infection preventioninfection prevention in hospital setting

infection prevention in hospital setting

1. INFECTION PREVENTION PRESENTED BY: REEMA ADHIKARI ROLL NO: 01 BSC NURSING 3 RD YEAR 10 TH BATCH, KMCTH

2. SPECIFIC OBJECTIVES At the end of this teaching learning session, you will be able to define decontamination enlist the steps of decontamination define cleaning list out the steps of cleaning define disinfection explain the methods of disinfection define sterilization explain the methods of sterilization

3. REVIEW

4. DECONTAMINATION It is the process of infection prevention which removes the micro-organism from the used instruments. It is the reduction or removal of chemical agents either by physical means or by chemical neutralization or detoxification .

5. STEPS OF DECONTAMINATION Leave on surgical gloves post-procedure. Place all instruments in freshly prepared 0.5% chlorine solution for 10 minutes. Dispose waste material in leak proof container or plastic bag. Decontaminate examination table by wiping them with 0.5% chlorine. Remove instruments from solution after 10 minutes and place them in water with soap or detergent.

6. Categories for sterilization, disinfection and cleaning: Critical items Items that enter sterile tissue or vascular system: Surgical instruments Intravascular catheters Urinary catheters needles Sterilization Semi-critical items Items that comes in contact with mucus membranes or skin: Respiratory suctioning tubing endoscopes Disinfection or sterilization

7. Non-critical items Items that come in intact skin but not mucous membranes: Bedpans BP cuffs Linens Stethoscopes Disinfection and cleaning

8. CLEANING

9. CLEANING Removal of organic and in-organic materials from objects and surfaces with use of water and mechanical action. Re-usable objects must be cleaned thoroughly before reuse and then either disinfected or sterilized. Contaminated objects are cleansed using a soft-bristled brush to scrub the surface.

10. CLEANING CONTD… Basic steps to clean an object are: Rinse a contaminated object or articles with cold running water to remove organic material. Wash the object with soap and warm water. Use a brush to remove dirt or material in grooves Rinse the object in warm water Dry the object and prepare it for disinfection or sterilization.

11. DISINFECTION

12. DISINFECTION Is the elimination of pathogens, except spores , from inanimate objects . Generally accomplished by the use of chemical disinfectant. Common disinfectants are alcohol, sodium hypochlorite, phenolic solutions, quaternary ammonium and glutaraldehyde .

13. DISINFECTION CONTD… High level disinfectants: HLD is the process that eliminates most but not all disease causing micro-organisms. It is used when sterilization equipment is either not available or not suitable. Destroys all micro-organism including hepatitis B and C, AIDS viruses except bacterial spores. Methods used in HLD are: boiling, steaming and use of chemicals. Major types of chemicals for HLD are formaldehyde, glutaraldehyde, 0.1%chlorine solution.

14. DISINFECTION CONTD… 2. Intermediate-level disinfectants: Are used for cleaning surfaces or some instruments which is contaminated by bacteria. Semi-critical instruments are disinfectant by this methods. Includes alcohols and hypochlorites. 3. Low level disinfectants: Non critical instruments and device are disinfected by this method. Includes phenolic compounds .

15. DISINFECTION CONTD… When disinfecting the articles, nurses need to follow agency protocol and following things: Type and number of infectious organisms The recommended concentration of disinfectant and duration of contact Presence of organic materials The surface to be treated

16. Disinfectant Time Uses Cidex Complete disinfection in 10 minutes Sporicidal within 4hrs Sterilization of small and sharp instruments, catheters and thermometers Hydrogen per-oxide 6% solution effective within 30 minutes Destroys anaerobic micro-organism and therefore used for cleaning the infected wounds.. Dettol (chloroxylenol) 2.5 % for thermometers(in 5 minutes) 5% for plastic equipments(15 minutes) 5% for wounds Over all uses includes cleaning hand, bed and wound as well Spirit 70% concentration of alcohol is more effective Before giving IM and IV Savlon No specific time Widely used for cleaning skin before cleaning the wound

17. STERILIZATION Process that destroys all micro-organisms, including spores and viruses. Factors that influence sterilizing methods includes: -Concentration of solution and duration of contact -Type and number of pathogens -Surface area to treat -Temperature of the environment -Presence of soap -Presence of organic materials

18. METHODS OF STERILIZATION

19. AUTOCLAVING Sterilization by Super-saturated steam above 100°C under pressure. Non-toxic, inexpensive, sporicidal and most widely used method. Holding time: 121°C for 15 minutes in 15 lb pressure. Dressing sets, aprons, catheters, surgical instruments except sharp instruments, etc are sterilized by this method.

