Infection Control in the Surgical Center Linda Verchick, MS Epidemiology Supervisor Clark County Health District.

Infection Control in the Infection Control in the Surgical CenterSurgical Center

Linda Verchick, MSLinda Verchick, MS

Epidemiology SupervisorEpidemiology Supervisor

Clark County Health DistrictClark County Health District

Outpatient Surgery Outbreaks Outpatient Surgery Outbreaks Mycobacterium Mycobacterium sp.sp.

MycobacteriumMycobacterium sp. (non-TB) associated sp. (non-TB) associated with outpatient/cosmetic surgery clinics.with outpatient/cosmetic surgery clinics.– 2003 2003 M. chelonaeM. chelonae from multi-dose container from multi-dose container

of methylene blue used to mark muscleof methylene blue used to mark muscle– 2001 mycobacterial keratitis associated with a 2001 mycobacterial keratitis associated with a

contaminated medical device contaminated medical device

Key Recommendations of CDC and Key Recommendations of CDC and HICPACHICPAC

Ventilation and water system performanceVentilation and water system performanceMultidisciplinary risk assessment teamMultidisciplinary risk assessment teamUse of dust control procedures during construction, Use of dust control procedures during construction, repair, renovation or demolitionrepair, renovation or demolitionEnvironmental surface cleaning and disinfection Environmental surface cleaning and disinfection strategies geared towards antimicrobial resistant strategies geared towards antimicrobial resistant organismsorganisms

NoteNote: There are actually 12 Key recommendations listed in : There are actually 12 Key recommendations listed in “Guidelines for Environmental Infection Control in Health-“Guidelines for Environmental Infection Control in Health-Care Facilities” Care Facilities”

Regulate the Operating Room Regulate the Operating Room EnvironmentEnvironment

Ventilation = positive pressure. Ventilation = positive pressure. – Variable air systems (positive Variable air systems (positive

pressure only) pressure only) – Air introduced at the ceiling and Air introduced at the ceiling and

exhausted near the floorexhausted near the floor

Humidity <68%Humidity <68%

Temperature control Temperature control

Regulate the Operating Room Regulate the Operating Room EnvironmentEnvironment

Minimize personnel Minimize personnel traffic during traffic during operationsoperations

Cleaning and DisinfectingCleaning and Disinfecting

Environmental SurfacesEnvironmental Surfaces

– Medical equipment surfaces Medical equipment surfaces

knobs, handles on equipment knobs, handles on equipment such as x-ray machines, such as x-ray machines, instrument cartsinstrument carts

– Housekeeping surfaces Housekeeping surfaces

floors, walls, chairs, and floors, walls, chairs, and tabletopstabletops

Cleaning and DisinfectingCleaning and Disinfecting

Medical EquipmentMedical Equipment– Manufacturer’s recommendation for Manufacturer’s recommendation for

sterilizationsterilizationRecommended chemical germicidesRecommended chemical germicides

Water-resistant propertiesWater-resistant properties

Required decontamination after servicingRequired decontamination after servicing

Non-critical medical equipment (see intermediate Non-critical medical equipment (see intermediate level disinfection)level disinfection)

Cleaning and DisinfectingCleaning and Disinfecting

Housekeeping SurfacesHousekeeping Surfaces Frequent hand contact “high touch surfacesFrequent hand contact “high touch surfaces

Doorknobs, bedrails, light switches, wall areas Doorknobs, bedrails, light switches, wall areas around the toilet, edges of privacy curtainaround the toilet, edges of privacy curtain

Clean/disinfect more frequentlyClean/disinfect more frequently

Minimal hand contactMinimal hand contactHard surface floors and window sillsHard surface floors and window sills– Clean on a regular basis, when soiled, and Clean on a regular basis, when soiled, and

when patient is discharged from facilitywhen patient is discharged from facility

Walls, blinds and window curtainsWalls, blinds and window curtains– Clean when visibly soiledClean when visibly soiled

CleaningCleaning

A form of decontamination by removing organic A form of decontamination by removing organic matter, salts, and visible soilsmatter, salts, and visible soils

– Physical action of scrubbing with detergents or Physical action of scrubbing with detergents or surfactants and rinsing with watersurfactants and rinsing with water

– Necessary step prior to sterilization or disinfectionNecessary step prior to sterilization or disinfection

Cleaning StrategyCleaning Strategy

Minimize contamination of cleaning Minimize contamination of cleaning solutions and toolssolutions and toolsChange cleaning solutions Change cleaning solutions frequentlyfrequently– Replace soiled cloths and mop heads Replace soiled cloths and mop heads

with each cleaning solution changewith each cleaning solution change– Launder cloths and mop heads after Launder cloths and mop heads after

use and allow to dry before re-use or use and allow to dry before re-use or use disposable cloths and mop headsuse disposable cloths and mop heads

Use manufacturers recommended Use manufacturers recommended concentrationconcentration

Cleaning Carpeting and Cloth Cleaning Carpeting and Cloth FurnitureFurniture

Vacuum carpeting and cloth furniture on Vacuum carpeting and cloth furniture on a regular basis a regular basis

Maintain vacuum to minimize dust Maintain vacuum to minimize dust dispersal by using HEPA filters dispersal by using HEPA filters

