Transcript Audiology Infection Control Practices

Audiology
Infection Control
Practices
Bruce Gamage, BSN CIC
Infection Control Consultant
BCCDC
Outline
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Basic risk factors in patients
Risk of cross-contamination
Chain of Infection
Spaulding classifications
Scope of practice
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Routine
High risk procedures
Routine Practices
Employee Health
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BBF exposure
Patient Risk Factors
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All treatment offered should minimize
potential disease transmission
Patients may have underlying disease
• May be immunosuppressed
• Drug related
• Leads to increase risk of infection from
opportunistic organisms
Chain of infection
Agent
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Infectiousness
Pathogenicity
Source
Period of infectivity
Portal of exit
Transmission
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Contact spread
Common vehicle spread
Airborne spread
Vectorborne spread
Host
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Portal of entry
Non specific defense mechanisms
• Skin, tears, mucous membranes, stomach
acid, inflammatory response
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Specific Immunity
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Host response
• Natural immunity, vaccinations
Environment
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Don’t over emphasize!
Temperature
Humidity
Cleanliness
Risk of cross-contamination
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Patients and technicians
Variety of contacts with environment and
objects
Direct or indirect contact with multiple
patients
Spaulding’s Classifications
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Critical items
• Penetrate the skin, contact blood, unintact
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mucous membranes require sterilization
E.g. curettes, wax loops, imittance and
autoacoustic emissions probe tips, ear
impression syringes and otoscopic specula
Many of these items are available as
disposables
Spaulding's Classifications
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Semi-critical
• Contact intact mucous membranes -
require
high-level disinfection
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Non-critical
• Contact intact skin only -
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sterilization not
required
Require cleaning and disinfection
Cleaning
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Remove gross contamination
Most important step to disinfection or
sterilization as soil will inhibit the process
• Accomplished with brush, wipe or ultrasonic
machine
Disinfection
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Kills specific organisms depending on chemical
used
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QAC, Phenolic will kill vegetative bacteria, enveloped
viruses (e.g. Hep B, C, HIV)
Aldehydes, Concentrated Hydrogen peroxide, chlorine
(bleach) will kill fungus, and enveloped viruses
dependent on contact time. Not bacterial spores
Prolonged contact time can provide sterilization. (must
follow manufacturer’s recommendations for
concentration and contact time)
Disinfection
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Disinfection is acceptable for non-critical items
– items that do not penetrate the skin, touch
mucous membranes
Noncritical items:
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Earmolds,
“in the ear” hearing aids
Supra-aural headphones
Otoscope specula
Probe tips
Electrodes
All items should be cleaned and disinfected
between patients
Disinfecting the Environment
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Surfaces in work areas should be
disinfected regularly
Disinfectant wipes/squirt bottle
Waiting room toys
• “Your saliva is my saliva”
Sterilization
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Kills all microbes, including spores
Autoclaves
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Uses moist heat
Must be used correctly
Must be monitored
Cold Sterilization
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Usually accomplished soaking in a chemical sterilant
(e.g. 2% gluteraldehyde, 7.5% hydrogen peroxide)
Requires correct contact time and concentration
Solutions should be monitored
Disposables
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Many items involved in cross-contamination
are available as disposables
• Otoscope specula, probe tips, earmold
impression syringe tips, insert receivers,
probe microphone tubes.
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May be cleaned and reused on same patient
Re-use of disposables between patients
• Don’t go there!
Scope of Practice
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Routine procedures
More invasive procedures
Exposure to body fluids
• Interoperative monitoring of cranial nerves
• Sensory evoked potentials
• Insertion needle electrodes
• Vestibular procedures (vomiting)
• Cerumen
Routine Practices
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Aimed at controlling exposure between people
and the environment/objects
Varies with the nature of the contact from
simple cleaning
sterilization
Responsibility of Clinician to provide a safe
work environment for themselves, their
colleagues and their patients
Assume that every patient is potentially
infectious
Routine Practices
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Handwashing
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Soap
Antibacterial soap
Alcohol based hand
rubs
• Equivalent to a
handwash as long as
hands are not visibly
soiled
Routine Practices
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Gloves
Should be worn for all procedures where risk of
exposure to body fluids ( e.g. cerumen
management, draining ear, lesions present,
cleaning spills and disinfecting)
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Single use
Task specific
Vinyl vs. Latex
Utility Gloves for handling chemicals
Routine Practices
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Protective apparel
• Safety glasses and masks should be worn is
risk of splash or spatter of body fluids
• Cerumen removal
• Working with grinding or buffing wheel
• Masks for potential TB patients
• Disposable headphone covers for mass
screenings
Waste Disposal
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Waste that is contaminated with blood , body
fluids (ear drainage, cerumen) can go in
regular garbage unless “dripping”
Saturated materials, tissue, etc. must be
placed in biohazardous waste bags
Proper sharps disposal
GVRD regulations require that biohazardous
waste/sharps must be picked up and
processed (either sterilization or incineration)
Employee Health
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Vaccinations:
• Hepatitis B Vaccine
• MMR
• Diphtheria/tetanus (every 10 years)
• Influenza
• Varicella
• Hepatitis A? If working with high-risk
population
BBF exposure
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Blood or other potentially infectious body fluids
Intact skin
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No risk – wash with warm soapy water
Splash to mucous membrane or sharps injury
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High risk – flush with NS, water
Don’t squeeze or soak in bleach
Report to nearest emergency department for:
• Assessment – type of exposure/status of source
• Baseline blood work
• Possible ART
Summary
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Cross-contamination
Cleaning, disinfection and sterilization
Routine practices