Ip presentation final 23.01.08

1

IP INFECTIONPREVENTION

Importance & purpose of IP practices

2

IP Principles have Two main aims

• To reduce the rate of infection and disease transmission to patients

• To protect health care providers

Universal Precautions are minimum level of infection prevention required to prevent the transmission of infection within all health care settings

3

IP Universal Precautions applications

• While handling blood, including dried blood• All other bodily fluids, secretion and excretions,• Non – intact skin: and • Mucous membranes

4

IP Universal Precautions Includes

Good hygiene practices Safe handling of sharps Cleaning treatment Cleanliness of care areas Disposing of medical waste

5

IP Viral Transmission Risk Risk of acquiring HIV after being stuck with a needle from an HIV+ client

4 : 1000 or 0.4 % Risk of acquiring HBV after being stuck with a needle from an HBV+ client

27 - 37: 100 or 30 %

6

IP Accidental Exposure of HBV Infected Blood

As little as 10-8 ml (0.00000001 ml) of HBV-infected blood can transmit HBV to a susceptible host.

Source: Bond et al 1982

7

IP Infection PreventionObjectives

To prevent major postoperative / post procedure infections

To minimize the risk of transmitting infections such as Hepatitis ‘B’, ‘C’ and HIV not only to clients, but also to service providers and staff

8

IP Importance of Infection Prevention Practices

• Prevents post procedure infections• Result in high quality and safe services• Prevents infections in service providers• Protect the community• Prevent antibiotic resistant• Lower the cost of health care services

9

IP Standard Precautions

• Wash your hands• Wear gloves and other protective attires• Correctly process instruments• Maintain correct environmental cleanliness • Appropriate waste disposal practices• Prevent injuries with sharps

10

IP

Hand washing

Protective Barriers

Handling Needles and Sharps

Waste Disposal

Processing Instruments

11

IP Infection PreventionPrinciples

Consider every person (clients and staff) infectious

Wash hands - the most practical procedure for preventing cross- contamination (person to person)

12

IPInfection PreventionPrinciples (cont'd)

Wear gloves before touching anything: wet/broken skin, mucous membranes, blood or other body fluids (secretions / excretions) or solid instruments and other items. Use physical barriers (protective goggles, face masks and aprons) if splashes and spills of any body fluids (secretions / excretions) are anticipated.

13

IP

Infection PreventionPrinciples (cont'd)

Use safe work practices, such as not recapping or bending needles and safely passing sharps instruments.

Isolate patients only if secretions (airborne) and excretions (urine or

feces) cannot be contained.

14

IPInfection PreventionPrinciples (cont'd)

Process instruments and other items (decontaminate, clean, high-level disinfect or sterilize) using recommended infection prevention (IP) practices

..........and finally:

Properly disposing medical waste.

15

IPHandwashing Practices

Handwashing is the most important way to reduce the spread of infections. But it is often underemphasized, and not performed correctly.

16

Hand-Washing

17

IP Handwashing Rules

Wash hands after removing gloves.

Wash hands after exposure to blood orany body fluid (secretions and excretions)even if gloves were worn.

Wash hands before and after examining any client ( direct contact )

18

IPTypes of Handwashing

Routine Handwashing Surgical Hand scrub Alcohol Hand rub

19

IP Routine Handwashing Practices

Use plain or antiseptic soap.

1

Vigorously rub lathered hands together for 15 - 30 seconds.

2

Rinse with clean running water from a tap or bucket.

3

Dry hands with a clean towel or air dry them

4

20

IPProcess of Surgical Hand

scrub Remove all jewelry Wet hands and forearms

thoroughly Clean under fingernail Apply antiseptic. Circular Motion.

Continue for 3-5 minutes. Rinse each arm separately. Use sterile towel to dry

21

•Antiseptic or soap (plain)- If an antiseptic is not available, use plain soap

followed by applying an alcohol solution and rub

until dry two times.

•Running water

•Stick or brush for cleaning the fingernails

•Soft brush or sponge for cleaning the skin

•Sterile Towels (sterile towels to be provided for the operating room)

Surgical Hand scrub SuppliesIP

22

Process of Alcohol Hand rub

2 ml glycerin or propylene glycol in100 ml of 60-90%alcohol

Use 3 - 5 ml for eachapplication and continue rubbing thesolution over the hands for about 2 minutes,using a total of 6 - 10 ml per scrub

Formula

IP

23

Protective Barriers:Gloves

Wear gloves:

- when performing a procedure in the clinic or operating room

- when handling soiled gloves, instruments,and other items

- when disposing of contaminated waste items (cotton gauze, dressings)

IP

24

IP Types of gloves and their Uses

Surgical gloves Should be worn during all procedures in which

there will be contact with blood stream or tissues under the skin

Single use examination gloves:- To reduce the risk of exposing the service

providers to blood or body fluids Utility gloves:- Should be worn for handling contaminated

instruments, linens and medical waste.