20. PRINCIPLES All articles must be clean and dry. The wrapper and container should allow penetration of steam into particles. The drum shouldn’t be too full nor the contents be arranged too compactly. Cans and jar must be opened and turned to their sides so that steam can penetrate the contents.

21. PRINCIPLES for autoclaving contd… The temperature and pressure of the steam must be 121°C and 1.05kg/cm². While operating an autoclave, all the air in chamber must be driven out and replaced by steam. When the autoclaving is over , wait for half an hour to dry the materials.

22. DRY HEAT High temperature and comparatively long exposure is required for hot air oven . Done at a temperature of 170ºC or 340°F for 2 hours. Instrument such as blades, knives, scissors and eye instruments are best for this method . Instrument such as plastic wires, syringes, catheters, tubes should not be sterilized by this method.

23. PRINCIPLES Glassware should be perfectly dry before placing in the oven. Oven must be allowed to cool down for 2 hours before the door is opened after sterilization. It should not be overloaded . Articles should be arranged in such a manner that free circulation of air is possible.

24. CHEMICAL METHODS Submerge cleaned and dried items in 2% gultaraldehyde or 8% formaldehyde solution, completely covering all items. Cover container and soak for appropriate time ( 8-10 hours for gultaraldehyde or at least 24 hours for formaldehyde). Remove items from the chemical solution using sterile gloves or sterile forceps. Rinse the items thoroughly with sterile water to remove all traces of chemical sterilant. Use the item immediately or place it in a sterile, covered container.

25. GAS STERILIZATION Ethylene oxide gas is employed in specially designed chambers in which temperature and humidity can be controlled and from which air can be evacuated. An exposure time is of 3 -6 hours . Other gases are formaldehyde and beta propiolactone. Eg: sterilization of delicate surgical instrument with optical lenses, tubings, plastic parts of hearts and lung machines, blanket, pillows .

26. SUNLIGHT Direct and continuous exposure to sunlight kills many organism. It kills pathogens in air, water and fomites. Have considerable effect on acid fast bacili . Most effective on contaminated linen and bed pans.

27. Flaming Burn the cheap supplies/articles by mixing with sawdust, paper or kerosene. Carried on when there is shortage of equipment and in emergency situation. Sterilize the delicate metal instrument like knives, blades, BCG needles, glass etc.

28. REFERENCES Potter and Perry’s, ”Fundamentals Of Nursing”, South Asian Edition, Elsevier Publication, Unit:24, Page no: 350-360 Kozier and Erb’s, ”Fundamentals Of Nursing”, 9 th Edition, Dorling Kindersley (India) Pvt, Ltd, Unit: 29, Page no: 691-692

29. REFERENCES CONTD.. Basavanthapa BT, “ Fundamentals Of Nursing”, 2 nd Edition, Jaypee Publication, Unit: 21, Page no: 674-676 Pathak S. and Devkota R., ”A Textbook Of Fundamentals Of Nursing,” 4 th Revised Edition, Vidyarthi Pustak Bhandar, Unit: 15, Page no: 342-349 Giri M. and Sharma P.,” Essentials Fundamentals Of Nursing”, 1 st Edition, Medhavi Publication, Unit: 14, page no: 280-286

30. RETRIEVED FROM https://www.google.com.np/search?q=autoclave&source=lnms&tbm=isch&sa=X&ved=0ahUKEwil5o7lx7TRAhXFvY8KHVusAYoQ_AUICCgB&biw=1366&bih=662#tbm=isch&q=hot+air+oven (last accessed on: 2073-09-24)

31. ASSIGNMENT Write down the principles of decontamination.