Standard Precaution

Presented during orientation

1. STANDARD PRECAUTIONS Ross Ibabao/ICCO KJO Hospital POLICY IC/PL 004

2. Standard Precaution Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These evidence-based practices are designed to both protect healthcare personnel and prevent the spread of infections among patients. Standard Precautions replaces earlier guidance relating to Universal Precautions and Body Substance Isolation.

3. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment.

4. IC/PL-12 Hand Hygiene Ross Ibabao/ICCO KJO Hospital

5. Hand Hygiene H ospital patients get an estimated 722,000 infections each year. That’s about 1 infection for every 25 patients. Infections that patients get in the hospital can be life-threatening and hard to treat. Hand hygiene is one of the most important ways to prevent the spread of infections.

6. Ignaz Semmelweis , 1815-1865 1840’s: General Hospital of Vienna Divided into two clinics, alternating admissions every 24 hours: First Clinic: Doctors and medical students Second Clinic: Midwives History

7. Hand Hygiene: Not a New Concept Semmelweis’ Hand Hygiene Intervention ~ Hand antisepsis reduces the frequency of patient infections ~ Adapted from: Hosp Epidemiol Infect Control, 2 nd Edition, 1999.

8. The Inanimate Environment Can Facilitate Transmission ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL. X represents VRE culture positive sites

9. Self-Reported Factors for Poor Adherence with Hand Hygiene Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

10. Indications for Hand Hygiene When hands are visibly dirty , do Hand Washing for contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an Alcohol-Based Hand R ub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

11. Efficacy of Hand Hygiene Preparations in Killing Bacteria Good Better Best Plain Soap Antimicrobial soap Alcohol-based handrub

12. Fingernails and Artificial Nails Natural nail tips should be kept to ¼ inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR) Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

13. Gloving Wear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

14. Education/Motivation Programs Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

15. Administrative Measures to Improve Hand Hygiene Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

16. Alcohol and Flammability Alcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry! Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.

17. Summary Alcohol-Based Handrubs: What benefits do they provide? Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition

18. Healthcare providers should practice hand hygiene at key points in time to disrupt the transmission of microorganisms to patients including: 5 Moments of Hand Hygiene 5 Moments of Hand Hygiene

19. Hand Hygiene Techniques

20. Hand Hygiene Techniques

21. PREVENTION IS PRIMARY! Protect patients…protect healthcare personnel… promote quality healthcare!

22. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure. R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment.

23. IC/PL-12 Personal Protective Equipment (PPE) Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings Ross Ibabao/ICCO KJO Hospital

24. What is Personal Protective Equipment? “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings

25. Regulations and Recommendations for PPE OSHA issues workplace health and safety regulations. Regarding PPE, employers must: Provide appropriate PPE for employees Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use OSHA also specifies circumstances for which PPE is indicated CDC recommends when, what and how to use PPE PPE Use in Healthcare Settings

26. Types of PPE Used in Healthcare Settings Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose Respirators – protect respiratory tract from airborne infectious agents Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings

27. Factors Influencing PPE Selection Type of exposure anticipated Splash/spray versus touch Category of isolation precautions Durability and appropriateness for the task Fit PPE Use in Healthcare Settings

28. Gloves Purpose – patient care, environmental services, other Glove material – vinyl, latex, nitrile, other Sterile or non-sterile One or two pair Single use or reusable PPE Use in Healthcare Settings

29. Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment Don’t touch your face or adjust PPE with contaminated gloves Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings

30. Do’s and Don’ts of Glove Use (cont’d) Change gloves During use if torn and when heavily soiled (even during use on the same patient) After use on each patient Discard in appropriate receptacle Never wash or reuse disposable gloves PPE Use in Healthcare Settings

31. Gowns or Aprons Purpose of use Material – Natural or man-made Reusable or disposable Resistance to fluid penetration Clean or sterile PPE Use in Healthcare Settings

32. Face Protection Masks – protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration Goggles – protect eyes Should fit snuggly over and around eyes Personal glasses not a substitute for goggles Antifog feature improves clarity PPE Use in Healthcare Settings

33. Face Protection Face shields – protect face, nose, mouth, and eyes Should cover forehead, extend below chin and wrap around side of face PPE Use in Healthcare Settings

34. Respiratory Protection Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis ) PPE types for respiratory protection Particulate respirators Half- or full-face elastomeric respirators Powered air purifying respirators (PAPR ) N-95 PPE Use in Healthcare Settings

