11

Infection Prevention (IP)Infection Prevention (IP)

22

IP: ObjectivesIP: Objectives

To prevent major postoperative infections To prevent major postoperative infections when providing surgical contraceptive when providing surgical contraceptive methodsmethods

To minimize the risk of transmitting serious To minimize the risk of transmitting serious infections (e.g., HBV, HIV/AIDS) from or to:infections (e.g., HBV, HIV/AIDS) from or to: clientsclients service providers service providers other staff, including cleaning and housekeeping other staff, including cleaning and housekeeping

personnelpersonnel

33

IP: PrinciplesIP: Principles

Consider every person (client or staff) infectious.Consider every person (client or staff) infectious. Wash handsWash handsCCthe most practical procedure for the most practical procedure for

preventing cross-contamination (person to person). preventing cross-contamination (person to person). Wear gloves before touching anything wetWear gloves before touching anything wetCCbroken broken

skin, mucous membranes, blood or other body fluids skin, mucous membranes, blood or other body fluids (secretions or excretions) (secretions or excretions) CCor soiled instruments and or soiled instruments and other items.other items.

Use physical barriers (protective goggles, face masks Use physical barriers (protective goggles, face masks and aprons) if splashes and spills of any body fluids and aprons) if splashes and spills of any body fluids (secretions or excretions) are anticipated.(secretions or excretions) are anticipated.

44

IP: Principles IP: Principles continuedcontinued

Use safe work practices:Use safe work practices: Not recapping or bending needlesNot recapping or bending needles Safely passing sharp instruments Safely passing sharp instruments Properly disposing of medical wasteProperly disposing of medical waste

Isolate patients only if secretions (airborne) or Isolate patients only if secretions (airborne) or excretions (urine or feces) cannot be contained. excretions (urine or feces) cannot be contained.

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

55

IP: Risk of Disease TransmissionIP: Risk of Disease Transmission

Source ofexposure

HBV(%)

HIV(%)

Skin puncture(broken skin)

27S37 0.3S0.4

Mucocutaneous S < 0.1

Source: Gerberding 1995; Seelf 1978.

66

IP: Accidental Exposure of HBV IP: Accidental Exposure of HBV Infected BloodInfected Blood

As little as 10As little as 10-8-8 ml (.00000001 ml) of HBV- ml (.00000001 ml) of HBV-infected blood can transmit HBV to a susceptible infected blood can transmit HBV to a susceptible host.host.

Source: Bond et al 1982.

77

IP: Practices for Reducing the IP: Practices for Reducing the Risk of Disease TransmissionRisk of Disease Transmission

Between clients and staff:Between clients and staff: HandwashingHandwashing Gloves (service provider and cleaning staff)Gloves (service provider and cleaning staff)

88

IP: Practices for Reducing the IP: Practices for Reducing the Risk of Disease Transmission Risk of Disease Transmission

From contaminated objects:From contaminated objects: Processing instruments and other itemsProcessing instruments and other items

Decontamination (staff)Decontamination (staff) Cleaning (clients and staff)Cleaning (clients and staff) Sterilization (clients and staff)Sterilization (clients and staff) High-level disinfection (clients and staff)High-level disinfection (clients and staff)

Proper waste disposal (staff and community)Proper waste disposal (staff and community)

99

IP: HandwashingIP: Handwashing

Handwashing may be the single most important Handwashing may be the single most important procedure in preventing infection. procedure in preventing infection.

Wash hands:Wash hands: Before and after examining any client (direct Before and after examining any client (direct

contact).contact). After removing gloves because gloves may have After removing gloves because gloves may have

holes in them.holes in them. After exposure to blood or any body fluids After exposure to blood or any body fluids

(secretions and excretions), even if gloves were (secretions and excretions), even if gloves were worn.worn.

