Antoinette Barton-Gooden Patient and Health Care worker
Safety
Slide 2
Objectives Identify infection control hierarchies. Discuss
occupational control measures in maintaining patient and health
care worker safety. Describe the classification system that guides
some control measures. List waste management strategies.
Slide 3
Pre-amble Disinfection and sterilization are essential for
ensuring that medical and surgical instruments do not transmit
infectious pathogens to patients. Multiple studies in many
countries have documented lack of compliance with established
guidelines for disinfection and sterilization. Failure to comply
with scientifically-based guidelines has led to numerous outbreaks.
Health-care policies must identify, primarily on the basis of the
items' intended use, whether cleaning, disinfection, or
sterilization is indicated. (CDC,2008)
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What are some health hazards? Patients Health Care Workers
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Infection control hierarchies Administrative measures
Environmental controls Use of personal protective equipment
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Infection control hierarchies The first and most important
level of the hierarchy, administrative measures, impacts the
largest number of people. It is intended primarily to reduce the
risk of uninfected people who are exposed to people with the
organism/disease.
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Infection control hierarchies contd. The second level of the
hierarchy is the use of environmental controls to reduce the
organisms. The first two control levels of the hierarchy also
minimize the number of areas in the health care setting where
exposure may occur.
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Infection control hierarchies contd. The third level of the
hierarchy is the use of personal protective equipment in situations
that pose a high risk of exposure.
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Infection control measures Sterilization: destroys or
eliminates all forms of microbial life and is carried out in
health-care facilities by physical or chemical methods. Steam under
pressure, dry heat, gas, hydrogen peroxide gas plasma, and liquid
chemicals are the principal sterilizing agents used in health-care
facilities.
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Infection control measures Disinfection: describes a process
that eliminates many or all pathogenic microorganisms, except
bacterial spores, on inanimate objects. In health-care settings,
objects usually are disinfected by liquid chemicals or wet
pasteurization. Each of the various factors that affect the
efficacy of disinfection can nullify or limit the efficacy of the
process.
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Infection control measures Cleaning is the removal of visible
soil (e.g., organic and inorganic material) from objects and
surfaces and normally is accomplished manually or mechanically
using water with detergents or enzymatic products. Thorough
cleaning is essential before high-level disinfection and
sterilization because inorganic and organic materials that remain
on the surfaces of instruments interfere with the effectiveness of
these processes. Decontamination removes pathogenic microorganisms
from objects so they are safe to handle, use, or discard.
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Infection control measures Chemical Disinfectants: Alcohol
Ethyl alcohol and isopropyl alcohol are germicidal characteristics.
These alcohols are rapidly bactericidal rather than bacteriostatic
against vegetative forms of bacteria; they also are tuberculocidal,
fungicidal, and virucidal but do not destroy bacterial spores. Must
be 60-90% in water to be effective against the listed organisms
(CDC, 2008.p.38).
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Infection control measures Chlorine and Chlorine Compounds:
Hypochlorites, the most widely used of the chlorine disinfectants,
are available as liquid (e.g., sodium hypochlorite) or solid (e.g.,
calcium hypochlorite). The most prevalent chlorine products in the
United States are aqueous solutions of 5.25%6.15% sodium
hypochlorite usually called household bleach. They have a broad
spectrum of antimicrobial activity, do not leave toxic residues,
are unaffected by water hardness, are inexpensive and fast acting
(CDC, 2008.p.40).
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Infection control measures Formaldehyde: is a disinfectant and
sterilant in both its liquid and gaseous states. Formaldehyde is
sold and used principally as a water-based solution called
formalin. The aqueous solution is a bactericide, tuberculocide,
fungicide, virucide and sporicide. The Occupational Safety and
Health Administration (OSHA) indicated that formaldehyde should be
handled in the workplace as a potential carcinogen and set an
employee exposure standard for formaldehyde that limits an 8-hour
time-weighted average exposure concentration of 0.75 ppm.
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Infection control measures Glutaraldehyde : is a high level
disinfectant and chemical sterilant. The aqueous solutions of
glutaraldehyde are acidic and generally in this state are not
sporicidal. Only when the solution is activated (made alkaline) by
use of alkalinating agents to pH 7.58.5 does the solution become
sporicidal. Once activated, these solutions have a shelf life of
minimally 14 days.
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When to use what?? Classification system: Critical Items:
confer a high risk for infection if they are contaminated with any
microorganism. They enter sterile tissue or the vascular system
must be sterile because any microbial contamination could transmit
disease. This category includes surgical instruments, cardiac and
urinary catheters, implants, and ultrasound probes used in sterile
body cavities.
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Classification system Most of the items in this category should
be purchased as sterile or be sterilized with steam if possible.
Heat-sensitive objects can be treated hydrogen peroxide gas plasma;
or if other methods are unsuitable, by liquid chemical sterilants.
Germicides categorized as chemical sterilants eg. 2.4%
glutaraldehyde-based formulations.
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Classification system Semicritical Items: come in contact with
mucous membranes or nonintact skin. Eg.respiratory therapy and
anesthesia equipment, some endoscopes, laryngoscope blades,
cystoscopes etc. These medical devices should be free from all
microorganisms; however, small numbers of bacterial spores are
permissible. Intact mucous membranes, such as those of the lungs
and the gastrointestinal tract, generally are resistant to
infection by common bacterial spores but susceptible to other
organisms eg. bacteria, mycobacteria, and viruses. Semicritical
items minimally require high-level disinfection using chemical
disinfectants. Eg.Glutaraldehyde
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Classification system Noncritical Items: are those that come in
contact with intact skin but not mucous membranes. Noncritical
items are divided into noncritical patient care items and
noncritical environmental surfaces. Examples of noncritical
patient-care items are bedpans, blood pressure cuffs, crutches etc.
In contrast to critical and some semicritical items, most
noncritical reusable items may be decontaminated where they are
used and do not need to be transported to a central processing
area.
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Waste Management See UHWI policy Infection control policy
(2007).
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Bibliography CDC guidelines for disinfection and sterilization
in healthcare facilities (2008)