Apply Infection Prevention Techniques and Workplace OHS

NILE-SIDE COLLEGE
PHARMACY
LEVEL III
Learning Guide #05
Unit of Competence: Apply Infection Prevention
Techniques and Workplace OHS
Module Title: Appling Infection Prevention
Techniques and Workplace OHS
LG Code:- HLT PHS3 M03 Lo1-Lo5

TTLM Code:- HLT PHS3 TTLM 0622v1
0
LO1. Apply Infection Prevention Techniques
Instruction Sheet 1 Learning Guide #3
This learning guide is developed to provide you the necessary information regarding the following content
covering and topics
 Introduction to disease transmission
 Infection prevention techniques
This guide will also assist you to attain the learning outcome stated in the cover page. Specifically, upon
completion of this Learning Guide, you will be able to:
 Introduction to disease transmission
 Infection prevention techniques
Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described below 3 to 6.
3. Read the information written in the information ―Sheet 1, Sheet 2, Sheet 3, Sheet 4 and sheet 5‖
4. Accomplish the ―Self-check 1,and Self-check 2 ‖ 13, and 41respectively.
5. If you earned a satisfactory evaluation from the ―Self-check‖ proceed to ―Operation Sheet 1, -- Operation
Sheet 5 ‖in page 42-44.
6. Do the ―LAP test‖ in page – 45 (if you are ready).
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Information Sheet-1 Introduction to disease transmission
1.1.1. Basic concepts in transmission of communicable disease
An enormous variety of organisms exist, including some which can survive and even develop in the body of
people or animals. If the organism can cause infection, it is an infectious agent.
Infectious agents which cause infection and illness are called pathogens. Diseases caused by pathogens, or the
toxins they produce are communicable or infectious diseases.
The transmission cycle of disease to be able to persist or live on, pathogens must be able to leave an infected
host, survive transmission in the environment, enter a susceptible person or animal, and develop or multiply in
the newly infected host.
The transmission of pathogens from current to future host follows a repeating cycle. This cycle can be simple,
with a direct transmission from current to future host, or complex, where transmission occurs through
(multiple) intermediate hosts or vectors. this cycle is called the transmission cycle of disease.
Stage of infection:-At this stage the infectious agent has entered the host‘s body and has begun multiplying.
The entry and multiplication of an infectious agent inside the host is known as the stage of infection. For
instance, a person who has eaten food contaminated with Salmonella typhii (the bacteria that cause typhoid
fever) is said to be exposed; if the bacteria enter the cells lining the intestines and start multiplying, the person
is said to be infected.
At this stage there are no clinical manifestations of the disease, a term referring to the typical symptoms and
signs of that illness. Symptoms are the complaints the patient can tell you about (e.g. headache, vomiting,
dizziness). Signs are the features that would only be detected by a trained health worker (e.g. high temperature,
fast pulse rate, enlargement of organs in the abdomen).
Stage of infectious disease: at this stage the clinical manifestations of the disease are present in the infected
host. For example, a person infected with Plasmodium falciparum, who has fever, vomiting and headache, is in
the stage of infectious disease – in this case, malaria. The time interval between the onset (start) of infection
and the first appearance of clinical manifestations of a disease is called the incubation period. For malaria
caused by Plasmodium falciparum the incubation period ranges from 7 to 14 days. Remember that not all
infected hosts may develop the disease, and among those who do, the severity of the illness may differ,
depending on the level of immunity of the host and the type of infectious agent. Infected hosts who have
clinical manifestations of the disease are called active cases. Individuals who are infected, but who do not have
clinical manifestations, are called carriers. Carriers and active cases can both transmit the infection to others.
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2.2 The transmission cycle has different elements:-
Infection spread by a chain of events and these events involves having the following parts:
Pathogen (infectious agent) : is the organism causing the infection.
Host (Reservoir) : is the infected person or animal ‗carrying‘ the pathogen. „
Route of exit: the method the pathogen uses to leave the body of the host.
Transmission: how the pathogen is transferred from host to susceptible person or animal, which can include
developmental stages in the environment, in intermediate hosts, or in vectors.
Route of entry: the method the pathogen uses to enter the body of the susceptible person or animal .
The susceptible person or animal: the potential future host who is receptive to the pathogen.
In order to understand why infections occur in a particular situation, and to know how to prevent them, the
transmission cycles of these infections must be understood.
2.2.1 The pathogen (Infectious agent):- the pathogen is the organism that causes the infection, Specific
pathogens cause specific infections. an example Cholera is caused by the bacterium Vibrio cholerae, and
Leishmaniasis is caused by different species of the protozoa Leishmaniasis.
Different categories of pathogens can infect humans. Infectious agents can have varying sizes. Some, such as
Plasmodiumfalciparum and all bacteria and viruses, are tiny and are called
micro-organisms, because they can only be seen with the aid of microscopes. Others, such as the Ascaris
worm (Ascarislumbricoides), can be easily seen with the naked eye. The pathogens causing the diseases are
 Viruses
 Bacteria
 Fungi
 Protozoa and Helminthes (worms).
Helminthes are worms made up of many cells; for example, Ascarislumbricoides.
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Protozoa are micro-organisms made up of one cell; for example, Plasmodium falciparum.
Bacteria are also micro-organisms made up of one cell, but they are much smaller than protozoa and have a
different structure; for example Vibrio cholerae, which causes cholera.
Viruses are infectious agents that do not have the structure of a cell. They are more like tiny boxes or particles
and are much smaller than bacteria; for example, HIV (the Human Immunodeficiency Virus), which can lead
to AIDS.
Though not as common as causes of communicable disease in humans, other types of infectious agents include
fungi (e.g. ringworm is caused by a fungus infection), and mites (similar to insects), which cause scabies.
All pathogens go through a lifecycle, which takes the organism from reproducing adult to reproducing adult.
This cycle includes
 phases of growth
 consolidation
 change of structure
 multiplication/reproduction, spread, and infection of a new host
The combination of these phases is called the development of the pathogen. pathogen must develop in the
environment or intermediate host before a susceptible person or animal can be infected. During the latent
period the pathogen is not infectious. A non-latent pathogen does not need to go through a development, and
can cause infection directly after being excreted.
also a persistent pathogen remains viable for a long period outside the host (perhaps months), while a non-
persistent pathogen remains viable for only a limited period (6) (days, or weeks).
It is important to realize that not all infections will result in disease. While a pathogen may cause illness in one
person, it may be killed or cause asymptomatic infection in another.
Perhaps to that active immunity is the resistance the person or animal develops against the pathogen after
overcoming infection or through immunization (vaccination), Depending on the pathogen, the effectiveness of
active immunity often decreases over time. Usually immunity only develops against the specific pathogen that
caused the infection. If there are different types (serotypes or strains) of the same pathogen (e.g. in dengue
fever and scrub typhus), immunity will often only develop against the particular type which caused the
infection. The person or animal can still develop the illness when infected with another serotype or strain of the
pathogen.
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2.2.2 The host (Reservoir): - the host is the person or animal infected by the pathogen. the importance of the
host in the transmission cycle, roles as both reservoir and source of pathogens.
There are two types of host: definitive and intermediate host.
 The definitive host is the person or animal infected with the adult, or sexual, form of the pathogen. In
the infections covered here, people are usually the definitive host. To keep things simple the definitive host is
called just ‗the host‘.
 The intermediate host is an animal or person infected by a larval, or asexual, form of the pathogen.
Helminthes have both definitive and intermediate hosts. All other pathogens only have definitive hosts,
although vectors function technically as intermediate hosts for protozoa.
Zoonosis: transmission from animal to person some pathogens are specific to humans, others to animals. Many
pathogens are less specific and can infect both people and animals. Infections that can naturally be transmitted
from animal to person are called zoonosis.
Zoonosis is very common many of these infections normally occur in an animal cycle, with people being
infected by chance. The problem with zoonosis is that a continuous reservoir of pathogens exists outside
humans. Even if all human infections were cured and transmission to people stopped, the presence of an
animal reservoir would remain a continuous risk to people.
Carriers: hosts without obvious illness a person or animal who develops an illness is an obvious example of a
host. It is very common, however, for infections to occur without the disease developing. The person or animal
infected can potentially spread the pathogen, but does not show clear symptoms and the symptoms may be
mild, or may be completely absent these hosts are called carriers.
The host can be infectious for a short period in transient carriers, or over a prolonged period in a chronic
carrier, Incubating carriers have been infected and can spread the pathogen, but do not yet show the
symptoms of the illness. Convalescent carriers continue to spread the pathogen even though they have
recovered from illness.
In many infections carriers play an important role in transmitting the pathogen. It is usually not possible to
identify asymptomatic carriers, and unless the family and other close contacts of the sick person or even the
whole population can be treated, carriers will remain a threat to the health of those surrounding them.
2.2.3 Transmission of disease: - To survive as a species, pathogens must infect new people or animals. They
must leave the body of the host, find their way to a new susceptible person or animal, and enter the body of
that person or animal. As the exit, transmission, and entry of the pathogens are closely associated.
Water and environmental sanitation interventions improve the health of a population usually try to reduce the
risk of transmission of infection.
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Some terms relating to the transmission or classification of infections are defined here:
Direct transmission refers to the transfer of an infectious agent from an infected host to a new host, without
the need for intermediates such as air, food, water or other animals. Direct modes of transmission can occur in
two main ways:
 Person to person: The infectious agent is spread by direct contact between people through touching,
biting, kissing, sexual intercourse or direct projection of respiratory droplets into another person‘s nose or
mouth during coughing, sneezing or talking. A familiar example is the transmission of HIV from an infected
person to others through sexual intercourse.
 Trans placental transmission: This refers to the transmission of an infectious agent from a pregnant
woman to her fetus through the placenta. An example is mother-to-child transmission (MTCT) of HIV.
 Indirect transmission:- is when infectious agents are transmitted to new hosts through intermediates
such as air, food, water, objects or substances in the environment, or other animals. Indirect transmission has
three subtypes:
A. Airborne transmission: The infectious agent may be transmitted in dried secretions from the
respiratory tract, which can remain suspended in the air for some time e.g. Dusts & droplets. For example, the
infectious agent causing tuberculosis can enter a new host through airborne transmission.
B. Vehicle- borne transmission – Indirect contact through contaminated in animate objects like hand
kerchiefs, soiled clothes, surgical instrument, contaminated food & water biological products like blood,
serum, IV fluids which then transmits it to a new host.
C. Vector-borne transmission: A vector is an organism, usually an arthropod, which transmits an
infectious agent to a new host. Arthropods which act as vectors include houseflies, mosquitoes, lice and ticks.
D. Mechanical transmission- The insect transport the agent by soiling its feet or proboscis in which case
multiplication of the agent in the vector does not occur. e.g. House fly
E. Biological transmission- This is when the agent multiplies in the arthropod before it is transmitted
such as the transmission of malaria by mosquito.
Food-borne infections: infections which can be transmitted through eating food containing the pathogen.
Vector-borne infections: infections transmitted through vectors. We use vector borne infections only for
infections with a biological vector, that is a vector in which the pathogen goes through a development before
further transmission is possible (e.g. mosquitoes, tsetse fly, body louse). We do not classify as vector borne
those infections which are transmitted by mechanical vectors that are the animal is only a vehicle for
transporting the pathogen (e.g. domestic flies, cockroaches).
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Water-borne infections: infections which can be transmitted through drinkingwater which contains the
pathogen.
Water-washed infections: infections caused by pathogens whose transmission can be prevented by improving
personal hygiene.
Infections can have either direct or indirect transmission routes.
 Infections with direct transmission:- a pathogen with a direct transmission route can infect a susceptible
person or animal immediately after leaving the host. The pathogen does not need to develop in the
environment, in an intermediate host, or in a vector.
Examples of infections with direct transmission are feco-oral infections, these pathogens leave the host through
faeces, and enter the susceptible person or animal through ingestion. Transmission occurs mainly through
direct contact with contaminated fingers, contaminated food directly with feaces, contaminated hands,
domestic flies, soil, or water; contaminated drinking-water; or contaminated soil generally the 5 “S’’
 Fingers
 Flies
 Food
 Feaces and Floods
Faecal-oral infections are food-borne, water-borne, and water-washed. asfaecal-oral infections are
transmitted directly, any route that will take matter polluted with faeces directly or indirectly to somebody‘s
mouth could potentially transmit the pathogen.
Some of these infections have mainly animal hosts, while others are limited to humans.
Example of Feco-oral infections includes diarrheal diseases such as cholera and bacillary dysentery, typhoid,
and poliomyelitis.
Figure 2.2 shows some common transmission routes of faecal-oral infections.
2.2.4 Route of entry
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Successful transmission of the infectious agent requires it to enter the host through a specific part of the body
before it can cause disease. The site through which an infectious agent enters the host is called the route of
entry. The routes of entry are
 The respiratory tract: some infectious agents enter the body in air breathed into the lungs. Example:
Mycobacterium tuberculosis.
 The gastrointestinal tract: some infectious agents enter through the mouth. Example: the infectious
agents causing diarrheal diseases enter through the mouth in contaminated food, water or on unclean hands.
 The skin: the skin provides a natural barrier against entry of many infectious agents, but some can
enter through breaks in the skin. Example: malaria parasites (Plasmodium species) get into the body when an
infected mosquito bites through the skin to suck blood.
2.2.5 Susceptible hosts and risk factors
After an infectious agent gets inside the body it has to multiply in order to cause the disease. In some hosts,
infection leads to the disease developing, but in others it does not. Individuals who are likely to develop a
communicable disease after exposure to the infectious agents are called susceptible hosts. Different
individuals are not equally susceptible to infection, for a variety of reasons.
Factors that increase the susceptibility of a host to the development of a communicable disease are called risk
factors. Some risk factors arise from outside the individual – for example, poor personal hygiene, or poor
control of reservoirs of infection in the environment. Factors such as these increase the exposure of susceptible
hosts to infectious agents, which makes the disease more likely to develop.
Additionally, some people in a community are more likely to develop the disease than others, even though they
all have the same exposure to infectious agents. This is due to a low level of immunity within the more
susceptible individuals. Immunity refers to the resistance of an individual to communicable diseases, because
their white blood cells and antibodies (defensive proteins) are able to fight the infectious agents successfully.
Low levels of immunity could be due to:
 diseases like HIV/AIDS which suppress immunity

 poorly developed or immature immunity, as in very young children
 not being vaccinated
 poor nutritional status (e.g. malnourished children) and Pregnancy.
2.2.6 Route of exit

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Before an infectious agent can be transmitted to other people, it must first get out of the infected host. The site
on the infected host through which the infectious agent gets out is called the route of exit. Some common
examples are
Respiratory tract: the routes of exit from the respiratory tract are the nose and the mouth. Some infectious
agents get out of the infected host in droplets expelled during coughing, sneezing, spitting or talking, and then
get transmitted to others. For example people with tuberculosis in their lungs usually have a persistent cough;
Mycobacterium tuberculosis uses this as its route of exit.
Gastrointestinal tract:the anus is the route of exit from the gastrointestinal tract (or gut). Some infectious
agents leave the human body in the stool or faeces, theinfectious agents of shigellosis, a disease which can
cause bloody diarrhoea, use this route of exit.
Skin: Some types of infectious agents can exit the body through breaks in the skin continuity. For example,
this route of exit is used by Plasmodium protozoa, which are present in the blood and get out of the human
body when a mosquito bites through the skin to suck blood.
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Self-Check -1 Written Test
Directions: Answer all the questions listed below. Use the Answer sheet provided in the next page:
1. Identify the main types of infectious agents.