35. Elements of a Respiratory Protection Program Medical evaluation Fit testing Training Fit checking before use PPE Use in Healthcare Settings

36. PPE Use in Healthcare Settings How to Safely Don, Use, and Remove PPE

37. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene PPE Use in Healthcare Settings

38. Sequence for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves PPE Use in Healthcare Settings

39. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back PPE Use in Healthcare Settings

40. How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit PPE Use in Healthcare Settings

41. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – Inhale – respirator should collapse Exhale – check for leakage around face PPE Use in Healthcare Settings

42. How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably PPE Use in Healthcare Settings

43. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings

44. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched PPE Use in Healthcare Settings

45. PPE Use in Healthcare Settings How to Safely Remove PPE

46. “Contaminated” and “Clean” Areas of PPE Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings

47. Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator PPE Use in Healthcare Settings

48. Where to Remove PPE At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings

49. How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand PPE Use in Healthcare Settings

50. How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard PPE Use in Healthcare Settings

51. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal PPE Use in Healthcare Settings

52. Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard PPE Use in Healthcare Settings

53. Removing a Mask Untie the bottom, then top, tie Remove from face Discard PPE Use in Healthcare Settings

54. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard PPE Use in Healthcare Settings

55. Hand Hygiene Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rub PPE Use in Healthcare Settings * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

56. What Type of PPE Would You Wear? Giving a bed bath? Generally none Suctioning oral secretions? Gloves and mask/goggles or a face shield – sometimes gown Transporting a patient in a wheel chair? Generally none required Responding to an emergency where blood is spurting? Gloves, fluid-resistant gown, mask/goggles or a face shield Drawing blood from a vein? Gloves Cleaning an incontinent patient with diarrhea? Gloves w/ wo gown Irrigating a wound? Gloves, gown, mask/goggles or a face shield Taking vital signs? Generally none PPE Use in Healthcare Settings

57. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure. R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment.

58. Respiratory Hygiene and Cough Etiquette Ross Ibabao/ICCO KJO Hospital

59. Respiratory Hygiene and Cough Etiquette To prevent the transmission of  all  respiratory infections in healthcare settings the following infection control measures should be implemented at the first point of contact with a potentially infected (e.g. ER, OPD) person . They should be incorporated into infection control practices as one component of Standard Precautions.

60. Visual Alerts Post visual alerts at the entrance to outpatient facilities (e.g., emergency departments, physician offices, outpatient clinics) instructing patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of symptoms of a respiratory infection when they first register for care and to practice Respiratory Hygiene/Cough Etiquette . Cover your cough

61. Respiratory Hygiene/Cough Etiquette The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection: Cover your mouth and nose with a tissue when coughing or sneezing; Use in the nearest waste receptacle to dispose of the tissue after use; Perform hand hygiene after having contact with respiratory secretions and contaminated objects/materials.

62. Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and visitors: Provide tissues and no-touch receptacles for used tissue disposal . Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.

63. Masking and Separation of Persons with Respiratory Symptoms O ffer masks to persons who are coughing,sneezing (surgical masks) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose) . When space and chair availability permit, encourage coughing persons to sit at least three feet away (1 meter) from others in common waiting areas.

64. Droplet Precautions Advise healthcare personnel to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent that requires   Droplet Precautions .

65. Stop the spread of germs that can make you and others sick! To help stop the spread of germs : Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue when you cough or sneeze. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Avoid touching your eyes, nose or mouth. Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

66. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure. R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment.

67. Sharp Safety Preventing Needle sticks and Other Sharps Injuries… Everything You Need to Know Ross Ibabao/ICCO KJO Hospital

68. What Strategies Exist to Eliminate Sharps Injuries? Eliminate or reduce the use of needles and other sharps Use devices with safety features to isolate sharps Use safer practices to minimize risk for remaining hazards

69. Injuries Related to Work Practices Injuries occur because of the following: Passing or transferring equipment Recapping contaminated needles Colliding with coworkers Decontaminating/processing used equipment Injuries occur from sharps left in unusual places: Laundry Mattresses Tables, trays, or other surfaces

70. How do sharps injuries happen?

71. What devices are involved with sharps injuries?

72. The Sharps Safety Continuum Prepare to use the device the moment the sharps are first exposed Take precautions while using sharps Take precautions during cleanup Take precautions during disposal

73. Sharps Safety Practices Be prepared Be aware Dispose with care

74. Organize equipment at the point of use Make sure work space has adequate lighting Keep sharps pointed away from the user Before Beginning a Procedure Be Prepared

