Pages from CDC 4N051_M07_Transcript_20230605.pdf

Lesson 1 of 10 Lesson 1- Infection Control After completing this lesson, the student will be able to apply infection control procedures in accordance with prescribed guidance and publications. High Level Disinfection/Prepare Supplies for Sterilization In order to determine the proper level of cleani...

Lesson 1 of 10 Lesson 1- Infection Control After completing this lesson, the student will be able to apply infection control procedures in accordance with prescribed guidance and publications. High Level Disinfection/Prepare Supplies for Sterilization In order to determine the proper level of cleaning or preparing items for sterilization, it all depends on the intended use of the medical equipment. Items that are categorized as critical, equipment that comes into contact with skin and tissue, will need to be sterilized. If categorized as semi critical, equipment that comes into contact with mucous membranes, will need high level disinfection, and equipment that is noninvasive which is categorized as non-critical, will just need to be cleaned. However, before an item is either sterilized or needs high level disinfection, prior cleaning needs to be done. N O N - C R I T I C A L E Q UI PME N T SE MI - C R I T I C A L E Q UI PME N T C R I T I C A L E Q UI PME N T Examples of non-critical equipment are blood pressure cuffs, beds and bed rails, monitors, stethoscopes, linen, floors, countertops and wheelchairs. These items will come into contact with a patient’s skin and have risk of transmitting diseases. These types of items will require low-level disinfection or proper cleaning techniques. N O N - C R I T I C A L E Q UI PME N T SE MI - C R I T I C A L E Q UI PME N T C R I T I C A L E Q UI PME N T Equipment that is deemed semi-critical are items that come into contact with patient’s mucous membranes. Items include, rectal and vaginal probes, intubation equipment, endotracheal scopes, prostate biopsy probes, bronchoscopes, and gastrointestinal scopes. Because these items have been categorized as semi-critical, they should be free of any bacteria, fungi, spores or viruses. In order to ensure proper cleanliness of the equipment high level disinfection is required. Keep in mind that these items should properly be cleaned and free of all tissue, debris and mucous prior to disinfection. N O N - C R I T I C A L E Q UI PME N T SE MI - C R I T I C A L E Q UI PME N T C R I T I C A L E Q UI PME N T Equipment that is categorized as critical have a high risk of transmitting diseases or infections and must be completely sterile. These items consist of surgical equipment, implants and either heart or urinary catheters. Probes used in vascular procedures or in body cavities will also be classified as critical. Because these items come into contact with sterile bodily tissues and cavities, they need to be properly cleaned and then processed for sterilization. Proper training is required to ensure equipment has been sterilized and free of any bacteria, spores, viruses and fungi. Once sterilized, all medical equipment will be documented, packaged and stored properly to ensure and validate that equipment is sterile prior to use. Cleaning To ensure equipment is free of any tissue or foreign material, items need to be cleaned using water and the proper detergent recommended by the instruction manual. Thorough cleaning is required prior to high level disinfection and sterilization since material could be “baked on” or could interfere with the functionality of the item. Surgical equipment should be presoaked, this will help soften and loosen any tissue or blood still on the item. If mechanical equipment is not used to help assist with cleaning, items will be cleaned manually. Scrubbing with a brush or rag is the preferred method as this will ensure all foreign material and debris has been removed. Equipment like scissors or forceps should be opened fully to allow proper cleaning. Assess the items to ensure they have been cleaned appropriately. High Level Disinfection and Sterilization Since surgical equipment has become more complex, the expectation and determination of cleanliness is constantly under scrutiny. Discussions are re-occurring in determining whether local reprocessing areas are just as effective as central sterile supply processing areas for high level disinfection. There are advantages to both areas, the personnel in central supply are thoroughly trained and use equipment that has been validated to ensure equipment has been processed properly and ready for use by certified technicians. With local processing, equipment processing is faster for turnover and fewer equipment items are lost. Endoscopes are essential for the physician to diagnose many medical conditions; however, outbreaks have been identified and traced back to contaminated endoscopes, which is why high-level disinfection is so important to destroy all microorganisms. This will help stop the spread of healthcare associated infections. There are constant improvements to the technology and processes of sterilization. Currently some technologies