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transcript

Microbiology Skill Lab

Dalia Mohamed Moemen Assistant Lecturer of Medical

Microbiology & Immunology

Department

Infection Control and Hospital

Safety Skills

• hand hygiene

• personal protective equipments

• handling of sharps

• waste disposal

Definition

• Infection control refers to policies and

procedures used to minimize the risk

of spreading infections, especially in

hospitals and health care facilities.

HAND HYGIENE

Introduction

• Hand Hygiene: a general term that

applies to either hand washing,

antiseptic hand wash, antiseptic hand

rub, or surgical hand antisepsis.

Hand-borne Microorganisms

• Presence – bacterial counts on hands range from 104 to 106 CFU/cm2.

– Resident microorganisms: attached to deeper layers of the skin and are more resistant to removal;

– less likely to be associated with HAIs.

– Transient microorganisms: colonize

the superficial layers of skin and

amenable to removable; acquired by

direct contact with patients or

contaminated environment surfaces;

frequently associated with HAIs.

Pittet D et al. Evidence-based model for hand transmission during

patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.

Types of Hand Hygiene

Agents Influence on

hand flora Main purpose Technique

Plain non-

antimicrobial

Partly removes

transient flora

Cleansing after

patient contact &

contamination

Routine Hand

Chlorhexidin

Hexa-chloraphen

Iodine;Iodophoo-

meta-xylenol

-Alcohol-based

waterless

antiseptic

Kills transient

and reduces

resident flora

Hand antisepsis

prior to invasive

procedures, or to

remove pathogens

(e.g., antimicrobial

resistant strains).

Antiseptic Hand

wash or

alcohol-based

handrub

Agents Influence on

hand flora Main purpose Technique

-Chlorhexidine

Hexachloraphene ,

Iodine;Iodophors; Para-

chloro-meta-xylenol

-Alcohol-

based.waterless

antiseptic.

-after washing hands by

soap and water.

Kills transient

flora and

reduces

resident flora

Preoperative antisepsis Surgical Hand

anti-sepsis

Sax H, et al. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene J Hosp Infect 2007; 67(1): 9–21

Hand Hygiene Technique

Effective Handwashing Technique

Hand Washing video.flv

Hand Hygiene Technique with Alcohol-

Based Formulation

Surgical Hand Preparation

• If hands are visibly soiled, wash hands with a plain soap before surgical hand preparation

• Surgical hand antisepsis should be performed using either an antimicrobial soap or an alcohol-based hand rub, preferably with sustained activity, before donning sterile gloves

• When performing surgical hand

antisepsis using an antimicrobial soap,

scrub hands and forearms for the

length of time recommended by the

manufacturer, 2 to 5 min.

Surgical scrub video

Drying Hands

A variety of methods are used for drying hands:

• Paper towels are the best method to dry hands.

• Cloth towels could be used if appropriately recycled.

• Warm air dryers shorten the time for hands to dry, however, they can only be used by one person at a time and are noisy and have the evidence of infection.

• Hand-drying materials should be placed near the sink in an area that will not become contaminated by splashing.

Hand drying video

PPE Use in Healthcare Settings:

Improve personnel safety in the

healthcare environment through

appropriate use of PPE.

PPE Use in Healthcare Settings

Personal Protective Equipment Definition

“Specialized clothing or equipment worn

by an employee for protection against

infectious materials” (OSHA)

Types of PPE Used in Healthcare Settings

• Gloves – protect hands

• Gowns/aprons – protect skin and/or clothing

• Masks and respirators– protect mouth/nose

– Respirators – protect respiratory tract from

airborne infectious agents

• Goggles – protect eyes

• Face shields – protect face, mouth, nose,

and eyes PPE Use in Healthcare Settings

Do’s and Don’ts of Glove Use

• Work from “clean to dirty”

• Limit opportunities for “touch

contamination” - protect yourself,

others, and the environment

– Don’t touch your face or adjust PPE with

contaminated gloves

– Don’t touch environmental surfaces except

as necessary during patient care

Do’s and Don’ts of Glove Use

(cont’d)

• Change gloves

– During use if torn and when heavily soiled

(even during use on the same patient)

– After use on each patient

• Discard in appropriate receptacle

– Never wash or reuse disposable gloves

Face Protection

• Face shields – protect face, nose, mouth,

and eyes

– Should cover forehead, extend below chin

and wrap around side of face

PPE Use in Healthcare

Settings:

How to Safely Don, Use, and

Remove PPE

Sequence* for Donning PPE

• Mask or respirator

• Goggles or face shield

• Gown

• Gloves

*Combination of PPE will affect sequence –

be practical

How to Don a Mask

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit

How to Don Eye and Face Protection

• Position goggles over

eyes and secure to the

head using the ear pieces

or headband

• Position face shield over

face and secure on brow

with headband

• Adjust to fit comfortably PPE Use in Healthcare Settings

How to Don Gloves

• Don gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over isolation gown cuffs

How to Don a Gown

PPE Use in Healthcare

Settings:

How to Safely Remove PPE

“Contaminated” and “Clean” Areas of PPE

• Contaminated – outside front • Areas of PPE that have or are likely to have been in contact

with body sites, materials, or environmental surfaces where the

infectious organism may reside

• Clean – inside, outside back, ties on

head and back • Areas of PPE that are not likely to have been in contact with

the infectious organism

Sequence for Removing PPE

• Gown

• Gloves

• Face shield or goggles

• Mask or respirator

Removing Isolation Gown

• Unfasten ties

• Peel gown away from

neck and shoulder

• Turn contaminated

outside toward the

inside

• Fold or roll into a

bundle

• Discard

How to Remove Gloves (1)

• Grasp outside edge near

• Peel away from hand,

turning glove inside-out

• Hold in opposite gloved

How to Remove Gloves (2)

• Slide ungloved finger

under the wrist of the

remaining glove

• Peel off from inside,

creating a bag for

both gloves

• Discard

Remove Goggles or Face Shield

• Grasp ear or head

pieces with ungloved

• Lift away from face

• Place in designated

receptacle for

reprocessing or

disposal PPE Use in Healthcare Settings

Removing a Mask

• Untie the bottom,

then top, tie

• Remove from face

• Discard

Hand Hygiene

• Perform hand hygiene immediately after

removing PPE. – If hands become visibly contaminated during PPE removal, wash

hands before continuing to remove PPE

• Wash hands with soap and water or use

an alcohol-based hand rub

* Ensure that hand hygiene facilities are available at the point needed,

e.g., sink or alcohol-based hand rub

HANDLING OF SHARPS

HOW DOES EXPOSURE

OCCUR? Needle sticks (most common) - 800,000 needle stick injuries occur each year in the

Cuts from other contaminated sharps

(scalpels, broken glass, etc.)

Contaminated blood contact with the

eyes, mucous membranes of the mouth

or nose, or broken (cut or abraded) skin

Needle Stick Injury and Accidental Exposure to Blood

Accidental exposure to blood caused by needle injuries or injuries

following, cutting, biting or splashing incidents carries the risk of

infection by blood-borne viruses such as the hepatitis B virus (HBV),

hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

HBV risk= 5 - 40%

HCV risk= 3 - 10%

HIV risk = 0.2 - 0.5%

Say NO to Recapping

One hand technique

HANDLING OF SHARPS

Immediately or as

soon as possible

after use,

contaminated sharps

shall be placed in

puncture-resistant,

leak proof and

labeled or color-

coded containers

until properly

reprocessed.

Clinical Waste – Sharps Containers

Sharps containers:

• Must be located as close as is feasible to

where sharps are used.

• Labeled or color-coded.

• Leakproof.

• Puncture resistant.

• Must not be overfilled, ¾ of its volume.

• Able to be closed well before disposal.

• Made of environment friendly material

• should be disposed according to Infectious

Waste Control Act requirements.

CLINICAL WASTE

• Regulated waste must

be placed in closeable,

leakproof containers built

to contain all contents

during handling, storing,

transporting or shipping

and be appropriately

labeled or color-coded.

Waste Disposal

Steps of Medical-

Waste Management

Sorting is separating waste by type (e.g., non-

medical waste, infectious waste, pharmaceutical

waste) into color coded bags at the place where

it is generated.

Sorting:

Office of Engineering

Safety

Waste sorting should be established

as follows:

Black Bags

•Waste to be disposed with the normal general waste. •Final disposal: Landfill

as follows:

Red bags

•For infectious & pathologic waste

•Final disposal: incineration

Infectious waste:

•Dressings (heavily blood stained or

from infected Wounds)

•Any waste item with a soiled infected

body fluid.

•Final disposal: incineration

Yellow bags

as follows:

Infectious Medical Waste

Incineration

Incineration is the best option for solid waste

disposal, high temperature (1300 °C)

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