75. Locate a sharps disposal container, or have one nearby Assess the patient’s ability to cooperate Get help if necessary Ask the patient to avoid sudden movement Before Beginning a Procedure (cont’d) Be Prepared

76. Be Aware Maintain visual contact with sharps during use Be aware of staff nearby Control the location of sharps to avoid injury to yourself and others During a Procedure

77. During a Procedure (cont’d) Do not hand pass exposed sharps from one person to another Use predetermined neutral zone for placing/retrieving sharps Alert others when sharps are being passed Be Aware

78. During a Procedure (cont’d) Activate safety feature of devices with engineered sharps injury prevention features as soon as procedure is completed Observe audible or visual cues that confirm the feature is locked in place Be Aware

79. Clean Up and Dispose with Care No recapping Be accountable for sharps you use Check procedure trays, waste materials, and bedding for exposed sharps before handling Look for sharps/equipment left behind inadvertently During Cleanup

80. Clean Up and Dispose With Care Transport reusable sharps in a closed container Secure the container to prevent spillage No passing of sharps item During Cleanup (cont’d)

81. Clean Up and Dispose With Care Inspect container Keep hands behind sharps Never put hands or fingers into sharps container While Disposing of Sharps

82. If you are disposing sharps with attached tubing Be aware that tubing attached to sharps can recoil and lead to injury Maintain control of both tubing and the device during disposal Clean Up and Dispose With Care While disposing of Sharps (cont’d)

83. Clean Up and Dispose With Care Visually inspect sharps container for overfilling Replace containers before they become overfilled Keep filled containers for disposal in a secure area After Disposing of Sharps

84. Handle carefully Keep hands behind sharps at all times Use mechanical device if you cannot safely pick up sharps by hand Clean Up and Dispose With Care If You Find Improperly Disposed Sharps in Work Environment

85. Sharps Safety Practices Be prepared Be aware Dispose with care

86. Sharps Injuries in the Operating Room Cuts/needle sticks occur in as many as 15% of operations Risk increases with longer, more invasive, higher blood loss procedures Suture needle injuries are most frequent Fingers used to manipulate needles and tissue Up to 16% of injuries occur while passing sharps

87. Needleless/no sharps alternatives Use alternative cutting methods such as blunt electrocautery and laser devices when appropriate Substitute endoscopy surgery for open surgery when possible Engineering controls Use round-tipped scalpel blades instead of sharp-tipped blades Use blunt suture needle Work practice controls Use instruments rather than fingers Give verbal announcement when passing sharps Use “neutral zone” to avoid hand-to-hand passing of sharps Sharps Injuries in the Operating Room

88. Wash needle sticks and cuts with soap in a running water Flush splashes to the nose, mouth, or skin with water Irrigate eyes with clean water, saline, or sterile irrigants Report the incident to your supervisor Immediately seek medical treatment (ER) Report to ICP (2176/2097) If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work,  immediately follow these steps :

89. Post Exposure Prophylaxis Post Exposure Prophylaxis.pdf 2. IC PL 002 EMPLOYEE MEDICAL SCREENING AND VACCINATION(1).pdf

90. Conclusion Preventing Sharps Injuries Your Role

91. You are Part of the Prevention Process when You Adhere to safe practices and assist and support coworkers in safer practices Report injuries or blood/body fluid exposures, sharps injury hazards, and near misses Participate in training for devices and properly use sharps safety features Participate in surveys (e.g., safety culture) and device evaluations

92. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure. R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment.

93. Waste Management EHS/PL-002 Ross Ibabao/ICCO KJO Hospital

94. Key Concepts Definitions of medical waste can be confusing Medical waste regulations and guidance should be based on scientific analysis.

95. Background Expert at the CDC stated: “there is no epidemiologic evidence to suggest that most hospital waste is any more infectious than residential waste. Moreover, there is no epidemiologic evidence that hospital waste disposal practices have caused diseased in the community; therefore, identifying wastes for which special precautions are indicated in largely a matter of judgment about the relative risks of disease transmission. Unfortunately, some confusion remains, compounded by inconsistent, specific, and occasionally conflicting definitions of “Medical Waste” or “Infectious Waste.” This is promoted by input from individuals with a little knowledge of infectious disease transmission or related microbiology.