2. Describe the chain of transmission of diseases.
3. Mention the pathogens that can cause disease.
4. Mention types of indirect mode of transmission.
Note: Satisfactory rating – 8>points Unsatisfactory - below 8 points

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

Short Answer Question
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Answer sheet
1. _______________________________________________________
___________________________________________________________
_____________________________
2. _______________________________________________________
___________________________________________________________
______________________________
3. _______________________________________________________
___________________________________________________________
___________________________________________________________
_________________
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Information Sheet-2 Infection prevention techniques
Introduction to infection prevention: -Infection prevention is a scientific and practical approach designed to
prevent harm caused by infections to the patients and health works. No country, no health care facility, even
with the most developed health care systems can claim to be free from problems associated with infections.
The health problems due to communicable diseases can be tackled by the application of relatively easy
measures at different levels of the health system.
Here, we will use some procedures at the individual and community levels, which are relevant to the
community. Some measures can be applied before the occurrence of the disease to protect a community from
getting it, and to reduce the number of cases locally in the future. These are called preventionmeasures. For
example,
 Hand washing procedure,
 Use of personal protective equipment‘s,
 Safe handling of sharp items and
 Instrument processing
Vaccination of children with the measles vaccine is a prevention measure, because the vaccine will protect
children from getting measles. Vaccination refers to administration of vaccines to increase resistance of a
person against infectious diseases. Once disease occurs and is identified in an individual, measures can be
applied to reduce the severity of the disease in that person, and to prevent transmission of the infectious agent
to other members of the community are called controlmeasures.
For example, once a child becomes infected with measles, treatment helps reduce the severity of the disease,
and possibly prevents the child‘s death, but at the same time it decreases the risk of transmission to other
children in the community. In this context, treatment of measles is considered a control measure.
 In the health care setting infection can easily spread from person to person, this transmission of
infection is called cross infectiona client may be infected while receiving care, or health worker may be
infected while carrying out their duties.People who work or interact with clients in a health care setting may be
infected.
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 It is essential to understand the way infection is controlled in any health care setting including
hospitals, residential aged care, community services, dental practices, mortuaries or alternative health care
services.
2.1. 1. Hand washing
Introduction to hand hygiene
Hands are the most common ways in which microorganisms such as bacteria can be transported and
subsequently causes infections, especially to those susceptible to infections. In order to prevent spread of
microorganisms hand hygiene must be performed adequately to reduce the transmission of infectious agent.
The transmission of microbes from one to another mostly takes place via our hands, or hands to contaminated
object.
Hand hygiene is one of the simplest and most effective procedures to prevent the spread of disease. It‘s
essential that everyone takes responsibility to ensure that the care provided is carried out in safe manner. Wash
hands by soap and water or use an antiseptic hand rub/Waterless hand washing
In order to facilitate compliance in public services in infection prevention and control following procedures
should be introduced
 Providing hand rubs at the entrance to service use areas for visitors if not contraindicated.
 Notices and hand hygiene poster should be displayed to attract attention of visitors and service users
 Hand hygiene leaflets should be distributed during outbreaks or mass media should be used.
Types of hand washing
 Water based hand washing (liquid soap and water): is using soap with water and it suspends
transient microorganisms allowing them to be rinsed off effectively (mechanical removal) of dirty. Soap and
water hand washing is effective as hand washing preparations containing anti-microbial agents (antiseptic
solutions) for decontaminating hands and removing and removing transient microorganism.
 Waterless hand washing (Alcohol based hand washing): is using hand alcohol rub sanitizers as
hand washing agent. Preparations contain an emollient which aid in reducing damage to the hands, these
preparations should only be used when there is no visible soiling of the hands, if there is visible soiling, soap
and water hand washing should be used.
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Alcohol hand rub provide an acceptable alternative to soap and water in moist situations when hands are physically
clean, this hand rubs are less effective if used immediately after the application of a hand lotions. However hands will
need to wash with soap and water after several applications in order to prevent a buildup of an emollient on the skin.
Levels of hand hygiene: hand washing is probably the most important method of protecting the service user. The
technique is more important than the solutions used. There are two main levels of hand hygiene.
 Routine hand washing: it is removing dirt, organic matter and most transient organism acquired through direct
contact with person, and from the environment. Liquid soap and water is adequate for this procedure. A fifteen to thirty
seconds hand wash using liquid soap is acceptable.
 Aseptic hand washing: it is disinfecting hands by removing transient microorganism and reducing resident
organism. Level of hand hygiene should be done prior invasive procedures. Aseptic hand washing can be achieved
through routine hand washing with soap and water followed by an application of alcohol hand rub or washing with
antiseptic solutions containing antimicrobial agents and ensures you are “bare below elbows”.
“Bare below the Elbow as per dress Code Policy‖include:
 Staff in clinical contact, direct patient care or involved in the cleaning of the environment/patient equipment,
must be ―bare below the elbow‖ to facilitate good hand hygiene practice.
 Sleeves should be short or rolled up
 All wrist and hand jewellery should be removed with the exception of a wedding ring
 Finger nails should be kept short, clean and free from nail vanish, artificial nails and nails extensions.
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3.1.1 When should perform hand washing?
WHO “FIVE KEY moments for hand hygiene‖
 Before touching a patient
 Before clean/aseptic procedure
 Immediately/After bodily fluids exposure
 After touching a patient
 After touching patient surroundings
Additional Moments for Hand Hygiene
 Before commencing work/after leaving work area
 Before and after preparing or eating food
 Before handling medicines
 Before wearing & after removing gloves*
 After handling contaminated laundry & waste
 After contact with used equipment
 After using the toilet
 After cleaning equipment or the environment.
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Standard hand washing procedure:
 Remove jewellery.
 Wet hands thoroughly all over.
 Use pH neutral soap.
 Lather soap all over hands.
 Rub hands together vigorously for 15-20 seconds. Pay particular attention to the fingertips, thumbs, wrists,
finger webs and the backs of the hands.
 Rinse under running water.
 Pat hands dry with paper towels.
Surgical hand washing/scrub: removes transient organisms and a substantial number of resident organisms.
Effective skin antisepsis can be achieved by:
 Surgical hand wash/scrub using aqueous skin disinfectants. the disinfectant solutions available for
surgical skin hand washing are: 4% Chlorhexidinegluconate skin cleanser, 7.5% Povidone iodine and 2%
Triclosan skin cleanser. It is important that mixtures of the different types of antiseptic solutions are not used
together as they may inactivate each other.
How to use an alcohol-based hand sanitizer
Alcohol-based hand sanitizers, which don't require water, are an acceptable alternative when soap and water
aren't available. If you use a hand sanitizer, make sure the product contains at least 60% alcohol. Follow these
steps:
 Apply the gel product to the palm of one hand. Check the label to find out the appropriate amount.
 Rub your hands together.
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 Rub the gel over all the surfaces of your hands and fingers until your hands are dry.
How to wash your hands: It's generally best to wash your hands with soap and water. Over the counter
antibacterial soaps are no more effective at killing germs than is regular soap. Follow these steps.
7. Steps To Wash Your Hands Properly
Step 1 - Wet your hands and apply enough soap (coin size).
Step 2 - Rub your palms together.
Step 3 - Rub the back of each hand.
Step 4 -Rub both your hands while interlocking your fingers
Step 5 - Rub the back of your fingers.
Step 6 - Rub your thumbs and the ends of your wrists.
Step 7 - Rinse both hands properly with water, and dry your hands with a clean towel or air.
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2.2. Personal Protective Barriers (PPE)
Personal Protective Barriers (PPE): is used to prevent exposure of infectious materials on the other hand
they act as a barrier to stop spread of germs.Some of the duties that you perform in the workplace may require
you to protect yourself from either the environment in which you are working, infectious clients, or to protect
the client from you if you are infectious. An examples of physical Personal protective equipment are (gloves,
face masks, goggles, gowns, plastic or rubber aprons, and drapes
2.2.1. Purpose of PPE
 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 prevention resources in caring for all
clients and patients
 Apply to care of all clients and patients attending healthcare facilities because most people with HIV or
other life-threatening blood-borne diseases do not have symptoms.
 To prevent body fluids, secretions and excretions (except sweat), non-intact skin and mucous
membranes because increased risk of exposure by touching, accidental injury (needle stick), or contact
(splashing or spraying of potentially contaminated blood or body fluids).
Personal protective equipment may include:-
 Face shields
 Gloves and goggles
 Head covers and shoe covers
 Masks and gowns.
Face shields: they cover and protect face from the infectious droplets and contact with contaminated materials
during health care activity in order not to splash. Without face shields germs can get access from the mucous
membrane of our body such as mouth and nose.
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Gloves: gloves are the most probably used personal protective equipment, they covers hand and wrist
protecting from exposure of droplets and contamination. Health care workers must use personal protective
equipment when providing care to their patients or at working area because gloves protect both patient and
client. Gloves should be used when issue on contamination is present. Also, when a caregiver has open wound
on the hands, it is a must that he/she use gloves. The outside of the gloves should not be touched when
removed as this is considered contaminated.
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,
 Before handling soiled instruments, contaminated waste items or touch contaminated surfaces.
 When disposing contaminated waste items
 When Handling chemicals or disinfectants
General rules
 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,
 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)
 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 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,
so that washing hand is essential before and after gloving.
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Surgical gloves can be reused.
When to Double Glove

 The procedure involves coming in contact with large amount of blood or other body fluid,Orthopedic
procedures in which sharp bone fragments, wire sutures and other sharps are likely to be encountered.
Steps of glove removing
1. Pull one glove near your wrist towards your finger tips until the glove folds over.
2. Carefully grab the fold and pull towards your finger tips. As you pull you are turning the inside of the
glove outwards.
3. Pull the fold until the glove is almost off.
4. To avoid contamination of your environment, continue to hold the removed glove. Completely remove
your hand from the glove.
5. Slide your finger from you glove free hand under the remaining glove. Continue to slide your finger
towards your finger tips until almost half of your finger is under the glove.
6. Turn you finger 180 degrees and pull the glove outwards and towards your finger tips. As you do this,
the first glove will be encased in the second glove. The inside of the second glove will also be turned outwards.
7. Grab the gloves firmly, by the uncontaminated surface (the side that was originally touching your
hand). Release your grasp of the first glove you removed. Pull your second hand free from its glove. Dispose
of the gloves properly.
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Other Issues with Gloves
 Regloving after contamination
 Allergic reactions to gloves
Do:
 Use the correct size.
 Change surgical goves perdiodically during long procedures.
 Keep nails short.
 Pull gloves over cuffs of gown to protect the wrists.
 Use water-soluble hand lotions to prevent skin from drying.
Don’t:
 Use oil-based and perfumed hand lotions.
 Store gloves where there are extremes in temp.
Elbow-Length Gloves
If elbow-length gloves are not available, an inexpensive, effective alternative can be easily made from
previously used surgical gloves that have been decontaminated, cleaned, and dried.
The steps for making elbow-length gloves are:

STEP 1: Cut the four fingers completely off each glove just below the place where all the fingers join the
glove.
STEP 2: Sterilize or high-level disinfect 2–3 pairs of cut-off (fingerless) gloves according to the recommended
process for each method. After final processing, store the gloves in a sterile or high-level disinfected container
until needed.
step 1 step 2
step 3 step 4
21
Masks: should fit comfortably over the nose and mouth. The same with a gown or apron, a wet mask is
considered contaminated. The front of the mask is also contaminated. Masks should not be worn around the
neck. For each client contact, a clean mask should be used.
Gown: is cloth covering and putted over clothes and tied behind that is long enough to cover your clothing.
Because the outside of the gown is considered contaminated, this should not be touched when it is removed. A
gown that is wet is, of course, considered contaminated also. A caregiver should wear a clean gown every
client care. In case the gown is not available, apron should be worn to mask clothing during client contact.
22
2.3. Handling of sharp items:
Needle stick injuries Needlesticks and other sharps-related injuries which expose workers to bloodborne
pathogens continue to be a significant hazard for hospital employees. OSHA estimates that 5.6 million workers
in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne
pathogens. Bloodborne pathogens are pathogenic microorganisms that are present in human blood and can
cause disease in humans. These pathogens include Human Immunodeficiency Virus (HIV), Hepatitis B Virus
(HBV), Hepatitis C Virus (HCV), and others.
According to the Centers for Disease Control and Prevention (CDC), about 385,000 sharps injuries occur
annually to hospital employees. reporting injuries and infections.
Safe handling andIncinerating (burning) items, 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, use PPE when handling wastes, and washing hands after handling wastes are best
practices in handling sharp items.
Hazards of needle stick injuries
Accidental punctures by contaminated needles can inject hazardous fluids into the body through the skin.
There is potential for injection of hazardous drugs, but injection of infectious fluids, especially blood, is by far
the greatest concern. Even small amounts of infectious fluid can spread certain diseases.
Accidental injection of blood-borne viruses is the major hazard of needle stick injuries, especially the viruses
that cause AIDS (the HIV virus), hepatitis B, and hepatitis C. The risk of infection after exposure to infected
blood varies by blood-borne pathogen. The risk of transmission after exposure to HIV-infected blood is about
0.3%, whereas it is estimated to be up to 100 times greater for hepatitis B virus (30%) and could be as high as
10% for hepatitis C virus.
How do needle stick injuries occur ?
A needle-stick injury is the result of an accident with a needle. Several studies show that needles cause injuries
at every stage of their use, disassembly, or disposal. But there is disagreement as to why the accidents are so
common among health care workers or why simple solutions fail to solve the problem. Equipment design,
nature of the procedure, condition of work, staff experience, recapping, and disposal have all been mentioned
as factors that influence this occurrence.
23
Who are at risk of having needle stick injuries?
Anyone is at risk for needle stick injuries. They may especially happen to:
 Children with relatives or neighbors using needles.
 Cleaners of public toilets, parks, trains, and cinema seats.
 Health caregivers who use needles most of the time while working.
 People who share needles for use with illegal drugs.
 Police and security officers especially while searching suspects or their property.
How can needle stick injuries be prevented?
 At work:
o Always use gloves when handling needles that are exposed to blood or other body fluids.
o Do not put the cap back on a needle, bend or break a needle by hand, or use a cutting device.
o Get a vaccination against certain diseases, such as hepatitis, for protection.
o Learn the right way to handle and throw away needles, scalpels, and other sharp objects.
o Put all sharp objects in a holder marked just for sharp objects. A puncture-proof, closed
container with a lid may be used to contain needles. The containers are placed in areas where needles are used.
It should be replaced before it becomes
Equipment Design
Safer innovative devices using protected needle devices or needle-free systems with self-sealing ports would
alleviate many of these injuries. There is accumulating evidence suggesting that syringes with safety features
reduce needle-stick injuries.
Nature of Procedure
Critical situations during clinical procedures include:
24
 Withdrawing a needle from a patient, especially if staff attend to bleeding patients while disposing of
the needle.
 Having the device jarred by a patient.
 Pulling a needle out of the rubber stopper of a vacuum tube which can jab the hand in a rebound reflex.
 Injuries commonly occur when workers try to do several things at the same time, especially while
disassembling or disposing of needles.
Conditions of Work
Work conditions that might contribute to an increase in the number of needle-stick injuries include:
 Staff reductions where nurses, laboratory personnel and students assume additional duties.
 Difficult patient care situations.
 Working at night with reduced lighting.
Recapping
Recapping can account for 25 to 30 percent of all needle stick injuries of nursing and laboratory staff. Often, it
is the single most common cause. It is extremely dangerous to hold a needle in one hand and attempt to cover it
with a small cap held in the other hand. Injuries occur three different ways:
 The needle misses the cap and accidentally enters the hand holding it.
 The needle pierces the cap and enters the hand holding it.
 The poorly fitting cap slips off of a recapped needle and the needle stabs the hand.
2.4. Instrument and material processing:are process designed for instrumentsin order to reduce the risk
of transmitting infections that are spread wholly or partly by airborne, droplet, or contact routes between
hospitalized patients, health workers and Equipment‘s. for example contact with Enteric pathogens (hepatitis
A, echo viruses) and herpes simplex used with wet or draining skin, eye, or wound infections that may be very
contagious.
Antimicrobial agent: Any agent that kills or suppresses the growth of microorganisms. Biocide: A chemical
or physical agent that kills all living organisms, pathogenic and nonpathogenic.
2.4.1. Key components of instrumental processing are

 Decontamination
 Cleansing
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 Sterilization
Decontamination: is the process of making inanimate objects safer to handle by staff before cleaning.It is
done by soaking the equipment‘s in 0.5% chlorine solution.
Principles:Inactivates HBV and HIV, makes items safer to handle and must be done before cleaning
 Instructions for Preparing Dilute Chlorine Solutions

% concentrate
Total parts (TP) of H2O = -----------------------1
% Dilute
E. g to make a 0.5% chlorine solution from 5% bleach
5% Concentrate
Total parts (TP) of H2O = ------------------------1 = 9 Total parts (TP) of H2O
0 .5% Dilute
 To make a 0.5% chlorine solution from 5% bleach, mix 1 part bleach with 9 parts of water.
Decontamination practices are:
Unclasped the instruments before soaking.

