Infectious Agent Transmission and Standard Precautions

Standard Precautions and Infectious Agent Transmission

• Standard precautions: operating procedures that minimize the risk of infection in healthcare, considering all blood and body substances as potentially infectious and all surgical instruments as potentially contaminated with microorganisms.

Chain of Infection

• Three essential factors for spread of microbial infection:
  • Source of infecting microorganisms at a sufficient level to cause infection
  • Susceptible host or hosts
  • Means for transmitting the infectious agent to the susceptible host or hosts

Ways to Spread Infection

• Air
• Cart wheels
• Shoes
• Staff
• Other patients

Reservoir

• Collection of microbes
• Hospital staff can minimize reservoir by:
  • Cleaning and disinfecting the environment and equipment
  • Treating patients with antimicrobial drugs
  • Applying various hygienic measures

Chain of Infection

• Infectious agent
• Susceptible host
• Reservoir
• Portal of entry
• Portal of exit
• Mode of transmission

Immune Condition of Patients

• Immunocompromised (poor health, immune system not functioning well)

Stopping Transmission of Microbial Infection in CSSD

• Decontaminate potentially infected RMD and ensure only properly decontaminated RMD are used on patients

Breaking the Chain of Infection

• Any one of the essential factors can be broken to prevent infection

Health-Acquired Infection (HAI)

• Patients who become infected by microbes while in hospital

Methods of Transmission

• Injection (deliberate or accidental penetration of the skin or mucous membrane)
• Ingestion (swallowing into the digestive tract via splash or droplet)
• Inhalation (enter the respiratory tract via a droplet or aerosol)
• Contact (transfer from contaminated object to the skin, eye, mucous membrane via a hand or glove or mask or droplet or splash)

Accidental Needle Stick or Sharps Injury

• Report immediately and seek medical attention, as the main risks are from bloodborne viruses, and CSSD staff are usually vaccinated against these risks.

Aerosols

• Defined as a suspension of tiny particles or droplets in the air
• Danger in CSSD: aerosol formation during handling liquids, operating ultrasonic baths, running taps, brushing or blowing on a wet surface, and when ventilation/humidification units release contaminating microbes.

Housekeeping and Infection Control

• Important part of breaking the infection chain in CSSD: cleaning and disinfecting the CSSD itself and properly managing waste streams
• Best practice for cleaning equipment: label or color-code equipment, store in a dedicated storage room, clean and inspect regularly, train staff, and record cleaning activities.

Waste Management

• Waste generated in the three zones of the CSSD: use bins or containers to receive waste and segregate into appropriate waste streams
• Waste from IAP and sterile storage zone: an infectious risk, and important waste stream to control; place in appropriate bags or bins with sharps waste in a dedicated sharps bin.

CDC Top HAI Causing Pathogens

• Coagulase-negative staphylococci
• Staphylococcus aureus
• Enterococcus species
• Candida species
• Escherichia coli
• Clostridium difficile
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Enterobacter species
• Acinetobacter baumannii
• Vancomycin-resistant Staphylococcus aureus
• Methicillin-resistant Staphylococcus aureus
• Tuberculosis (TB)

Managing the Central Sterile Supply Department Environment

• Control traffic through the main three zones and maintain proper heating, ventilation, and air conditioning (HVAC) systems.

Environmental Control

• Air pressure:
  • Decontamination zone: negative pressure (- 5 Pascal) ± 5%
  • Preparation & Packaging zone: positive pressure (+ 5 Pascal) ± 5%
  • Sterilization zone: positive pressure (+ 5 Pascal) ± 5%
• Air changes per hour:
  • Decontamination zone: at least 10
  • Preparation & Packaging zone: at least 10
  • Sterilization zone: at least 4
• Temperature:
  • Decontamination zone: 18 °C to 20 °C
  • Preparation & Packaging zone: 20 °C to 23 °C
  • Sterilization zone: 20 °C to 24 °C
• Humidity:
  • Decontamination zone: 30% to 70%
  • Preparation & Packaging zone: 30% to 70%
  • Sterilization zone: up to 70%

Asepsis and Infection Control

• Asepsis: the absence of microorganisms that cause disease
• Aseptic technique: any activity or procedure that prevents infection or breaks the chain of infection
• Types of aseptic techniques:
  • Medical asepsis: clean technique to reduce the number of microorganisms and minimize their spread
  • Surgical asepsis: sterile technique to eliminate the presence of all microorganisms or prevent their introduction to an area

Standard Precautions and Infectious Agent Transmission

• Standard precautions: operating procedures that minimize the risk of infection in healthcare, considering all blood and body substances as potentially infectious and all surgical instruments as potentially contaminated with microorganisms.

