it is out,

208
 Incinerator

▪ It reduces volume of the waste and eliminates pathogens

 Incinerator can range from extremely sophisticated, high temperature operating

plants to very basic combustion units that operate at much lower temperature.

 All types of incinerator, if operated properly, eliminate pathogens from waste and

reduce the waste in to ash

209
 Incinerator
➢ Four basic types of incinerators are used for treating waste:

 Double-chamber, high temp. Incinerators are designed to burn infectious waste,

 Single-chamber furnaces, which should be used only if double-chamber

incinerators are not affordable,

 Rotary kilns operating at high temperature – used for destroying cytotoxic

substances and heat-resistant chemicals

 Drum or brick (clay) incinerators operates at lower temperature and are less effective.

Rotary kilns

210
 Single chamber Incinerator

211
 Drum incinerators

212
 A brick incinerator

213
 Incinerator
Using an incinerator:

▪ Keep incinerators clean

▪ Some incinerators need to be preheated by burning general non-medical waste

▪ Safety boxes and infectious wastes should be loaded at a rate that maintains a

constant and good but not fierce fire in the crate

214
 Incinerator
Things must not be incinerated:-

 Plastics containing polyvinyl chloride (e.g. blood bags, and IV lines.

Important! syringe bodies are NOT PVC plastic)

 Mercury thermometers

 Used batteries

 X-ray or photographic materials

 Aerosol cans or gas contains

 Glass vials
215
 Because there is no easy or completely safe disposal method
➢ Prevention is best

 Eliminate purchase and use whenever possible

 Recycle

 Use smallest quantities possible with engineering controls and PPE

 Segregate hazards

 Supervise disposal using best available ecologic option

216
LO7 Clean environmental surfaces

Environmental Cleaning and Its Relevance to Infection Prevention & Control

 Primary focus must remain on protection of client/resident, staff and visitors

 Practices must help minimize spread of infection

 Practices are understandable and attainable

 Practices must incorporate workflow measurement

 Practices must be reviewed regularly to keep them current

 How Long Can Germs Live???
 Entercocci and staphylococci on hospital fabrics and plastics up to 90 days

 MRSA outbreak strains-up to 9 weeks after drying

 Gram-negative bacteria (pseudomonas aeruginosa, salmonella, E.coli etc)-on

hospital fabrics and plastics up to 60 days

 VRE-58 days on countertops

 Influenza-48 hours on nonporous surfaces

 Principles of Effective Cleaning
➢ Apply to all settings where care is delivered

 Process

 Selection of appropriate product for the task

 Frequency
Environmental Cleaning Principles
Highest point and work towards the lowest

From the outside to the inside

From the cleanest to the dirtiest

Environmental Cleaning Principles

CLEAN IN AN ESTABLISHED PATTERN

 Cleaning in a determined pattern will ensure that all surfaces are being cleaned

 You will know where you left off if you are interrupted during cleaning
 Choosing a Disinfectant
Microorganisms present a range of resistances to chemical disinfectants and no
single disinfectant is effective in all situations
Consider the following points when selecting a disinfectant:
 Type of microorganism, number and presence of spores

 Physical situation (e.g., surface type)

 Contact available between disinfectant and microorganisms

 Possible interaction between disinfectant and materials

 Contact time allowable

 Concentration
Choosing a Disinfectant

➢ “Hospital disinfectant” effectiveness

 Pseudomonas aeruginosa

 Staphylococcus aureus

 Salmonella choleraesuis

➢ “Tuberculocidal” indicator of effectiveness

 Broad spectrum
 Types of Disinfectants
 Chlorine compounds

 Generally used in the form of sodium hypochlorite

 Alcohols

 Ethanol (80% v/v ethyl alcohol) or 2-propanol (60-70% v/v isopropyl alcohol)

solutions are used to disinfect skin and decontaminate clean surfaces

 Hydrogen Peroxide

 A concentration of 3% (weight/volume) generally used for disinfection

 Types of Disinfectants
➢ Phenolics

 Synthetic phenolics (clear soluble fluids) can be used as general disinfectants in

the laboratory

➢ Quaternary Ammonium Compounds

 Quaternary ammonium compounds are positively charged surface active

disinfectants
Advantages and Disadvantages of Common Disinfectants

Disinfectant Advantages Disadvantages

Sodium hypochlorite Inexpensive Odor can be irritating

(household bleach) Fast-acting Corrosive to metals
Widely available Inactivated by organic
Active against bacteria, spores, material
Mtb, viruses May discolor fabrics

Rutala WA et al. CDC Guideline for Disinfection & Sterilization In Healthcare Facilities, 2008

Ethyl or isopropyl Inexpensive Not effective against

Advantages and Disadvantages of Common Disinfectants

Disinfectant Advantages Disadvantages

Quaternary ammonium Not too expensive Not effective against

compounds Widely available bacterial spores, Mtb,
Good cleaning agents non-enveloped viruses
May become
contaminated
 Using Disinfectants Wisely
 Item or surface must first be free of visible soil (unless using a combined

cleaner/disinfectant)

 Use according to the manufacturer instructions:

 Dilution, temperature, contact time, etc.

 No double dipping

 No spraying disinfectants

 Use proper PPE to prevent exposure to chemical as on MSDS

 Frequency of Cleaning

High/low touch items

Level of contamination

Client/resident risk level

FREQUENCY OF CLEANING
 Frequency of Cleaning: High-touch Surfaces

Determine your own high-touch surfaces!

 Sink tops  Remote controls
 Door handles  Over bed tables
 Support rails  Telephones
 Toilet handles
 Bed rails
 Toilet seat
 Patient/visitor chairs
 Light switches
 Dressers
 Bed pan cleaners
 Computer stations
 Frequency of Cleaning
Level of Contamination
 Heavy contamination

 Exposed to major amounts of blood or body fluids (bathrooms of

client/resident with diarrhea)

 Moderate contamination

 Exposed to some amounts of blood or body fluids (client/resident room or

bathroom)

 Light contamination

 Not exposed to blood or body fluids (offices, lounge, library)

 Frequency of Cleaning

Client/Resident Risk Group

 More at risk persons

 Chemotherapy, dialysis, burns or other major wounds, indwelling devices, etc.

 MDRO patients, CDI patients

 Less at risk persons

 All others
Determining How Often To Clean
Probability of
Potential for Exposure
contamination with
pathogens High touch surface =3 Low touch surface = 1

At risk Less at risk At risk Less at risk

persons = 1 persons = 0 persons = persons =
1 0

= cleaning once a day and when soiled.

Heavy contam = 3 7 6 5 4
Applying the Scores
Total Cleaning Risk Type Minimum Cleaning Frequency
Score

7 High Risk Clean after each

case/event/procedure and at least
2x per day and when soiled

4-6 Moderate risk Clean at least once a day and when

Documenting Cleaning Policies
➢ Plan components

 Defined responsibilities for items and areas

 Procedures for various cleaning tasks

 Procedures for specific organisms that transmit well in the environment

 Procedures for outbreaks

 Cleaning standards including how often to clean

 Monitoring process

 Education
Is It Really Clean?

 Not just a visible check!

 Must include audits of actual work

 May use “markers” e.g. glo germ solution to check for “missed” spots

 Cultures are not generally recommended

 Thank you for attention.

238