1010

IP: Handwashing PracticesIP: Handwashing Practices

Steps:Steps: Use a plain or antiseptic soap.Use a plain or antiseptic soap. Vigorously rub lathered hands together for 10Vigorously rub lathered hands together for 10BB15 15

seconds.seconds. Rinse with clean running water from a tap or Rinse with clean running water from a tap or

bucket. bucket. Dry hands with a clean towel or air dry them.Dry hands with a clean towel or air dry them.

Source: Larsen 1995.

1111

IP: Surgical Handscrub SuppliesIP: Surgical Handscrub Supplies

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

then apply an alcohol solution and rub until dry two then apply an alcohol solution and rub until dry two times.times.

Running waterRunning water Stick or brush for cleaning the fingernailsStick or brush for cleaning the fingernails Soft brush or sponge for cleaning the skinSoft brush or sponge for cleaning the skin Towels (sterile towels should be provided in the Towels (sterile towels should be provided in the

operating room)operating room)

1212

IP: Alcohol Solution for Surgical IP: Alcohol Solution for Surgical HandscrubHandscrub

Add 2 ml glycerine to 100 ml 60Add 2 ml glycerine to 100 ml 60BB90% alcohol solution.90% alcohol solution. Use 3 to 5 ml for each application and continue rubbing Use 3 to 5 ml for each application and continue rubbing

the solution over the hands for about 2the solution over the hands for about 2BB5 minutes, using 5 minutes, using a total of 6 to 10 ml per scrub.a total of 6 to 10 ml per scrub.

Formula

1313

IP: Skin Preparation Prior to IP: Skin Preparation Prior to Surgical ProceduresSurgical Procedures

Purpose:Purpose: To minimize the number of microorganisms on the To minimize the number of microorganisms on the

skin or mucous membranes by:skin or mucous membranes by: Washing with soap and water Washing with soap and water Applying an antisepticApplying an antiseptic

1414

IP: Skin and Mucous Membrane IP: Skin and Mucous Membrane PreparationPreparation

Do not shave hair at the operative site (if Do not shave hair at the operative site (if necessary, trim hair close to skin surface necessary, trim hair close to skin surface immediately before surgery)immediately before surgery)

Ask the client about allergic reactions before Ask the client about allergic reactions before selecting an antiseptic solutionselecting an antiseptic solution

Wash first with soap and water if visibly soiledWash first with soap and water if visibly soiled Apply antiseptic starting from the operative site Apply antiseptic starting from the operative site

and working outward in a circular motion for and working outward in a circular motion for several inchesseveral inches

1515

IP: Cervical and Vaginal IP: Cervical and Vaginal PreparationsPreparations

Apply antiseptic solution liberally to the cervix Apply antiseptic solution liberally to the cervix (2 or 3 times) and then to vagina.(2 or 3 times) and then to vagina. It is not necessary to prep the external genital area It is not necessary to prep the external genital area

if it appears clean. if it appears clean. If heavily soiled, it is better to have the client wash If heavily soiled, it is better to have the client wash

her genital area thoroughly with soap and water her genital area thoroughly with soap and water before starting the procedure.before starting the procedure.

1616

IP: Protective BarriersIP: Protective Barriers

Wear gloves:Wear gloves: When performing a procedure in the clinic or When performing a procedure in the clinic or

operating roomoperating room When handling soiled instruments, gloves and When handling soiled instruments, gloves and

other itemsother items When disposing of contaminated waste items When disposing of contaminated waste items

(cotton, gauze or dressings)(cotton, gauze or dressings)

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

1717

IP: Effectiveness of Methods for IP: Effectiveness of Methods for Processing InstrumentsProcessing Instruments

Effectiveness (removal orinactivation of microbes)

End point

Decontamination Kills HBV and HIV 10 minute soak

Cleaning (water only) Up to 50% Until visibly clean

Cleaning (detergentwith rinsing water)

Up to 80% Until visibly clean

Sterilization1 100% Autoclave, dry heat orchemical forrecommended time

High-leveldisinfection1

95% (does not inactivatesome endospores)

