Transcript Disinfection & Environmental Decontamination in

DISINFECTION
AND
ENVIRONMENTAL
DECONTAMINATION
IN NEONATOLOGY UNITS
Dr Anjum Hashmi
CCS(USA),MPH.
Infection Prevention & Control Specialist,
Director Employee's Health,
Advisor Quality Management Department
East Najran Hospital
Najran, Saudi Arabia
A TRIBUTE TO IGNAZ PH. SEMMELWEIS
Hungarian physician now known as an early
pioneer of infection control procedures.
ENVIRONMENTAL SURFACES
A SOURCE OF INFECTION
• The contamination of the environment
(surfaces in patient care areas and mobile
medical equipment) play a major role in the
transmission of potential pathogens.
• Numerous studies have demonstrated that
contaminated environmental surfaces in
healthcare facilities can contribute to the
transmission of infectious pathogens and the
cleaning and disinfection of these high-touch
surfaces is necessary.
TERMINOLOGY
• Antisepsis: Chemical destruction of
vegetative pathogens on living tissue.
• Degerming: Mechanical removal of microbes
from limited area.
• Sanitization: Lowering microbial counts on
eating and drinking utensils to safe levels.
• Sepsis: Bacterial contamination.
• Asepsis: Absence of significant contamination.
• Aseptic technique: Minimizes contamination.
CLEANING
• Physical removal of foreign material,
e.g., dust, soil, organic material such
as blood, secretions, excretions and
microorganisms.
• Cleaning generally removes rather
than kills microorganisms.
• It is accomplished with water,
detergents and mechanical action.
DECONTAMINATION
• Decontamination:
The removal of
disease-producing
microorganisms
to leave an item
safe for further
use.
DISINFECTION
• Disinfection: Defined as cleaning some or
all pathogenic organisms from an article
of which may cause infection.
• Perfect disinfectant should offer complete
and full sterilization, without harming
other forms of life, be inexpensive, and
non-corrosive.
• Unfortunately ideal disinfectants do not
exist.
ANTISEPTICS & DISINFECTANTS
• Antiseptics:
• Use on skin and mucous membranes to kill
microorganisms.
• Not for use on inanimate objects.
• Disinfectants:
• Use to kill microorganisms on inanimate objects.
• Not for use on skin or mucous membranes.
• Disinfectants according to chemical nature &
duration of contact time results in disinfection,
which may be of High, Intermediate and Low
levels.
HIGH LEVEL DISINFECTION
• High level disinfection processes destroy
vegetative bacteria, mycobacteria, fungi
and enveloped (lipid) and nonenveloped
(non lipid) viruses, but not necessarily
bacterial spores.
• High level disinfectant chemicals (also
called chemical sterilant) and are capable of
sterilization if contact time is extended.
• All items must be thoroughly cleaned prior
to high level disinfection.
INTERMEDIATE LEVEL DISINFECTION
• Intermediate level
disinfectants kill
vegetative
bacteria, most
viruses and most
fungi but not
resistant bacterial
spores.
LOW LEVEL DISINFECTION
• Low level disinfectants kill most
vegetative bacteria and some fungi as
well as enveloped (lipid) viruses (e.g.,
hepatitis B & C, hantavirus and HIV).
• Low level disinfectants do not kill
mycobacteria or bacterial spores.
• Low level disinfectants are typically
used to clean environmental surfaces.
SPAULDING CLASSIFICATION of
DEVICE CATEGORIES
• Critical Device enters sterile tissue or vasculature,
therefore pose a high risk of infection if contaminated
with microorganisms:
•
Require Sterilization
• Semi-critical Device comes in contact with mucous
membranes or skin that is not intact, therefore pose
a moderate risk of infection if contaminated with
microorganisms:
•
Require High Level Disinfection
• Non-critical Device comes in contact with intact skin
but not with mucous membranes, therefore, pose
little to no risk of infection if contaminated with
microorganisms:
•
Require Disinfection
DISINFECTANTS USE IN
NEONATOLOGY
UNITS
ALCOHOLS
• Alcohol refers to two water-soluble chemicals:
Ethyl Alcohol and Isopropyl Alcohol.
• Alcohols are bactericidal against vegetative
forms of bacteria (Gram +ve & -ve); they also
are tuberculocidal, fungicidal and viridical
against enveloped viruses.
• Disadvantage: Alcohols are not effective
against bacterial spores and have limited
effectiveness against nonenveloped viruses.
• Expensive.
QUATERNARY AMMONIUM
COMPOUNDS (PHENOLICS)
• Examples: Benzyl-4-chlorophenol, Amyl
phenol, Phenyl phenol, Lysol.
• Good general purpose disinfectants.
• Not readily inactivated by organic matter.
• Active against wide range of organisms
Gram +ve & -ve (including mycobacterium).
• Usually used in hospital environment.
• Disadvantage: Not effective against nonenveloped viruses and spores.
