Lesson 11: Standard Precautions PDF

Principles of Standard Precautions Ts Dr Sharifah Shafinaz binti Sh Abdullah NRS413  Outline ▪ Define nosocomial infection ▪ Definition of Standard precautions ▪ Hand hygiene ▪ Use of personal protective equipments ▪ Instrument reprocessing ▪ Asepti...

Principles of Standard Precautions Ts Dr Sharifah Shafinaz binti Sh Abdullah NRS413  Outline ▪ Define nosocomial infection ▪ Definition of Standard precautions ▪ Hand hygiene ▪ Use of personal protective equipments ▪ Instrument reprocessing ▪ Aseptic techniques ▪ Environmental cleaning and disinfection ▪ Waste management  Nosocomial infections also referred to as healthcare-associated infections (HAI), are infection(s) acquired during the process of receiving health care that was not present during the time of admission. They may occur in different areas of Nosocomial healthcare delivery, such as in hospitals, long-term care facilities, and ambulatory infection settings, and may also appear after discharge. HAIs also include occupational infections that may affect staff.  Standard precautions ▪ Routine infection control precautions that should apply to ALL patients, in ALL healthcare settings. ▪ Designed to facilitate SAFE medical procedures. ▪ Protect patients as well as the healthcare workers.  Hand hygiene Use of personal protective equipments Standard Instrument reprocessing Precautions Aseptic techniques Environmental cleaning and disinfection Waste management  Hand Hygiene and Use of PPE ▪ Of particular importance when providing care for patients with acute respiratory illness  STANDARD PRECAUTIONS AND ISOLATION miss sharifah/lesson2/nrs411  STANDARD PRECAUTIONS Preventative practices to be used in the care of all clients in hospitals regardless of diagnosis or resumed infection status. miss sharifah/lesson2/nrs411  STANDARD PRECAUTIONS APPLY TO … Blood. All body fluids, secretions, and excretions except sweat, regardless of whether those fluids contain visible blood. Non-intact skin. Mucous membranes. miss sharifah/lesson2/nrs411  STANDARD PRECAUTION PRACTICE Must be practiced with all clients. Represents the most effective means of decreasing the risk of infection among clients and caregivers. miss sharifah/lesson2/nrs411  BARRIER PRECAUTIONS Used to minimize the risk of exposure to blood and body fluids. Involve use of personal protective equipment (masks, gowns, and gloves) to create a barrier between person and the microorganism and thus prevent transmission of the microorganism. miss sharifah/lesson2/nrs411  ASPECTS OF STANDARD PRECAUTIONS Hand hygiene Environmental Gloves control Mask, eye Linen protection, face Occupational shield health and blood- Gowns borne pathogens Client-care equipment Client placement miss sharifah/lesson2/nrs411  HAND HYGIENE The most basic aspect of standard precautions. To prevent cross-contamination of different body sites on one client, hand hygiene may be necessary between tasks and procedures on that client. miss sharifah/lesson2/nrs411  GLOVES To be worn when touching blood, body fluids, secretions, excretions, and contaminated items. Must be changed between tasks. Must be removed promptly after use. Hands must be cleansed immediately. Assess client for latex allergy. miss sharifah/lesson2/nrs411 miss sharifah/lesson2/nrs411  MASK, EYE PROTECTION, FACE SHIELD Should be worn to protect the mucous membranes of the eyes, nose, and mouth when procedures and client- care activities are likely to splash or spray blood, body fluids, secretions, or excretions. miss sharifah/lesson2/nrs411 miss sharifah/lesson2/nrs411  GOWNS Should be worn to protect the skin and prevent soiling of clothing. Select a gown that is appropriate for the activity and potential amount of fluids. Remove soiled gowns promptly. Cleanse hands. miss sharifah/lesson2/nrs411 miss sharifah/lesson2/nrs411 Donning and Removing Personal Protective Equipment (PPE) Gowns Masks miss sharifah/lesson2/nrs411 Donning and Removing PPE: Gloves miss sharifah/lesson2/nrs411  CLIENT-CARE EQUIPMENT Single-use items must be discarded. Reusable equipment must not be used in care of another client until it has been cleansed and sterilized appropriately. miss sharifah/lesson2/nrs411 Instrument reprocessing  Instrument Reprocessing ▪ Processing instruments used in healthcare make them safe for reuse ▪ Single use items should be disposed off ▪ Never reprocess single use items  Decontamination Removal of contamination: A vague term meaning sterilisation, disinfection or cleaning as appropriate  Sterile ▪ Absence of all microbial life ▪ Aseptic technique is intended to minimize contamination from all pathogens. ▪ Sterile technique is intended to completely remove any microorganisms, pathogenic or otherwise  Clean ▪ “Absence of extraneous organic contamination” ▪ “Removal of all material that is not part of the item ▪ Using chemical agents (detergent, alcohol etc)  Disinfection ▪ A practical definition is “The removal or destruction of all microbes except bacterial spores” Aseptic techniques  Aseptic techniques ▪ Aseptic means "without microorganisms." ▪ Aseptic technique refers to practices that help reduce the risk of post procedure infections in clients by decreasing the likelihood that microorganisms will enter the body during clinical procedures. ▪ Some of these practices are also designed to reduce service providers' risk of exposure to potentially infectious blood and tissues during clinical procedures  Aseptic techniques These include: ▪ Handwashing ▪ Surgical scrub ▪ Using barriers (surgical attire) ▪ Client prep (preparing a client for clinical procedures) ▪ Maintaining a sterile field ▪ Using safe operative technique (making small incisions, avoiding trauma to tissue and surrounding structures, and controlling bleeding) ▪ Maintaining a safer environment  STERILE TECHNIQUE Sterile: free of all microorganism. Practiced in operating room & special diagnostic area. Also employed for many procedures, e.g:- Administering