Infection Control in Healthcare and Acupuncture Settings

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Questions and Answers

What is the primary responsibility of the clinic manager regarding cleaning contractors?

Providing training on cleaning and disinfection protocols

Performing regular cleaning and disinfection of the treatment rooms

Scheduling cleanings and decontamination of the clinic

Providing written notification regarding the presence of contaminated sharps and bloodborne contamination (correct)

Why is it important to maintain a clean and sanitary environment in an acupuncture treatment location?

To create a clean field for treatment (correct)

To reduce the risk of bloodborne contamination

To meet OSHA regulations

To improve the aesthetic appeal of the clinic

What type of hand soap is required in an acupuncture treatment location?

Foam hand soap

Liquid hand soap (correct)

Alcohol-based hand sanitizer

Antibacterial hand soap

What is the purpose of providing written notification to cleaning contractors?

To notify them of the presence of biohazardous materials Signup and view all the answers

What is the recommended method for drying hands after washing?

Using a single-use, disposable towel Signup and view all the answers

What is the requirement for paper towels used for handwashing stations?

They must be clean and disposable Signup and view all the answers

What is the purpose of having a sink with hot and cold running water in or near the treatment rooms?

To provide a convenient location for handwashing Signup and view all the answers

What should be done with paper or disposable materials used on a chair, seat, couch, or treatment table after a patient's use?

They should be discarded and replaced with new materials Signup and view all the answers

How often should treatment room table tops, shelves, and other working surfaces be cleaned with a suitable disinfectant?

At least once a day and whenever visibly contaminated Signup and view all the answers

What is the minimum duration for which Hepatitis B virus can survive on surfaces at room temperature?

At least one week Signup and view all the answers

What is a disadvantage of using hypochlorites in high concentrations?

Corrosiveness to metals Signup and view all the answers

What is the purpose of EPA-registered disinfectants in clinical settings?

To reduce the danger of infection Signup and view all the answers

What is the purpose of activating glutaraldehyde solutions?

To make it more alkaline Signup and view all the answers

What is a limitation of glutaraldehyde?

It has limited mycobacteriocidal activity Signup and view all the answers

Why is it important to follow the manufacturer's instructions for mixing EPA-registered disinfectants?

To ensure the solution is effective against most viruses Signup and view all the answers

What is the term used to describe a germicide that can sterilize?

Sterilant Signup and view all the answers

What is the primary use of glutaraldehyde?

High-level disinfecting of medical equipment Signup and view all the answers

What is a characteristic of stabilized hydrogen peroxide?

Not toxic and does not require hood ventilation Signup and view all the answers

What is the classification of items that enter the vascular system or any sterile internal part of the body?

Critical Signup and view all the answers

What is the primary advantage of using sodium hypochlorite as a disinfectant?

It is inexpensive and fast acting Signup and view all the answers

What is the primary use of iodophors?

Antiseptics on skin or tissue Signup and view all the answers

What is the current status of household bleach as a suitable instrument disinfecting solution?

Not approved by the CDC for use in healthcare settings Signup and view all the answers

Why should treatment tables and chairs be disinfected between each patient visit?

To reduce the risk of infection Signup and view all the answers

What should be stated on the label of a mixed disinfectant solution?

The type of disinfectant, the date it was mixed, and the concentration Signup and view all the answers

What is a characteristic of hypochlorite solutions?

Inactivated by organic matter Signup and view all the answers

What is the classification of EPA-registered disinfectants that correspond to the CDC's low-level disinfectants?

Sanitizers Signup and view all the answers

What is the purpose of following manufacturer instructions for preparing hypochlorite solutions?

To ensure the solution is used within a specific timeframe Signup and view all the answers

What is the primary use of phenolic germicides?

Low-level disinfecting of environmental surfaces Signup and view all the answers

What is the authority under which the EPA regulates chemical germicides in the United States?

Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) of 1947 Signup and view all the answers

What is the purpose of the EPA's list of registered disinfectants?

To register disinfectants intended for use against microorganisms Signup and view all the answers

What is the requirement for labeling containers of disinfectants according to OSHA regulations?

The label must include what the solution is, when it was mixed, and its concentration Signup and view all the answers

According to the CDC, when is sterilization required?

For instruments that enter normally sterile tissue or the vascular system Signup and view all the answers

What is the purpose of rinsing items after high-level disinfection?

To remove any remaining disinfectant Signup and view all the answers

What is the recommended frequency for disinfecting noncritical patient-care surfaces?

On a regular basis, depending on the type of surface and frequency of use Signup and view all the answers

Why is thorough cleaning required before disinfection and sterilization?

To ensure the effectiveness of the disinfectant or sterilant Signup and view all the answers

What is the reason for not reusing single-use medical devices?

