INFECTION PREVENTION & CONTROL

Lecture 2: HAND HYGIENE

Why is hand-washing important?

 Practicing hand hygiene is a simple yet effective way to prevent infections in
healthcare settings.
 Hand hygiene, which means cleaning your hands by washing with soap and water or
using an alcohol-based hand sanitizer, is one of the best ways to avoid getting sick
and prevent spreading germs to others
 Appropriate hand hygiene prevents up to 50% of avoidable infections acquired
during health care delivery, including those affecting the health work force
 So, infection prevention and control (IPC) is defined here; due to its high correlation
with the first standard precaution(hand hygiene):
It is a practical, evidence-based approach preventing patients and health workers from
being harmed by avoidable infections
 The Role of Hands in Disease Transmission

WHO / WHEN: Who needs to handwash and when ?

Critical times for Handwashing in Health Care Facilities
FOR HEALTH CARE WORKERS Befor After
On Entry of the HCF On Exit of the HCF
Before putting on (Donning) PPE After removing (Doffing) PPE
Before touching a patient (Moment 1) After body fluid exposure (Moment 3)
Before clean/aseptic technique (Moment 2) After touching a patient (Moment 4)
Before break / eating or smoking After touching patient surrounding (Moment 5)
After handling soiled linen, waste, etc.
After going to the toilets

FOR PATIENTS / CARE-TAKERS

On Entry of the HCF On Exit of the HCF
Before break / eating or smoking After coughing/sneezing into hands or into a tissue
After going to the toilets
 Hand Hygiene in HealthCare Settings
 The 5 Moments for hand hygiene
 Hands that are not properly cleaned carry microorganisms from one place to
another
 Droplets/aerosols and airborne
transmission and hand hygiene
 When should hand hygiene be done
in other settings ?

RIGHT TIME, RIGHT TECHNIQUE

WHO’s five golden rules for hand hygiene

1 Hand hygiene must be performed at the point-of-care*
(right time)

2 During care delivery, there are five moments when it is essential

to perform hand hygiene

Hand rubbing with an alcohol-based formulation, if available,

3
makes hand hygiene possible at the point of care, is faster, more
effective and better tolerated
technique)

4 Hand washing with soap and water is necessary when hands are
(right

visibly soiled

5 The appropriate technique and time taken to clean hands is also

important
 The 5 Moments for Hand hygiene

Moment 1 and Moment 4

 Before (Moment #1) and after(Moment #4) touching a patient
 Clean your hands before touching the patient to prevent microorganisms from
being transferred from yourself to the patient
 Clean your hands after touching the patient to prevent the transfer of
patients’ germs from your hands to yourself, to the healthcare environment
and to others
 Reflect on when you have contact with patients
 Moment 2 Before a Clean/Aseptic Procedure

 Clean your hands just before performing a clean or aseptic procedure to

protect the patient from risk of infection · , Si 15 20
,

 Prevents introducing germs (even patient’s own microorganisms) into a clean

or sterile site of the patient or where you are contacting mucous membranes
 Examples are putting in eye drops, providing oral care, taking blood sample)

Image Source: Microsoft office Clip Art

Moment 3 After Body Fluid Exposure/Risk

 Clean your hands when visibly soiled with blood or body fluids
 When there was a risk of exposure to blood or body fluids
 Glove use and risk of body fluid exposure

Image Source: Microsoft office Clip Art

Moment 5
After Touching Patient Surroundings
 After touching anything in the area around the patient
 Clean hands when leaving the patient zone
 Prevents germs from being carried out of the patient zone to other areas or to
other people

Image Source: Microsoft office Clip Art

Handwash versus Handrub

Alcohol-based handrub is better at killing most germs but soap and water
physically washes away germs and dirt
You should wash with soap and water instead of handrub when:
 Hands look dirty or are soiled
 Hands are contaminated with blood and body fluids
 After using the latrine/ toilet
 After every 8-10 uses of hand rub to remove the build up of residue
 Using the right technique

