Environmental cleanliness- Standard precautions.pptx

Standard precautions- environmental cleanliness

1. Module 2: Infection Control Practices. Topic: Environmental sanitation

2. Learning Objectives After this module, participants will be able to understand Role of cleaning & disinfection in infection prevention & control Role of air & ventilation in reducing transmission Safe way of disposing of biomedical waste 2

3. Environmental Cleaning 2 All health care professionals should adopt adequate procedures for routine cleaning of the different areas of the hospital and frequently touched surfaces.

4. Air & Ventilation Airborne infections can be transmitted through air Aerosol-generating procedures also produce infected droplets which can be transmitted through air Airborne infection – droplet nuclei >5microns Particles are suspended in air, and travel distances over 1 meter. Ventilation is key to prevent airborne transmission . 5

5. Minimum Air Changes Per Hour 14 Type of healthcare setting Minimum air changes per hour Minimum hourly averaged ventilation rates (litres/ second/ patient) Registration areas >6 ACH > 40 litres/second/patient Outpatient departments and waiting areas >6 ACH >40 litres/second/patient Inpatient departments >6 ACH >40 litres/second/patient High-risk settings and their waiting areas, ART centres, TB/chest departments (outpatient and inpatient bronchoscopy procedure room MDR-TB wards and clinics,) Airborne precaution rooms >12 ACH 80–160 litres/second/ patient

6. Cleaning & Sanitation 19 Cleaning is the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces . It is normally accomplished manually or mechanically using water with detergents or enzymatic products. Disinfection describes a process that eliminates many or all pathogenic microorganisms, except bacterial spores , on inanimate objects Sterilization describes a process that destroys or eliminates all forms of microbial life & is carried out in health-care facilities by physical or chemical methods. Decontamination removes pathogenic microorganisms from objects, so they are safe to handle , use, or discard.

7. Cleaning & Sanitation 20 Dry conditions – gram-positive bacteria Wet conditions – gram-negative bacteria, fungal spores Pathogenic organisms, fomites, infectious droplets are present in the environment Cleaning will help in reducing the bacterial load and makes the environment unsuitable for microorganism growth Routine cleaning of the healthcare facility is important to keep it clean from dust & soil Written policies should guide the frequency of cleaning

8. Cleaning & Sanitation 22 Cleaning methods should be determined by zones Zone Patient contact Cleaning A No patient contact Normal domestic cleaning B Patients are not infected nor highly susceptible Clean using detergents, wet mopping is preferred C Infected patients Clean with disinfection solution with separate cleaning equipment D Highly susceptible patients Using high level disinfection

9. General Principles 23 Cleaning should be done regularly All the high-touch sites like doorknobs, bedrails, and switches should be cleaned frequently as compared to low-touch sites walls, beds, curtains, and windows. All surfaces especially high-risk areas (ICU’s isolation wards, OT ) should be cleaned regularly with disinfectant or detergent solution All horizontal surfaces like washbasins & commodes should be cleaned daily Administrative offices or no patient contact areas still require normal domestic cleaning Fresh detergent/disinfectant solution should be prepared daily as they can be contaminated by the end of the day

10. Cleaning High Touch Surface 25 High touch surfaces in a hospital are surfaces that are in frequent contact with the hands. These surfaces should be cleaned and disinfected daily. For example: Doorknobs, bedrails, and elevator buttons.

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13. 32 Cleaning of OT

14. 32 Figure of 8 Stroke Technique for Mopping

15. 32 Low touch surfaces in a hospital are surfaces that are in minimal hand contact. These surfaces should be cleaned regularly(but not necessarily daily)and when a patient gets discharged. For example: Floors and walls. Cleaning Low Touch Surface

16. 32 All patient care equipment should be cleaned and then based on the degree of risk involved, each equipment should be either disinfected/ sterilised before reuse. Cleaning Patient Care Equipment

17. 32 Routine cleaning is done based on the following criterion: Type of surface: High touch surface. Low touch surface. Risk of infection associated with the area. Patient's vulnerability.

