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Outpatient Surgery Outbreaks Mycobacterium sp.. Mycobacterium sp. (non-TB) associated with outpatient/cosmetic surgery clinics.2003 M. chelonae from multi-dose container of methylene blue used to mark muscle2001 mycobacterial keratitis associated with a contaminated medical device . Key Recommen
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1. Infection Control in the Surgical Center Linda Verchick, MS
Epidemiology Supervisor
Clark County Health District
2. Outpatient Surgery Outbreaks Mycobacterium sp.
Mycobacterium sp. (non-TB) associated with outpatient/cosmetic surgery clinics.
2003 M. chelonae from multi-dose container of methylene blue used to mark muscle
2001 mycobacterial keratitis associated with a contaminated medical device Outbreaks of not TB mycobacterium have been associated with outpatient surgical centers. In 2003 Mycobacterium chelonae infection was associated with use of a multidose container of methylene blue which was used to mark the muscle during surgery. In 2001, several patients had acquired mycobacterial keratitis from a contaminated medical device used in Lasix surgery to correct vision problems.Outbreaks of not TB mycobacterium have been associated with outpatient surgical centers. In 2003 Mycobacterium chelonae infection was associated with use of a multidose container of methylene blue which was used to mark the muscle during surgery. In 2001, several patients had acquired mycobacterial keratitis from a contaminated medical device used in Lasix surgery to correct vision problems.
3. Key Recommendations of CDC and HICPAC
Ventilation and water system performance
Multidisciplinary risk assessment team
Use of dust control procedures during construction, repair, renovation or demolition
Environmental surface cleaning and disinfection strategies geared towards antimicrobial resistant organisms
Note: There are actually 12 Key recommendations listed in “Guidelines for Environmental Infection Control in Health-Care Facilities”
4. Regulate the Operating Room Environment
Ventilation = positive pressure.
Variable air systems (positive pressure only)
Air introduced at the ceiling and exhausted near the floor
Humidity <68%
Temperature control
5. Regulate the Operating Room Environment
Minimize personnel traffic during operations
6. Cleaning and Disinfecting Environmental Surfaces
Medical equipment surfaces
knobs, handles on equipment such as x-ray machines, instrument carts
Housekeeping surfaces
floors, walls, chairs, and tabletops
7. Cleaning and Disinfecting Medical Equipment
Manufacturer’s recommendation for sterilization
Recommended chemical germicides
Water-resistant properties
Required decontamination after servicing
Non-critical medical equipment (see intermediate level disinfection)
8. Cleaning and Disinfecting
Housekeeping Surfaces
Frequent hand contact “high touch surfaces
Doorknobs, bedrails, light switches, wall areas around the toilet, edges of privacy curtain
Clean/disinfect more frequently
Minimal hand contact
Hard surface floors and window sills
Clean on a regular basis, when soiled, and when patient is discharged from facility
Walls, blinds and window curtains
Clean when visibly soiled
9. Cleaning A form of decontamination by removing organic matter, salts, and visible soils
Physical action of scrubbing with detergents or surfactants and rinsing with water
Necessary step prior to sterilization or disinfection
10. Cleaning Strategy Minimize contamination of cleaning solutions and tools
Change cleaning solutions frequently
Replace soiled cloths and mop heads with each cleaning solution change
Launder cloths and mop heads after use and allow to dry before re-use or use disposable cloths and mop heads
Use manufacturers recommended concentration
11. Cleaning Carpeting and Cloth Furniture
Vacuum carpeting and cloth furniture on a regular basis
Maintain vacuum to minimize dust dispersal by using HEPA filters
Maintain wet cleaning equipment in good repair and allow to dry between uses
Note: Avoid use of carpeting and cloth furnishings in areas where spills are likely to occur
12. Disinfection “The process that eliminates many or all pathogenic micro-organisms on inanimate objects with the exception of bacterial spores”
Spaulding’s* three levels of disinfection:
High-level
Intermediate-level
Low-level
*for treatment of devices and surfaces that do not require sterility for safe use
13. High-level Disinfection Includes powerful sporocidal chemicals (glutaraldehyde, peracteic acid and hydrogen peroxide)
Inactivates all vegetative bacteria, mycobacteria (TB), viruses, fungi, some bacterial spores, enveloped and non enveloped viruses
Utilize for items that come into contact with intact mucous membranes and are heat sensitive
semi-critical medical instruments (s/a flexible fiber optic endoscopes)
thermometers
vaginal speculums
sigmoidoscopes
14. Intermediate-level Disinfection
Includes Chlorine-containing compounds, alcohols (small surfaces), some phenolics, and some iodophors
Inactivates a highly resistant organisms and exhibits some sporcidal activity
Utilize for non-critical medical equipment s/a stethoscopes, blood pressure cuffs, dialysis machines, equipment knobs and controls.
15. Low-level Disinfection Includes quaternary ammonium compounds, some phenolics, and some iodophors
Inactivates vegetative bacteria, fungi, and some lipid enveloped medium size viruses
Utilize for items that come in contact with intact skin such as examining table top, baby weigh scale, blood pressure cuff
17. Special Pathogen Concern Recent studies indicate that MRSA and VRE are most likely transmitted either:
Patient to patient contact
Via health-care workers hands
Hand transfer from contaminated environmental surfaces and patient care equipment
Note: Use standard cleaning and disinfection protocols to control environmental contamination with antibiotic-resistant, gram-positive cocci People represent the primary reservoir of S. aureus. Although it has been isolated from a variety of environmental surfaces (e.g., stethoscopes, floors, charts, furniture, dry mops and hydrotherapy tanks), the role of environmental contamination in transmission of this organism in health care appears to be minimal. Colonized patients are the principal reservoir of VRE. The mechanisms by which cross-colonization take place are not well defined, although recent studies have indicated that both MRSA and VRE are most likely transmitted by the mechanisms outlined in this slide. In one survey, hand carriage of VRE in workers in a long-term care facility ranged from 13% to 41%.People represent the primary reservoir of S. aureus. Although it has been isolated from a variety of environmental surfaces (e.g., stethoscopes, floors, charts, furniture, dry mops and hydrotherapy tanks), the role of environmental contamination in transmission of this organism in health care appears to be minimal. Colonized patients are the principal reservoir of VRE. The mechanisms by which cross-colonization take place are not well defined, although recent studies have indicated that both MRSA and VRE are most likely transmitted by the mechanisms outlined in this slide. In one survey, hand carriage of VRE in workers in a long-term care facility ranged from 13% to 41%.
18. Hand Hygiene Avoid artificial nails and keep natural nails < ¼ in
For visibly soiled hands use soap and water
Use alcohol-based handrubs
Before and after each patient
Before and after glove use
Improved hand hygiene adherence has:
Terminated outbreaks in health care facilities
? transmission of AR organisms
? overall infection rates
19. References “Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and Healthcare Infection Control Practices Advisory Committee (HICPAC)”
http://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdf
“Cleaning, Disinfecting and Sterilizing Office Instruments. CPSA Guideline”
http://www.cpsa.ab.ca/publicationsresources/attachments_policies/Cleaning,%20Disinfecting%20&%20Sterilizing%20Office%20Instruments.pdf
Centers for Disease Control and Prevention
www.cdc.gov