How to Handwash
 Medical hand washing(not less than 20 seconds)
 Step 0 Wet Hands with water
 Step 1 Apply enough soap to cover all of your hands
 Step 2 Rub hands palm to palm
 Step 3 Put your right hand over your left and interlace fingers to rub in between all fingers
 Step 4 Rub palm to palm with fingers interlaced
 Step 5 Place backs of fingers against the opposite palm and interlock fingers
 Step 6 Clasp each thumb in opposite palm and rub in a rotation
 Step 7 Rub finger tips of each hand in circles on the opposite palm
 Step 8 Rinse hands with water
 Step 9 Dry hands with a single use clean towel
 Step 10 Use towel to turn off tap ( taps have germs on them)
Handwashing Steps 0-5

Hand Washing Steps 6-11

How to Handrub (using alcohol-based handrub)
 Step 1: Place an amount of the at least 60% alcohol product into a cupped hand
and cover all surfaces
 Step 2: Rub hands palm to palm
 Step 3: Place right palm over back of left hand, interlace fingers and rub in
between all fingers
 Step 4: Interlace fingers with palms facing each other and rub between all fingers
 Step 5: Place Backs of fingers to opposing palms with fingers interlocked and rub

How to Handrub (alcohol-based handrub)

 Step 6: Rotational rubbing of left thumb clasped in right palm and vice versa
 Step 7: Rotational rubbing, backwards and forwards with clasped fingers of right
hand in left palm and vice versa
 Step 8: Rub until dry (20 seconds)

Note: use enough product to keeps hands wet for 20 seconds

Cleaning Hands With Alcohol-based Handrub Steps 1-5

Cleaning Hands With Alcohol-based Handrub

Steps 6-8
 Implementing a Hand Hygiene Programme:
A Multimodal Approach ????

Institutional System
support change

Reminders
Training
in the
/Education
workplace

Evaluation
and
Feedback

Institutional support & the infection prevention department

hospitals are the most places contain bacteria which is highly

resistance to anti-biotic

 Set standards to ensure that patients do not acquire healthcare-associated

infections (HAI) and infections do not spread to visitors and healthcare
personnel · eum gas ,i w 80d ,
 System Change
 Infrastructure support
 Access to a safe, continuous water supply
 Access to soap and towels

Training / Education
 Regular training to all healthcare workers
 Based on 5 moments for hand hygiene
 Discuss barriers and enablers to providing hand hygiene
Evaluation and feedback
 Monitoring hand hygiene practices and infrastructure,
 Monitor perceptions and knowledge among health-care workers
 Provide performance feedback to staff
 Hawthorne Effect (the modification of behavior by health workers in response
to their knowledge that they are being observed or singled out for special
treatment. In the simplest terms, the Hawthorne effect is increasing output in
response to being watched)

Reminders in the workplace

Signage
 Show the indications for hand hygiene
 How to handwash
 How to handrub
 Show photos
 Show different types of healthcare workers
 Display at point of care
 Display throughout the facility
Where to locate Handwashing stations
Organize your setting so that handwashing stations are located “at the point
of use” – i.e. where the user will need to wash hands

 At the entrance of the facility

 At all point of care
 In areas where PPE is put on or taken off
 Where health care waste is handled
 Within 5 meters of toilets
 At the exit of the facility
 In waiting rooms, dining rooms, and other public areas

Cough/ Sneeze Etiquette

Cough and sneeze into the crease of the elbow or tissue
ind

Image Source: Microsoft office Clip Art

 Quiz
QUESTION 1: WHY IS HANDWASHING SO IMPORTANT ?
Answer
Handwashing helps remove any dust/organic material and most of infectious agents present
on your hands (mechanical action)
Handwashing with soap / detergent will help disolve material and rince it off your hands