25

Protective Barriers:Goggles, Face Masks, Aprons

Wear protective goggles, face masks, and aprons if splashes and spills of any body fluids are likely.

IP

26

IP

27

What parts of the field are sterile?

28

IP Processing of Instruments and other Items

•Decontamination •Cleaning •Sterilization or High-level disinfection

•Storage

29

IP Decontamination

• Definition It is the first step in processing

instruments and kills viruses and many other microorganisms making instruments and other items safer to handle by staff who clean them.

• Bleach ( Sodium Hypo chlorite)• It is inexpensive, •kills HIV, hepatitis B & hepatitis C

quickly•Can be used to decontaminate large

surfaces

30

IP Processing Soiled Instruments and Other Items

DecontaminationPlace instruments and reusable

glovesin 0.5% chlorine solution after use

Soak for 10 minutes and rinse immediately

Wipe surfaces (exam tables) with chlorine solution

31

Instructions for PreparingDilute Chlorine Solutions

% Concentrate

% Dilute

Total Parts (TP) (H2O)

= ( ) - 1

To make a 0.5% chlorine solutionfrom 5% bleach mix:

1 part bleach to parts water

IP

32

IP

Instructions for PreparingChlorine Solution from Powder

% Dilute desired

% Concentration of chlorine in bleach powder

Gram / Liter

= () x 1000

To make a 0.5% chlorine solution from a 35% chlorine powder mix:

15 Tea spc (14.2 grams) of powder to 1 liter of water

33

IPProcessing Soiled Instruments & Other Items

Cleaning

Wash with detergent and water

Scrub instruments until visibly clean

Thoroughly rinse with clean water

34

IPHigh Level

Disinfection

Disinfection:

Process that eliminates all microorganisms but does not reliably kill all bacterial endospores which cause diseases such as tetanus and gas gangrene.

35

IP Methods of HLD

Boiling:•Boil instruments and other items for

20 minutes

•(sufficient up to 18,000 ft / 5,500 mtr altitude)

Soaking in Chemicals:• Steam instruments, gloves, and other items

for 20 minutes

Steaming:•An alternative to this is HLD by use of chemical disinfectant. Soak for 20 minutes.

36

IPBoiling Tips

Always boil for 20 minutesin a pot with a lid.

Start timing when the water begins to boil.Do not add anything to

the potafter timing begins.

Air dry before use or storage.

37

IP Steaming Tips

Always steam for 20 minutes.

Be sure there is enough water in thebottom pan for the entire steam cycle.Bring water to a rolling

boil.

Start timing when steam begins to come out between pans.

Do not add anything to the pan after timing starts.

Air dry and store in the covered steamer pans.

38

IP Chemical High-level Disinfection Tips

-

Cover all items completely with high - level disinfectant.

- Soak for 20 minutes

- Rinse with boiled water

- Air dry before use and storage

39

IPBoil (if small) ......... or

Fill a clean container with 0.5% chlorine solution- Soak for 20 minutes- Pour out solution. (The chlorine solution can then be transferred to a plastic container and reused.)- Rinse thoroughly with boiled water

Air dry and use for storage of HLD items.

Preparing a High-Level Disinfected Container

40

IP

Definition: Process that eliminates all

microorganisms including bacterial endospores.

Sterilization

41

IP Methods of Sterilization

Chemical

Steam (autoclave) or

Dry heat (oven)

42

Standard Conditions for Heat Sterilisation

121°C (250 ° F) at 106 kPa (15 lbs/square inch) pressure

- 20 minutes for unwrapped items

- 30 minutes for wrapped items

Allow all items to dry before removal to dry sterile container

IPSteam Sterilization

43

160° C. (320° F.) for 2 hours

Standard Conditions for HeatSterilization

170° C. (340° F.) for 1 hour ..... or

IP

Dry HeatBy Electrical

Oven

44

Chemical Sterilization

Soak items in Glutaraldehyde for 10 hours

Rinse in sterile water

Store in a sterile container

IP

45

Sterilization of Various Instruments

46

Sterilization of various instrumentsI

PInstrument/Item

Sterilization Time/pressure

47

Sterilization of Various InstrumentsIP

48

Processing MVA EquipmentIP

Syringes should be soaked in 0.5% Chlorine for 20 minutes, then rinsed and driedSyringes should be reassembled when dry, lubricated, and stored in a clean, dry containerDo NOT boil syringes.

Step 3: Processing syringes

Step 4: S torage

Place cannulae in separate sterile (or HLD) container using steri le pickupsUse s terile forceps to remove items from containerAvoid contaminating other cannulae in container.

Do NOT autoclave either syringes or cannulae!