Place used instruments in 0.5% chlorine solution.
Soak instruments for 10-20 minutes& rinse immediately with warm water & then wash adequately
with soap and cold water.
Wipe surfaces (exam tables) with chlorine solution.
Flush syringe and needles with 0.5% chlorine solution.
26
Cleaning: removes organic material that protects microorganisms against sterilization and HLD. Also it
inactivates disinfectants. Cleaning is method of mechanically reducing the number of microorganisms, and it
must be done before sterilization and High level dis infection (HLD) to be effective.
Practices after items are decontaminated:
 Use PPE during cleaning

 Disassemble instruments
 Wash with detergent, water, and a soft brush.
 Scrub instruments under the water surface until visibly clean.
 Thoroughly rinse with clean water.
Sterilization: is the process of completely destructing or removal of all microorganisms including spores.It is
the recommended method for processing instruments and other items that will come in contact with the
bloodstream or tissues under the skin
The efficiency of a sterilization process is often related to the degree of severity of treatment e.g. length of
exposure to heat. The effectiveness of any method of sterilization is also dependent upon four other factors:
 The type of microorganism present, Some microorganisms are very difficult to kill while others die
easily.
 The number of microorganisms present, it is much easier to kill one organism than many. Also the
amount and type of organic material that protects the microorganisms.
 Blood or tissue remaining on poorly cleaned instruments acts as a shield to microorganisms during the
sterilization process.
 The number of cracks and crevices on an instrument that might harbor microorganisms, because
icroorganisms collect in, and are protected by, scratches, cracks and crevices such as the serrate.
Methods of sterilization: there are two main kinds of sterilization namely Heat sterilization and chemical.
Irradiation and filtration are also other methods of sterilization
1. Heat sterilization: heat sterilization could be by either of Dry or wet heat. Dry heat is cheaper than
wet heat sterilization but it is less reliable. It is known that microbes vary enormously in their capacity to resist
heat. The main effect of heat is the degradation of organic matters especially the proteins here are some
examples of different levels of microbial tolerance to heat treatment
27
 M. tuberculosis 65-100 0C
 Fungi & viruses 60-100 0C
 HIV 60 0C 30 min
 HBV >80 0C
 Spores>100 0C
Moist heat: Also called Autoclaving (steam under pressure). It is done at 121°C at 15 pounds pressure over
the square inch for 15 minutes (15 lb/in²), It is a very good method for sterilizing almost anything, except heat-
labile substances (like some plastics).
Steam sterilization requires four conditions:
1. adequate contact
2. sufficiently high temperature
3. correct time
4. sufficient moisture
Advantages of moist heat (autoclave).
 Most commonly used effective method of sterilization

 Sterilization cycle time is shorter than with dry heat or chemical sterilants.
Disadvantages of moist heat (autoclave).
 Requires a continuous source of heat (wood fuel, kerosene or electricity)

 Requires equipment (steam sterilizer), which must be expertly maintained to keep it in working
condition
 Requires strict adherence to time, temperature and pressure settings
 Repeated sterilization cycles can cause pitting and dulling of cutting edges of instruments (i.e., scissors)
 Plastic items cannot withstand high temperatures
Dry heat • This is a hot air oven sterilization method done at 170°C for 1 hour or 160°C for 2 hours and can
be used to sterilize glasses and metals
Remember:
 Exposure time begins only after the sterilizer has reached the target temperature.
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 Do not overload the sterilizer
 Leave at least 7.5 cm [3 inches] between the items and walls of sterilizer
 Overloading alters heat convection and increases the time required to sterilize
Advantages of dry heat:
 Effective method, as dry heat by conduction reaches all surfaces of instruments, even for instruments
that cannot be disassembled.
 Protective of sharps or instruments with a cutting edge (fewer problems with dulling of cutting edges).
 Dry heat leaves no chemical residue.
 Eliminates wet pack problems in humid climates
29
Disadvantages of dry heat:
 Plastic and rubber items cannot be dry-heat sterilized because temperatures used (160–170 oC) are too
high for these materials.
 Dry heat penetrates materials slowly and unevenly.
 Requires oven and continuous source of electricity.
When using dry heat to sterilize instruments wrapped in cloth, be sure that temperature does not exceed
170oC (340oF). Use dry heat only for items that can withstand a temperature of 170oC (340oF).
170oC (340oF) 60 minutes
121oC (250oF) overnight
Needles and other instruments with cutting edges should be sterilized at lower temperatures 160oC
(320oF)], because higher temperatures can destroy the sharpness of cutting edges. Depending on the
temperature selected, the total cycle time (preheating, sterilization time and cool down) will range from about
2.5 hours at 170oC to more than 8 hours at 121oC.
Other Heat methods include
Flaming:is done to loops and straight-wires in microbiology labs. Leaving the loop in a Bunsen burner until it
glows red ensures that any infectious agent gets oxidized completely into small molecules. Commonly used for
small metal or glass objects, but not for large objects .
Incineration: will also burn any organism to ash. It is used to sanitize medical and other bio hazardous waste.
Boiling: boiling in water for 15 minutes is unsuitable for sterilization. It is simple and familiar, though is
hazardous and cumbersome. Boiling will kill bacteria and viruses, but it is ineffective against many bacterial
spores and prions. High-level disinfection is best achieved by moist heat such as boiling in water (100°C for
one minute holding time), which kills all organisms except for a few bacterial spores. It is important to note
that boiling equipment items in water will not achieve sterilization.
30
Steps of boiling:-
Step 1: Clean all items to be high-level
Step 2: Open all hinged instruments and disassemble those with sliding or multiple parts. Place bowls and
containers upright so they fill with water. Make sure that all itemsare completely submerged because water
must touch all surfaces for HLD to be achieved.
Step 3:Cover the pot or close the lid on the boiler and bring the water to a gentle, rolling boil.
Step 4: Once the water is in a rolling boil, start timing for at least 1 minute. Use a timer or make sure to record
when the boiling begins. From this point on do not add or remove any water or items.
Step 5: Lower the heat to keep the water at a gentle, rolling boil. Too vigorous boiling may damage items and
will speed the evaporation of the water.
Step 6: After 1 minute holding time, remove items using dry, high-level disinfected pickups. Place items to
air-dry on a high-level disinfected tray or on a high-level disinfected container that is away from dust and
insects and in a low-traffic area. Never leave boiled instruments and other items in water that has stopped
boiling; they can become contaminated as the water cools.
Step 7: Store the dry items in a high-level disinfected and covered container and use items immediately or
keep in a covered, dry, high level disinfected container and use within one week.
Step 8: The boiler should be emptied and dried.
4. Chemical sterilization: is an alternative to high-pressure steam or dry-heat sterilization. Chemical

sterilization (often called cold sterilization). Objects can be chemically sterilized. But if using high-pressure
31
steam or dry-heat sterilization would damage them. Chemicals (disinfectants and antiseptics) vary greatly in
ability to kill microorganisms by either of three mechanisms :-
 disruption of lipid containing membranes
 modification of proteins
 modification of DNA and includes
Disinfectant: A disinfectant is a chemical agent that destroys most pathogens but may not kill bacterial spores.
Chemical disinfection should only be used if heat treatment is impractical or if it may cause damage to the
equipment.
Disinfection: Disinfection is the elimination of many or all pathogenic microorganisms, with the exception of
bacterial spores using antiseptics and disinfectants.
Levels of disinfection: There are three High level disinfection
1. High level disinfection (HLD): eliminates bacteria, viruses, fungi and parasites but does not reliably
kill all bacterial endospores .is the only acceptable alternative to sterilization and can be achieved by boiling,
chemical high level disinfect and steaming
2. Intermediate level disinfection (ILD):Inactivates vegetative bacteria, Mycobacterium and most fungi
and viruses, but do not necessarily kill spore-forming bacteria
3. 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.
Irradiation: irradiation kills microorganisms by damaging their DNA by utilizing ultraviolet light. This is
usually used for air disinfection in labs and operating theaters. An example of radiation is
Gammairradiationused for sterilization of single–use disposable syringes.
Filtration: Filtration is used to sterilize (remove microorganisms from) liquids which cannot be sterilized by
heat (e.g., antibiotics, serum, injectable drugs and vitamins • Filters are made of special substances (ceramic,
asbestos, cellulose ester).
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Figure of different Instrumental processing
33
1. Describe hand washing procedure.

2. List out Purpose of using Personal protective equipment.

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

34
Answer sheet
1__________________________________________________________
___________________________________________________________
__________________________
2__________________________________________________________
___________________________________________________________
___________________________
3__________________________________________________________
___________________________________________________________
___________________________________________________________
______________
35
Operation Sheet 1 Hand washing techniques
Techniques for washing hands properly
Step 1 - Wet your hands and apply enough soap (coin size).
Step 2 - Rub your palms together.
Step 3 - Rub the back of each hand.
Step 4 -Rub both your hands while interlocking your fingers
Step 5 - Rub the back of your fingers.
Step 6 - Rub your thumbs and the ends of your wrists.
Step 7- Rinse both hands properly with water, and dry your hands with a clean towel or air.
Operation Sheet 2 Glove removing techniques

Steps of glove removing
Step-1Pull one glove near your wrist towards your finger tips until the glove folds over.
Step-2Carefully grab the fold and pull towards your finger tips. As you pull you are turning the inside of the
glove outwards.
Step-3Pull the fold until the glove is almost off.
Step-4 to avoid contamination of your environment, continue to hold the removed glove. Completely remove
your hand from the glove.
Step 5-Slide your finger from you glove free hand under the remaining glove. Continue to slide your finger
towards your fingertips until almost half of your finger is under the glove.
Step-6Turn you finger 180 degrees and pull the glove outwards and towards your finger tips. As you do this,
the first glove will be encased in the second glove. The inside of the second glove will also be turned outwards.
Step-7Grab the gloves firmly, by the uncontaminated surface (the side that was originally touching your hand).
Release your grasp of the first glove you removed. Pull your second hand free from its glove. Dispose of the
gloves properly.
36
Operation Sheet 3 Procedure of boiling items
Steps of boiling:-
Step 1: Clean all items to be high-level
Step 2: Open all hinged instruments and disassemble those with sliding or multiple parts. Place bowls and
containers upright so they fill with water. Make sure that all itemsare completely submerged because water
must touch all surfaces for HLD to be achieved.
Step 3:Cover the pot or close the lid on the boiler and bring the water to a gentle, rolling boil.
Step 4: Once the water is in a rolling boil, start timing for at least 1 minute. Use a timer or make sure to record
when the boiling begins. From this point on do not add or remove any water or items.
Step 5: Lower the heat to keep the water at a gentle, rolling boil. Too vigorous boiling may damage items and
will speed the evaporation of the water.
Step 6: After 1 minute holding time, remove items using dry, high-level disinfected pickups. Place items to
air-dry on a high-level disinfected tray.
Step 7: Store the dry items in a high-level disinfected and covered container and use items immediately or
keep in a covered, dry, high level disinfected container and use within one week.
Step 8: The boiler should be emptied and dried.
37
Operation Sheet 4 Process of waste management
Steps in waste management
Step 1Waste Minimization
Step 2Segregation/ Separation
Step 3Handling, i.e. collecting, storing
Step 4Treatment
Step 5 Transporting and Disposal
38
LAP Test Practical Demonstration
Name: _____________________________ Date: ________________

Time started: ________________________ Time finished: ________________
Instructions: Given necessary templates, tools and materials you are required to perform the following
tasks within 2 hour.
Task 1. Perform proper hand washing procedure.

Task 2. Properly wear sterile gloves.
Task 3.Show how to make elbow length glove.
39
LO2. Establish and maintain participative arrangement
Instruction Sheet Learning Guide #7
This learning guide is developed to provide you the necessary information regarding the following content
covering and topics
 Definition of terms
 Introduction to occupational health hazards
This guide will also assist you to attain the learning outcome stated in the cover page. Specifically, upon
completion of this Learning Guide, you will be able to:
 Definition of terms
 Introduction to occupational health hazards
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described below 3 to 6.
3. Read the information written in the information ―Sheet 1, Sheet 2, Sheet 3, and sheet 4‖
4. Accomplish the ―Self-check 1, Self-check 2, Self-check 3, and Self-check 4
5. If you earned a satisfactory evaluation from the ―Self-check‖ proceed to ―Operation Sheet 1, Operation
Sheet 2, operation sheet 3, operation sheet 4 and Operation Sheet 5 ‖
6. Do the ―LAP test‖
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Information Sheet-1 Definition of terms
1.1 2.1 Definition of terms
Health: is deﬁned as a complete state of physical, mental and social well-being and not the merely absence of
disease.
Disease: a state of physiologic or psychologic dysfunction.

Infection:is the entry and development or multiplication of an infectious agent in the body of man or animals.
An infection does not always cause illness.
Hazard:is anything that may cause harm to an individual, such as chemicals, electricity, open drawers, and
inadequate ventilation.
Risk: is the possibility that somebody could be harmed by these and other hazards and the indication of how
serious the harm can be.
Decontamination: is the process of making inanimate objects safer to handle by staff before cleaning. It is
done by soaking the equipment‘s in 0.5% chlorine solution.
Sterilization: the complete destruction or removal of all microorganisms including spores.
Waste: is any substance which is discarded after primary use , or substance of no use.
Healthcare waste (HCW) is defined as the total waste stream from a healthcare facility.
Waste management: refers to the many methods and processes of dealing with waste at every stage from
generation and collection through to final disposal.
41
1. _______is any substance which is discarded after primary use or substance of no use?
A) Waste B) hazard C) infection D) All
2. Define this terms Risk, Hazard and Infection.
Note: Satisfactory rating - 2 points Unsatisfactory - below 2 points

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

42
Answer sheet
1__________________________________________________________
___________________________________________________________
__________________________
2__________________________________________________________
___________________________________________________________
___________________________
3__________________________________________________________
___________________________________________________________
___________________________________________________________
______________
43
Information Sheet-2 Introduction to occupational health hazards
2.1. Introduction to occupational health hazards

Occupational Health and Safety
Occupational Health and Safety is the campaign and maintenance of the well-being of workers in every
occupation. It talks about providing a safe working environment to achieve an injury-free workplace and a
healthy atmosphere that protects every worker against illness. As an effect, it may also protect co-workers,
family members, clients, and other members of the community who are affected by the workplace
environment.
Occupational safety and health (OSH), also commonly referred to as occupational health and safety
(OHS), occupational health, or workplace health and safety (WHS), is a multidisciplinary field concerned
with the safety, health, and welfare of people at work.
The goals of occupational safety and health programs include fostering a safe and healthy work environment.
may also protect co-workers, family members, employers, customers, and many others who might be affected
by the workplace environment. In the United States, the term occupational health and safety is referred to as
occupational health and occupational and non-occupational safety and includes safety for activities outside
of work.
In common-law jurisdictions, employers have a common law duty to take reasonable care of the safety of their
employees. May in addition impose other general duties, introduce specific duties, and create government
bodies with powers to regulate workplace safety issues: details of this vary from jurisdiction to jurisdiction.
44
What are the principles of occupational health and safety jobs?
There are quite a few principles of occupational safety and health that are important to consider such as:-
 Effective OSH procedures and policies

 Leadership and commitment to enhance and improve OSH
 Involvement in risk assessment programs
 Competent and trained employees in the workplace
 Efficient measures for risk control
 Continuous monitoring and process reviews
These principles of occupational safety and health apply to a majority of organizations, whether it is a small or
large organization. What you need to realize in having a good company is that you have to recognize the
importance of your reputation and image. Not only do large organizations benefit from occupation health and
safety, but also smaller companies. As long as they have employees, this principle will always apply.
 What are the benefits of occupational health and safety?
The primary goal of occupational health and safety is:-
 To nourish and foster the work environment for all the individuals in the work field. By keeping
everyone safe and healthy, businesses could reduce their workers‘ medical expenses and insurance costs,
reduce return-to-work pay-outs, decrease the costs for job accommodations for those employees who are
injured and with medical illnesses.
 Keeping everybody in the company safe and healthy will surely increase the efficiency and productivity
of the entire business, which will lead to a successful and good business.
45
Why Occupational Safety and Health is important?
There are a wide variety of reasons why occupational safety and health is crucial for running a success and
they are the following:-
 It demonstrates that the business is socially responsible

 Enhances and protects brand value and its image
 Increases the productivity of employees and workers of all kinds
 Enhances the worker‘s commitment to their company
 Builds a healthier workforce and increases the worker‘s competency levels
 Decreases business disruption and its costs
 Allows business to meet the OSH expectations of their customers
 Encourages the work field to have an active life
1.2 OHS legislation

Legislation is the act of process of legislating, lawmaking, or it‘s a process of enacted law or group of laws
The legislation provides a general framework so employers can manage their individual OHS needs in
consultation with their employees.
In addition to prosecutions and/or on-the-spot fines, inspectors have the authority to either close the workplace
until the hazard is fixed, or allow work to continue provided that the hazard is fixed in a certain time. If the
hazard is not rectified, the employer may be prosecuted.
Monitor OHS Legislation: OHS legislation is constantly changing as new laws are passed and current
standards are refined and updated. As a manager you are ultimately responsible for ensuring that your team is
using current and appropriate work practices. To achieve this it is essential that you keep abreast of the changes
and modify your OHS policies and procedures accordingly.
There are many ways of doing this but the most effective is to monitor the government bodies that create and
enforce OHS legislation. Using the www site addresses in this program is a good place to start.
This information can be obtained from:-
 Store's OHS Representative or officer