that include self-disinfecting processes which utilize heavy metals and cleaning solutions. Surgical trays consist of complex configurations and intricate equipment that causes extended sterilization cycles, and potentially exceed the weight limit. But when equipment is properly cleaned and either sterilized or disinfected, healthcare facilities can ensure all equipment is deemed safe for patient care. Strict guidance and adherence help prevent transmissions of infectious diseases and exposure to agents. Multiple Response What is an example of a piece of non-critical equipment? Mark all that apply. Stethoscopes Intubation equipment Blood pressure cuffs Bronchoscopes SUBMIT Complete the content above before moving on. Disposing Contaminated Material Waste Management Fundamentals - The fundamentals of waste management are the techniques and physical barriers that block disease transmission. The way the different techniques are used remains constant, but the need for the different techniques varies with each type of infection. Bagging Procedures - Used articles may need to be enclosed in You learned the double-bagging technique in tech school, but let’s refresh a bag before they are removed from an isolation unit. Since your memory. This procedure requires two technicians—one inside the these articles are probably contaminated, they are bagged or isolation unit and one outside. The technician in the unit places placed in a container to prevent contamination of the general contaminated items in a bag and seals it tightly. The technician inside the environment and other people. If there is no possibility an item room then takes the bag to the door where another technician is standing is contaminated, it may be removed without bagging. A single outside the room. The technician outside should be holding another bag is adequate if the bag is sturdy and the article can be placed impervious bag open with their hands under a cuff made by rolling back the in the bag without contaminating the outside of the bag. If there top of the bag. The technician inside the isolation room then places the bag is any doubt, the article should be double bagged. In any case, containing contaminated items into the other bag, being careful not to touch the bag should be sealed, labeled appropriately, and disposed of the outside. The technician on the outside of the room seals and labels the promptly. bag and disposes of it promptly. Infectious Waste Any waste that poses a threat to either the patient or hospital staff needs to be properly packaged and disposed of. Infectious waste must be properly marked or identified as biohazardous. Accrediting agencies require that all material be placed in red bags labeled bio-hazard. Biohazard bags may require to be placed in a stronger secondary container to ensure the integrity of the bag. Bio-hazardous material typically requires that it be sent to another location for proper disposal. C O NT I NU E Clean Patient Unit Unfortunately, you cannot always rely on the availability of housekeeping personnel to clean and maintain the isolation units. If they are not there, guess who gets to do it? Right! You do! Cleaning may be either routine or terminal. Routine cleaning is done every day. It is usually performed the same as in other areas of the hospital (wiping up spills, bed rails, all horizontal surfaces, etc.). If the patient’s disease is such that they require a private room, cleaning equipment should be conducted using an approved disinfectant before going to another room (discard water; launder and dry mop heads and cloths; disinfect buckets; etc.). If the cleaning cloths and mop heads are grossly contaminated, bag and label them appropriately before sending them to be laundered. Prior to cleaning, conduct a visual assessment of the area that needs to be cleaned. Ensure that you are wearing the appropriate personal protective equipment (PPE) and have gathered all the supplies needed to move or adjust any possible obstacles. Once all the surfaces have dried, you can reuse the equipment and use the room. T E R MI N A L C L E A N I N G R E GUL A R C L E A N I N G This type of cleaning is directed primarily toward objects the patient has actually been in contact with (e.g., the patient is unlikely to come in contact with the ceiling so you do not have to worry much about cleaning it). Prepare fresh disinfectant or detergent solution for terminal cleaning. The solution you use is selected by your local infection control committee according to Environmental Protection Agency (EPA) standards. Use the same protective precautions (gowns, mask, gloves, etc.) used when the patient was in the room. Clean (as necessary), bag, and label any reusable items (bedpans, instruments, etc.), and send them to central supply (CS) for disinfection and processing. Discard disposable items. If these items are contaminated, bag, label, and dispose of them according to your infection control committee’s guidelines. Clean any equipment that was not sent to CS or discarded with the appropriate disinfectant-detergent solution. This would include all