Quiz
QUESTION 2: DO I NEED TO HANDWASH BEFORE I PUT ON MY PPE ?
AFTER I REMOVE MY PPE ?
Yes
 Quiz
QUESTION 3: DO PATIENTS ALSO NEED TO WASH HANDS ? WHEN ?
Answer
Yes, patients also need to WASH HANDS:

When they enter the Health Care Facility

After sneezing / coughing in your hands, or after disposing of the tissue
After using the toilets
Before eating
On leaving the facility

Quiz
QUESTION 4: CAN YOU CITE THE 5 MOMENTS FOR HAND HYGIENE IN HCF SETTING ?
Answer
Moment 1 Before touching a patient
Moment 2 Before a Clean/Aseptic Procedure
Moment 3 After Body Fluid Exposure/Risk
Moment 4 After touching a patient
Moment 5 After Touching Patient Surroundings
 Quiz
QUESTION 5: HANDWASHING WITH WATER & SOAP OR ALCOOL BASED HAND RUB ?
WHAT IS PREFERABLE ?
Answer
Both are acceptable
It might be easier to implement frequent use of alcohol based hand rub so ABHR is prefered
– however water / soap is also fine.

Quiz
QUESTION 6: DO YOU THINK TRAINING HCWs ON HANDWAHSING IS SUFFICIENT ?
WHAT ARE OTHER POTENTIAL ELEMENTS TO INCREASE COMPLIANCE ?
Answer
No. Other elements include:

1. System change
2. Training / Education
3. Evaluation and feedback
4. Reminders in the workplace
5. Institutional safety climate
 Quiz
QUESTION 7: WHERE HANDWASHING STATIONS SHOULD BE LOCATED ?
Answer
“at the point of use” – i.e. where the user will need to wash hands:

At the entrance of the facility

At all point of care
In areas where PPE is put on or taken off
Where health care waste is handled
Within 5 meters of toilets
At the exit of the facility
In waiting rooms, dining rooms, and other public areas

Cleaning, disinfection and Sterilization of anesthesia tools L1

 Terminology & definitions
 Infection: Is a disease state that results from the presence of
pathogens (disease-producing microorganisms) in or on the body.

 M-O (Microorganism): are microbes or germs that are too small to

be seen by naked eye.

 Pathogenic M-O: are those capable of causing diseases.

 Non pathogenic M-O: those, which do not cause disease.

They live in the body with out causing disease and called normal
flora.
 For example; M-O found in the skin, nose, mouth, and the vagina.

Terminology & definitions

 Asepsis: Includes all activities to prevent infection or break the
chain of infection.
The anesthetist uses aseptic techniques to halt the spread of
MO and minimize the threat of infection.
 Two types:
 Medical asepsis: (clean technique) involves procedures and
practices that reduce the number and transfer of pathogens as
performing hand and wearing gloves.

 Surgical asepsis: (sterile technique). practices used to render

and keep objectives and areas free from M-O
Example: Inserting an indwelling urinary catheter or inserting i.v
catheter.
Terminology & definitions
 Sepsis: it means infection and causing a disease through the invasion of M-
O to the body.
 Antisepsis: a chemical used to prevent or inhibit the growth of M-O (e.g.
H2O2, Iodine).
 Bacteriocides: practices that kill M-O (e.g. disinfectant and germicides)
cidex.
 Sterilization: a process by which all M-O including spores are destroyed.
 Disinfection: A process by which all M-O except spores are destroyed.
 Sterile field: a work area that is free of all M-O.
 Vaccination: The act of introducing a vaccine into the body to produce
protection from a specific disease.
 Immunization: A process by which a person becomes protected against a
disease through vaccination. This term is often used interchangeably with
vaccination or inoculation

Hand Washing Is The Most

Effective Way To Help
Prevent The Spread Of
Organisms.
Disease Transmission
 Five major groups of microorganisms
1. Bacteria
2. Rickettsiae -- -
-
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- 1251s 25
S S
&