To reduce the risk of infection transmission Signup and view all the answers

What is the purpose of pre-cleaning reusable medical equipment?

To remove foreign material and organic material from the equipment Signup and view all the answers

What should be done with reusable medical and AOM equipment between use on patients?

They should be cleaned and then disinfected Signup and view all the answers

What level of disinfectant is required for a BP cuff before reuse?

Low-level disinfectant Signup and view all the answers

Which of the following equipment is considered semi-critical?

Cups used for wet cupping Signup and view all the answers

What is the first step in the disinfecting procedure for reusable equipment?

Remove all biological and foreign material using soap and water Signup and view all the answers

What is the recommended disinfecting procedure for equipment that touches intact skin but has been subjected to compression?

Intermediate-level disinfectant Signup and view all the answers

What is the category of equipment that breaks the skin or enters the vascular system?

Reusable Critical Signup and view all the answers

What is the recommended disinfecting procedure for equipment that has touched non-intact skin?

High-level disinfectant Signup and view all the answers

What is the purpose of the two-step disinfecting procedure for smooth surfaces?

To remove biological and foreign material Signup and view all the answers

Why are cups and gua sha tools considered semi-critical?

They cause extravasation of blood and fluids Signup and view all the answers

What is the recommended disinfecting procedure for equipment that has been contaminated with visible organic material?

Clean with soap and water, then disinfect with an intermediate-level solution Signup and view all the answers

What is the controversy surrounding the use of cups and gua sha tools?

How often the skin barrier is compromised Signup and view all the answers

What is the recommended method for preventing contamination of lubricants in open-mouth jars?

Using a pump or squeeze bottle of lubricant Signup and view all the answers

Why is it important to disinfect non-critical surfaces in healthcare facilities?

To prevent the spread of healthcare-associated infections Signup and view all the answers

What should be done with blood-contaminated items in a healthcare facility?

Discard them in the biohazard containers Signup and view all the answers

What is the recommended method for cleaning surfaces in non-patient care areas?

Using detergent and water Signup and view all the answers

What type of disinfectant should be used to disinfect medical equipment surfaces?

EPA-registered/FDA-cleared low- or intermediate-level disinfectant Signup and view all the answers

What should be done to mop heads and cleaning cloths in healthcare facilities?

Launder and dry them daily Signup and view all the answers

Why is it important to consider high-level disinfection of all cups and gua sha instruments?

To prevent the risk of infection to patients Signup and view all the answers

What should be done to clean and disinfect surfaces contaminated with blood or other potentially infectious materials?

Use an EPA-registered commercial hypochlorite solution Signup and view all the answers

What is the purpose of wrapping or packaging cups and gua sha instruments?

To prevent contact contamination Signup and view all the answers

What is the recommended frequency for cleaning housekeeping surfaces in healthcare facilities?

Three times a week Signup and view all the answers

Who is responsible for providing, laundering, cleaning, repairing, replacing, and disposing of personal protective equipment?

Employers Signup and view all the answers

What should be done with reusable cups and gua sha equipment that have been contaminated?

Clean and disinfect them before reuse Signup and view all the answers

What should be used to disinfect surfaces in healthcare offices?

Products registered with EPA and labeled for healthcare use Signup and view all the answers

What should be done with sharps containers?

Label them with the universal biohazard symbol and the word 'biohazard' Signup and view all the answers

What should be changed between each patient visit?

Table paper, draping, linens, and gowns Signup and view all the answers

What should be done with blood-contaminated items?

Discard them in biohazard containers in compliance with federal regulations Signup and view all the answers

What should be the surface type of treatment tabletops, shelves, and other working surfaces?

Smooth and impervious Signup and view all the answers

How often should surfaces be cleaned when spills occur?

Immediately Signup and view all the answers

What is the primary purpose of using duct tape on a sharps container?

To secure the lid of the container Signup and view all the answers

What is the definition of regulated waste according to the Bloodborne Pathogens Standard?

Waste that requires special handling due to the risk of bloodborne pathogens Signup and view all the answers

What is the requirement for disposing of regulated waste?

Dispose of it according to applicable state regulations Signup and view all the answers

What is the purpose of labeling or color-coding containers used for regulated waste?

To comply with OSHA regulations Signup and view all the answers

What should be done with contaminated laundry?

Handle it as little as possible and bag it or containerize it at the location of use Signup and view all the answers

What is the requirement for employees who handle contaminated laundry?

They must wear protective gloves and other appropriate PPE Signup and view all the answers

What is the purpose of placing contaminated laundry in bags or containers that prevent soak-through and/or leakage of fluids?

To prevent the spread of infection Signup and view all the answers

What is the requirement for sharps containers?

They must be easily accessible to employees and located as close as feasible to the immediate area where sharps are used Signup and view all the answers

What is the purpose of the Bloodborne Pathogens Standard?