96. Background Hospital and other healthcare settings have recognized the potential occupational risk of disease transmission and therefore use caution when handling and disposing of waste. Healthcare “Infectious” waste may include: Microbiological laboratory waste Hazardous waste Blood and body fluids Sharps Pathology waste Pharmaceutical waste And certain waste from patients who are placed in isolation room

97. Waste Terminology Terms such as “biomedical waste,” “regulated waste,” “red bag waste,” “ medial waste,” “ and “infectious waste” have been used interchangeably. Category of waste my vary from state to state and even agency to agency. To reduce the confusion, the term ‘ infectious waste ” is used here to refer to “waste that is capable of producing an infectious diseases. (APIC)

98. Cont. A common misconception is to assume that the presence of a pathogen will result in infection from waste. Pathogenic are found in many different day to day settings. Household garbage, bed linens, soiled diaper, and unwashed hands are all example of environment in which pathogen can routinely be found both within and outside the healthcare setting . A number studies have shown that although hospital waste can have a greater variety of organisms than residential waste, those from households are more heavily contaminated Waste Terminology

99. For a waste to be capable of causing infection, the following specific factors are necessary: Dose Host susceptibility Presence of pathogen Virulence of pathogen Portal of e ntry Note: Concisely, all five of these factors must be present for infection to occur from waste.

100. Infectious waste category Contaminated Sharps – have come into contact with potentially infectious materials. Microbiologic Cultures and Stocks of Infectious Agents – untreated cultures, stocks, and amplified microbiological populations pose the greatest potential for infectious disease transmission because they contain high concentrations of potentially pathogenic organism Animal Waste – discarded material originating from animals inoculated with infectious agents during research, production of biological, or pharmaceutical testing should be considered infectious waste. Blood and Blood Products – as defined by OSHA known or suspected to be contaminated with a transmissible agent must be handled carefully. Small amount, dried on dressings or other disposable items represent an insignificant hazard once they are properly contained. Selected isolation waste – treated in isolation should be classified as infectious waste.

101. Integrated Waste Management Policy EHS PL 002,6 - INTEGRATED WASTE MANAGEMENT.pdf

102. Standard Precaution Include: H and H ygiene Use of personal protective equipment (e.g., gloves, gowns, facemasks), depending on the anticipated exposure. R espiratory hygiene and cough etiquette Sharp Safety or Safe injection practices, and Waste Management and Safe handling of potentially contaminated equipment or surfaces in the patient environment, (Cleaning, Disinfection And Sterilization)

103. Cleaning, Disinfection, and Sterilisation of Patient Equipment IC/PL-010 Ross Ibabao/ICCO KJO Hospital

104. Process of CSSD Rinsing -> Cleaning ->Disinfection->Sterilization Non-Critical - Departmental Rinsing ->Cleaning ->low level disinfection ( minuten ) Semi Critical – Rinsing (Department) Cleaning ( water+Prolystica ) Disinfection ( Anioxyde ) Rinsing (water) Drying (with minuten )

105. Process of CSSD Critical – Rinsing (Departmental) Cleaning – Manual - ( water+Prolystica ) Cleaning – Mechanical – ( water+prolystica+liquijet ) (Disinfection) Sterilization Steam Gas Hydrogen peroxide

106. Key points - 1 Cleaning, disinfection, and sterilisation are the backbone of infection prevention and control Proper cleaning essential before any disinfection or sterilisation process Failure to clean, disinfect and sterilise reusable medical devices properly may spread infections The type and level of device decontamination depends upon the nature of the item and its intended use December 1, 2013 117

107. Key points - 2 Steam sterilisation effective only when preceded by Thorough pre-cleaning, proper packaging/loading, and careful monitoring of autoclaves. Chemical disinfectants must be selected, used, and discarded to minimise harm. Those responsible for processing contaminated items must be fully trained and wear protective clothing when necessary. Clearly written policies and procedures must be available on-site for training personnel and for monitoring their performance. 118

108. Cleaning Cleaning is the first step in reprocessing a device. The purpose of cleaning and rinsing is to remove all visible debris from an item and to reduce the number of particulates, micro-organisms and potential pathogens. December 1, 2013 119

109. Disinfection A process that eliminates many or all pathogenic microorganisms on inanimate objects, with the exception of bacterial spores December 1, 2013 120

110. Sterilisation The complete elimination or destruction of all forms of microbial life Includes large numbers of highly resistant bacterial spores Store in clean, dry place Protect wrapping Inspect before use December 1, 2013 121

111. Single-Use Devices (SUD’s) Single-use items must be safely discarded after use e.g ., injection needles No reprocessing before carefully considering the following: Is device undamaged and functional? Can it be disassembled for reprocessing? Can its sterility be validated, if needed? Is the reprocessing cost-effective? Is an authorised person onsite willing to be responsible for any negative consequences? December 1, 2013 122