horizontal surfaces of furniture, mattress covers, and floors. Wash walls, blinds, and curtains only if they are visibly contaminated. (NOTE: Do not worry about using disinfectant fogging or airing the room; the former is ineffective and the latter is unnecessary.) Once all the surfaces have dried, you can resupply and use the room. Examples of Terminal Cleaning – Same scenarios as regular cleaning but may be required to wear N95 mask. Room might be designated as a negative pressure room or an isolation room which is indicated by placards or signs. T E R MI N A L C L E A N I N G Examples of Regular Cleaning: R E GUL A R C L E A N I N G High touched/frequency contaminated (Ensure individual has all appropriate PPE – gown, gloves, googles, and mask). Handrails, bedrails, call lights, light switches, countertops, medical equipment, bedside tables, intravenous (IV) poles, patient monitors, patient bathrooms, patient care floors, and transport equipment. Any spill, blood or body fluids. Multiple Choice What type of cleaning would you use for handrails, bedrails, call lights, and light switches?? Terminal Regular Disease Transitional SUBMIT Complete the content above before moving on. Perform Isolation Precautions Isolation Precautions - The physical barriers of isolation fundamentals include the unit itself, masks, gowns, gloves, equipment, linen, trays, and the patient’s personal belongings. Patient Unit The most effective type of isolation unit is a private room. Here, the patient is physically separated from other patients and personnel are more apt to remember to wash their hands, etc., before going on to the other patients. A private room is not a requirement, but should be used for patients who are affected by highly infectious or virulent disorders. It should also be used for patients who have poor hygiene habits and will likely contaminate the environment, or who share contaminated items (e.g., pediatric or confused patients). In addition, patients who have clinically significant microorganisms (resistant bacteria) or infectious blood disorders will be placed in a private room. Private rooms should be equipped with handwashing, toilet, and bathing facilities. An anteroom (waiting room) is useful for storage and creating a space barrier to prevent airborne transmission, but is not essential. The room should also have a trash container lined with an impervious bag and a linen hamper. In some instances (e.g., patients with infectious airborne pathogens), a room with negative pressure ventilation is recommended. This ventilation creates a pressure difference between the room and the outside so that air is drawn into the room rather than expelled when the door is opened. This system should provide at least six air changes per hour and should be discharged outdoors. Handwashing Ventilation Discharged Outdoors Private Bathroom As an alternative to an anteroom, you can place an isolation cart just outside the door to the isolation unit. This cart should have all the supplies (barriers) that are needed for isolation precautions. You should restock the cart as needed and keep it outside the room. As a final note, there should be a sign on the door specifying the type of isolation and precautions to take. Masks – Masks are used to prevent transmission of airborne infectious agents. They protect the wearer from inhaling large particle aerosols (droplets) that are transmitted by close contact (with infected patients), and generally travel only short distances (three feet). They also protect against small particle aerosols (droplet nuclei) that remain suspended in air and travel longer distances. Masks might also prevent transmission of some infections that are spread by direct contact with mucous membranes, because masks may discourage personnel from touching the mucous membranes of their eyes, nose, and mouth. The high-efficiency disposable masks are more effective than cotton gauze or paper tissue masks. Place the mask on before entering the room and remove it before exiting. If the infection is transmitted by large-particle aerosols, you need a mask only if you are working close to the patient. If the infection is transmitted over longer distances, you should wear a mask when you enter the room for any reason. Gowns – Gowns are used to prevent contamination of your uniform when caring for patients and to protect your skin from blood and body fluid exposures. You will most likely need a gown if you are going to have extensive contact with the patient, or if the patient’s disorder could cause an outbreak in the hospital. When gowns are worn to prevent the spread of infection they are worn only once and discarded before leaving the unit. Gloves – Gloves are worn: (1) to provide a protective barrier and prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin; (2) to reduce the likelihood that microorganisms present on the hands will be transmitted to patients during invasive or other patient care procedures that involve touching a patient’s mucous membranes and non-intact skin; and (3) to reduce the likelihood that hands contaminated with microorganisms