To protect employees from the risk of bloodborne pathogens Signup and view all the answers

What should be done if the outside of a regulated waste container becomes contaminated?

Place the container in a second container that meets the OSHA requirements Signup and view all the answers

What should be done when cleaning accidental spills of blood or body fluid?

Use disposable absorbent material to pick up the visible matter, then clean the area with a detergent soap and water, and finally clean the area with an approved disinfecting solution Signup and view all the answers

When should safety glasses and a disposable or sterilizable clothing protector be worn?

When there is a risk of splashing or a very large spill Signup and view all the answers

What should be done with disposable materials used in the cleanup job?

Discard them in double wrapping in biohazard bags or containers Signup and view all the answers

What should be done when cleaning accidental spills of needles contaminated with blood?

Pick up the needles using gloves and hemostats first, then discard them into an appropriate sharps container Signup and view all the answers

What should be done with linens, gowns, etc. between patient treatments/visits?

Change them between patient treatments/visits Signup and view all the answers

What is the minimum temperature required for commercial laundry facilities to remove significant quantities of microorganisms from grossly contaminated linen?

160°F Signup and view all the answers

What should be done with fabrics soiled with blood in a commercial laundry facility?

Dry clean them to render them free of the risk of pathogen transmission Signup and view all the answers

What must sharps containers be labeled with?

The universal biohazard symbol and the word 'biohazard' Signup and view all the answers

What should be done when a sharps container is replaced?

Close the container immediately prior to removal or replacement to prevent spillage during handling Signup and view all the answers

What should be done with a secondary container if leakage is possible?

Label the container and make sure it is closable and constructed to contain all contents and prevent leakage during handling Signup and view all the answers

Study Notes

Cleaning and Pathogen Reduction Techniques in Healthcare and AOM Practice Locations

The WHO, CDC, and OSHA standards for cleaning and disinfection apply to all types of healthcare practices, including acupuncture practices.
Acupuncture schools and clinics offer training in the practical applications of these regulations for the acupuncture practitioner.

Maintaining a Clean and Sanitary Environment

The treatment location should be kept clean and sanitary.
OSHA requires a written schedule for cleaning and decontamination, and a clean and sanitary workplace.
The cleanliness of the general environment affects the practitioner's ability to create a clean field.

Hand Hygiene and Cleaning

A sink with hot and cold running water must be located in or near the treatment rooms.
Liquid hand soap and paper towels must be available at handwashing stations.
Single-use, disposable towels should be used to dry hands.
Clean paper towels are appropriate for use.

Treatment Room and Equipment Disinfection

The treatment room table tops, shelves, and other working surfaces should have a smooth, impervious surface, be in good repair, and be cleaned with a suitable disinfectant at least once a day and whenever visibly contaminated.
Hepatitis B virus can survive on surfaces for at least one week at room temperature.
Treatment tables and chairs used for treatments need to be disinfected between each patient visit.

Disinfectants

Disinfectants are recommended for office surfaces and equipment.
Disinfectants do not kill all germs or spores, but they will reduce the danger of infection.
EPA-registered disinfectants for clinical settings neutralize most viruses, including hepatitis B.
Disinfectants must be mixed according to the manufacturer's instructions and labeled if not in the original bottle.

Classification of Disinfectants

The Environmental Protection Agency (EPA) classifies disinfectants according to claims by the manufacturer.
The CDC classification system establishes three categories of items requiring sterilization and disinfection: critical, semi-critical, and non-critical.
Disinfectants may be classified as high-level disinfectants, intermediate-level disinfectants, and low-level disinfectants.

Types of Disinfectants

Chlorine and chlorine compounds: have a broad spectrum of antimicrobial activity, are inexpensive, and fast-acting, but can be corrosive and toxic.
Glutaraldehyde: is a high-level disinfectant, but has limitations in its mycobacteriocidal activity and can coagulate blood and tissue to surfaces.
Hydrogen peroxide: is capable of high-level disinfection, non-toxic, and does not require hood ventilation.
Iodophors: are used as antiseptics on skin or tissue, but not as high-level disinfectants.
Phenol: has occupied a prominent place in the field of hospital disinfection, but is not FDA-cleared as a high-level disinfectant.

EPA and FDA Approval of Disinfectants

The EPA regulates chemical germicides under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) of 1947.
A list of products registered with the EPA and labeled for use as sterilants or tuberculocides or against HIV and/or HBV is available on the EPA's website.
A list of FDA-approved high-level disinfectants is available on the FDA's website.

Monitoring and Labeling of Disinfectants

All disinfectants should be handled according to the manufacturer's instructions.
Hypochlorite solutions should be made fresh daily according to the intended use.
OSHA regulations require that containers of disinfectant must be labeled if not in their original bottle.
An MSDS (Manufacturer Safety Data Sheet) should always be available in case of accidents.