 State Government Departments
 Federal Government
46
The key elements of OHS legislation are:
 Protection for every worker

 Duty of care not to endanger the health or safety of self or others, and resolve OHS issues in a timely
manner
 Consultation with workers to discuss the penalties for breaches of the legislation
As the store's health and safety policies and procedures should conform to, the OHS requirements, it is
important that you have a sound knowledge of the Occupational Health and Safety legislation that applies to
your working environment.
1.3 OHS regulations
The occupational health and safety regulations in 2017 (OHS regulations) build on the OHS. They set out how
to fulfill duties and obligations and particular that supports the OHS Act.
For example they include requirements for:
 Safe operation of major hazard facilities and mines
 Training for high risk works
 Managing and removing asbestos
 Licenses for specific activities
The OHS regulation came in to effect on June 18 2017 and replaced the old OHS regulations in 2007.
1.2 Introduction to infection prevention: -Infection prevention is a scientific and practical approach
designed to prevent harm caused by infections to the patients and health works. No country, no health care
facility, even with the most developed health care systems can claim to be free from problems associated with
infections. The health problems due to communicable diseases can be tackled by the application of relatively
easy measures at different levels of the health system.
• Occupational Health is multi disciplinary activity aimed at:
47
– The protection and promotion of the health of workers by preventing and controlling occupational
diseases and accidents and by eliminating occupational factors and condition hazardous to health and safety at
work
– The development and promotion of healthy and safe work, work environments and work organizations
– The enhancement of the physical, mental and social wellbeing of workers and support for the
development and maintenance of their work capacity, as well as professional and social development at work.
– Enabling workers to conduct socially and economically productive lives and to contribute positively to
sustainable development
– Occupational health has gradually developed from a mono-disciplinary, risk-oriented activity to a multi
disciplinary and comprehensive approach that considers an individual‘s physical, mental and social-wellbeing,
general health and personal development.
What is procedure?
– Procedure is a step by step instruction, prescribing an exact sequence of action. A procedure explains
how to and who (which position) will implement the policy.
– Together Policies and Procedures empower a process by providing clear and concise direction necessary
for consistent operation.
What is policy?
 A Policy defines an outcome; it is a premeditated rule set by a business to guide organizational

direction, employees and business decisions, and to regulate, direct and control actions and conduct.
 They are the direct connection between a company's Vision and its daily operations and the
underpinnings to a company's culture.
Health and Safety Policy
 A written health and safety policy is public declaration of the employer‘s commitment to health and
safety in the workplace.
 The health and safety policy states: employer commitment to health and safety overall goals and
objectives for health and safety responsibilities of management, workers, visitors and contractors requirements
to comply with relevant government legislation and the company‘s own health and safety standards
48
 This policy is shared with staff, posted prominently in the workplace, and is often the first page of the
company‘s health and safety manual.
 The policy is only the starting point. The company needs to follow it.
Purpose of the OH & S Policy & Procedures:
Occupational Health and Safety (OH&S) Policy &Procedures has been developed to assist managers and
employees to improve their understanding and management of OHS in their workplace.
The OH&S Policy & Procedures provides practical information and guidance in how managers and employees
can work together to achieve a safe and healthy work environment.
Using the Policy & Procedures will assist to attain compliance with:
 Relevant statutory legislation and codes of practice
 Company policies and workplace standards
 Common law duty of care
 Recognized OH&S best practice
– The processes outlined in the OH&S Policy & Procedures are designed for use as integral
components in operating the company to its maximum potential.
– An organized approach to OH&S management is an essential contributor in ensuring the staff

and clients can do their work safely.
– The primary responsibility for ensuring OH&S standards are implemented within organization
is with:
– Company directors/ Employer‘s
– The management team /Senior manager‘s.
– The responsible officer/ Supervisors
– Workers‘/employee‘s
– However, all staff has responsibilities in creating a safe work environment.
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Employer’s responsibilities
• establish the health and safety management system
• provide the resources to maintain the system
• conduct an annual review of the system
• train supervisors in their health and safety responsibilities
• provide a safe and healthy work environment
• ensure hazards are adequately controlled
• set a good example
Senior manager responsibilities:
Manager‘s will work with employees in pursuing the following courses of action:
• Observing statutory and organizational standards
• Providing and maintaining a safe and healthy working environment
• Providing suitable means of access and egress to workplaces
• Developing, implementing and improving safe work systems
• Monitoring factors that may affect employees‘ occupational health, safety and welfare.
• Providing safe facilities and equipment and ensuring it is maintained in a safe condition
• Recording and investigating accidents and incidents and implement appropriate corrective actions
• orient and train new workers
• provide ongoing training to all workers
• conduct regular health and safety meetings
• perform inspections and incident investigations
• correct hazards or report them to the employer
• correct unsafe acts or behaviours by workers
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Workers‘ responsibilities:
• learn and follow safe work procedures
• use any required equipment and tools
• correct hazards or report them to their supervisor
• participate in inspections and investigations actively participate in health and safety meetings and
discussions
―Duty of Care‖ means providing care and support for individuals within the law and also within the policies,
procedures and agreed ways of working of your employer.
– Every individual should be supported and enabled to live in an environment which is free from
prejudice and safe from abuse.
– Your responsibilities under the duty of care are to do everything reasonable within the definition
of your job role to make this happen.
Health Hazards
– When work is associated with health hazards, it may cause occupational diseases, be one of the
multiple causes of other disease or may aggravate existing ill-health of non-occupational origin.
– In developing countries, where work is becoming increasingly mechanized, a number of work

processes have been developed that treat workers as tools in production, putting their health and lives at risk.
– Safety: The state of being relatively free from harm, danger, injury or damage.
Hazard: A condition with the potential of causing or contributing to an accident or illness/harm.
 A hazard is the potential for harm.
 In practical terms, a hazard often is associated with a condition or activity that, if left uncontrolled, can
result in an injury or illness.
Accident: an unexpected and undesirable event, especially one resulting in damage or harm.
 Some hazards can be acute – they have an immediate effect, such as being hit by a truck.
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 Other hazards are considered chronic – repeated exposures, over time, can eventually cause an effect,
such as hearing loss after repeated overexposure to noise.
Hazards are generally grouped into five categories
• Physical
• Chemical
• Biological
• Psychosocial
• Ergonomic
Risk
• A measure of the probability and severity of a hazard to harm human health, property, or the
environment
• A measure of how likely harm is to occur and an indication of how serious the harm might be.
 The relation of risk to hazard may be expressed as;
 R = f (H x E) = f (H x D x t)
 Where R is risk, f is function of, H is hazard, E is exposure, D is dose and t is time
• Risk  0
Hazard Identification and Assessment
• Hazard identification and assessment is at the foundation of a quality occupational health and safety
management system.
• Employers must:
– assess a work site and identify existing or potential hazards
– prepare a written and dated hazard assessment, including the methods used to control or
eliminate the hazards identified.
– involve workers in the hazard assessment, where possible

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– make sure workers are informed of the hazards and the methods used to control the hazards
An employer must make sure that a hazard assessment is done:
– at reasonably practicable intervals to prevent the development of unsafe and unhealthy working
conditions
– when a new work process is introduced
– when a work process or operation changes
– before the construction of a new work site
Hazard Assessment
• Assessing hazards means taking a careful look at the different activities that workers do and asking,
―What could go wrong?‖, trying to find out about anything that could harm workers at the work site.
• The purpose of hazard assessment is to prevent work-related injury or illness to workers.
Reason to Conduct a Hazard Assessment
 learning more about what could harm workers
 finding better and safer ways to do the job
 Identifying any weaknesses in worker training
 identifying poor or missing procedures.
 increasing workers‘ involvement of workplace health and safety
 having a useful tool when investigating an incident
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3. _______is any substance which is discarded after primary use or substance of no use?
B) Waste B) hazard C) infection D) All
4. ______is the entry and development or multiplication of an infectious agent in the body of man or
animals?
A) Infection B) Disease C) A& B D) None
5. _______is deﬁned as a complete state of physical, mental and social well-being and not the merely
absence of disease?
A) Disease B) infection C) sterilization D) ALL
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Answer sheet
1__________________________________________________________
___________________________________________________________
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2__________________________________________________________
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3__________________________________________________________
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___________________________________________________________
______________

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

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LO3. Assess and control risks and hazards
Instruction Sheet1 Learning Guide #3

This learning guide is developed to provide you the necessary information regarding
the following content covering and topics
 Principles of occupational safety and health
 Environmental health hazards
This guide will also assist you to attain the learning outcome stated in the cover page.
Specifically, upon completion of this Learning Guide, you will be able to:
 Principles of occupational safety and health
 Environmental health hazards
o Read the specific objectives of this Learning Guide.
o Follow the instructions described below 3 to 6.
o Read the information written in the information ―Sheet 1, Sheet 2, and sheet 3‖
o Accomplish the ―Self-check 1, Self-check 2, and Self-check 3‖
o If you earned a satisfactory evaluation from the ―Self-check‖ proceed to ―Operation
Sheet 1, Operation Sheet 2, operation sheet 2 and Operation Sheet 3 ‖
o Do the ―LAP test‖
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Information Sheet-1 Principles of occupational safety and health
Principles of occupational Health and Safety
Factory management spends large amount of expenses for health insured workers. The
workers compensation expenses include medical payments (hospital and clinic treatment);
partial, temporary, and permanent disability costs; death benefits; and legal costs. The cost
claims may steadily rise up if the employers do not take measure to intervene the problem. The
productivity of the factory will obviously decline in such situations. The role of occupational
health and safety, therefore, lies in designing ways and means for cost reduction through
workers proper health service provision. Occupational diseases, accidents, and death prevention
are the issues to be addressed. The scope of occupational health and safety is three-fold. It
begins with the anticipation and recognition of workers‘ health problems in an industrial
atmosphere. The causes of these problems may be chemical, physical, biological, psychological,
and ergonomical environments. The second scope includes evaluation of the recognized
problem, which encompasses mainly data collection, analysis, interpretation, and
recommendations. Finally, the third scope involves the development of corrective actions to
eliminate or limit the problem. Generally, the work frame of occupational health and safety is
wide and needs multidisciplinary approach. It requires the knowledge of physics, biology,
chemistry, ergonomics,medicine, engineering, and related sciences. It also requires public health
management skills for proper communication and decision making.
The basic principles for the development of occupational health and safety services are as
follows:
a) The service must optimally be preventive oriented and
multidisciplinary.
b) The service provided should integrate and complement the
existing public health service.
c) The service should address environmental considerations
d) The service should involve, participation of social partners and
otherstakeholders
e) The service should be delivered on panned approach
f) The service should base up to date information, education,
training, consultancy, advisory services and research findings
g) The service should be considered as an investment
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Directions: Answer all the questions listed below. Use the Answer sheet provided in the next
page:
1. Define Principles of occupational Health and Safety

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

Answer sheet
1_________________________________________________
__________________________________________________
____________________________________________
2_________________________________________________
__________________________________________________
_____________________________________________
3_________________________________________________
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Information Sheet-2 Environmental health hazards
Definition of terms
Hazard-is anything that may cause harm to an individual, such as chemicals, electricity, open
drawers, and inadequate ventilation.
Risk-is the possibility that somebody could be harmed by these and other hazards and the
indication of how serious the harm can be.
Policy- is a course of principle of action adopted or proposed by an organization or
individuals.
Occupational Health and Safety is the campaign and maintenance of the well-being of
workers in every occupation. It talks about providing a safe working environment to achieve
an injury-free workplace and a healthy atmosphere that protects every worker against illness.
As an effect, it may also protect co-workers, family members, clients, and other members of
the community who are affected by the workplace environment.
1.1 HAZARDS AND RISKS

Hazard is anything that may cause harm to an individual, such as chemicals, electricity, open
drawers, and inadequate ventilation.
Risk is the possibility that somebody could be harmed by these and other hazards and the
indication of how serious the harm can be.
Occupational Health and Safety is the campaign and maintenance of the well-being of
workers in every occupation. It talks about providing a safe working environment to achieve
an injury-free workplace and a healthy atmosphere that protects every worker against illness.
As an effect, it may also protect co-workers, family members, clients, and other members of
the community who are affected by the workplace environment.
Types of Hazards
 Physical hazards are the most normal occurrences in workplaces. They are usually easy
to detect, however, very often are neglected because people are too accustomed to them.
Another reason may be due to lack of knowledge or people do not see situations as hazards.
Examples of physical hazards that a caregiver may be exposed to:
 Electrical hazards: Even in day care institutions or nursing homes where care
should be of utmost concern, improper wiring and frayed cords may still go
unnoticed. Misuse of electrical equipment also happens in any type of work
environment.
 Endless loud noise: If one is going to work in a nursing home, frequent noise
from patients who are suffering from depression is definitely a hazard.
 Spills on floors or tripping hazards: There are times when even the caregivers
themselves do not mind spills on floors. This, definitely, poses hazard to
everyone.
Some of the Effects of Physical Hazards
 Fire
 Decreased efficiency
 Annoyance
 Falls
 Biological hazards come from working with animals, people or infectious materials.
This is, therefore, one of the most common hazards that a caregiver faces. If one is
working in a day care, hospital, hotel laundry, nursing home, laboratories, he/she may be
exposed to biological hazards.
Examples of physical hazards that a caregiver may be exposed to:
- blood or other body fluids
- fungi
- bacteria and viruses
- contaminated wastes
Some of the Effects of Biological Hazards
 infections
 skin irritations
 allergy
 Tuberculosis
 AIDS
 Ergonomic hazards occur when a caregiver‘s nature of work, body position and
working conditions put pressure on his/her body. It is difficult to spot this type of hazard,
because caregivers do not immediately notice the effect to their bodies. At first, sore
muscles may be experienced. But long term exposure to this type of hazard can cause
musculoskeletal problems.
Examples of ergonomic hazards that a caregiver may be exposed to:

 performing tasks that require lifting heavy loads
 too much bending and reaching
 standing for long periods of time
 holding body parts for long period of time
 awkward movements, especially if they are repetitive ,repeating the same
movements over and over
Some of the Effects of Ergonomic Hazards

 pain in the shoulders
 back injury
 too much impact on wrist and hands
 numbness in some parts of the body
 muscle cramps
 Chemical hazards are present when a worker is exposed to any chemical preparation in
the in any form (solid, liquid or gas). There may be chemicals which are safe, but some
caregivers who are sensitive to solutions may cause skin irritation, illness or breathing
problems.
Examples of chemical hazards, may be exposed to:
 liquids like cleaning products
 disinfecting solutions
Effects of Chemical Hazards
 Lung diseases
 Difficulty in breathing
 Allergy
 Psychological Hazards take place when a caregiver‘s work environment becomes
stressful or demanding.
Examples of psychological hazards that a person may be exposed to:
- Burn out‖, fatigue and on call duty
- Unreasonable expectations from patients or clients
- Verbal abuse form dissatisfied clients
- Unreasonable expectations from supervisors and management
Some of the Effects of Psychological Hazards
- Depression
- Anxiety
- Loss of confidence
- Loss of concentration at work
- Deterioration of performance at work
Recognizing Hazards and Risks in the Workplace

Hazards and risks vary from one workplace to another. Even in day care or nursing homes
where work routines may be the same, hazards will differ depending on the type of building
the establishment is situated, and the attitudes of caregivers, clients, or employers.
The good news is hazards and risks can be prevented! However, before thinking about what
control measures are needed, first a caregiver has to know whether there are health and safety
problems in his/her workplace. So, how can someone identify the hazards in the workplace?
 The following are some ways to determine health and safety problems:
1. Observe the workplace.
2. Examine complaints from his/her co-workers.
3. Check accident records.
4. Examine chart on results of inspections done by the employers or private organizations.
5. Use checklists and inspect the workplace.
6. Study reports or any other vital information about the nursing home.
1.2 EVALUATING AND CONTROLLING HAZARDS AND RISKS
Once you recognize a hazard in the workplace, then you can proceed with risk assessment,
that is focusing on the risks that really matter in the workplace. Evaluating hazards and risks is
the process of determining the level of risk created by the hazard and the likelihood of injury
or illness occurring. Most of the time, simple measures can be done, with no trouble, to
control risks. An example of this is making sure that cabinet drawers are kept closed so that
people do not trip.
Needless to say, the concern for control increases as the recognized level of risk increases.
A person identifying the risk of harm or injury from a hazard in a nursing home or day care
should consider these questions:
 How likely it is that a hazard will cause harm;
 How serious that harm is likely to be;
 How often (and how many) workers are exposed.
It is a must that you have a record of every risk assessment done. If a certain accident or
damage happens again, it might be that you will trace back the original records to check if the
assessment overlooked a potential hazard. Assessing or evaluating the hazards and risks is
crucial in making a decision on the mode of control to be used.
1.3 CONTROL HAZARDS AND RISKS
It is possible that workplace hazards can be controlled by a variety of methods. Of course, the
very reason why hazards should be controlled is to prevent workers from being exposed to
occupational hazards. Hazard control comes in different processes. But one method may be
more effective than the others.
When we speak of controlling hazards and risks, it means settling on the measure that will
solve the trouble most successfully.
There are five major categories of control measures:
 Elimination
 Substitution
 Engineering controls
 Administrative controls
 Personal protective equipment.
1. Eliminating a hazard means removing it completely.