MODE OF ACTION OF QACs
• The components of
the cell membrane
vary by organism type
and can inhibit the
effects of QACs.
• QACs take longer to
affect the cell.
• In the laboratory, some bacteria have
developed resistance to QACs over time.
SODIUM HYPOCHLORITE
• Advantages:
• They have a broad spectrum
of antimicrobial activity.
• Unaffected by water
hardness.
• Inexpensive.
• Fast acting, and have a low
incidence of serious toxicity. .
• Readily available as
“household bleach”.
SODIUM HYPOCHLORITE
• Disadvantages:
• Corrosiveness to metals in high
concentrations.
• Inactivation by organic matter
so cleaning must precede.
• Discoloring of fabrics.
• Staining of plastic tubing on
long exposure.
• Pungent odor of chlorine gas.
HYPOCHLORITE’S MODE OF ACTION
• Clorox /Bleach is effective against a broader
range of microorganisms and needs less
contact times.
• Bleach tears apart the
microbe’s cell walls
& deactivates proteins
required for bacterial
growth (by destroying
molecular structure).
HYPOCHLORITE’S MODE OF ACTION
• As a strong oxidizer,
bleach reacts with
nucleic acids (DNA /
RNA), lipids and fatty
acids associated with
the cell membrane and
destroys the cellular
activity of structural
and functional proteins
in membrane.
CDC GUIDELINES FOR HOSPITAL
SURFACE DISINFECTION
• Clorox/ Bleach Disinfecting Formulas at or
above the 1:10 Concentration Meets CDC
Guidelines for Hospital Surface Disinfection
and OSHA Bloodborne Pathogen Standards.
• At a target level 5000ppm or above as CDC
recommended, Clorox Healthcare Bleach
Germicidal Wipes and Dispatch products kill
the pathogens of most concern in healthcare
settings.
NO RESISTANCE REPORTS
• There is no scientific based
evidence of bacteria or
viruses developing resistance
to the powerful oxidizing
action of bleach when used at
recommended dilutions.
CLOROX PRODUCTS
• Ready made products contain chlorine
at concentration 5000 ppm so can be
readily use to disinfect hospital
environment.
RECOMMENDED DILUTIONS FOR
DISINFECTION
• For routine solid surface disinfection e.g.,
floor, walls; 40-50 ml of Clorox / bleach in 1
liter tap water (2500-2700 ppm chlorine) is
required (freshly prepared).
• For disinfecting a blood stains items, blood
and body fluid spills, 100 ml of bleach in 900
ml of tap/distilled water to have an
approximate 10% / 1:10 concentration or
5000-6000 ppm chlorine (freshly prepared).
CDC 2003 Guideline For Interventions
Relating Surface Decontamination
• Rate at which organisms suspended in the air
are removed, and type of surface and
orientation [i.e., horizontal or vertical].
• Potential for direct patient contact.
• Degree and frequency of hand contact.
• The potential contamination of the surface
with body substances or environmental
sources of microorganisms (such as soil, dust,
and water).
CDC 2003 Guideline For Interventions
Relating Surface Decontamination
• Healthcare professionals should consider the
number and types of microorganisms
present on environmental surfaces, depends
on following factors:
• Number of people in the environment.
• Amount of activity.
• Amount of moisture.
• Presence of material capable of supporting
microbial growth.
Major Considerations Related To
Proper Surface Decontamination
• What to clean: environmental surfaces,
such as bedside tables, if soiled, could
become a source of contamination to hands
or other objects which may have contact
with the patient.
• The CDC recommends environmental
surfaces (especially high-touch surfaces)
should be cleaned regularly with an EPAapproved, hospital-grade disinfectant.
Major Considerations Related To
Proper Surface Decontamination
The bugs
• Taking into account the types of organisms
commonly found on surfaces where
healthcare is delivered.
• Different types of microorganisms vary in
how easy they are killed by disinfectants.
• Some are very hard to kill, while others can
easily be killed by many disinfectants, even
simple soap and water.
Strategy & Approaches to Cleaning
• The methods, thoroughness and
frequency of cleaning and the products
used are determined by healthcare
facility policy according to risk category
& in line with 2003 CDC guideline.
• Surfaces with minimal hand-contact
(such as floors and ceilings) and those
with frequent hand-contact (―hightouch surfaces‖) require different
approaches for cleaning.
Strategy & Approaches to Cleaning
• Infection control practitioners typically use a
risk-assessment approach to identify high-touch
surfaces and then coordinate an appropriate
cleaning and disinfecting strategy and schedule
with the housekeeping staff.
• High-touch housekeeping surfaces in patientcare areas (e.g., doorknobs, bedrails, light
switches, wall areas around the toilet in the
patient’s room, and the edges of privacy
curtains) should be cleaned and/or disinfected
more frequently than surfaces with minimal
hand contact.
