Principles of Standard Precautions

1. Principles of Standard Precautions

2. Outline • Definition of Standard precautions • Hand hygiene • Use of personal protective equipments • Instrument reprocessing • Aseptic techniques • Environmental cleaning and disinfection • Waste management

3. 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.

4. Standard Precautions • Hand hygiene • Use of personal protective equipments • Instrument reprocessing • Aseptic techniques • Environmental cleaning and disinfection • Waste management

5. Hand Hygiene and Use of PPE • Of particular importance when providing care for patients with acute respiratory illness • Will be discussed in details later

6. Instrument reprocessing

7. Instrument Reprocessing • Processing instruments used in healthcare make them safe for reuse • Single use items should be disposed off • Never reprocess single use items

8. Decontamination Removal of contamination: A vague term meaning sterilisation, disinfection or cleaning as appropriate

9. Sterile • Absence of all microbial life • This can not be a partial definition. “Nearly sterile”is a definition without meaning; it means “not sterile”

10. Disinfected • More complex, more subjective definition than “sterile” • A practical definition is “The removal or destruction of all microbes except bacterial spores”

11. Clean This is even less well-defined than “disinfected” • “Absence of extraneous organic contamination” • “Removal of all material that is not part of the item” but to what extent?

12. Infection: difficult Intact skin Intact mucous membrane Broken skin or mucous membrane Foreign body implant (fully enclosed) Foreign body from outside to inside Infection: easy

13. Risks to patients from equipmentSpaulding classification • HIGH - Anything that enters a normally sterile body area • MEDIUM - Anything in contact with intact mucous membrane • LOW - Anything in contact with intact skin • MINIMAL - Items not in contact with the patientor their immediate surroundings

14. Decontamination of equipment • HIGH – Sterilised • MEDIUM - Sterilised, heat disinfected, chemical disinfected only if thermo-labile. • LOW - Cleaned; disinfected if heavily or highly susceptible patient • MINIMAL - Cleaning

15. Aseptic techniques

16. 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

17. 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

18. What is required to establish a good aseptic procedure? • Think before you act • Plan what you are going to do • Which order you are going to do it in • Make sure you have everything you need close at hand • Understand the procedure • Carry out and COMPLETE the procedure beforedoing something else!

19. Environmental cleaning

20. 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.

21. Environmental Cleaning • Removes all visible dirt. • Reduces the bioburden (the number of germs present), so disinfection or sterilization can be more effective • Reduces pyrogens present in dead organisms. • enhance both the safety and quality of patient care • when absent can lead to clusters of Hospital-acquired infections. • Facility looks appealing and improves the morale of staff and patients.

22. General Guidelines for Cleaning • Warm water and detergent removes 80% of microorganisms. The majority of these microorganisms are skin flora and spores. • Minimizes the scattering of dust and dirt. • A damp cloth or wet mop should be used for surfaces • Vacuum cleaner can be used for dust removal (!filters!) • Cleaning begins from the least soiled area to the most soiled area (toilets and soiled storage areas) and from top to bottom.

23. General Guidelines for Cleaning • The use of friction or scrubbing action is the most effective way to remove dirt and microorganisms. • Cleaning solutions should be changed frequently. If a disinfectant is used it is less likely to kill infectious microorganisms if it is heavily soiled. • Cleaning of environmental surfaces should be performed by using separate buckets. One for detergent and the other for plain water. The procedure starts by wiping or scrubbing with detergent, followed by rinsing with water, and drying at the end.

24. General Guidelines for Cleaning • Reusable equipment (e.g., bed, chairs) is not used for the care of another patient until it has been cleaned. • Cleaning supplies must be kept dry and stored properly. Reusable cleaning supplies should be washed and disinfected after use • If disinfectant is used, make up the disinfectant solution separately, use as directed by the label. • Note: Disinfectants are NOT recommended for routine

25. Protective Clothing for Cleaning Workers should always wear gloves, shoes that cover the toes. If there is a potential for splashing or for splattering, they may need additional protection such as an impermeable apron, mask, and protective eyewear.

26. Hospital Environment • Low-Risk Areas: • Waiting Rooms, Administrative Areas. These areas are usually not contaminated with blood or body fluids or microorganisms • Intermediate Risk Areas: • Patient Wards. These are areas used for the care of patients who are not obviously infectious and not highly susceptible. • High Risk Areas: • These are special care areas (e.g., isolation wards, intensive therapy units, operating room, dialysis unit).

27. Frequency of Cleaning • Low-risk clinical areas: Once daily and whenever needed. • Intermediate-risk areas: At least twice daily, and whenever needed, e.g. after visits. Immediate removal of organic material. • High-risk areas: more frequent, cleaned between each patient and thoroughly at the end of the day. Disinfectants may be used as needed.

28. Hospital Laundry • All linen should be sent to the hospital laundry • Collect used linen in fluid resistant bags with considerable size • No need to double bag from isolation rooms • If wet, fold wet areas to the inside • Bag racks are ideal so linen is not held next to body, and work load is reduced, keeps linen off floor • Assume all used linen is contaminated no need for color coding

29. Cleaning Policies and Schedules • Cleaning policy should be developed by the head nurse in accordance with hospital policies • Should be posted to where all cleaning staff • It should take into consideration immediate cleaning after any organic contamination e.g. blood spills

30. Cleaning up Body Fluid Spills • Always wear gloves, such as disposable or heavy duty gloves. • If the spill is small: wipe it with a disposable cloth and then disinfect the surface area of the spill with another disposable cloth that has been saturated with a disinfectant (100-200 PPM chlorine solution). • If the spill is large: place a disposable paper or cloth towel over the spill to soak up the fluid. pick up the towel, dispose into a bag to be disposed as biological waste and then soak the area with non-diluted chlorine). Leave it for considerable time then dry the surface.

31. Ineffective Methods • Fumigation • Ultraviolet lights

32. Waste management

33. DEFINITIONS • Health-care waste All waste from health care activities • Hazardous health-care waste 10 - 25% is hazardous

34. Infectious Anatomic waste Lab waste Sharps Pharmaceutical Chemo, expired medications Other Chemicals Heavy metals Pesticides Pressurized containers Radioactive waste Hazardous healthcare waste

35. Steps of Medical-Waste Management

36. Infectious waste and sharps • Sorting should be at point of generation • Non-hazardous waste should disposed as regular waste • Highly infectious waste (from laboratories) should be autoclaved before disposal. • 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

37. Thank you