3. Viruses
·

4. Protozoa S , >
-

5. Fungi

Bacteria
 One celled microorganisms
 Humans host a variety of bacteria at all times
 The skin, respiratory tract and gastrointestinal tract are
inhabited by harmless bacteria
Diseases Caused by Bacteria
• Dental Decay
• Periodontal Disease
• Pneumonia
• Rheumatic Fever
• Syphilis
• Tuberculosis

Rickettsiae
The rickettsiae are a diverse collection of intracellular Gram-
negative bacteria found in ticks, lice, fleas,and mammals. They
include the genera Rickettsiae, Ehrlichia, Orientia, and
Coxiella.

Transmitted to humans by bite of an infected insect ( lice , fleas,

ticks, and mosquitoes)
• Typhus(Typhus fever is caused by the bacteria Rickettsia, which
is transferred to humans through arthropods like lice, ticks,
mites, or fleas. Typhoid fever is caused by the bacteria
Salmonella typhi, which is related to the salmonella that causes
food poisoning)
 Protozoa
• Found in freshwater and in moist soil
• May be responsible for intestinal infections in humans
• Examples: amoeba, Giardiasis

Viruses
• Require an electron microscope to see them
• Much smaller than bacteria
• Parasitic – live and multiply only inside an appropriate
host cell
• Not affected by antibiotics
• Diseases caused by viruses include: AIDS, Hepatitis,
Herpes, Polio, West Nile, SARS (Severe acute
respiratory syndrome )
 Fungi
• Plants such as mushrooms, yeasts and moulds that lack
chlorophyll
• Fungi are not green
• Two divisions: yeasts and moulds
• Oral Candidiasis is a common yeast found in the oral
cavity of about ½ the patient population

Stages of Infection (infection cycle):

 Infectious Agent.
 Reservoir
 Portal of exit
 Means of transmission.
 Portal of entry
 susceptible host

Rout of entry
 inhalation
 ingestion
 inoculation through the skin or mucous membrane
 Transplacental infection as in syphilis.
Rout of exit
 mucous or saliva
 feces
 vomiting
 discharge of wounds
 blood
 urine
Infections and the Chain of Transmission

The Chain of Infection Depends on:

• Virulence – refers to the degree of strength of that
organism in its ability to produce disease
• Numbers – there must be a high enough number of
microorganisms present to overwhelm the body’s defenses
• Susceptible host – is a person who is unable to resist
infection
• Portal of Entry – means of entering the body such as a
needlestick
Universal Precautions
• The basis of Universal Precautions is acceptance that blood
and certain body fluids of all patients are considered
potentially infectious for HIV, Hepatitis B and all other
Blood borne pathogens.
• Not all patients with infectious diseases can be identified
by obtaining a medical history.

INFECTION PREVENTION & CONTROL

Lecture 3: STANDARD PRECAUTIONS

Ayman Ya’akba

1
 STANDARD PRECAUTIONS

Objectives
The students will be able to
 Define Standard Precautions (SP)
 Describe how SP differ from Transmission Based Precautions
 List 3 examples of use of Standard Precautions in a healthcare facility
 Describe some activities that can be used to train students
 Role of IPC in healthcare emergencies

What are Standard Precautions ?

Standard Precautions are the basic level of IPC
precautions to be used for ALL patients at ALL times
(regardless of the suspected or confirmed status of patients)

 Required measures to prevent exposure of the health care provider to

blood, body fluids, secretions, excretions, mucous membranes, non-intact
skin or soiled items and to prevent the spread of microorganisms.
 Required measures to prevent the spread of microorganisms.