from a patient or fomites can transmit these organisms to another patient. Eye Protection – Wearing goggles or face shields in certain circumstances is mandated by the Occupational Safety and Health Administration (OSHA) to prevent the transmission of blood borne pathogens. The purpose of wearing such protective equipment is to protect your eyes and the mucous membranes of your mouth when the possibility of splattering or splashing of blood or body fluids is possible. – Food Trays There are no special precautions needed for dishes, glasses, cups, or eating utensils. Your facility will use either disposable or reusable dishes for patients in isolation. The Center for Disease Control (CDC) has determined the use of hot water and detergents in hospital dishwashers is sufficient to decontaminate the reusable tray items. Linens – You should handle linen carefully, and as little as possible, to avoid contamination. Do not shake linen out to unfold it or drop it on the floor when you are changing the bed. Most linen used in isolation rooms are contaminated with pathogenic microorganisms, but the risk of transmission is insignificant if it is handled, transported, and laundered in a manner that avoids transfer of microorganisms. All handling of linen, whether or not it is isolation linen, is determined by local policy. Laundered linen helps prevent exposure to staff and the surrounding area. The utilization of two dirty linen bags is not needed as a single bag is adequate. Do not overfill the linen bag and ensure that it is sealed tightly and appropriately. Dirty linen hampers or carts should be disinfected quarterly. Patients' Belongings – Patients often bring several personal items with them when they come into the hospital. There is nothing wrong with this in most instances, because these items improve a patient’s morale. However, isolation patients must be advised any item in the room that becomes contaminated must be disinfected or destroyed. This can create problems, particularly when personally significant items cannot withstand the disinfection process. To avoid having to destroy such items, explain the isolation policy to the patient, family and friends and ask them to send home any valuable items that could become contaminated. Waste Products – Waste products were mentioned earlier when you learned about terminal cleaning. However, you should not wait for the patient to leave to take care of contaminated dressings, urine, feces, and other waste products. Urine and feces should be flushed, and bedpans and other containers should be cleaned and disinfected immediately after they are used. All waste products (contaminated dressings, disposable dishes, etc.) should be bagged, labeled, and disposed of according to local policy and EPA standards. This should be done at least daily or more often to prevent accumulation. When working with a patient in isolation, the gloves you wear may be either sterile or nonsterile, depending on the type of isolation or the procedure being done. If you are doing a sterile procedure or working with an immunosuppressed patient, for example, you should wear sterile gloves. Sterile Gloves Non-Sterile Gloves For routine care, you can wear nonsterile gloves. Gloves, however, do not eliminate the need for handwashing. You will still accumulate microorganisms beneath the gloves, and there is always a possibility that the gloves could be torn or punctured. Equipment If disposable equipment becomes contaminated, it should be bagged, labeled, and disposed of according to local policy. When non-disposable equipment becomes contaminated, it should be cleaned, bagged, and sent to CS for disinfection and processing. No special precautions are needed for sphygmomanometers and stethoscopes, unless they become contaminated. If so, they are dealt with in the same manner as other contaminated equipment. All equipment should be wiped down with an approved disinfectant. Thermometers should be sterilized before being reused. Sharps Container Biohazard Bin Sani-Wipes Take special care with needles, syringes, scalpel blades, and other items that may be contaminated with the patient’s blood. Place such items in an appropriate biohazard storage device. This device should be maintained in the isolation unit. When it is full or when the patient leaves, the device should be bagged, labeled, and disposed of according to infection control and EPA guidelines. For equipment that is non-disposable, the use of disinfectant cloths or cleaning agents will be utilized and the equipment will be thoroughly wiped down and disinfected. For large equipment that has internal components that are required to be clean (i.e. ventilators or specialty beds) will be cleaned using a two-step process. All surfaces will be wiped down and disinfected and brought out of the dirty room and moved into a decontamination room. At this time, the internal portion will be removed and disinfected. True or False: For large equipment that has internal components that are required to be clean, they will use the two-step process. True False SUBMIT E ND O F L E S S O N