2. Substitution is replacing or substituting a hazardous agent or work process with a less
dangerous one.
3. An engineering control may mean changing a piece of machinery (for example, using
proper machine guards) or a work process to reduce exposure to a hazard.
4. An administrative control may mean working a limited number of hours in a hazardous
area is an example of an administrative control (for example, job rotation)
5. Personal Protective Equipment includes ear and eye protection, respirators and protective
clothing.
Obviously, the best method of controlling hazards and risks is through elimination. That is to
take away or to get rid of the hazard. However, more often than not, this is not possible. So,
employers make use of any of the remaining control measures. The general rule is that the use
of personal protective equipment (PPE) should be the last alternative in controlling hazards
and risks in a workplace. Although it is said that the best method of control measure is
through elimination of hazards, a very good technique for a safe and healthy environment is
through the utilization of a combination of methods.
PRACTICAL WAYS TO PREVENT HAZARDS AND RISKS
A Closer Look at Electricity

 As common sense dictates, you have to ensure that all electrical equipment you use is
in good condition.
 Check electrical cords and make sure they are not frayed.
 Your hands should be dry before attempting to use any electrical equipment.
 Do not attempt to change fuses unless you know what you are doing.
 Do not turn on all appliances at the same time just because you want to save time.
Use of Personal Protective Equipment

Caregivers should religiously abide by the following to prevent biological hazards from
happening:
- Wear gown that is long enough to cover your clothing. Because the outside of the gown
is considered contaminated, this should not be touched when it is removed. A gown that
is wet is, of course, considered contaminated also. A caregiver should wear a clean
gown every client care. In case the gown is not available, apron should be worn to mask
clothing during client contact.
- Masks should fit comfortably over the nose and mouth. The same with a gown or apron,
a wet mask is considered contaminated. The front of the mask is also contaminated.
Masks should not be worn around the neck. For each client contact, a clean mask should
be used.
- Gloves should be used when issue on contamination is present. Also, when a
- caregiver has open wound on the hands, it is a must that he/she use gloves. The outside
of the gloves should not be touched when removed as this is considered contaminated.
Disposal of Health Care Wastes

In order to reduce the burden of disease, health care wastes should be managed appropriately.
Whether a caregiver is working in a hospital, a day care, or even at home, proper discarding of
medical wastes should be of great consideration.
Human waste products.Obviously, these wastes should be flushed down the toilet without
delay and should not be discarded in the street or in any public places.
Blood and bloody fluids.These must be removed right away. It is best if they can be directly
flushed down the toilet. If clothes are contaminated, they should be washed separately using
hot water and should be dried. Dressings with blood need to be double-bagged in plastic and
disposed of based on existing community or local rules.
Needles (sharps).Sharps should be kept in a container which is not easy to pierce like metal
(coffee can). Some items may be kept while some should be discarded right away. It is
advisable to discuss with the supervisor for the best disposal method.
Medical equipment. If the equipment is contaminated, it should be thrown away. It is ideal

that the equipment be double-bagged and disposed of based on the existing regulations in the
community. Also, this should be discussed with the immediate supervisor as to whether or not
the said equipment can be kept or should be disposed of already.
Proper Hand washing
As you touch people, tables, chairs, books, sinks, handrails, and other objects and surfaces,
there is a possibility that you contaminate your hands. The germs that have accumulated when
touching things may be the means for you to get sick and spread illness to others. The
importance of hand washing comes in. It is by far the best and simplest way to prevent germs
from spreading and to keep the people around you from getting sick. Though it is said that
hand washing is the first line of defense against the spread of illnesses, you should be aware
of the proper way of doing it. Otherwise, you may just be wasting your time doing it because
you do not really wipe out what should be eliminated.
The following steps will help you in performing proper hand washing to rid yourself of
germs in no time.
1. Prepare your materials before washing your hands: paper towel, bar or liquid soap.
2. Turn on the faucet and wet wrists and hands thoroughly. Use a generous amount of soap.
3. Rub your hands together and between fingers. Be sure to use friction when washing as this
helps in cleaning your hands. Do not forget the surface of your hands, palms, the spaces
within the fingers and above the wrists. Do this process for at least 20 seconds.
You might want to sing ―happy birthday‖ twice slowly to make sure you attained the
minimum number of seconds in washing your hands.
4. Clean your nails by rubbing the soap later through them. If your nails are long (it is
advisable that health care workers do not grow their nails long), use a soft stick or the nails of
the other hand to remove the dirt under them.
5. Rinse your hands thoroughly under running water. Remember to rinse from above the wrist
down to the fingers.
6. Use a paper towel to dry hands and discard immediately.
7. Use a new paper towel to close faucet being careful not to contaminate your hands. This
paper towel should be discarded right away.
Put a Stop to Ergonomic Hazard
Efficient control measures are now being utilized by employers to avoid ergonomic hazards
among health care workers. Manual handling of patients, for example, has become less
stressful due to some paraphernalia being used that facilitate the task. Adjustable height work
stations, improved tool design, and adjusted work pace are now part of a worker‘s life.
Unfortunately, ergonomic hazard effects continue to happen. Why? At times, the workers
themselves invite these hazards due to the wrong way they do their tasks. Conscious or not,
they have to examine their work routine and consider these simple rules:
 Avoid twisting the body.
 Bend knees if it is needed.
 Avoid too much stretching when reaching for something.
 Use a ladder when reaching for hard-to-reach materials or objects.
 Ask for help from someone if the task cannot be done by one person.
HIERARCHY OF HAZARDS CONTROL
To ensure a safe workplace, hazards must be controlled using a range of methods. The
hierarchy of hazard controls is a list, in order of preference, which can be considered in hazard
control. It emphasizes controlling a hazard at the source. This is done by giving preference to
the use of the 'engineering controls' as listed below.
Where possible, the ideas listed below should be used because they are less likely to be
affected by human failure and because they are less disruptive and uncomfortable for people
working in the area. Whichever method is used, the effectiveness of the control measure used
should be monitored regularly.
Engineering Controls
o Design. Try to ensure that hazards are 'designed out' when new materials, equipment and
work systems are being planned for the workplace.
o Remove the hazard or Substitute less hazardous materials, equipment or substances.
o Adopt a safer process alteration to tools, equipment or work systems can often make
them much safer.
o Enclose or isolate the hazard through the use of guards or remote handling techniques.
o Provide effective ventilation through local or general exhaust ventilation systems.
Administrative Controls
o Establish appropriate Administrative Procedures such as:

 job rotation to reduce exposure or boredom, or timing the job so that fewer
workers are exposed
 routine maintenance and housekeeping procedures
 training on hazards and correct work procedures.
Personal Protective Equipment

o Provide suitable and properly maintained Personal Protective Equipment (PPE) and
training in its use.
Examples of common hazards
The table below shows examples of typical problems created by workplace hazards and some
injuries and illnesses that can result. Individual workplaces may have hazards other than those
listed below.
TYPICAL PROBLEMS TYPICAL INJURY/ILLNESS
HAZARD
REQUIRING FIRST AID
Manual handling Overexertion/Repetitive movement Sprains, strains, fractures
Falls Falls from heights, slips and trips on Fractures, bruises, cuts,
uneven surfaces dislocations, concussion
Electricity Contact with electrical current Shock, burns, loss of

consciousness, cardiac arrest
Plant Being hit by projectiles, striking objects, Cuts, bruises, dislocations,

being caught in machinery, overturning fractures, amputation, eye damage
vehicles
Hazardous Exposure to chemicals. E.g. solvents, Dizziness, vomiting, dermatitis,

substances acids, hydrocarbons respiratory problems, burns to skin
or eyes
Temperature, UV Effects of heat or cold from weather or Sunburn, frostbite, heat stress, heat
radiation work environment stroke, hypothermia
Biological Allergens, needle stick, exposure to Severe allergic reaction, injuries,

infectious agents skin rash, infection
Occupational Intimidation, conflict, physical assault Nausea, shock, collapse, physical

violence injuries
The working environment
Employers also have obligations in relation to the working environment. The requirements
relate to:
o Working space
 provide sufficient working space to allow people to work safely
 ensure that floors and surfaces are constructed and maintained to minimize the
possibility of slips, trips and falls
 ensure that people are able to move about a place of work safely and unhindered.
Lighting
 provide adequate lighting to allow workers to work safely, move safely, and enter
and exit the workplace safely (including from emergency exits)
 ensure that there is not excessive glare or reflection
 ensure that lighting allows persons who are not workers to move safely within the
place of work.
o Hot and cold working environments
 provide adequate ventilation and air movement in indoor environments that may
become hot
 provide adequate access to heated or sheltered areas and warm clothing or other
personal protective equipment if employees are exposed to cold
 provide appropriate work and rest regimes relative to physical fitness, general
health, medication taken and body weight appropriate for both hot and cold
working environments.
o Noise management
 It is not allow exposure to noise levels that exceed an eight-hour noise equivalent
of 85 dB(A) or peak at more than 140 dB(C).
o Other obligations
 fire prevention, electricity, confined spaces, manual handling, atmosphere
ventilation, working at heights.
Directions: Answer all the questions listed below. Use the Answer sheet provided in the next
page:
 What is elimination?
 List types of hazards?
 List five major categories of control measures

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________

Answer sheet
1_________________________________________________
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2_________________________________________________
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3_________________________________________________
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LO 5: Limit contamination
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics –
Limit contamination
 Demarcating of Clean and contaminated zones
 Storage of records, materials and medicaments to a clean zone
 well-designating Contaminated instruments and equipment to contaminated zone
Specifically, upon completion of this Learning Guide, you will be able to –
 demarcate and maintain clean and contaminate zones in all aspects of health care work
 confine records, materials and medicaments are to a well-designated clean zone
 Confined contaminate instruments and equipment to a well-designated contaminated zone
Information Sheet-1 Demarcating of Clean and contaminated zones
Demarcating Clean and contaminated zones
When something has been exposed to infectious agents it is considered to have been contaminated.
Ways to limit contamination in the healthcare setting may include:
 cleaning surfaces
 protecting all materials, equipment and instruments from contaminants
 maintaining sterile objects
 being aware of the guidelines for single-use objects.
An important strategy to limit contamination in healthcare settings is to set and maintain:
 clean zones
 treatment zones
 contaminated zones.
Maintaining these three zones helps reduce the risk of contamination. it is the responsibility of every
person working in the healthcare environment to:
 understand where the clean, treatment and contaminated zones are
 do what is required to maintain them.
Zones
Maintaining clean, treatment and contaminated zones helps reduce the risk of contamination and
makes it easier to remember that anything entering a clean zone must first be decontaminated.
The clean Zone
Clean areas include those surfaces and drawers where clean, disinfected or sterilized
instruments are stored and never come in contact with contaminated instruments or equipment
The clean zones are areas where non-contaminated items are kept. Example of these items and zones
include:
 sterile instruments
 clean linen
 medical records
 kitchen preparation areas
 supply stores.
Before entering a clean zone it is important to remove contaminated gloves and other PPE and perform
hand hygiene (decontamination).
The treatment Zone
The treatment zone is where items are currently being used by the client or healthcare worker.
For example, the client's bedside is a treatment zone as it has been exposed to microorganisms.
Contaminated zone
Contaminated zones are for objects and waste that is waiting for decontamination sterilization or
disposal
The contaminated zone boundaries should be clearly defined, because this has implications for
surface management and for the placement of equipment.
Instruments placed into the contaminated zone for a treatment session but not used during the
session must be regarded as contaminated. For this reason, all bulk supplies such as opened
boxes of gloves, cotton rolls or gauze must be stored outside the contaminated zone and
protected from contamination from splashes and aerosols.
An example of this zone is a linen skip, in which used linen is stored while awaiting
decontamination in the laundry.
If there is any possibility that any item may have been contaminated, it should be treated as if
it has been contaminated.
Self-Check 1 Written Test
Directions: Answer all the questions listed below. Use the Answer sheet provided in
the next page:
1. Ways to limit contamination in the healthcare setting may include:

A. cleaning surfaces
B. protecting all materials, equipment and instruments from contaminants
C. maintaining sterile objects
D. being aware of the guidelines for single-use objects.
E. ALL
2. An important strategy to limit contamination in healthcare settings is to set and maintain:
A. clean zones
B. treatment zones
C. contaminated zones
D. ALL
3. Ways to limit contamination in the healthcare include all of the following, except
a. Cleaning surfaces
b. Protecting all materials from contaminants
c. Maintaining sterile objects
d. None of the above
4. An important strategy to limit contamination in healthcare settings is to set and maintain
a. Demarcation among different zones
b. Effective treatment
c. Taking prophylaxis
d. Isolation of patients
5. Areas where non-contaminated items are kept is
a. Treatment Zone
b. Contaminated zone
c. Clean zone
d. Patient zone
6.
You can ask you teacher for the copy of the correct answers.
Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________
Short Answer Questions
1. ________________________________________________________________
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2. ________________________________________________________________
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3. ________________________________________________________________
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Storage of records, materials and medicaments to a clean
Information Sheet 2
zone
Storage of records, materials and medicaments to a clean zone
Records, materials and medicaments

All records that are kept and archived should be kept in a clean zone. All packaging materials
and medicaments should be kept in a clean zone. These items should not be stored in a
contaminated zone or a risk of cross contamination will occur.
Contaminated instruments and equipment

When items are received into the sterilizing facility, all reusable items that have been used or
unused during patient treatment need to be cleaned in a physically separate area to prevent
possible contamination of processed items
Instructions: Answer all the questions listed below. Illustrations may be necessary
to aid some explanations/answers. Write your answers in the sheet
provided in the next page.
1. All records that are kept and archived should be kept in

A. a clean zone
B. Treatment Zone
C. Patient zone
D. Contaminated zone
E.
2. All packaging materials and medicaments should be kept in (4 points)
A. a clean zone
B. Treatment Zone
C. Patient zone
D. Contaminated zone
3. Which zone is used for objects and waste that is waiting for decontamination sterilization or
disposal
A. Treatment Zone
B. Contaminated zone
C. Clean zone
D. Patient zone
Note: Satisfactory rating - 12 points Unsatisfactory – below 12 points