EQUIPMENT
DISINFECTION
PROTOCOL IN
NEONATOLOGY
A SIMPLE 3-STEP EQUIPMENT
DISINFECTION PROTOCOL
• For small surfaces and medical equipment,
disinfect after each patient use by following this
protocol to help ensure effective
disinfection and reduction of crosscontamination.
• Sanitize hands, then put on gloves.
• 1. Thoroughly wet the exterior of
the equipment or surface.
A SIMPLE 3-STEP EQUIPMENT
DISINFECTION PROTOCOL
• 2. Observe contact time
to ensure the surface
stays wet for the required
amount of time.
• 3. Dispose wipes and
gloves in infectious
waste bin.
ENVIRONMENTAL
DECONTAMINATION
IN NEONATOLOGY
Infection Control Risk Assessment of Hospital Areas
ENVIRONMENTAL DECONTAMINATION
• Cleaning MUST precede decontamination
• Disinfectant is ineffective if any organic matter
present.
• Use mechanical force
– Scrubbing
– Brushing
– Flush with water
• Wipe nonporous surfaces with sponge or wet cloth
– Allow to dry
• Use fresh diluted Clorox/bleach daily !
• 40-50 ml Clorox + 1 liter water (2500-2700 ppm Chlorine)
UNIT CLEANING PROTOCOL
• Always prepare to clean by washing hands,
donning gloves and appropriate PPE (personal
protective equipment), thoroughly clean and
disinfect the room, following cleaning path
(clockwise, top to bottom).
• Step 1 | Remove trash and soiled linens:
• Place them into appropriate receptacles. Clean
and disinfect the surfaces of the waste and linen
receptacles and allow to air dry.
• Step 2 | Dust overhead: Using a high duster, dust
hard-to-reach areas such as above the high wall
vents, curtain rods, tops of doors and lights.
UNIT CLEANING PROTOCOL
• Step 3 | Clean and disinfect area:
• Remove gross soil (e.g., areas with blood,
tissue or body fluids).
• Clean and disinfect all hard, nonporous room
surfaces including:
• Patient’s bed area, headboard, mattress, side
rails, bed frame, footboard and over-bed table.
• Furniture and high-touch areas: TV, remotes,
light switches, door handles, lamps, window &
window blinds.
ISOLATION ROOM CLEANING
• Using a clean mop, mop the entire floor
surface, working your way from the far corner
back to the entrance.
• Visually inspect the room and ensure all
surfaces have been cleaned and disinfected.
• Then disinfect any cleaning equipment (like
mop handles) before returning to the cleaning
cart.
• Remove PPE and put in a yellow trash bag prior
to leaving the room.
• Wash hands.
CLEAN AND DISINFECT BATHROOM
• Make Clorox sol (40-50 ml Clorox + 1 liter water)
• Clean and disinfect all precleaned hard, nonporous
bathroom surfaces. Start with the highest surface
(like the mirror) and leave the toilet for last.
• Ensure that all surfaces, including the sink area,
mirrors, grab bars and shower fixtures, are
thoroughly disinfected.
• Disinfect and clean toilet exterior, toilet seat
surface, and outer of bowl.
• For inner use 250ml pure bleach contact time 5 min.
• Ensure all surfaces stay wet.
THE CLEAN TEAM
• Establish better communication with
environmental services & include them in
the patient care unit team – as they are a
critical member of the team.
• The 'Clean Team' includes
representatives from nursing,
environmental services and infection
prevention and control.
• This type of collaboration enhances
problem solving – and reduces infections.
EDUCATING THE CLEAN TEAM
• Infection preventionists has to provide
continuous training to nurses and
housekeeping personnel.
• First and foremost is fundamental
education of staff about infection
prevention and control basics such as hand
hygiene, clean and dirty are located in
separate areas, standard precautions
/isolation, proper cleaning, disinfection,
and sterilization etc.
MISCONCEPTION AMONG HCWs
• Many HCWs don’t realize that they
have germs on their hands because
they underestimate transmission from
various environmental surfaces.
• Some environmental surfaces may be
perceived as being less likely to harbor
bacteria but healthcare workers can get
thousands of bacteria on their hands
after touching these surfaces.
SIMPLE TASKS CONTAMINATES HANDS
•
•
•
•
•
- Pulling up patients in bed.
- Taking a blood pressure or pulse.
- Touching a patient’s hand.
- Rolling patients over in bed.
- Touching the patient’s gown or bed
sheets.
• - Touching equipment like bedside
rails, over-bed tables, IV pumps.
A HYGIENIC AND SCIENTIFIC HAND
WASHING CONTINUES TO BE BEST PRAYER
IN THE HOSPITAL
STAFF MUST BE TRAINED TO CLEAN
HIGH-TOUCH AREAS ALL THE TIME
• Hand hygiene is the No.1 way to
prevent infections, but it’s not a
complete solution.
• If hospitals are inadequately cleaned,
doctors’ and nurses’ hands will
become contaminated seconds after
they are washed.
THANK YOU
Contact: [email protected]