3
Transmission –based Precautions
 Precautions that are necessary in addition to Standard Precautions for
certain pathogens or clinical presentations.
 These precautions are based on the method/mode of transmission for a
specific disease (e.g., contact, droplet, airborne)

Some Definitions
 Mode of Transmission: The way in which infectious agents spread from one
person to another (e.g. contact, droplet or airborne routes)
 Transmission based precautions : Precautions based on the method/mode of
transmission (e.g., contact, droplet, airborne.
Necessary in addition to Standard Precautions for certain pathogens or
clinical presentations)

5
More Definitions
 Risk Assessment: An evaluation of the interaction of the health care provider,
the patient and the patients environment to assess and analyze the potential
for exposure to infectious disease
 Respiratory Etiquette: Personal practices that help prevent the spread of
bacteria and viruses that cause acute respiratory infections

Infections and the Chain of Transmission

7
Principles of Standard Precautions
 Based on a risk assessment by the healthcare provider to protect themselves
and prevent spread of infection to others
 Assumes that all patients are potentially infectious even if asymptomatic
 Risk assessment determines the prevention measures to be used
- Describes practices that should be used all the time with all patients
 Healthcare worker uses the risk assessment to decide on measures or
practices needed to protect themselves and prevent spread of infections
(patient to provider and patient to patient)

Standard Precautions Prevents Transmission

Staff to Patient

Patient to Staff

Staff to Staff

Patient to Patient
9
Standard Precautions in HCF include
 Hand hygiene
 Respiratory Hygiene / Etiquette
 Use of personal protective equipment (PPE)(according to risk)
 Safe Injection Practices and sharps safety
 Safe handling, cleaning, disinfection of patient care equipment
 Environmental cleaning
 Safe Handling and cleaning of soiled linen
 Waste management
10

Standard Measures to prevent infection

during COVID 19
 Hand hygiene
 Respiratory Hygiene / Etiquette
 Physical Distancing
 Use of barriers /personal protective equipment (PPE)
(according to the risk)

11
Hand Hygiene

12

Respiratory Hygiene / Etiquette

Or Cough/ Sneeze Etiquette

Good respiratory hygiene can reduce the spread of microorganisms

(germs) that cause respiratory infections

 Turning your head away & cough and sneeze into the crease of the elbow
or into a tissue
 Throw tissues out immediately after use
 Perform hand hygiene
 Stay home from work if sick
 Protect others from your respiratory droplets
Image Source: Microsoft office Clip Art
13
Respiratory Hygiene / Etiquette
Or Cough/ Sneeze Etiquette
How to Promote Respiratory Hygiene ?
 Encourage Handwashing for patients/people with respiratory symptoms
 Provide masks for patients with respiratory symptoms
 Post visual aids reminding patients / visitors to cover their coughs
 Consider having masks and tissues available for patients in all areas

• Patients with fever / cough should be kept

away in single room or at least 1m from other
patients
Source: MSF IPC Training 14

Effect of the use of masks

to limit the spread of germs in normal breathe, cough

https://youtu.be/kYJvU81DKgk
15
Use of PPE based on risk assessment

16

Infection Control Risk Assessment in

Practice
Will I be exposed to body fluids (blood or excretions or secretions) or non intact skin ?
Yes

Will my hands be exposed ?

Wear gloves

Will my Face or eyes be exposed ?

Wear Face protection

Will skin or clothes be exposed

Wear gown

NB: Risk assessment to be done for each patient, each time 17

 Infection Control Risk Assessment in
Practice (examples)

18

Standard Precautions Adapted

For Other Settings
 Do the risk assessment to determine exposure to blood, body fluids,
excretions , secretions and non intact skin
 Choose appropriate PPE
 Choose to work differently to prevent contamination of the environment

19
Tools for Implementation
 Checklists
 Audits
 On the spot feedback

20

Role of IPC in HealthCare Emergencies

 Reduce the risk of transmission or incidence of infection
 Context of IPC work changes and sometimes is difficult to predict
 Effective communication and action is pivotal to reducing risk
 May need to stop doing normal activities
 IPC activities do not start and end with the event