Boiling, steaming orchemical for 20 minutes

1 Prior decontamination and thorough cleaning required.

1818

IP: Processing Soiled IP: Processing Soiled Instruments and Other ItemsInstruments and Other Items

Decontamination

Thoroughly wash and rinse

Sterilization High-Level Disinfection

Cool

Autoclave Dry Heat Boil Chemical

Preferred Methods

Acceptable Methods

Chemical Steam

1919

IP: DecontaminationIP: Decontamination

Principles:Principles: Inactivates HBV and HIVInactivates HBV and HIV Makes items safer to handleMakes items safer to handle Must be done before cleaningMust be done before cleaning

Practices:Practices: Place instruments and reusable gloves in 0.5% chlorine solution after use. Place instruments and reusable gloves in 0.5% chlorine solution after use. Soak for 10 minutes and rinse immediately.Soak for 10 minutes and rinse immediately. Wipe surfaces (exam tables) with chlorine solution.Wipe surfaces (exam tables) with chlorine solution.

2020

IP: Instructions for Preparing IP: Instructions for Preparing Dilute Chlorine SolutionsDilute Chlorine Solutions

To make a 0.5% chlorine solution from 5% To make a 0.5% chlorine solution from 5% bleach mix 1 part bleach to 9 parts waterbleach mix 1 part bleach to 9 parts water

Dilute %

eConcentrat %Total parts (TP) (H2O) = -

1

Dilute .5%

eConcentrat 5%Total parts (TP) (H2O) = - 1 = 9 Total parts (TP) (H2O)

2121

IP: Instructions for Preparing a IP: Instructions for Preparing a Chlorine Solution from a Chlorine Solution from a

PowderPowder

To make a 0.5% chlorine solution from a 35% To make a 0.5% chlorine solution from a 35% chlorine powder mix 14.2 grams of powder to 1 chlorine powder mix 14.2 grams of powder to 1 liter of waterliter of water

eConcentrat %

Dilute %Gram/Liter = X 1000

eConcentrat 35%

Dilute .5%Gram/Liter = X 1000 = 14.2 Gram/Liter

2222

IP: CleaningIP: Cleaning

Principles: Principles: Removes organic material that: Removes organic material that:

protects microorganisms against sterilization and HLDprotects microorganisms against sterilization and HLD can inactivate disinfectantscan inactivate disinfectants

Must be done for sterilization and HLD to be effectiveMust be done for sterilization and HLD to be effective Method of mechanically reducing the number of endosporesMethod of mechanically reducing the number of endospores

Practices:Practices: Wash with detergent and water.Wash with detergent and water. Scrub instruments until visibly clean.Scrub instruments until visibly clean. Thoroughly rinse with clean water.Thoroughly rinse with clean water.

2323

IP: SterilizationIP: Sterilization

Principles:Principles: Destroys all microorganisms including endosporesDestroys all microorganisms including endospores Used for instruments, gloves, and other items that come in direct Used for instruments, gloves, and other items that come in direct

contact with blood stream or tissue under the skincontact with blood stream or tissue under the skin

2424

IP: Sterilization IP: Sterilization continuedcontinued

Practices:Practices: Steam sterilization (autoclave):Steam sterilization (autoclave):

121121C (250C (250F); 106 kPa (15 lbs/inF); 106 kPa (15 lbs/in22) pressure: 20 minutes for unwrapped items, 30 minutes for wrapped items) pressure: 20 minutes for unwrapped items, 30 minutes for wrapped items Allow all items to dry before removingAllow all items to dry before removing

Dry-heat (oven):Dry-heat (oven): 170170C (340C (340F) for 1 hour, or 160F) for 1 hour, or 160C (320C (320F) for 2 hours F) for 2 hours

Chemical sterilization:Chemical sterilization: Soak items in glutaraldehyde for 8Soak items in glutaraldehyde for 8BB10 hours or formaldehyde for 24 hours10 hours or formaldehyde for 24 hours Rinse with sterile waterRinse with sterile water

2525

IP: High-Level DisinfectionIP: High-Level Disinfection

Principles:Principles: Destroys all microorganisms including HBV and HIV; does not reliably Destroys all microorganisms including HBV and HIV; does not reliably

kill all bacterial endosporeskill all bacterial endospores Only acceptable alternative when sterilization equipment is not availableOnly acceptable alternative when sterilization equipment is not available

Source: Favero 1985; McIntosh et al 1994.