112. Critical I tems Enter normally sterile tissues, the vascular system, or equipment through which blood flows Items must be properly and safely pre-cleaned and sterilised before use December 1, 2013 123

113. Critical Items - Examples Implants Prosthetic devices Surgical instruments Needles Cardiac catheters Urinary catheters Biopsy forceps of endoscope December 1, 2013 124

114. Semi-critical Items Contact mucous membranes but do not penetrate soft tissue or body surfaces Meticulous physical cleaning followed by appropriate high-level disinfection December 1, 2013 125

115. Semi-critical Item - Examples Flexible fiber optic endoscopes Respiratory therapy equipment Anaesthesia equipment Endotracheal tubes Bronchoscopes Vaginal specula Cystoscope Hand-piece December 1, 2013 126

116. Non Critical Items Direct contact with the patients intact skin (unbroken skin) Little risk of pathogen transmission directly to patient Clean and disinfect using a low to intermediate level disinfectant December 1, 2013 127

117. Examples of Non Critical Items Items which are in contact with intact skin Bedpans B lood pressure cuffs C rutches Stethoscopes Face mask X-ray machine December 1, 2013 128

118. Disinfection Reduction in numbers of pathogens on inanimate surfaces/objects For items that will contact intact skin or mucous membrane Use physical or chemical agents or both Level of disinfection High-level Intermediate-level Low-level December 1, 2013 129

119. High-level Disinfectants - 1 Active against vegetative bacteria, viruses (including the non-enveloped ones), fungi, and mycobacteria May have some activity against bacterial spores With extended contact times HLDs are used to disinfect heat-sensitive and semi-critical devices Such as flexible fibreoptic endoscopes 130 December 1, 2013

120. High-level disinfectants - 2 HLDs typically require 10-45 minutes contact time Depends on the temperature After disinfection, items require thorough rinsing/flushing with sterile or filtered water to remove any chemical residues They must then be dried with an alcohol rinse or by blowing clean, filtered air through the device’s channels prior to storage 131 December 1, 2013

121. Intermediate-level Disinfectants Active against vegetative bacteria, mycobacteria, fungi and most viruses May fail to kill spores, even after prolonged exposure 132 December 1, 2013

122. Low-level Disinfectants Active against vegetative bacteria (except mycobacteria ), some fungi, and only enveloped viruses In many cases, washing with unmedicated soap and water would be sufficient in place of LLD 70% Alcohol, Minuten Spray 133 December 1, 2013

123. Spaulding Classification Divided hospital instruments into general categories based on the risk of infection involved in their use Critical items Semi critical item Non critical items SPAULDING CLASSIFICATION . pdf December 1, 2013 134

124. Chemical Indicators External Chemical Indicator process indicator - autoclave tape distinguishes processed from unprocessed medical devices secures pack labels pack Check external indicator to ensure it has changed color before using any package If the indicator did not change, do not use 135 December 1, 2013

125. Biological Indicators Requires routine monitoring daily Test must be dated and labeled Once removed from the steriliser the test pack opened, BI labeled , crushed and incubated in the incubator Records of time, date of incubation and staff initials is required and then time and date and initials of the staff reading the final BI result 136 December 1, 2013

126. Biological Monitoring Steam Geobacillus stearothermophilus Dry heat B.atrophaeus (formerly B.subtilis ) EO B.atrophaeus New low temperature sterilisation technologies Plasma sterilisation ( Sterrad ) B.atrophaeus Peracetic acid - Geobacillus stearothermophilus 137 December 1, 2013

127. References - 1 Guidelines for Environmental Infection Control in Health-Care Facilities. MMWR 2003; 52(RR10):1-42. http:// www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf Ontario Ministry of Health & Long-Term Care. Provincial Infectious Diseases Advisory Committee (PIDAC) Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, 2010. http:// www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/PIDAC/Pages/PIDAC_Documents.aspx December 1, 2013 138

128. References - 2 Rutala WA, Weber DJ. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Centers for Disease Control and Prevention, Atlanta, GA. http:// www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf Snyder, OP. Calibrating thermometers in boiling water: Boiling Point / Atmospheric Pressure / Altitude Tables. http://www.hi-tm.com/Documents/Calib-boil.html Sattar A. Allen Denver Russell Memorial Lecture, 2006. The use of microbicides in infection control: a critical look at safety, testing and applications. J Appl Microbiol 2006; 101:743-753. December 1, 2013 139