injection Changing dressing Performing urinary catheterization miss sharifah/lesson2/nrs411  STERILE FIELD Sterile field: a microorganism free area Should follow the principles of surgical asepsis when setting up a sterile field All objects used in a sterile field must be sterile Sterile objects become unsterile when touched by unsterile objects Sterile items that are out of vision or below the waist or table level are considered unsterile miss sharifah/lesson2/nrs411  STERILE FIELD (cont.) Sterile objects can become unsterile by prolonged exposure to airborne microorganisms Fluids flow in the direction of gravity; moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action The edges of a sterile field are considered unsterile The skin cannot be sterilized and is unsterile; and consciousness, alertness, and honesty are essential qualities in maintaining surgical asepsis. miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field Opening the first flap of a sterile wrapped package. Opening the second flap to the side. Pulling the last flap toward oneself by grasping the corner. miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field Opening the second flap to the side miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field Pulling the last flap toward oneself by grasping the corner miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field Opening a wrapped package while holding it. miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field miss sharifah/lesson2/nrs411 Establishing and Maintaining a Sterile Field miss sharifah/lesson2/nrs411 Environmental cleaning  Definition General cleaning of environmental surfaces and to the maintenance of cleanliness in a health care facility. It is the physical removal of organic materials such as soil and dirt, followed by complete drying.  Disinfection a reduction in the number of viable organisms Can be achieved by: Low-temperature steam Boiling water Chemical disinfectants  Low-temperature steam Most bacteria and viruses are killed by exposure to moist heat Usually achieved with dry saturated steam at 73 C for greater than 10 minutes Effective and reliable and suitable for instrument with a lumen Unsuitable for heat-sensitive items  Chemical disinfectants Destroys microorganisms by chemical or physicochemical means Different organisms vary in their sensitivity – Gram-positive - highly sensitive – Gram-negative - relatively resistant – Clostridial & mycobacterial species - very resistant – Slow viruses - highly resistant Disinfectants are suitable for heat-sensitive items Less effective than heat Chemicals used include: – Clear soluble phenolics – Hypochlorites – Alcohols – Quaternary ammonium compounds  Sterilisation Removal of viable microorganisms including spores and viruses Can be achieved by: – Autoclaves – Hot air ovens – Ethylene oxide – Low-temperature steam and formaldehyde – Sporicidal chemicals – Irradiation – Gas plasma Sterilization (or sterilisation) is the elimination of all transmissible agents (such as bacteria, prions and viruses) from a surface, a piece of equipment, food or biological culture medium. This is different from disinfection, where only organisms that can cause disease are removed by a disinfectant In general, any instrument that enters an already sterile part of the body (such as the blood, or beneath the skin) should be sterilized. This includes equipment like scalpels, hypodermic needles and artificial pacemakers. This is also essential in the manufacture of many sterile pharmaceuticals. Heat sterilization is known to have been in used in Ancient Rome, but it mostly disappeared throughout the Middle Ages where sanitation was not usually a concern. The preferred principle for sterilization is through heat. There are also chemical methods of sterilization.  Autoclaves Steam under pressure has a higher temperature than 100 C To be effective against viruses and spore forming bacteria need to Have steam in direct contact with material Vacuum has to be created Need to autoclave for 3 min at 134 C or 15 min at 121 C Check performance by colour changes on indicator tape Autoclaves are highly effective and inexpensive Unsuitable for heat-sensitive objects  Heat sterilization Autoclaves A widely-used method for heat sterilization is the autoclave. Autoclaves commonly use steam heated to 121°C (250°F), at 103 kPa (15 psi) above atmospheric pressure, for 15 minutes. The steam and pressure transfer sufficient heat into organisms to kill them. Proper autoclave treatment will inactivate all fungi, bacteria, viruses and also bacterial spores, which can be quite resistant. It will not necessarily eliminate all prions (discussed later). Autoclaves Waste management  DEFINITIONS ▪ Health-care waste All waste from health care activities ▪ Hazardous health-care waste 10 - 25% is hazardous  Hazardous healthcare waste Infectious Other Chemicals ▪ Anatomic waste ▪ Heavy metals ▪ Pesticides ▪ Lab waste ▪ Pressurized containers ▪ Sharps Pharmaceutical Radioactive waste Chemo, expired medications  Disposable of General and Clinical Waste Go to fullsize image miss sharifah/lesson2/nrs411  Disposal of waste General waste Clinical waste - Disposal of tissues paper, - Disposal of contaminated plastic bag, etc (all items items with client’s body without client’s body fluids such as gauze with fluids) Go to fullsize image blood, swab with pus etc miss sharifah/lesson2/nrs411  Sharp bin Disposal of sharp item such as needles, scalpels, and other sharp instruments (sharps). miss sharifah/lesson2/nrs411 Steps of Medical-Waste Management  Infectious waste and sharps ▪ Sorting should be at point of generation ▪ Non-hazardous waste should disposed as regular waste ▪ All sharps should be disposed in safety boxes ▪ Control access to syringes and medical equipment to prevent re-use. Segregate, Incinerate, encapsulate and bury. ▪ Blood can be disposed of in municipal sanitary sewers that undergo treatment Thank you