Transcript High Risk Areas

Principles of Standard
Precautions
Outline

Definition of Standard precautions

Hand hygiene

Use of personal protective equipments

Instrument reprocessing

Aseptic techniques

Environmental cleaning and disinfection

Waste management
Standard precautions
 Routine infection control precautions that
should apply to ALL patients, in ALL
healthcare settings.
 Designed to facilitate SAFE medical
procedures.
 Protect patients as well as the healthcare
workers.
Standard Precautions
 Hand hygiene
 Use of personal protective equipments
 Instrument reprocessing
 Aseptic techniques
 Environmental cleaning and disinfection
 Waste management
Hand Hygiene
and Use of PPE
 Of particular importance when providing care for patients
with acute respiratory illness
 Will be discussed in details later
Instrument reprocessing
Instrument Reprocessing
 Processing instruments used in healthcare make them
safe for reuse
 Single use items should be disposed off
 Never reprocess single use items
Decontamination
Removal of contamination:
A vague term meaning sterilisation,
disinfection or cleaning as appropriate
Sterile
 Absence of
all microbial life
 This can not be a partial definition.
“Nearly sterile”is a definition without
meaning; it means “not sterile”
Disinfected
 More complex, more subjective definition than
“sterile”
 A practical definition is
“The removal or destruction of all microbes
except bacterial spores”
Clean
This is even less well-defined than “disinfected”
 “Absence of extraneous organic
contamination”
 “Removal of all material that is not part
of the item”
but to what extent?
Infection: difficult
Intact skin
Intact mucous membrane
Broken skin or mucous membrane
Foreign body implant (fully enclosed)
Foreign body from outside to inside
Infection: easy
Risks to patients from equipment
Spaulding classification
 HIGH - Anything that enters a normally sterile body
area
 MEDIUM - Anything in contact with intact mucous
membrane
 LOW - Anything in contact with intact skin
 MINIMAL - Items not in contact with the patient or
their immediate surroundings
Decontamination of equipment
 HIGH – Sterilised
 MEDIUM - Sterilised, heat disinfected, chemical
disinfected only if thermo-labile.
 LOW - Cleaned; disinfected if heavily or highly
susceptible patient
 MINIMAL - Cleaning
Aseptic techniques
Aseptic techniques
 Aseptic means "without microorganisms."
 Aseptic technique refers to practices that help reduce
the risk of post procedure infections in clients by
decreasing the likelihood that microorganisms will enter
the body during clinical procedures.
 Some of these practices are also designed to reduce
service providers' risk of exposure to potentially
infectious blood and tissues during clinical procedures
Aseptic techniques
These include:

Handwashing
 Surgical scrub
 Using barriers (surgical attire)
 Client prep (preparing a client for clinical procedures)
 Maintaining a sterile field
 Using safe operative technique (making small
incisions, avoiding trauma to tissue and surrounding
structures, and controlling bleeding)
 Maintaining a safer environment
What is required to establish a good
aseptic procedure?
 Think before you act
 Plan what you are going to do
 Which order you are going to do it in
 Make sure you have everything you need close at hand
 Understand the procedure
 Carry out and COMPLETE the procedure before doing
something else!
Environmental cleaning
Definition
General cleaning of environmental
surfaces and to the maintenance of
cleanliness in a health care facility.
It is the physical removal of organic
materials such as soil and dirt, followed
by complete drying.
Environmental Cleaning
 Removes all visible dirt.
 Reduces the bioburden (the number of germs present),
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so disinfection or sterilization can be more effective
Reduces pyrogens present in dead organisms.
enhance both the safety and quality of patient care
when absent can lead to clusters of Hospital-acquired
infections.
Facility looks appealing and improves the morale of staff
and patients.
General Guidelines for Cleaning
 Warm water and detergent removes 80% of
microorganisms. The majority of these microorganisms are
skin flora and spores.
 Minimizes the scattering of dust and dirt.
– A damp cloth or wet mop should be used for surfaces
– Vacuum cleaner can be used for dust removal (!filters!)
 Cleaning begins from the least soiled area to the most
soiled area (toilets and soiled storage areas) and from top to
bottom.
General Guidelines for Cleaning
 The use of friction or scrubbing action is the most
effective way to remove dirt and microorganisms.
 Cleaning solutions should be changed frequently. If a
disinfectant is used it is less likely to kill infectious
microorganisms if it is heavily soiled.
 Cleaning of environmental surfaces should be performed
by using separate buckets. One for detergent and the
other for plain water. The procedure starts by wiping or
scrubbing with detergent, followed by rinsing with water,
and drying at the end.
General Guidelines for Cleaning
 Reusable equipment (e.g., bed, chairs) is not used for the
care of another patient until it has been cleaned.
 Cleaning supplies must be kept dry and stored properly.
Reusable cleaning supplies should be washed and
disinfected after use
 If disinfectant is used, make up the disinfectant solution
separately, use as directed by the label.
 Note: Disinfectants are NOT recommended for routine
Protective Clothing for Cleaning
Workers should always
wear gloves, shoes that
cover the toes. If there is
a potential for splashing
or for splattering, they
may need additional
protection such as an
impermeable apron,
mask, and protective
eyewear.
Hospital Environment
 Low-Risk Areas:
 Waiting Rooms, Administrative Areas. These areas are usually
not contaminated with blood or body fluids or microorganisms
 Intermediate Risk Areas:
 Patient Wards. These are areas used for the care of patients
who are not obviously infectious and not highly susceptible.
 High Risk Areas:
– These are special care areas (e.g., isolation wards, intensive
therapy units, operating room, dialysis unit).
Frequency of Cleaning
 Low-risk clinical areas: Once daily and whenever
needed.
 Intermediate-risk areas: At least twice daily, and
whenever needed, e.g. after visits. Immediate removal of
organic material.
 High-risk areas: more frequent, cleaned between each
patient and thoroughly at the end of the day. Disinfectants
may be used as needed.
Hospital Laundry
 All linen should be sent to the hospital laundry
 Collect used linen in fluid resistant bags with
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considerable size
No need to double bag from isolation rooms
If wet, fold wet areas to the inside
Bag racks are ideal so linen is not held next to body, and
work load is reduced, keeps linen off floor
Assume all used linen is contaminated no need for color
coding
Cleaning Policies and Schedules
 Cleaning policy should be developed by the head nurse
in accordance with hospital policies
 Should be posted to where all cleaning staff
 It should take into consideration immediate cleaning after
any organic contamination e.g. blood spills
Cleaning up Body Fluid Spills
 Always wear gloves, such as disposable or heavy duty
gloves.
 If the spill is small: wipe it with a disposable cloth and
then disinfect the surface area of the spill with another
disposable cloth that has been saturated with a
disinfectant (100-200 PPM chlorine solution).
 If the spill is large: place a disposable paper or cloth
towel over the spill to soak up the fluid. pick up the towel,
dispose into a bag to be disposed as biological waste
and then soak the area with non-diluted chlorine). Leave
it for considerable time then dry the surface.
Ineffective Methods
 Fumigation
 Ultraviolet lights
Waste management
DEFINITIONS
 Health-care waste
All waste from health care activities
 Hazardous health-care waste
10 - 25% is hazardous
Hazardous healthcare waste
Infectious
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Anatomic waste
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Lab waste
Sharps
Pharmaceutical
Chemo, expired
medications
Other Chemicals
 Heavy metals
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Pesticides
Pressurized containers
Radioactive waste
Steps of Medical-Waste
Management
Infectious waste and sharps
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Sorting should be at point of generation
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Non-hazardous waste should disposed as
regular waste
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Highly infectious waste (from laboratories)
should be autoclaved before disposal.
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All sharps should be disposed in safety boxes
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Control access to syringes and medical
equipment to prevent re-use. Segregate,
Incinerate, encapsulate and bury.
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Blood can be disposed of in municipal
sanitary sewers that undergo treatment
Thank you