You can ask your trainer for the copy of the correct answers.
Answer Sheet Score = ___________
Rating: ____________
Name: _________________________ Date: _______________
1. ________________________________________________________________
________________________________________________________________
2. ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
3. ________________________________________________________________
________________________________________________________________
________________________________________________________________
4. ________________________________________________________________
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5. ________________________________________________________________
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_______________________________________________________________
well-designating Contaminated instruments and
Information Sheet 3 equipment to contaminated zone
well-designating Contaminated instruments and equipment to contaminated zone
Workflow
To maintain the separation of clean and contaminated zones, workflow should be from the cleanest to
the most contaminated areas – this ensures that there is never any movement of contaminated items
into clean zones.
The cleanest to most contaminated approach also applies to cleaning surfaces, when you should start at
the cleanest area and work out toward the most contaminated area. Make sure that cleaning equipment
is correctly decontaminated and stored after use, to prevent it becoming another source of
contamination.
Objects that have moved from the clean to the contaminated zone may only return when they have
been cleaned, decontaminated, or sterilized as required. Take them from the contaminated zone,
decontaminate them, and then place them in the clean zone. Be careful not to place a newly
decontaminated item back in a contaminated zone, such as on a contaminated bench.
If there is a possibility that something may possibly have been contaminated, it should be treated as if
it has definitely been contaminated.
Many healthcare facilities use dedicated trolleys and containers for holding and moving contaminated
items and clean or sterile items, and you must ensure that the correct trolleys and containers are used.
If a single trolley is used for both, it must be thoroughly cleaned before use for clean items. Clean and
contaminated items can never be placed on the trolley together.
There are two basic rules to follow to limit contamination.
 Maintain clean zones and contaminated zones within the workplace.
 All movement of instruments and equipment must be from clean to contaminated.
The aim of barrier nursing is to protect the HCW but also the community from transmission of
Infectious disease. Proper barrier management is the cornerstone in containing the spread of
Infectious disease. in healthcare settings.
Figure . Zones and colour code
Different zones Activities Specification
Red zone •  Patient treatment area  Monitored by direct or video assisted observation
Patient treatment  Point of care; diagnostics
area  After visible contamination, cleaning and disinfection of HCW
Dark yellow zone  First re-entry step for staff exiting the red zone  Critical zone for prevention and control of secondary
 Assisted disinfection and doffing for exit HCW contamination.
 Potentially contaminating processes, such as cleaning and  Abundant space required for unrestricted assisted
disinfection of boots and waste bags doffing process of two HCW in PPE
 Preparing waste for further processing, such as packaging waste  Additional dedicated cleaning and disinfection areas
bags in containers with non-removable clip-on lids  Additional generously dimensioned waste storage
 Storage of waste areas.
Light yellow zone  Hand disinfection for HCW before stepping into the green zone  Supervisor (barrier nursing guardian)
Green Zone  Second step re-entry of staff from light yellow zone  Strict access control
 Complete assisted donning for entry HCW  Space for clean supplies
 Briefing and de-briefing of staff  Zones for staff recreation
 Staff coordination and supervision of activities
• Inbound and outbound communications
Functionally, the yellow zone needs to be understood as the decisive area, in which secondary
contamination is prevented and controlled: Here a contaminated HCW exiting from the red
zone is brought in to clean conditions, which enable him or her to safely re-enter the green
zone. In addition, any material coming from the red zone, such as waste bags, re-usable PPE
items, patient samples needed to be processed outside of the isolation unit are first cleaned
and disinfected in the yellow zone. A particular function lies in the temporary storage of
considerable amounts of waste produced every day in the nursing of a patient with an
Infectious disease.
Practical hints
 Different zones need to be clearly marked.
 Prevention and control of secondary contamination happens in the yellow zone.
 The yellow zone has a virtual gradient from ‗high potential for contamination‘ (dark yellow) to ‗low
potential of contamination‘ (light yellow).
 Instructions for staff should be displayed at the entry of the isolation area.
 If there is a cross-contamination incident outside the red zone (e.g. patient leaving the red zone), the
contaminated area has also to be considered as a red zone. New yellow and green zones need to be
established around the new red zone. The zones can be put back into normal function by room
disinfection, once the patient has been dismissed.
 Donning and doffing areas must be separated and visually marked. The donning area is in the green
zone.
 The doffing area must be in the dark yellow zone, but has to be clearly separated from the light yellow
zone.
Written Test
Self-Check 3
Instructions: Answer all the questions listed below. Illustrations may be necessary to aid
some explanations/answers. Write your answers in the sheet provided in the
next page:
1. Patient treatment zone
A. Red zone
B. Dark yellow zone
C. Green Zone
D. NONE
2. Critical zone for prevention and control of secondary contamination.
A. Red zone
B. Dark yellow zone
C. Green Zone
D. NONE
3. Zones for staff recreation
A. Red zone
B. Dark yellow zone
C. Green Zone
D. NONE
A.


Rating: ____________
Name: _________________________ Date: _______________

1. ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Prepare tools and equipment for identification and
Operation Sheet 3 measuring Muda.
1. Discuss and plan to prepare tools and equipment for Muda identification.
2. Prepare tools and equipment for Muda identification.
Practical Demonstration
LAP Test
Name: _____________________________ Date: ________________

Instructions: Given necessary templates, workshop, tools and materials you are required
to perform the following tasks.
Task 1: Identify and prepare tools and equipment for measuring and identification of Muda.
LO 5: Clean environmental surfaces
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics –
Clean environmental surfaces
 wearing PPE during cleaning procedures
 removal of dust, dirt and physical debris from work surfaces
 cleaning work surfaces before and after any activity
 decontamination of equipments
 drying work surfaces before and after use
 replacing surface covers
 maintaining and storing Cleaning equipments
Specifically, upon completion of this Learning Guide, you will be able to –
 worn personal protective clothing and equipment during cleaning procedures
 remove all dust, dirt and physical debris from work surfaces
 clean all work surfaces with a neutral detergent and warm water solution before and after
each session or when visibly soiled
 decontaminate equipment requiring special processing in accordance with quality
management systems to ensure full compliance with cleaning, disinfection and
sterilization protocols
 all work surfaces are dried before and after use
 replace surface cover where applicable
 maintaine and store cleaning equipment
Information Sheet-1 wearing PPE during cleaning procedures
 wearing PPE during cleaning procedures
7.1 Personal protective clothing and equipment during cleaning procedures

Wear gloves while cleaning instruments and equipment. (Thick household or utility gloves
work well.) If torn or damaged, they should be discarded; otherwise they should be cleaned
and left to dry at the end of the day for use the following day.
 Even when wearing heavy-duty utility gloves, care should be taken to prevent needle sticks
or cuts when washing sharps.
Wear protective eyewear (plastic visors, face shields, goggles or glasses) and a plastic apron,
if available, while cleaning instruments and equipment to minimize the risk of splashing
contaminated fluids into the eyes and onto the body.
 In most cleaning situations, gloves and aprons are sufficient.
 If there is risk of splashing waste into the face or eyes, face shields should also be used.
 PPE can only work if it is intact and undamaged, is fit for the purpose and is worn correctly
 Make sure the PPE fits you securely.
 If you notice any damaged PPE, notify your supervisor immediately
 Be familiar with the type of clothing you are required to wear for the purpose; for example,
should the apron be waterproof
Directions: Answer all the questions listed below. Use the Answer sheet provided in
the next page:
1. In most cleaning situations, gloves and aprons are sufficient. True | False
2. If there is risk of splashing waste into the face or eyes, face shields should also be used.
True | False
3. PPE can only work if it is intact and undamaged, is fit for the purpose and is worn
correctly True | False
4. In most cleaning situations make sure the PPE fits you securely. True | False
5. Be familiar with the type of clothing you are required to wear for the purpose; for
example, should the apron be waterproof.True | False

Answer Sheet
Score = ___________
Rating: ____________
Name: _________________________ Date: _______________
8. ________________________________________________________________
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9. ________________________________________________________________
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10. ________________________________________________________________
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11. ________________________________________________________________
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12. ________________________________________________________________
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13. ________________________________________________________________________
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14. ______________________________________________________________
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Information Sheet 2 Removal of dust, dirt and physical debris
7.2 Removing dust, dirt and physical debris

Dust, soil and microbes on surfaces can all transmit infection. Cleaning removes foreign material and
reduces the numbers of infectious agents and thus makes transmission of infectious organisms less
likely
Floors
 Vacuum carpets and clean hard floors daily. Sweeping with an ordinary broom releases dust
and bacteria into the air and so is not suitable.
 Wash buckets and mops after use with detergent and water and store them dr
Walls and fittings
 Generally, walls, blinds and curtains need less attention than floors unless they are in areas
where soiling often happens (particularly if soiling is with blood or other body fluids). They
should all be cleaned regularly and when visibly soiled. Curtains need changing regularly.
1. __________is the removes foreign material and reduces the numbers of infectious agents
and thus makes transmission of infectious organisms less likely
A. Disposing
B. Disinfecting
C. Sterilization
D. Cleaning
Note: Satisfactory rating - 12 points Unsatisfactory – below 12 points

You can ask your trainer for the copy of the correct answers.

Rating: ____________
Name: _________________________ Date: _______________
6. ________________________________________________________________
________________________________________________________________
7. ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
8. ________________________________________________________________
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9. ________________________________________________________________
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Information Sheet 3 cleaning work surfaces before and after any activity
7.3 Cleaning
Cleaning is the process that physically removes soiling, including large numbers of microorganisms
and the organic material on which they grow. This is usually carried out using neutral detergent and
warm water. Or
Cleaning is the removal of visible soil, organic, and inorganic contamination from a device or
surface, using either the physical action of scrubbing with a surfactant or detergent and water or an
energy based process with appropriate chemical agents.
Routine environmental cleaning is required to minimize the number of microorganisms in the
environment. A risk assessment must be undertaken to determine the method of decontamination
required. Items not in close contact with patients or their immediate surroundings, e.g., floors, walls,
ceiling, sinks and drains, present a minimal risk to patients and do not usually require disinfection. In
most cases cleaning with a neutral detergent and warm water will be sufficient.
Disinfection: describes a process that eliminates many or all pathogenic microorganisms,
except bacterial spores, on inanimate objects
Sterilization is a process that destroys or eliminates all forms of microbial life, including
bacterial spores
Routine cleaning is the standard, everyday procedure for cleaning of clinical areas, including
mopping of floors, damp dusting of surfaces with detergent, etc.
Terminal cleaning is performed when a patient with a transmissible illness is discharged (usually for
isolation rooms), e.g. MRSA and other drug-resistant bacteria, tuberculosis, Clostridium difficile. The
terminal cleaning process requires:
 Removal and discarding of all unused consumables and personal protective equipment (PPE)
from the room
 Removal and laundering of all linen
 Removal and safe disposal of all waste
 Washing of all surfaces with detergent (including walls to a height of 2 metres)
 Wiping of all surfaces with an appropriate disinfectant (including bed frame, mattress and
pillows). The IPC practitioner should be asked to advise on an appropriate disinfectant
(usually alcohol-based or chlorine-based disinfectants at an appropriate strength or dilution).
Remember that chlorine can be corrosive (causing damage to metal surfaces).
 Allowing all surfaces to dry before admission of a new patient.
Cleaning Methods
Dry Methods
 Dust attractant mop
 Dry dusting is not recommended as it may disperse dust and micro-organisms
 Sweeping brushes must not be used in clinical areas as they disperse dust and micro-organisms
Wet Methods
 Scrubbing
 Mopping
 Damp dusting
Once an item is washed it also needs to be rinsed and usually dried. Thorough rinsing with
clean water removes any soap residue that can interfere with sterilization or HLD.3 After
rinsing, items should be dried, especially if they will be sterilized or high-level disinfected
using chemical disinfectants. Water remaining on the items (e.g., surgical instruments)
dilutes the solution and may cause the process to fail
7.3.1 Purposes of cleaning
Cleaning in healthcare serves the dual functions of providing surface cleanliness and infection
prevention and control
Cleaning holds special importance for hospitals and other healthcare facilities. The healthcare
industry represents a significant population for health studies on cleaners because of the
intensive and frequent cleaning with a wide range of cleaning and disinfecting products.
While the aesthetic benefits of cleaning are necessary for attracting and retaining patients,
cleaning and disinfection play an essential role in healthcare settings by preventing healthcare-
associated infections (HAIs)
Cleaning is important because:
 It is an effective way to reduce the number of microorganisms, especially endospores that
cause tetanus, on soiled instruments and equipment.
 Neither sterilization nor high-level disinfection is effective without prior
A thorough washing with soap and clean water also physically removes organic material such
as blood and body fluids.2 This is important because dried organic material can entrap
microorganisms, including endospores, in a residue that protects them against sterilization or
disinfection. Organic matter also can partially inactivate some high-level disinfectants,
rendering them less effective (AORN 1992; Rutala et al 1998).
Use of soap is important for effective cleaning because water alone will not remove protein,
oils and grease (Nyström 1981). The use of hand (bar) or powdered soap is discouraged
because the fatty acids in bar soap react with the minerals in hard water leaving a residue or
scum (insoluble calcium salt), which is difficult to remove. Using liquid soap, if available, is
preferable because it mixes more easily with water than bar or powdered soaps. In addition,
liquid soap breaks up and dissolves or suspends grease, oil and other foreign matter in
solution so that they can be removed more easily by the cleaning process.
7.3.2 Maintaining a clean work place
The importance of a clean workplace
The workplace environment influences employees‘ productivity, performance and well-being. No
matter the industry, maintaining a clean workplace may help keep staff members safe, healthy and
efficient. However, busy production schedules and increasing workloads may cause standards to dip.
Essential to safety
 When employees work in a messy environment, they may not notice all hazards, which
increases the risk of an accident. According to the Occupational Safety and Health
Administration (OSHA), an occupational hazard is anything in the workplace that may cause
harm.
An occupational hazard is commonly caused by neglect on the part of the employer or a lack of
awareness by workers. When the office or worksite isn‘t clean, it may increase the chance that a
hazard will go unnoticed by a supervisor and staff members.
Employers may want to remember to keep the workplace free of debris and remind workers to put all
equipment, such as personal protective equipment (PPE), in designated places to prevent an accident.
Crucial to health
 Flu season is rapidly approaching and workplaces may see an increase in the number of
employees using sick days if they become ill. According to Kimberly-Clark Professional,
germs can spread quickly through the workplace if supervisors and employees don‘t
adequately sanitize their hands and their workspaces. Commonly used spaces, such as break
rooms, can be hot spots for germs to accumulate.
Cleanliness is crucial in healthcare settings
 Controlling the spread of infections or viruses is vitally important in many different locations
and settings – such as schools, leisure centres and the workplace – but it is even more crucial
for healthcare providers. People visiting or receiving treatment in these environments are
already vulnerable to the spread of infection, so making sure that effective cleaning regimes
are in place for waiting rooms, corridors, reception areas and wards is key. A clean and
welcoming environment is also important from an aesthetic point of view, engendering
feelings of well-being and trust in people who may be anxious or unwell.
The steps for cleaning are:
 Wear gloves while cleaning instruments and equipment. (Thick household or utility gloves
work well.)
 Wear protective eyewear (plastic visors, face shields, goggles, or glasses), protective shoes,
and a plastic apron, if available, while cleaning instruments and equipment to minimize the
risk of splashing contaminated fluids into the eyes and onto the body.
 Using a soft brush or old toothbrush, detergent, and water, scrub instruments and other items
vigorously to completely remove all blood, other bodily fluids, tissue, and other foreign
matter. Hold items under the surface of the water while scrubbing and cleaning to avoid
splashing. Disassemble instruments and other items with multiple parts, and be sure to brush
in the grooves, teeth, and joints of items where organic materials can collect and stick.
 Rinse items thoroughly with clean water to remove all detergent. Any detergent left on the
items can reduce the effectiveness of further chemical processing.
 Allow items to air dry (or dry them with a clean towel).
The guidance goes on to say that the arrangements for cleaning should include:
 Clear definition of specific roles and responsibilities for cleaning
 Clear, agreed and available cleaning routines
 Sufficient resources dedicated to keeping the environment clean and fit for purpose
 Consultation with Infection Control Teams (ICTs) or equivalent local expertise on cleaning
protocols when internal or external contracts are being prepared
 Details of how staff can request additional cleaning, both urgently and routinel
6 Reasons Why a Clean Workplace Means a Safe Workplace