Indications for Sterilization, High-Level Disinfection, and Low-Level Disinfection

Sterilization is required for instruments that enter normally sterile tissue or the vascular system.
High-level disinfection is required for equipment that touches either mucous membranes or non-intact skin.
Low-level disinfection is required for noncritical patient-care surfaces and equipment that touch intact skin.

Cleaning and Disinfecting Reusable Medical Equipment

Reusable medical equipment must be disinfected between use on patients.
Cleaning is the removal of foreign material from objects and is normally accomplished using water with detergents or enzymatic products.
Thorough cleaning is required before low-, intermediate-, or high-level disinfection and sterilization.

Safety Guidelines for Disinfecting Reusable Medical Equipment

Sterility requirements vary depending on the type of equipment and its intended use.
Examples of non-critical, semi-critical, and critical equipment are provided.

Preventing Cross-Contamination

Reuse of single-use medical devices is not acceptable in AOM practices.
Pre-cleaning of reusable medical equipment is required before low-, intermediate-, or high-level disinfection and sterilization.
Equipment and devices that do not touch the patient or that only touch intact skin of the patient need only be cleaned with a low-level disinfectant or detergent.

Clean Use of Lubricants

Lubricants in open-mouth jars can become contaminated by the practitioner's hands.
Pump or squeeze bottles of lubricants should be used, or decant a treatment-sized portion of lubricant into a small disposable cup or other clean disposable container.

Cleaning and Disinfecting Environmental Surfaces in Healthcare Facilities

Clean housekeeping surfaces regularly, when spills occur, and when these surfaces are visibly soiled.
Follow manufacturers' instructions for proper use of disinfecting products.
Clean walls, blinds, and window curtains in patient-care areas when these surfaces are visibly contaminated or soiled.### Disinfectants for Surface Cleaning
Noncritical surfaces (e.g., floors, door handles) have a minor risk of causing infection, primarily HAI such as influenza.
Noncritical medical equipment surfaces (e.g., blood pressure cuffs, stethoscopes) should be disinfected with an EPA-registered low- or intermediate-level disinfectant between each patient use.

Blood or Body Fluid Spills

Decontamination of spills involves a three-step procedure: (1) removing visible matter with disposable absorbent material, (2) cleaning with detergent soap and water, and (3) disinfecting with an EPA-registered commercial hypochlorite solution.
Protective gloves and PPE should be worn, and a gown or impervious apron should be worn if there is a risk of contaminating clothing.
Safety glasses and a disposable or sterilizable clothing protector should be worn if there is a risk of splashing or a large spill.

Laundering Sheets, Towels or Other Linens

All linens, gowns, etc. must be changed between patient treatments/visits.
Cloth gowns, sheets, etc. are safe for reuse after laundering with hot water and soap or detergent.
Adding hypochlorite (bleach) solution to the wash provides an extra margin of safety.

Sharps and Non-Sharps Biohazard Equipment and Disposal

Sharps containers must be labeled with the universal biohazard symbol and the word "biohazard" or be color-coded red.
Sharps containers must be maintained upright, replaced routinely, and not be allowed to overfill.
Reusable containers must not be opened, emptied, cleaned manually, or used in any other manner that would expose employees to the risk of percutaneous injury.

Regulated Waste

Regulated waste includes liquid or semi-liquid blood or OPIM, items contaminated with blood or OPIM, and contaminated sharps.
Disposal of regulated waste must be in accordance with applicable state regulations.
OSHA rules require regulated waste to be placed in containers that are closable, constructed to contain all contents, and labeled or color-coded in accordance with the standard.

Contaminated Laundry

Contaminated laundry must be handled as little as possible with a minimum of agitation.
Contaminated laundry must be bagged or containerized at the location where it was used and must not be sorted or rinsed in the location of use.
Employees who have contact with contaminated laundry must wear protective gloves and other appropriate PPE.

Summary of Recommendations

Critical: All instruments that break the skin should be single-use pre-sterilized equipment.
Critical: Never reuse single-use medical devices.
Critical: Clean and disinfect surfaces only with products registered with EPA and labeled for use in the healthcare office.
Critical: Promptly clean and decontaminate spills of blood and other potentially infectious materials (OPIM).
Strongly Recommended: The clinical workplace must be maintained in a clean and sanitary condition, and there must be an appropriate written schedule for cleaning and decontamination.
Strongly Recommended: All linens, gowns, etc. must be changed between patient treatments/visits.

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Description

This quiz covers the importance of cleaning and disinfection in healthcare and acupuncture practices, adhering to WHO, CDC, and OSHA standards. It also explores the role of acupuncture schools and clinics in training practitioners in these regulations.