21
Infection Control Knowledge Areas
Standard
Precautions and Facility Design Water and Waste
Hand Hygiene Transmission based including Triage Management
Precautions

Cleaning,
Disinfection and Environmental
Cleaning and Linen Aseptic Technique Monitor and Audit
Sterilization of
Medical Devices Management

Personal Protective
Equipment

22

Preparation and Planning in IPC

 Preparedness planning
 Development of measures and guidelines ( surveillance systems , review of PPE,
training, post recovery) in conjunction with others
 Be able to identify an outbreak
 Involved in design of facilities ( ability to isolate, store equipment, storage of
vaccines , storage of dead bodies)
 Ensure staff are trained to understand basic IPC principles and practices
 Risk mitigation
 Identify and help reduce risks , provide resources, adapt guidelines to setting
 Response – assist in planning how services will be delivered
23
Plan, Do, Check(study), Act (PDCA)or (PDSA) Cycle

Plan Do
 IPC plan  Policies and Procedures
 Alternate care sites
 Multidisciplinary planning
 Point of Entry
 Collaboration with community  Triage
 Training
 Logistics
 Employee Health
 Isolation capacity

24

Plan, Do, Check(Study), Act (PDCA) (PDSA) Cycle

Check(Study) Act
 Exercises ( e.g. PPE)  Audit activities
 Test Communications  Identify barriers and enablers
 Validate staff knowledge  Apply learning
 Include media communications  Revise policies and procedures
 Validate resources are available  Incorporate changes into training and
 Validate staff are available exercises

25
 Essential Elements to remember

Standard Precautions are routine measures that need to be applied at ALL times with ALL patients
– because the Health Care Setting is a place where various pathogens are found and can be
transmitted.

Standard Precautions are not always applied routinely everywhere > importance of monitoring &
feedback and ensuring IPC is a continuous programme.

Respiratory Hygiene / Etiquette to be applied by both HCWs and Patients / visitors since 2003
SARS outbreak

26

Ayman ya’akba

1
Objectives
 Define some commonly used terms used in reprocessing
 Science behind reprocessing
 Spaulding Criteria and terminology
 Steps in reprocessing of medical devices
 Design of Reprocessing Areas

Some Definitions
 Adverse Event: An event that happens as a result of care that has or may have
the potential harm to the patient
 Automated Endoscope Reprocessor (AER): Machines that clean and disinfect
endoscopes
 Bioburden: The number and types of microorganisms that contaminate the
equipment/device
 Biological Indicator (BI): A test system containing viable microorganisms
providing a defined resistance to a specified sterilization process.

3
 More Definitions
 Chemical Indicator (CI): A system ( may be a paper strip) that shows a
chemical or physical change resulting from exposure to the process and allows
one to know that the process worked or did not work
 Critical Medical Equipment/Devices: Medical equipment/devices that have
been associated with a high risk of infections if not properly cleaned and
sterilized because they enter sterile tissues, including the vascular system (
bloodstream)
 Decontamination: The process of cleaning, followed by the inactivation of
microorganisms, in order to render an object safe for handling

laparoscope
s-.C
Si
Siisy ↑

More Definitions
&s
 Disinfection: The inactivation of disease-producing microorganisms but not their
spores. Cannot occur if cleaning has not first occurred.
-d. 19
 Endoscope : Devices used to examine either critical spaces (joints and sterile
cavities) or semicritical space such as the mucous membranes of the respiratory or
gastrointestinal tract (laryngoscopes, nasopharyngeal scopes , transesophageal
probes, colonoscopes, gastroscopes, duodenoscopes, sigmoidoscopes)
- 81
 Enzymatic Cleaner: >
-
↑

- sS #
& -
, I
-19
S

 A pre-cleaning agent that contains enzymes that break down proteins (blood, body
-

fluids, secretions and excretions) from surfaces and equipment.