A clean workplace means more than just having a sparkling, fresh building. A clean workplace also
ensures the safety and health of employees and visitors. In 2012 alone, nearly 3 million nonfatal
workplace injuries and illnesses were reported by private industry employers. Workplace injuries can
be prevented by taking action to ensure a clean, safe work environment.
Here are six reasons why a clean workplace also means a safe workplace:
1. Clean, dry floors to prevent slips and falls.
 Maintaining clean, dry floors is essential for the prevention of slips and falls in the
workplace.
2. Disinfectants prevent the spread of germs and illness, including the flu.
 Germs can easily spread throughout a workplace, particularly during flu season—but
disinfecting surfaces and objects stop germs in their tracks.
3. Proper air filtration lowers employee exposure to hazardous substances.
 Dusts and vapors are hazardous substances that can create an unsafe environment for
employees. Building ventilation is one important factor in reducing airborne transmission of
respiratory infections and maintaining the health and productivity of workers. Regularly
cleaning prevents them from becoming saturated, which could lead to potential microbial
growth and odor concerns..
4. Clean light fixtures improve lighting efficiency.
 Dirty light fixtures can reduce essential light levels, making it difficult and unsafe for
employees to complete their daily tasks. Clean light fixtures significantly improve
lighting efficiency in the workplace.
5. Green cleaning products are safer for both your employees and the environment.
 Not all cleaning products are the same, and some are held to a higher standard than
others. Products with third-party certifications, such as Green Seal or
GREENGUARD, must meet specific standards and guidelines, which ensures they‘re
safer for both people and the environment.
6. Proper disposal of waste and recyclable materials keeps work areas clutter-free.
 Allowing trash to pile up not only produces clutter, but it also presents a breeding
ground for pests that pose a threat to your work environment. Placing ―no-touch‖
wastebaskets in key locations throughout your facility ensures materials are disposed
of and reduces the spread of germs. Recycling materials using clearly labeled waste
receptacles also makes for a more sustainable environment.
7.3.3 General Principles of Cleaning
1. Ensure any electrical equipment to be cleaned is unplugged before commencing the
decontamination cleaning. (Ensure cold chain for vaccine storage is maintained if fridge is
unplugged).
2. Refer to the health and safety data sheets before using any product.
3. Display warning signs in the area, ensuring all signs are visible.
4. Wear suitable personal protective equipment. For most tasks gloves and aprons are sufficient. If
there is the potential of a splash/irritation to the conjunctiva or mucous membranes face protection
such as a mask and visor or goggles must be worn.
5. Prepare a fresh solution of cleaning agent or disinfectant as required.
6. Do not over-wet the floor.
7. Clean using lightly moistened clean disposable cloths (color coded as per National Hospital Office,
below).The number of cloths required for cleaning per room depends on the level of activity being
carried out e.g one for patient examination area, one for desk area, one for washbasin to prevent
transfer of microorganism from one area to another.
8. Particular attention should be given to frequently touched surfaces and those most likely to be
contaminated with blood or body fluids e.g., toilet seats/flush handles, sinks/taps and doorknobs.
9. Sodium hypochlorite may damage metal surfaces. Remove disinfectant solution with clean water
and dry with a disposable paper towel.
10. Dry equipment with paper towel.
11. Change gloves and perform hand hygiene between different tasks.
12. Dispose of solution in the toilet or designated household sink. Do not discard into wash hand
basins
13. Dispose of cleaning cloth.
14. All chemicals must be used in accordance with manufacturer‘s instructions to ensure correct
dilution and usage. These should be stored in a locked cupboard/room safely away from public
access.
15. All equipment should be left clean, dry and tidy in storage area after use.
16. Do not use abrasive cleaners (e.g., Vim® or Comet®) or steel wool because these products can
scratch or pit metal or stainless steel. These scratches then become a nesting place for
microorganisms, making cleaning more difficult, as well as increasing the chance of corrosion
(rusting).
7.4 Cleaning agents
All work surfaces must be cleaned correctly both before and after each session and when visibly
soiled. There are different procedures depending on the level of risk; that is, the probability and the
consequences of contamination. The following outlines some of the cleaning products that are
commonly used in cleaning different surfaces in different areas.
Detergents
 When dealing with non-critical areas, detergent and warm water is all that is needed to clean
the work area.
 Typically, detergents with a neutral pH are used. This means that they are neither alkaline nor
acidic. Both alkaline and acidic substances can damage the skin and eyes and will also reduce
the life of equipment and furnishings.
 Detergents with a neutral pH are far gentler and they clean most work areas effectively.
 Always complete any documentation necessary to indicate that cleaning has been carried out
Sanitisers and disinfectants
 Stronger cleaning products can be used when appropriate. These vary in strength:
o Low-level disinfectants are effective in killing some bacteria and viruses; these can be
used in most domestic settings.
o Medium-level disinfectants are effective at killing a range of bacteria and viruses;
these should be used if clients have tuberculosis or where there is a high likelihood
that tuberculoid-causing pathogens are present.
High-level disinfectants are effective in killing all pathogens except for bacterial spores; these
disinfectants should be used when cleaning medical equipment
Written Test
Self-Check 3
1. __________is the removal of visible soil, organic, and inorganic contamination from a device or
surface.
A. Disposing
B. Disinfecting
C. Sterilization
D. Cleaning
2. An occupational hazard is commonly caused by
A. neglect on the part of the employer
B. lack of awareness by workers
C. When the office or worksite isn‘t clean
D. ALL
E.


Rating: ____________
Name: _________________________ Date: _______________
2. ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Information Sheet 4 decontamination of equipments
a. Instruments processing
One area of infection prevention and control (IPC) in health facilities is the proper processing of
instruments and other items that have come in contact with patients‘ bodily fluids. It is critical in
reducing the transmission of infections during clinical procedures and patient care.
Every item, whether it is soiled metal instruments or a pair of surgical gloves, requires special
handling and processing in order to minimize the risk of accidental injury or blood or body fluid
exposure to cleaning and housekeeping staff; provide a high-quality end product (i.e., sterile or high-
level disinfected instruments and other items).
The basic IPC practices recommended to reduce disease transmission from soiled instruments and
other reusable items are decontamination, cleaning, and either sterilization or HLD.
After completing an operation or invasive medical procedure, and while still wearing gloves, the
health worker should
 Dispose of contaminated objects (gauze or cotton and other waste items) in a plastic bag or leak-
proof, covered container.
 Next, disposable sharps (e.g., scalpel blades and suture needles) should be placed in a sharps
container.
 Finally, all instruments and reusable items such as surgical gloves and suction cannulas, whether or
not they were used in the operation, should be decontaminated by soaking for 10 minutes in a
disinfectant (e.g., 0.5 percent chlorine solution).
Following decontamination
 The instruments and reusable items should be thoroughly cleaned with soap and water,
completely rinsed, and dried.
 The surgical instruments and those items that come in contact with the bloodstream or that
normally touch sterile tissue beneath the skin (critical items) should be sterilized to destroy
all microorganisms including bacterial endospores.
o When sterilization is not feasible or equipment is not available, however, HLD by
boiling, steaming, or soaking in a chemical disinfectant is the only acceptable
alternative.
 Instruments and other items that touch only mucous membranes or broken skin (semi-critical
items), however, only need to be high-level disinfected
Important Definitions
Decontamination: This is a process that makes inanimate objects safer to be handled by staff before
cleaning (i.e., inactivates HBV, HCV, and HIV, and reduces the number of other microorganisms but
does not eliminate them).
Cleaning: A 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. It consists of thoroughly washing with soap or detergent and
water, rinsing with clean water, and drying.
HLD: A process that eliminates all microorganisms except some bacterial endospores from inanimate
objects by boiling, steaming, or using chemical disinfectants.
Sterilization: A process that eliminates all microorganisms (bacteria, viruses, fungi, and parasites)
including bacterial endospores from inanimate objects by high-pressure steam (autoclave), dry heat
(oven), chemical sterilants, or radiation
Chemical Disinfectants
Disinfectants are chemicals that destroy or inactivate microorganisms on inanimate objects, such as
instruments and surfaces. Disinfectants are not meant to be used on the skin or mucous membranes.
Many disinfectants are used alone or in combination (e.g., hydrogen peroxide and peracetic acid) in
the health care setting. In most instances, a given product is designed for a specific purpose and is to
be used in a certain manner. Therefore, users should read labels carefully to ensure the correct product
is selected for the intended use and applied efficiently.
Decontamination
In instrument processing, decontamination is the first step in handling used instruments and gloves.
Decontamination inactivates HBV, HCV, and HIV and reduces the number of microorganisms. It is
one of the most highly effective IP measures that can minimize the risk of transmission of these
viruses to health care workers, especially cleaning and housekeeping staff, when they handle soiled
medical instruments, surgical gloves, or other items. The objective of decontamination is to protect
individuals who handle surgical instruments and other items that have been in contact with blood or
bodily fluids from serious diseases.
Before cleaning, all soiled surgical instruments, surgical gloves, and other items should be first
decontaminated by placing them in a 0.5 percent chlorine solution for 10 minutes. Because of the
potentially high load of microorganisms and/or other organic material (blood or other bodily fluids) on
soiled items, using a 0.5 percent solution for decontamination
Decontaminating Used Instruments and Other Items
1. Place all instruments in a 0.5 percent chlorine solution for 10 minutes immediately after
completing the procedure
2. Decontaminate any surfaces contaminated during the procedure by wiping them with a cloth
soaked in a 0.5 percent chlorine solution.
3. Immerse gloved hands in a 0.5 percent chlorine solution.
4. Remove gloves by turning inside out. If disposing of gloves, place them in a leak-proof
container or heavy-duty plastic container.
5. If reusing gloves, soak in a 0.5 percent chlorine solution for 10 minutes for decontamination.
6. Remove instruments from the 0.5 percent chlorine solution after 10 minutes and immediately
rinse them with cool water to remove residual chlorine before being thoroughly cleaned.
7. Two buckets can be used in the procedure areas or operating rooms, one filled with 0.5 percent
chlorine solution and one with water, so instruments can be placed in the water after 10
minutes to help prevent corrosion.
a. Use a plastic container for decontamination to help prevent:
i. Dulling of sharps (e.g., scissors) due to contact with metal containers
ii. Rusting of instruments
Key steps in processing instruments and other items
Cleaning
After decontamination, cleaning is the next step in instrument processing. Cleaning is a
process of physically removing infectious agents and other organic matter on which they live
and thrive. This process does not necessarily destroy infectious agents. This is important
because dried organic material can entrap microorganisms, including endospores, in a residue
that protects them against sterilization or disinfection. Cleaning is an essential prerequisite to
ensure effective disinfection or sterilization. Neither sterilization nor HLD could be effective
without prior cleaning
Recall the steps of cleaning from chapter six
Sterilization and Storage
Sterilization is the destruction of all microorganisms, including bacterial endospores.
Sterilization in health facilities can be achieved by high-pressure steam (autoclaves), dry heat
(oven), chemical sterilants (glutaraldehyde or formaldehyde solutions), or physical agents
(radiation).
To be effective, sterilization requires time, contact, temperature, and, with steam sterilization,
high pressure. Because sterilization is a process, not a single event, all components must be
carried out correctly for sterilization to occur. The effectiveness of any method of sterilization
is also dependent on the following four factors:
1. The type of microorganism present.
2. The number of microorganisms present.
3. The amount and type of organic material that protects the microorganisms. Blood or tissue
remaining on poorly cleaned instruments acts as a shield to microorganisms during the
sterilization process.
4. The number of cracks and crevices on an instrument that might harbor microorganisms.
Methods of Heat Sterilization
The most common and readily available sterilization methods are:
1. High-pressure steam sterilization (autoclaves)
2. Dry heat sterilization (oven)
3. Chemical sterilization
High-Pressure Steam Sterilization (Autoclaves)
High-pressure steam sterilization (autoclave) is an effective method of sterilization but is the
most difficult to do correctly.
The temperature, pressure, and time combinations for steam sterilization are as follows:
 At a temperature of 121°C (250°F), pressure of 106 kPa (15 lb/in2) for 20 minutes for
unwrapped items and 30 minutes for wrapped items.
 At a higher temperature of 132°C (270°F), pressure of 30 lb/in2 for 15 minutes for wrapped
items
Note: Pressure settings (kPa or lb/in2) may vary slightly depending on the sterilizer used.
When possible, follow the manufacturer‘s recommendations.
The two reasons why steam sterilization is an effective sterilization are as follows:
 Saturated steam is an extremely effective carrier of thermal energy that makes it many times
more effective in conveying the necessary energy to the items to be sterilized than dry air.
 Steam is an effective sterilant because any resistant, protective outer layer of the
microorganisms can be softened by steam, allowing coagulation of the inner sensitive portion
of the microorganisms.
Advantages:
• Most commonly used effective method of sterilization.
• Sterilization cycle time is shorter than with dry heat or chemical sterilants.
Limitations:
• Requires a continuous source of heat (wood fuel, kerosene, or electricity).
• Requires equipment (steam sterilizer) that must be expertly maintained to keep it in
working condition.
• Requires strict adherence to time, temperature, and pressure settings.
• Difficult to produce dry packs because breaks in procedure are common (e.g., not allowing
items to dry before removing, especially in hot, humid climates).
• Repeated sterilization cycles can cause pitting and dulling of cutting edges of instruments
(i.e., scissors).
• Plastic items cannot withstand high temperatures.
Preparing Items for Steam Sterilization
All instruments and other items should be decontaminated and thoroughly cleaned and dried before
being sterilized. All jointed instruments should be open (or in the unlocked position) and
disassembled. Reusable cloth items should be laundered and dried prior to sterilization.
Packing and Wrapping
Wrapping items to be sterilized permits sterile items to be handled and stored without being
contaminated. Materials used for wrappers should:
• Allow air removal and steam penetration
• Act as a barrier to microorganisms and fluids
• Resist tears and punctures and be free of holes
• Be inexpensive
Dry Heat Sterilization (Oven)
Dry heat sterilization is caused by hot air that destroys microorganisms through oxidation that causes
slow destruction of the microorganisms‘ protein. Initially heat is absorbed by the exterior surface of an
item and then passed to the next layer. Eventually, the entire object reaches the temperature needed for
sterilization. Dry heat sterilization can be achieved with a simple oven as long as a thermometer is
used to verify the temperature inside the oven.
Advantages:
• Effective method, as dry heat by conduction reaches all surfaces of instruments, even of
instruments that cannot be disassembled
• Protective of sharps or instruments with a cutting edge (fewer problems with dulling of
cutting edges)
• Leaves no chemical residue
• Eliminates ―wet pack‖ problems in humid climates
Limitations:
Plastic and rubber items cannot be dry heat sterilized because temperatures used (160–170°C) are too
high for these materials.
• Dry heat penetrates materials slowly and unevenly.
• It requires oven and continuous source of electricity.
Instructions for Dry Heat Oven
To ensure correct operation, consult specific operating instructions supplied by the oven‘s
manufacturer.
• Step 1: Decontaminate, clean, and dry all instruments and other items to be sterilized.
• Step 2: If desired, wrap instruments in aluminum foil or place in a metal container with a
tight-fitting, closed lid. Wrapping helps prevent recontamination prior to use. Hypodermic
or suture needles should be placed in glass tubes with cotton stoppers.
 Note: When using dry heat to sterilize instruments wrapped in cloth, be sure that the
temperature does not exceed 170°C/340°F.
• Step 3: Place loose (unwrapped) instruments in metal containers or on trays in the oven
and heat to desired temperature.
• Step 4: After the desired temperature is reached, begin timing
 Note: Use dry heat only for items that can withstand a temperature of 170°C (340°F).
Needles and other instruments with cutting edges should be sterilized at lower
temperatures (160°C [320°F]), because higher temperatures can destroy the sharpness
of cutting edges.
 Depending on the temperature selected, the total cycle time (preheating, sterilization
time, and cool down) will range from about 2.5 hours at 170°C to more than 8 hours at
121°C.
• Step 5: After cooling, remove packs and/or metal containers and store. Loose items should
be removed with sterile forceps/pickups and used immediately or placed in a sterile
container with a tight-fitting lid.
Chemical Sterilization
Some high-level disinfectants will kill endospores after prolonged (10- to 24-hour) exposure.
If objects need to be sterilized, but using high-pressure steam or dry heat sterilization would
damage them or equipment is not available (or operational), they can be chemically sterilized.
Common disinfectants that can be used for chemical sterilization include glutaraldehydes and
formaldehyde. Sterilization takes place by soaking for at least 10 hours in 2 to 4 percent
glutaraldehyde solution or at least 24 hours in 8 percent formaldehyde. Glutaraldehydes, such
as Cidex, are often in short supply and very expensive, but they are the only practical
sterilants for some instruments, such as laparoscopes, that cannot be heated. Both
glutaraldehydes and formaldehyde require special handling and leave a residue on treated
instruments; therefore, rinsing with sterile water is essential if the item must be kept sterile.
Advantages:
• Glutaraldehydes and formaldehyde solutions are not readily inactivated by organic
materials.
• Both can be used for items that will not tolerate heat sterilization such as laparoscopes.
• Formaldehyde solutions can be used for up to 14 days (replace sooner if cloudy); some
glutaraldehydes can be used for up to 28 days.
Limitations:
• Glutaraldehydes and formaldehyde are chemicals that cause skin irritation; therefore, all
equipment soaked in either solution must be thoroughly rinsed with sterile water after
soaking.
Storage of Sterile Instruments and Items
All sterile items should be stored appropriately to protect them from dust, dirt, moisture,
animals, and insects. The storage area should be located next to or connected to where
sterilization occurs and in a separate enclosed area with limited access that is used only to
store sterile and clean patient care supplies.
Instructions for Storing Sterile Items
1. Keep the storage area clean, dry, dust-free, and lint-free.
2. Control temperature and humidity (approximate temperature 24°C and relative humidity less
than 70 percent) when possible.
3. Packs and containers with sterile (or high-level disinfected) items should be stored 20 to 25 cm
off the floor, 45 to 50 cm from the ceiling, and 15 to 20 cm from an outside wall.
4. Do not use cardboard boxes for storage. Cardboard boxes shed dust and debris and may harbor
insects.
5. Date and rotate the supplies (first in/first out). This process serves as a reminder, but does not
guarantee sterility of the packs.
6. Distribute sterile and high-level disinfected items from this area.
High-Level Disinfection and Storage
When sterilization equipment is either not available or not suitable, HLD is the only
acceptable alternative method for the final processing of instruments. The HLD process
destroys all microorganisms (including vegetative bacteria, tuberculosis, yeasts, and viruses)
except some bacterial endospores.
HLD can be achieved by:
 Boiling in water
 Steaming (moist heat)
 Soaking instruments in chemical disinfectants (chemical disinfection)
Boiling
Boiling in water is an effective, practical way to high-level disinfect instruments and other
items. Although boiling instruments in water for 20 minutes will kill all vegetative forms of
bacteria, viruses (including HBV, HCV, and HIV), yeasts, and fungi, boiling will not reliably
kill all endospores.
Steps for High-Level Disinfection by Boiling
• Step 1: Decontaminate and clean all instruments and other items to be high-level
disinfected
• Step 2: If possible, completely immerse items in water. Adjust the water level so that there
is at least 2.5 cm (1 inch) of water above the instruments. In addition, make sure all bowls
and containers to be boiled are full of water. For example, empty bowls that turn bottom
side up and float to the surface contain air pockets.
• Step 3: Close lid over pan and bring water to a gentle, rolling boil. (Boiling too vigorously
wastes fuel, rapidly evaporates the water, and may damage delicate [or sharp] instruments
or other items.) Hence, a gentle rolling boil is sufficient and will prevent instruments or
other items from being bounced around and possibly damaged by striking other
instruments or the side walls of the boiling pot.
• Step 4: Boil all items for 20 minutes. Start timing when the water begins to boil.
• Step 5: After boiling for 20 minutes, remove objects with previously high-level
disinfected forceps. Never leave boiled instruments in water that has stopped boiling. As
the water cools and steam condenses, air and dust particles are drawn down into the
container and may contaminate those instruments.
• Step 6: Use instruments and other items immediately, or with high-level disinfected
forceps or gloves, place objects in a high-level disinfected container with a tight-fitting
cover. Once the instruments are dry, if any pooled water remains in the bottom of the
container, remove the dry items and place them in another high-level disinfected container
that is dry and can be tightly covered
Steaming
The best method for HLD of gloves and a useful method of HLD of cannulas used during MVA is to
steam them in a steamer containing one to three tiers of gloves or cannulas.
Steps for High-Level Disinfection by Steaming