2626

IP: High-Level Disinfection IP: High-Level Disinfection BoilingBoiling

Practices:Practices: Boil instruments and other items for 20 minutes (sufficient up to 5500 meters/18,000 ft.).Boil instruments and other items for 20 minutes (sufficient up to 5500 meters/18,000 ft.). Always boil for 20 minutes in pot with lid.Always boil for 20 minutes in pot with lid. Start timing when water begins to boil.Start timing when water begins to boil. Do not add anything to pot after timing begins.Do not add anything to pot after timing begins. Air dry before use or storage.Air dry before use or storage.

2727

IP: High-Level Disinfection IP: High-Level Disinfection SteamingSteaming

Practices:Practices: Steam instruments, gloves and other items for 20 minutes.Steam instruments, gloves and other items for 20 minutes. Always steam for 20 minutes.Always steam for 20 minutes. Be sure there is enough water in bottom pan for entire Be sure there is enough water in bottom pan for entire

steam cycle.steam cycle. Bring water to rolling boil.Bring water to rolling boil. Start timing when steam begins to come out from under Start timing when steam begins to come out from under

lid.lid. Do not add anything to pan after timing starts.Do not add anything to pan after timing starts. Air dry and store in covered steamer pans.Air dry and store in covered steamer pans.

Source: McIntosh 1994.

2828

IP: Steamer Used for High-Level IP: Steamer Used for High-Level DisinfectionDisinfection

2929

IP: Chemical High-Level IP: Chemical High-Level DisinfectionDisinfection

Practices:Practices: Cover all items completely with disinfectant.Cover all items completely with disinfectant. Soak for 20 minutes.Soak for 20 minutes. Rinse with boiled water.Rinse with boiled water. Air dry before use and storage.Air dry before use and storage.

3030

IP: Preparing a High-Level IP: Preparing a High-Level Disinfected ContainerDisinfected Container

Boil (if small), or Boil (if small), or Fill a clean container with 0.5% chlorine Fill a clean container with 0.5% chlorine

solution.solution. Soak for 20 minutes.Soak for 20 minutes. Pour out solution. (The chlorine solution can then Pour out solution. (The chlorine solution can then

be transferred to a plastic container and reused.)be transferred to a plastic container and reused.) Rinse thoroughly with boiled water.Rinse thoroughly with boiled water.

Air dry and use for storage of HLD items.Air dry and use for storage of HLD items.

3131

IP: Waste DisposalIP: Waste Disposal

Principles:Principles: Prevents spread of infection to clinic personnel who Prevents spread of infection to clinic personnel who

handle wastehandle waste Prevents spread of infection to local communityPrevents spread of infection to local community Protects those who handle wastes from accidental injuryProtects those who handle wastes from accidental injury

Practices: Practices: Wearing utility gloves, place contaminated items (gauze Wearing utility gloves, place contaminated items (gauze

or cotton) in leak-proof container (with a lid) or plastic or cotton) in leak-proof container (with a lid) or plastic bag.bag.

Dispose by incineration or burial.Dispose by incineration or burial.

3232

IP:Traffic Flow and Activity IP:Traffic Flow and Activity PatternsPatterns

Goal: To eliminate level of microbial Goal: To eliminate level of microbial contamination in areas where “clean activities” contamination in areas where “clean activities” take place:take place: procedure roomsprocedure rooms surgical areassurgical areas areas for final processing and instrument storageareas for final processing and instrument storage

Number of microorganisms in area is related Number of microorganisms in area is related to number of people present and their activityto number of people present and their activity