Prevention of infection in the

ward and operating room

Yidnekachew (MD)
 Outline of presentation
• Definition
• Infection prevention
• Hand washing and surgical hand scrub
• Using personal protective equipments
• Processing instruments
– Disinfection
– sterilization
• Health waste management
 Infection prevention
• Goal
– Preventing infection of a client as a result of
procedure
– Protecting both healthcare workers and
client from acquiring serious disease such as
HIV, HBV, HCV, HDV
 Introduction
• Traditional barrier precautions
– Hand hygiene and gloves
• Universal precautions
– Blood
• Body substance isolation
– Secretion, excretion and blood
• Standard precautions
• Transmission based precautions
• Isolation precautions
 Definition
• Asepsis and aseptic technique.
– Combination of efforts made to prevent entry of
micro-organisms into any area of the body where
they are likely to cause infection.
– The goal of asepsis is to reduce to a safe level, or
eliminate, the number of micro-organisms on both
animate (living)surfaces (skin and mucous
membranes) and inanimate objects (surgical
instruments and other items).
– Use of techniques such as gloves
 Definition
• Antisepsis.
– Process of reducing the number of micro-
organisms on skin, mucous membranes or
other body tissue by applying an
antimicrobial (antiseptic) agent.
– Use of chemicals
 Infection prevention
• is
– Washing your hands
– Using gloves
– Processing instruments and storage
– Safely disposing soiled instruments
 Hand washing & surgical hand scrub
• Most important procedure
• The decision to clean hands is based on:
– intensity of contact with patient and/or
blood and body fluids,
– likelihood of microbial transmission,
– patient’s susceptibility to infection, and
– procedure being performed.
 Hand washing & surgical hand scrub
• Hand washing should be done before:
– examining (direct contact with) a patient;
and
– putting on sterile or high-level disinfected
surgical gloves prior to an operation, or
examination gloves for routine procedures
such as a pelvic examination.
 Hand washing & surgical hand scrub
• Hand washing should be done after:
– any situation in which hands may become
contaminated, such as:
• handling soiled instruments and other items;
• touching mucous membranes, blood or other
body fluids (secretions or excretions);
• having prolonged and intense contact with a
patient; and
– removing gloves
 Hand washing & surgical hand scrub
• Use soap and water
• You can use
– Sink + running water
– Pitcher + a basin
• Steps
– Scrub for 15 – 30 seconds
– Rinse with clean running water
– Dry with clean towel or air
 Hand washing & surgical hand scrub
• For surgical hand scrub
– Use antiseptic soap
– Chlorhexidine
– Iodophor
– Alcohol (60-90 % + glycerine)
– Scrub with soft sponge brush for 3-5
minutes
– Clean with sterile towel
 Using gloves
• Barrier b/n you and blood and other body fluids
• 3 types of gloves
– Surgical gloves
• should be used when performing invasive medical or
surgical procedures.
• Can be single use or reusable
• Can be sterile or HLD
• Made of latex rubber, nitrile
– Examination gloves
• provide protection to healthcare workers when
performing many of their routine duties
• Made of made of vinyl
 Using gloves
– Utility (heavy duty) gloves
• should be worn for
– processing instruments, equipment and
other items;
– for handling and disposing of contaminated
waste; and
– when cleaning contaminated surfaces.
• Made of thick rubber,
 Using gloves
• Depending on the situation, clean examination or utility
gloves should be worn by all staff when:
– there is reasonable chance of hand contact with blood or
other body fluids, mucous membranes or non intact skin;
– they perform invasive medical procedures (e.g., inserting
vascular devices such as peripheral venous lines); or
– they handle contaminated waste items or touch
contaminated surfaces.
• Always wash your hands after wearing gloves b/c they may
have been thorned during procedure
 Processing instruments
• Risk of infection from equipment
– Low risk(non critical items) eg stethoscope
– Intermediate risk(semi critical items) come
in contact with mucous membrane eg
endoscopes
– High risk (critical items) are items that
penetrate sterile tissues such as body
cavities and vascular system eg surgical
instruments
 Spaulding classification
• Critical:
– These items & practices affect normally sterile tissues or
the blood system and represent the highest level of
infection risk.
• Semi-critical:
– These items and practices are second in importance and
affect mucous membranes and small areas of non intact
skin..
• Non-critical:
– Management of items and practices that involve intact skin
and represent the lowest level of risk.
 Processing instruments
• Before instruments used
– Decontamination
– Cleaning
– Sterilization or
– High level disinfection(HDL)
 Decontamination
• Process that makes inanimate objects safer to
be handled by staff before cleaning (i.e.,
inactivates HBV, HCV and HIV and reduces, but
does not eliminate, the number of other
contaminating micro-organisms).
 Decontamination
• Use
– 0.5 % chlorine solution (bleach + tap water) to soak for 10
minutes
– 70% ethyl or isopropyl alcohol and
– 0.5–3% phenolic compounds
• If no disinfectants are available for decontamination, extreme
care must be taken when handling and cleaning sharps (e.g.,
suture needles, scissors and scalpel blades).