After instruments and other items have been decontaminated and thoroughly cleaned, they are ready
for HLD by steaming.
 Step 1: Place instruments, plastic MVA cannulas, and other items in one of the steamer pans
with holes in its bottom. To make removal from the pan easier, do not overfill the pan.
 Step 2: Repeat this process until up to three steamer pans have been filled. Stack the filled
steamer pans on top of a bottom pan containing water for boiling. A second empty pan without
holes should be placed on the counter next to the heat source.
o Remember: Be sure there is sufficient water in the bottom pan for the entire 20
minutes of steaming.
 Step 3: Place a lid on the top pan and bring the water to a full rolling boil. (When water only
simmers, very little steam is formed and the temperature may not get high enough to kill
microorganisms.)
 Step 4: When steam begins to come out between the pans and the lid, start the timer or note
the time on a clock and record the time in the HLD log.
 Step 5: Steam items for 20 minutes.
 Step 6: Remove the top steamer pan and put the lid on the pan that was below it (the pan now
on top). Gently shake excess water from the pan just removed.
 Step 7: Put the pan that was just removed onto the empty pan (see Step 3). Repeat until all
pans are restacked on this empty pan and the top pan is covered with the lid. (This step allows
the items to cool and dry without becoming contaminated.)
 Step 8: Allow items to air dry in the steamer pans (one to two hours) before using.
 Step 9: Using a high-level disinfected forceps, transfer the dry items to a dry, high-level
disinfected container with a tight-fitting cover. Instruments and other items can also be stored
in the stacked and covered steamer pans as long as a bottom pan (no holes) is used.
Soaking Instruments in Chemical Disinfectants
Although a number of disinfectants are commercially available in most countries, four
disinfectants—chlorine, glutaraldehydes, formaldehyde, and peroxide—are routinely used as
high-level disinfectants. A high-level disinfectant should be selected for use based on the
characteristics of the items to be disinfected, the physical area (i.e., is it well ventilated?), and
the skills of personnel available to do the procedure.
HLD by chlorine solutions
 Prepare 0.1 percent chlorine solution using boiled water that has been filtered if the tap water
is cloudy.
 Soak for 20 minutes.
Formaldehyde
 Use 8 percent formaldehyde, which is inexpensive and readily available.
Hydrogen peroxide
 Use a 6 percent solution. The 3 percent hydrogen peroxide solutions used as antiseptics should
not be used as a disinfectant.
Glutaraldehydes
 Use a 2 to 4 percent solution.
 Soak for 20 minutes at 25°C.
Key Steps in Chemical High-Level Disinfection
 Decontaminate instruments and other items that may have been contaminated with blood and
bodily fluids, and thoroughly clean and dry them before placing them in the disinfectant
solution.
 Completely immerse all items in the high-level disinfectant.
 Remove items using high-level disinfected or sterile forceps or gloves.
 Rinse well with boiled and filtered (if necessary) water three times and air dry
 Use promptly or store in a dry, high-level disinfected, covered container.
Written Test
Self-Check 4
3. A process that makes inanimate objects safer to be handled is

A. Decontamination
B. Chlorination
C. Boiling
D. Incineration
4. Which of the following method of instrumental processing is used to eliminates all

microorganisms including bacterial endospores from inanimate objects
A. HLD
B.Sterilization
C.Contamination
D. Decontamination
5. The effectiveness of any method of sterilization is also dependent on the following four
factors:
A. The type of microorganism present.
B. The number of microorganisms present.
C. The amount and type of organic material that protects the microorganisms.
D. The number of cracks and crevices on an instrument
E. ALL
6. _________is an effective method of sterilization but is the most difficult to do correctly
A. High-pressure steam sterilization
B.Dry Heat Sterilization
C.Chemical sterilization
D. Incineration
7. The first step in processing of instrument is
A. HLD
B.Sterilization
C.Contamination
D. Decontamination


Rating: ____________
Information Sheet 6
Storage of Sterile Instruments and Items

All sterile items should be stored appropriately to protect them from dust, dirt, moisture,
animals, and insects. The storage area should be located next to or connected to where
sterilization occurs and in a separate enclosed area with limited access that is used only to
store sterile and clean patient care supplies.
insects.
SHELF LIFE
 The shelf life of an item (how long items can be considered sterile) after sterilization is
event-related. An item remains sterile until something causes the package or container to
become contaminate—time elapsed since sterilization is not the determining factor.
 To make sure items remain sterile until you need them, prevent events that can
contaminate sterile packs, & protect them by placing them in plastic covers (thick
polyethylene bags). An event can be a tear or worn area in the wrapping, the package
becoming wet or anything else that will enable microorganism to enter the package or
container.
 Before using any sterile item, look at the package to make sure the wrapper is intact and
the seal unbroken and is clean and dry (as well as having not water stains).
 If the quality of wrapping cloth is poor and plastic bags are not available, limiting the shelf
life is a reasonable option to ensure the sterility of the instruments
Written Test
Self-Check 7
Instructions: Answer all the questions listed below. Illustrations may be necessary to aid
some explanations/answers. Write your answers in the sheet provided in the next page

2. Control temperature and humidity (approximate temperature 24°C and relative humidity
less than 70 percent) when possible.
3. Do not use cardboard boxes for storage.
Decontaminating Used Instruments and Other Items
Operation Sheet 1
1. Place all instruments in a 0.5 percent chlorine solution for 10 minutes immediately after
completing the procedure
2. Decontaminate any surfaces contaminated during the procedure by wiping them with a cloth
soaked in a 0.5 percent chlorine solution.
3. Immerse gloved hands in a 0.5 percent chlorine solution.
4. Remove gloves by turning inside out. If disposing of gloves, place them in a leak-proof
container or heavy-duty plastic container.
5. If reusing gloves, soak in a 0.5 percent chlorine solution for 10 minutes for decontamination.
6. Remove instruments from the 0.5 percent chlorine solution after 10 minutes and immediately
rinse them with cool water to remove residual chlorine before being thoroughly cleaned.
7. Two buckets can be used in the procedure areas or operating rooms, one filled with 0.5 percent
chlorine solution and one with water, so instruments can be placed in the water after 10
minutes to help prevent corrosion.
8. Use a plastic container for decontamination to help prevent:
i. Dulling of sharps (e.g., scissors) due to contact with metal containers
ii. Rusting of instruments
Instructions: Given necessary templates, tools and materials you are required to perform
the following tasks within 5min.
Task 1: Perform Decontamination
Instructions for Dry Heat Oven
Operation Sheet 2
Step 1: Decontaminate, clean, and dry all instruments and other items to be sterilized.
Step 2: If desired, wrap instruments in aluminum foil or place in a metal container with a tight-fitting,
closed lid. Wrapping helps prevent recontamination prior to use. Hypodermic or suture needles should
be placed in glass tubes with cotton stoppers.
 Note: When using dry heat to sterilize instruments wrapped in cloth, be sure that the
temperature does not exceed 170°C/340°F.
Step 3: Place loose (unwrapped) instruments in metal containers or on trays in the oven and heat to
desired temperature.
Step 4: After the desired temperature is reached, begin timing
 Note: Use dry heat only for items that can withstand a temperature of 170°C (340°F).
Needles and other instruments with cutting edges should be sterilized at lower
temperatures (160°C [320°F]), because higher temperatures can destroy the sharpness
of cutting edges.
 Depending on the temperature selected, the total cycle time (preheating, sterilization
time, and cool down) will range from about 2.5 hours at 170°C to more than 8 hours at
121°C.
Step 5: After cooling, remove packs and/or metal containers and store. Loose items should be
removed with sterile forceps/pickups and used immediately or placed in a sterile container with a tight-
fitting lid
LAP Test
Name: _____________________________ Date: ________________

Task 1: Perform dry heat sterilization
Operation Sheet 3
Steps for Storing Sterile Items

insects.
LAP Test
Name: _____________________________ Date: ________________

Task 1: Perform storing of sterile items
Operation Sheet 4 High-Level Disinfection by Boiling
 Steps for High-Level Disinfection by Boiling

1. Decontaminate and clean all instruments and other items to be high-level disinfected
2. If possible, completely immerse items in water.
 Adjust the water level so that there is at least 2.5 cm (1 inch) of water above the
instruments. In addition, make sure all bowls and containers to be boiled are full of
water. For example, empty bowls that turn bottom side up and float to the surface
contain air pockets.
3. Close lid over pan and bring water to a gentle, rolling boil. (Boiling too vigorously wastes
fuel, rapidly evaporates the water, and may damage delicate [or sharp] instruments or other
items.) Hence, a gentle rolling boil is sufficient and will prevent instruments or other items
from being bounced around and possibly damaged by striking other instruments or the side
walls of the boiling pot.
4. Boil all items for 20 minutes. Start timing when the water begins to boil.
5. After boiling for 20 minutes, remove objects with previously high-level disinfected forceps.
Never leave boiled instruments in water that has stopped boiling.
 As the water cools and steam condenses, air and dust particles are drawn down into
the container and may contaminate those instruments.
 Use instruments and other items immediately, or with high-level disinfected forceps or
gloves, place objects in a high-level disinfected container with a tight-fitting cover.
 Once the instruments are dry, if any pooled water remains in the bottom of the
container, remove the dry items and place them in another high-level disinfected
container that is dry and can be tightly covered
Task 1: Perform High-Level Disinfection by Boiling
Operation Sheet 5 High-Level Disinfection by Steaming
Steps for High-Level Disinfection by Steaming.
1. Place instruments, plastic MVA cannulas, and other items in one of the steamer pans with
holes in its bottom. To make removal from the pan easier, do not overfill the pan.
2. Repeat this process until up to three steamer pans have been filled. Stack the filled steamer
pans on top of a bottom pan containing water for boiling. A second empty pan without holes
should be placed on the counter next to the heat source.
 Remember: Be sure there is sufficient water in the bottom pan for the entire 20 minutes
of steaming.
3. Place a lid on the top pan and bring the water to a full rolling boil. (When water only
simmers, very little steam is formed and the temperature may not get high enough to kill
microorganisms.)
4. When steam begins to come out between the pans and the lid, start the timer or note the time
on a clock and record the time in the HLD log.
5. Steam items for 20 minutes.
6. Remove the top steamer pan and put the lid on the pan that was below it (the pan now on top).
Gently shake excess water from the pan just removed.
7. Put the pan that was just removed onto the empty pan (see Step 3). Repeat until all pans are
restacked on this empty pan and the top pan is covered with the lid. (This step allows the items
to cool and dry without becoming contaminated.)
8. Allow items to air dry in the steamer pans (one to two hours) before using.
9. Using a high-level disinfected forceps, transfer the dry items to a dry, high-level disinfected
container with a tight-fitting cover. Instruments and other items can also be stored in the
stacked and covered steamer pans as long as a bottom pan (no holes) is used.
Task 1: Perform High-Level Disinfection by Steaming
Operation Sheet 6 Disinfecting by high level chemical
Steps in Disinfection High-Level Chemical

1. Decontaminate instruments and other items that may have been contaminated with
blood and bodily fluids, and thoroughly clean and dry them before placing them in the
disinfectant solution.
2. Completely immerse all items in the high-level disinfectant.
3. Soak for 20 minutes.
4. Remove items using high-level disinfected or sterile forceps or gloves.
5. Rinse well with boiled and filtered (if necessary) water three times and air dry
6. Use promptly or store in a dry, high-level disinfected, covered container
Task 1: Perform Disinfecting high-level chemical

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NILE-SIDE COLLEGE

LG Code:- HLT PHS3 M03 Lo1-Lo5

1.1.1. Basic concepts in transmission of communicable disease

Helminthes are worms made up of many cells; for example, Ascarislumbricoides.

Figure 2.2 shows some common transmission routes of faecal-oral infections.

2.2.4 Route of entry

2.2.5 Susceptible hosts and risk factors

Low levels of immunity could be due to:

 diseases like HIV/AIDS which suppress immunity

2.2.6 Route of exit

1. Identify the main types of infectious agents.

Note: Satisfactory rating – 8>points Unsatisfactory - below 8 points

Name: _________________________ Date: _______________

 Hand washing procedure,

 Use of personal protective equipment‘s,

 Safe handling of sharp items and

2.1. 1. Hand washing

Introduction to hand hygiene

Types of hand washing

“Bare below the Elbow as per dress Code Policy‖include:

 Sleeves should be short or rolled up

WHO “FIVE KEY moments for hand hygiene‖

 Before touching a patient

 Before clean/aseptic procedure

 Immediately/After bodily fluids exposure

 After touching a patient

 After touching patient surroundings

Additional Moments for Hand Hygiene

 Before commencing work/after leaving work area

 Before and after preparing or eating food

 Before handling medicines

 Before wearing & after removing gloves*

 After handling contaminated laundry & waste

 After contact with used equipment

 After using the toilet

 After cleaning equipment or the environment.

 Wet hands thoroughly all over.

 Use pH neutral soap.

 Lather soap all over hands.

 Rinse under running water.

 Pat hands dry with paper towels.

How to use an alcohol-based hand sanitizer

7. Steps To Wash Your Hands Properly

Step 2 - Rub your palms together.

Step 3 - Rub the back of each hand.

Step 4 -Rub both your hands while interlocking your fingers

Step 5 - Rub the back of your fingers.

Step 6 - Rub your thumbs and the ends of your wrists.

When to Wear Gloves

When to Double Glove

The steps for making elbow-length gloves are:

neck. For each client contact, a clean mask should be used.

Hazards of needle stick injuries

How do needle stick injuries occur ?

 Children with relatives or neighbors using needles.

 Cleaners of public toilets, parks, trains, and cinema seats.

 People who share needles for use with illegal drugs.

How can needle stick injuries be prevented?

o Get a vaccination against certain diseases, such as hepatitis, for protection.

Critical situations during clinical procedures include:

2.4.1. Key components of instrumental processing are

 Instructions for Preparing Dilute Chlorine Solutions

Decontamination practices are:

Unclasped the instruments before soaking.

Name: ___________ Date: _

Name: ___________ Date: _

Name: _____________ Date:

Name: ___________ Date: _