49

IP Effectiveness of Methods for Processing Instruments

Method Effectiveness(removal/inactivation ofmicrobes)

End point

Decontamination Kills HBV and HIV

10 minute soak

Cleaning (water only)

Up to 50% Until visiblyclean

Cleaning(detergentand rinsing withwater)

Up to 80% Until visiblyclean

Sterilization 100 % High pressure steam (autoclave),dry heat, chemical

High-level Disinfection **Prior decontaminationand thorough cleaningrequired.

95% (does not inactivatesome endopores)

Boiling, steamingOr chemical

50

Waste Disposal

51

IP

Types of waste

General Waste Medical Waste Hazardous Chemical

Waste

Waste Disposal

52

IP

Four Aspects of Medical Waste Management

Sorting Handling Interim Storage Disposal: Incinerator is always

the best method of disposal medical waste.

53

IP

Collect sharp items in puncture proof containers

Transport securely to disposal place

Burn in high temperature

incinerator or

Decontaminate and bury in safe place

Disposal of Sharps

54

Waste Disposal

Practices Place contaminated items in leak-proof

container or plastic bag. Dispose by incineration or burial.

55

IPAntiseptics and

Disinfectants

Antiseptics: A chemical agent used on the

skin and mucous membranes to remove or kill microorganisms without causing damage or irritation to the skin and mucous membranes .

56

IP Disinfectant

Definition:A chemical agent used to kill microorganisms on inanimate objects, such as instruments and surfaces. Disinfectants are not meant to be used on the skin or mucous membranes.

57

IP

Surgical hand scrub Skin, cervical and

vaginal preparation Hand washing in

high risk situation:

Uses of antiseptics

58

Skin Preparation Prior to Surgical ProcedureIP

Purpose:

To minimize the number of microorganisms on the skin or mucous membranes by:

- Washing with soap and water

- Applying antiseptics

59

Skin Preparation Prior to Surgical ProcedureIP

60

Skin Preparation Prior to Surgical ProcedureIP

Purpose:

To minimize the number of microorganisms on the skin or mucous membranes by:

- Washing with soap and water

- Applying antiseptics

61

Skin Preparation Prior to Surgical ProcedureIP

62

Skin and Mucous MembranePreparationIP

Do not shave hair ! Clip with scissors if necessary.

Ask the client about allergic reactions.

Wash first with soap and water ifvisibly soiled.

Apply antiseptic starting from the operation site and working outwardin a circular motion for several inches.

63

Cervical and VaginalPreparations

IP

Apply antiseptic solution liberally to the cervix and vagina (2 times)

It is not necessary to prep the external genital area if it appears clean.

- If heavily soiled, it is better to have

the client wash her genital area

thoroughly with soap and water before starting the procedure.

64

IP

Wash needle sticks and cuts with soap and water

Flush splashes to the nose, mouth or skin with water

Irrigate splashes to the eyes with water or saline

Management of sharp injuries

65

IPAvoid dipping hands in a basin containing stand water

66

IP

67

Conclusion

IP can’t be a stand-alone practice; it needs to be integrated into all areas of the clinical reproductive health environment.

IP principles can be adapted to any environment.

IP is important; it’s cheap; you can do it!

68

Hand Washing

Wet hands with running water Rub hands together with soap & lather

well, covering all surfaces, for 30 seconds

Weave fingers & thumbs together 7 slide them back & forth

Rinse hands under a stream of clean, running water until all soap is gone

Blot hands dry with a clean personal towel or air dry

69

Usually left out parts during Hand Washing

70

Hand Washing

71

Hand Washing

72

Steps of Surgical Hand washing

1.Remove all jewelry, watch etc. on hands forearms & wrist

2.Wet hands & forearms thoroughly3.Clean all finger nails with soft nailbrush4.Apply antiseptic soap/solution5.Using a circular motion, continuing

from finger tips to elbow, create lather & wash between fingers

6.Repeat for the second hand & arm

73

Steps of Surgical Hand washingcontd……

7. Continue washing for 3 – 5 minutes

8. Rinse each arm separately, fingertips first, holding your hands above the level of your elbow.

9. Use a sterile towel to dry hands or air dry

10. Keep hands above the level of waist and do not touch any thing.

74

Steps of Putting on Sterile Surgical Gloves

75

Steps of Putting on Sterile Surgical Gloves

76

Steps of Putting on Sterile Surgical Gloves

77

Processing Instruments, gloves and other items Decontamination

Soak in 0.5% Chlorine solution 10 minutes THROUGHLY WASH & RINSE

Wear gloves & other protective barriersPreferred Acceptable Methods Methods

AUTOCLAVE15lbs/in ² pressure 121˚C,20 min. unwrapped 30 min wrapped

CHEMICALSoak in CIDEX for 8-10 hours. Rinse with sterile water

CHEMICALSoak in CIDEX for 20 min. Rinse with water boiled for 20 minutes

COOL & DRY (use immediately or Store)

BOILLid on 20 minutes

STERILIZATION

HIGH LEVEL DISINFECTION