&
 Most enzymatic cleaners also contain a detergent. Enzymatic cleaners are used to
loosen and dissolve organic substances prior to cleaning
-↳
S

5
What is Reprocessing ?
 The steps performed to prepare used medical equipment/devices for use (e.g.,
cleaning, disinfection, sterilization)

What Are The Different Levels of Processing

Low-Level Disinfection (LLD):
 For processing non-invasive medical equipment (i.e., non-critical equipment) and some
environmental surfaces
 Equipment and surfaces must be thoroughly cleaned prior to low-level disinfection
High-Level Disinfection (HLD):
 For processing semi-critical medical equipment/devices.
 Destroys vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non-enveloped (non-
lipid) viruses, but not necessarily bacterial spores
 Examples: Glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde, and peracetic acid with
hydrogen peroxide

Sterilization:
 For processing critical medical equipment/devices
 Destroys all forms of microbial life including bacteria, viruses, spores and fungi

7
 Understanding Spaulding’s Criteria

Spaulding’s Criteria for Reprocessing

Critical Semi-critical Non-Critical
Equipment Equipment Equipment
• Enters sterile • Comes in • Touches only
tissue or contact with intact skin, not
bloodstream mucous mucous
membranes or membranes or
non-intact skin doesn’t touch
patient
9
Critical Equipment

 Surgical instruments
 Surgical Implants ( e.g. total hip and knee replacement)
 Biopsy instruments
 Eye equipment
 Dental equipment

10

Semi-Critical Equipment
 Respiratory therapy equipment
 Anaesthesia equipment
 Tonometer

11
Non-Critical Items
 ECG machines
 Commodes >
-
jajj

 Blood pressure cuffs

 Oxygen saturation finger monitors

12

The Spaulding Disinfection and Sterilization Classification Scheme

13
The Spaulding Disinfection and Sterilization Classification Scheme

↳ intermediate

14

Infections and the Chain of Transmission

15
What are the important Elements for
Proper Reprocessing to Occur ?
Centralized
area/department where
reprocessing takes place

A committee/group that
Monitoring reprocessing reviews all of the
procedures to ensure medical devices that are
their quality being reprocessed

Point of use verification Written policies and

of indicators procedures

Validation of cleanliness,
sterility and function of
Staff training
the reprocessed
equipment/device

16

Why is it Best to Centralize Reprocessing?

 Oversight by content experts is easier
 Education of staff is done centrally
 Cost effective use of equipment and human resources
 Space has been designed to physical accommodate all of the equipment
needed
 Human resources are able to be more efficiently used

17
Manufacturers Guidelines Must:??
 Be available and accessible for all reprocessing staff
 Contain information about the design of the equipment/device
 Contain written and/or electronic manuals/directions for use
 Contain device-specific recommendations for disassembly, cleaning and
reprocessing
 Contain evidence that the device has been validated for
disinfection/sterilization using the recommended process/processes

18

Manufacturer/ Guidelines Must Provide

 Recommended detergents, enzymatic cleaners, disinfectants/sterilants and
lubricants for use with the equipment/device
 Recommended chemical exposure time
 Education for staff on use, cleaning and the correct reprocessing
 Number of times the equipment/device may be reprocessed without
degradation
 Recommendations for auditing the recommended process.

19
Decontamination area of Department
 Have enough room for both the cleaning process and storage of necessary
equipment and supplies
 Be distinctly separate from areas where clean/disinfected/sterile equipment/devices
are handled or stored
 Have hand hygiene facilities at entrance and exit to decontam. Area
 Surfaces that can be cleaned and disinfected
 Have slip-proof flooring that can withstand hospital-grade cleaning and disinfecting
products
 Have environmental control (e.g., temperature, ventilation, humidity)
 Have restricted access from other areas in the setting and ensure one-way
movement by staff form clean to dirt and not the reverse

20

Decontamination Area (Soiled Side)