Chain of Infection

• Three essential factors for spread of microbial infection:
  • Source of infecting microorganisms at a sufficient level to cause infection
  • Susceptible host or hosts
  • Means for transmitting the infectious agent to the susceptible host or hosts

Ways to Spread Infection

• Air
• Cart wheels
• Shoes
• Staff
• Other patients

Reservoir

• Collection of microbes
• Hospital staff can minimize reservoir by:
  • Cleaning and disinfecting the environment and equipment
  • Treating patients with antimicrobial drugs
  • Applying various hygienic measures

Chain of Infection

• Infectious agent
• Susceptible host
• Reservoir
• Portal of entry
• Portal of exit
• Mode of transmission

Immune Condition of Patients

• Immunocompromised (poor health, immune system not functioning well)

Stopping Transmission of Microbial Infection in CSSD

• Decontaminate potentially infected RMD and ensure only properly decontaminated RMD are used on patients

Breaking the Chain of Infection

• Any one of the essential factors can be broken to prevent infection

Health-Acquired Infection (HAI)

• Patients who become infected by microbes while in hospital

Methods of Transmission

• Injection (deliberate or accidental penetration of the skin or mucous membrane)
• Ingestion (swallowing into the digestive tract via splash or droplet)
• Inhalation (enter the respiratory tract via a droplet or aerosol)
• Contact (transfer from contaminated object to the skin, eye, mucous membrane via a hand or glove or mask or droplet or splash)

Accidental Needle Stick or Sharps Injury

• Report immediately and seek medical attention, as the main risks are from bloodborne viruses, and CSSD staff are usually vaccinated against these risks.

Aerosols

• Defined as a suspension of tiny particles or droplets in the air
• Danger in CSSD: aerosol formation during handling liquids, operating ultrasonic baths, running taps, brushing or blowing on a wet surface, and when ventilation/humidification units release contaminating microbes.

Housekeeping and Infection Control

• Important part of breaking the infection chain in CSSD: cleaning and disinfecting the CSSD itself and properly managing waste streams
• Best practice for cleaning equipment: label or color-code equipment, store in a dedicated storage room, clean and inspect regularly, train staff, and record cleaning activities.

Waste Management

• Waste generated in the three zones of the CSSD: use bins or containers to receive waste and segregate into appropriate waste streams
• Waste from IAP and sterile storage zone: an infectious risk, and important waste stream to control; place in appropriate bags or bins with sharps waste in a dedicated sharps bin.

CDC Top HAI Causing Pathogens

• Coagulase-negative staphylococci
• Staphylococcus aureus
• Enterococcus species
• Candida species
• Escherichia coli
• Clostridium difficile
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Enterobacter species
• Acinetobacter baumannii
• Vancomycin-resistant Staphylococcus aureus
• Methicillin-resistant Staphylococcus aureus
• Tuberculosis (TB)

Managing the Central Sterile Supply Department Environment

• Control traffic through the main three zones and maintain proper heating, ventilation, and air conditioning (HVAC) systems.

Environmental Control

• Air pressure:
  • Decontamination zone: negative pressure (- 5 Pascal) ± 5%
  • Preparation & Packaging zone: positive pressure (+ 5 Pascal) ± 5%
  • Sterilization zone: positive pressure (+ 5 Pascal) ± 5%
• Air changes per hour:
  • Decontamination zone: at least 10
  • Preparation & Packaging zone: at least 10
  • Sterilization zone: at least 4
• Temperature:
  • Decontamination zone: 18 °C to 20 °C
  • Preparation & Packaging zone: 20 °C to 23 °C
  • Sterilization zone: 20 °C to 24 °C
• Humidity:
  • Decontamination zone: 30% to 70%
  • Preparation & Packaging zone: 30% to 70%
  • Sterilization zone: up to 70%

Asepsis and Infection Control

• Asepsis: the absence of microorganisms that cause disease
• Aseptic technique: any activity or procedure that prevents infection or breaks the chain of infection
• Types of aseptic techniques:
  • Medical asepsis: clean technique to reduce the number of microorganisms and minimize their spread
  • Surgical asepsis: sterile technique to eliminate the presence of all microorganisms or prevent their introduction to an area