Maintain wet cleaning equipment in good Maintain wet cleaning equipment in good repair and allow to dry between usesrepair and allow to dry between uses

NoteNote: Avoid use of carpeting and cloth : Avoid use of carpeting and cloth furnishings in areas where spills are furnishings in areas where spills are likely to occurlikely to occur

DisinfectionDisinfection

““The process that eliminates many or all The process that eliminates many or all pathogenic micro-organisms on inanimate pathogenic micro-organisms on inanimate objects with the exception of bacterial spores”objects with the exception of bacterial spores”

Spaulding’sSpaulding’s** three levels of disinfection: three levels of disinfection:High-levelHigh-levelIntermediate-levelIntermediate-levelLow-levelLow-level

**for treatment of devices and surfaces that do not require for treatment of devices and surfaces that do not require sterility for safe usesterility for safe use

High-level DisinfectionHigh-level Disinfection

Includes powerful sporocidal chemicals (glutaraldehyde, Includes powerful sporocidal chemicals (glutaraldehyde, peracteic acid and hydrogen peroxide) peracteic acid and hydrogen peroxide)

Inactivates all vegetative bacteria, mycobacteria (TB), Inactivates all vegetative bacteria, mycobacteria (TB), viruses, fungi, some bacterial spores, enveloped and viruses, fungi, some bacterial spores, enveloped and non enveloped virusesnon enveloped viruses

Utilize for items that come into contact with intact Utilize for items that come into contact with intact mucous membranes and are heat sensitivemucous membranes and are heat sensitive– semi-critical medical instruments (s/a flexible fiber optic semi-critical medical instruments (s/a flexible fiber optic

endoscopes)endoscopes)– thermometersthermometers– vaginal speculumsvaginal speculums– sigmoidoscopessigmoidoscopes

Intermediate-level DisinfectionIntermediate-level Disinfection

Includes Chlorine-containing compounds, Includes Chlorine-containing compounds, alcohols (small surfaces), some phenolics, and alcohols (small surfaces), some phenolics, and some iodophorssome iodophors

Inactivates a highly resistant organisms and Inactivates a highly resistant organisms and exhibits some sporcidal activityexhibits some sporcidal activity

Utilize for non-critical medical equipment s/a Utilize for non-critical medical equipment s/a stethoscopes, blood pressure cuffs, dialysis stethoscopes, blood pressure cuffs, dialysis machines, equipment knobs and controls.machines, equipment knobs and controls.

Low-level DisinfectionLow-level Disinfection

Includes quaternary ammonium compounds, some Includes quaternary ammonium compounds, some phenolics, and some iodophorsphenolics, and some iodophors

Inactivates vegetative bacteria, fungi, and some lipid Inactivates vegetative bacteria, fungi, and some lipid enveloped medium size virusesenveloped medium size viruses

Utilize for items that come in contact with intact skin such Utilize for items that come in contact with intact skin such as examining table top, baby weigh scale, blood as examining table top, baby weigh scale, blood pressure cuffpressure cuff

Monitor employee compliance to hand hygiene recommendations

Special Pathogen ConcernSpecial Pathogen Concern

Recent studies indicate that MRSA and VRE are most Recent studies indicate that MRSA and VRE are most likely transmitted either:likely transmitted either:– Patient to patient contactPatient to patient contact– Via health-care workers handsVia health-care workers hands– Hand transfer from contaminated environmental Hand transfer from contaminated environmental

surfaces and patient care equipmentsurfaces and patient care equipment

NoteNote: Use standard cleaning and disinfection protocols : Use standard cleaning and disinfection protocols to control environmental contamination with to control environmental contamination with antibiotic-resistant, gram-positive cocciantibiotic-resistant, gram-positive cocci

Hand HygieneHand Hygiene

Avoid artificial nails and keep natural nails < ¼ inAvoid artificial nails and keep natural nails < ¼ in

For visibly soiled hands use soap and waterFor visibly soiled hands use soap and water

Use alcohol-based handrubs Use alcohol-based handrubs – Before and after each patientBefore and after each patient– Before and after glove useBefore and after glove use

Improved hand hygiene adherence has: Improved hand hygiene adherence has: – Terminated outbreaks in health care facilitiesTerminated outbreaks in health care facilities– ↓↓ transmission of AR organismstransmission of AR organisms– ↓↓ overall infection ratesoverall infection rates

ReferencesReferences““Guidelines for Environmental Infection Control in Health-Care Guidelines for Environmental Infection Control in Health-Care

Facilities. Recommendations of CDC and Healthcare Infection Facilities. Recommendations of CDC and Healthcare Infection Control Practices Advisory Committee (HICPAC)”Control Practices Advisory Committee (HICPAC)”

http://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdfhttp://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdf

““Cleaning, Disinfecting and Sterilizing Office Instruments. CPSA Cleaning, Disinfecting and Sterilizing Office Instruments. CPSA Guideline”Guideline”

http://www.cpsa.ab.ca/publicationsresources/attachments_policies/Clehttp://www.cpsa.ab.ca/publicationsresources/attachments_policies/Cleaning,%20Disinfecting%20&%20Sterilizing%20Office%20Instruments.paning,%20Disinfecting%20&%20Sterilizing%20Office%20Instruments.pdfdf

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

www.cdc.govwww.cdc.gov