18. Frequency of Cleaning Routine cleaning is done based on the following criterion: Type of surface: High touch surface. Low touch surface. Risk of infection associated with the area. Patient's vulnerability. 18

19. Disinfection 28 Disinfection procedures must: Kill microorganisms Has a detergent effect Should work despite the hardness of water, number of bacteria, and presence of soap

20. Spaulding Classification 29 Classification Item Use Goal Appropriate Process Critical item Items entering sterile tissue, the body cavity, the vascular system and non-intact mucous membranes E.g., surgical instruments Objects will be sterile (free of all Microorganisms including bacterial spores) Sterilization (or use of single use sterile products) (steam sterilization) Semi-Critical items Items that make contact, directly or indirectly, with intact mucous membranes or non-intact skin. e.g., endoscopes, anesthetic equipment, Respiratory therapy Equipment Endocavitory probes Objects will be free of all microorganisms, except for high numbers of bacterial spores High level disinfection Thermal disinfection Chemical disinfection (glutaraldehyde, OPA) Non-Critical items   Objects that meet intact skin but not mucous membranes E.g., crutches, BP cuffs, Table tops Bed pans, bed rail, bedside table, ECG leads etc. Objects will be clean Low level disinfection Cleaning (manual or mechanical)

21. Classification of Disinfectants 30 Disinfectants Use Example High Level Disinfectant Destroy all microorganisms vegetative bacteria, some bacterial spores, Fungi, Viruses 2% Glutaraldehyde Ethylene Oxide 1%Sodium Hypochlorite (10,000ppm of chlorine) Intermediate Level Disinfectants Destroys all bacteria but not bacterial spores & most viruses and fungi Isopropyl alcohol (70%), ethyl alcohol , sodium hypochlorite (0.1%), chlorhexidine , hydrogen peroxide, phenolic solutions. Low Level Disinfectants Destroys most bacteria, and fungi but is not effective against non enveloped viruses & bacterial spores Quaternary ammonium compounds like benzalkonium chloride, and some soap

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24. 32 Discuss cleaning in IPD, OPD, floors, toilets, specialized patient areas, OT, OR, CSSD, ICU, Labor rooms, pediatric areas and methods for assessing effectiveness using the hospital protocols

25. Sterilization 33 Sterilization is required for all medical devices penetrating sterile body sites Sterilization should be done for all equipment that will be reused Items for sterilization should be wrapped to keep sterilization intact Methods of Sterilization: Steam Sterilization (Autoclaving) Chemical Sterilization Dry Heat Sterilization Radiation Sterilization Filtration Sterilization

26. ETO STERILIZATION 33 It is carried out by use of ethylene oxide as biocide to destroy bacteria, virus, fungus and other microorganism. Delicate surgical instrument like cystoscope, heart lung machine, bronchoscope, implants etc are sterilized by this method.

27. STERILIZATION SEGREGATION 33 PLASMA ETO STEAM

28. STEAM STERILIZATION 33 They are used for sterilization of glass wares, container, linen, rubber articles, OT instruments etc.

29. CHEMICAL INDICATORS 33

30. TERMINAL CLEANING 33 Upon discharge of a patient, the room, cubicle or bed space, bed, bedside equipmen,t and environmental surfaces shall be thoroughly cleaned before another patient is admitted.

31. TERMINAL CLEANING 33 Walls, Beds, lockers and tables: Clean with 0.5% sodium hypochlorite solution. Utensils: Clean with 0.5% sodium hypochlorite solution. Soak for 30 minutes. Wash in warm soapy water, rinse, and dry. Linen : Place in the appropriate bag. If soiled, decontaminate, remove dirt, rinse, and place in the appropriate bag. Equipment: Decontaminate, clean, and soak in 0.5% sodium hypochlorite for 10- 30 minutes. Wash in warm soapy water, rinse, and dry

32. THANK YOU 45 Work Schedule 7.30 am 1.00 pm 7.30 pm Brush the floor Mop the floor Dusting Toilet wash Wash basin cleaned Liquid soap refill Wall tiles cleaned Lights and fans cleaned Doors cleaned Windows cleaned Waste collected Waste bins cleaned Name of cleaning / Housekeeping staff Signature of ward nurse Sign of administrator Cleaning Checklist

33. IMMEDIATE ENVIRONMENTAL CLEANLINESS Disinfection of instruments: Blunt instruments can be disinfected by boiling or autoclaving. Sharp instruments like knives and scissors are treated with chemical disinfectants like Lysol or carbolic acid. Syringes can be autoclaved or boiled in plain water. 33

34. ENVIRONMENTAL CLEANLINESS: 33 Disinfection of dead bodies:   It is done by embalming which is the most effective method. The solution used for embalming has the following composition: Formalin 40 % - 2 to 3 liters. Glycerin - 3 liters. Alcohol - 1 liter. Common salt - 1 kg. Carbolic acid - 60 ml. It is made up to 10 liters with water. 10 liters of this solution is used for one dead body. This solution is pumped through femoral artery. Dead bodies disinfected by this method resist decomposition and are stable even beyond 20 years.

35. Take Home Messages 43 Good architecture of a hospital can help in designing a hospital where adequate facilities are available Infection may be transmitted over short distances through air Ventilation helps in clearing the infected droplets Pathogens can survive in the hospital environment and hence regular cleaning & sanitation is important

36. THANK YOU 45