• Hypodermic needles and syringes that are to be disposed of
should be decontaminated, placed in a puncture-resistant
sharps container and, when the container is three-quarters full,
burned, encapsulated or buried
 Cleaning
• Process that physically removes all visible
dust, soil, blood or other body fluids from
inanimate objects as well as removing
sufficient numbers of micro-organisms to
reduce risks for those who touch the skin or
handle the object.
 Cleaning
• four steps:
– Rinsing the object under cold water
– Applying detergent or soap and scrubbing object
– Rinsing the object under warm clean water
– Drying the object prior to sterilization or disinfection
• Washing with detergent + rinsing until visibly clean can
remove up to 80% of the micro organisms
• Use
– tooth brush, utility glove ,face mask
• Instruments should be cleaned for sterilization to be effective
 Sterilization
• Process that eliminates all micro-organisms
(bacteria, viruses, fungi and parasites)
including bacterial endospores from
inanimate objects by
 Types of Sterilization
• Steam under pressure(autoclave)
– Temperature should be 121 º C ,pressure should be 106 kPa ,
20-30 minutes for unwrapped items; 30 minutes for wrapped
items.
– More penetrative power than dry heat
– Coagulation & denaturation of protiens
– Control of sterilization
– Physical : T º chart recorder
– Chemical : Browne's tube (red to green)
– Biological : geobacillus stearothermophilus
– Culture media & dressings
– used in most hospital and microbiology laboratory settings
 Types of Sterilization
• Dry heat (hot air oven)
– Exposure to high temperature ,160 º for 2 hrs or 170 º for 1 hr
– Action
• Oxidative effects & Denaturation or coagulation of proteins
– Heat transferred by radiation , conduction and convection
– Should have
• Thermostat
• Temperature indicator
• Meshed shelves
• Adequate insulation
– Control of sterilization
• Physical : T º ,Time & pressure readings
• Chemical : Tape with lines(indicator strips) that change colour when
temperature has been reached Browne's tube (red to green)
• Biological :bacillus subtillis ,37 º ,3-5 days
 Types of Sterilization
• Chemical sterilization (cold sterilization).
– 2% glutaraldehyde (cidex) for 10 hrs
– 8% formaldehyde for 24 hrs
– Rinse with sterile water
– Sterile container with tight fitting container
• Radiation
 High level disinfection(HLD)
• The process that eliminates all microorganisms except some bacterial
endospores from inanimate objects eg tetanus
• Used if sterilization not available
• Types
– Boiling for 20 minutes
– Chemicals
• For heat labile instruments
• soak instruments with
– 0.1 % chlorine solution(bleach + boiled water) for 20 minutes
– 2% glutaraldehyde for 20 minute
– 8% formaldehyde for 20 minutes
– H2O2(6-7.5 %) for 20-30 minutes
– Per acetic acid (0.2-0.35%) for 5 minutes
– Rinse with boiled or sterile water
 High level disinfection(HLD)
− Moist heat at 70-100 degree centigrade
− Pasteurization
− destroys pathogens (Mycobacterium tuberculosis,
Salmonella typhi, etc.) without altering the flavor of the
food—does not sterilize (63°C for 30 seconds)
− Higher temperature short time pasteurization applies
higher heat for a much shorter time (72°C for 15 seconds)
− An ultra-high-temperature, very short duration treatment
(140°C for 3 sec.) is used to sterilize dairy products
− Inspissation :
− 80- 85 º for 30 minutes on three successive days
 Disinfectant & sterilization Performance
 Is dependent on
 Disinfectant or sterilant concentrations
 length (time) of administration
 temperature during administration
 T º & time are inversely proportional ,as T º increase− time decrease
 Microbe type
 e.g. mycobacterium, spores, and certain viruses can be very resistant to
disinfection
 Substrate effects
 e.g., high organic content( proteins, oils, fats) interferes with disinfection
 Number of micro organisms
 It is easier (and faster) to kill fewer microbes than many microbes
 Nature of heat : moist heat is more stable than dry heat
 Health care waste management
• involved in the collection, handling,
treatment, conditioning, transport, storage
and disposal of waste produced at healthcare
facilities
• to control and reduce HAIs and to ensure that
the environment outside is well protected
 Health care waste management
• Healthcare wastes can be classified as high risk and
low risk wastes depending on the level of the risk
they pose to the health provider, patient and
community.
• High Risk Wastes
– Infectious waste, Anatomical waste, Sharps
wastes (used or unused), Chemical waste,
Pharmaceutical waste, Radioactive wastes
• Low Risk Wastes
– Non infectious waste/Communal wastes
 Health care waste management
• The key steps in the management of healthcare waste
– Waste Minimization/Containment
– Segregation : separating waste by type at the place where it is
generated
• Noninfectious (Black color code)
• Infectious (Yellow color code)
• Sharps waste eg Safety box
– Waste Handling, Collection and Storage
– Waste Transportation : on site or off site
– Treatment and Disposal: Healthcare waste is treated to render
it non-hazardous. Non-infectious waste does not need to be
treated
• Bury, open burning or incineration