21
Environmental Cleaning
 Written procedures with assigned responsibility
 Floors to be cleaned daily
 Clean spills immediately
 Sinks for cleaning respiratory equipment cleaned between each use
 Clean from clean to soiled , top to bottom
 Dedicate cleaning tools to decontamination ( not for use in clean side)

22

Staff Training
 The manager and all supervisors involved in reprocessing must, as a minimum,
have completed a recognized qualification/certification course in reprocessing
practices.
 A plan must be in place for each person involved in reprocessing to be
properly trained and have feedback on performance
 Yearly in-service updates and as needed
 Re-certification is recommended every 5 years

23
Occupational Health And Safety
 Use Standard Precautions
 Ventilation must be adequate
 Chemicals labelled and stored appropriately
 Eyewash station available
 PPE available for task based on risk assessment

24

Steps to Follow

25
Pre Cleaning
 Remove gross soil ( blood , sputum) at point of use
 Transport ( should be transported in covered labelled containers to
differentiate clean and dirty)
 Precleaning
 Disassemble
 Sort
 Soak

26

Clean
 Clean (physically remove under submerged liquid)
 Manual clean
 Mechanical clean
 Rinse
 Dry

27
After Cleaning
 Have a system for marking ( labels , coloured tags, indicator tape ) to
differential reprocessed items from items that have not yet been processed)
 Visually Inspect (cleanliness and integrity)
 Wrap ( to allow air removal and steam penetration)

28

High Level Disinfection or Sterilization

High Level Disinfection Sterilization
 Liquid Chemicals  Steam Sterilization
 Chemical Sterilant
 Gas Sterilization – Ethylene Oxide

29
 Classification of disinfectants
High-level disinfection (HLD)
 The goal of this type of process is to kill all but the most resistant of spores.
Depending on the item to be processed either heat or liquid immersion
techniques can be used.
 For a liquid immersion technique to be successful, objects must be completely
immersed in a verified high-level disinfectant solution for a predetermined
period of time. For example, 0.2% glutaraldehyde solution can be used for up
to 45 minutes or 0.2% peracetic acid solution can be used for 12 minutes. It is
important to note that long contact times between metal objects and acidic
solutions can cause corrosion.
 Heat processing for high-level disinfection is known as pasteurization
30

Intermediate level disinfection (ILD) SLDSI S . Spores 1

 At this level, most bacteria and fungi are inactivated including slow-growing
Mycobacterium tuberculosis. However, some infectious spores may remain
after processing.
 Bleach and alcohols are two examples of intermediate (occasionally
&
low) level
disinfectants. There are two main types of bleach; oxygen-based bleaches use
0
· ifhydrogen peroxide as their main active ingredient, while Chlorine-based ones
rely on chlorine liberating compound like sodium hypochlorite to do the
cleaning. Combining the two can result in large volumes of chlorine gas being
quickly released. In a small enclosed space like a bathroom, this can kill a
person! This is why people are advised not to mix cleaning products.
jm15 n 8 82 a
Chonine based
31
Low-level disinfection (LLD)
 This is the most basic form of disinfection and is sometimes referred to as
sanitization. While many bacteria are inactivated by such processing, M.
tuberculosis may survive as may some fungi and spores.

32

Basic cleaning
 At its most basic, cleaning is the simple removal of surface soil and debris
from an object (like doing the washing up!). Surface soil can impede the
ingress of steam or chemical sterilants, making sterilization processes
ineffective. As such, Simple cleaning serves as the foundation for all other
decontamination processes. Washing items in water and detergent can be a
simple and effective technique. Using enzymes also means a lower
temperature can be used during disinfection.
 The presence of enzymes in biological detergents is why washing up gloves are
important; over a lifetime of exposure, the enzymes in biological dish soap can
wreak havoc on your skin!
 The utility of some common disinfectants is summarized below:

33
 Chlorhexidine is an antiseptic and disinfectant. It helps reduce the number of
germs (bacteria) in your mouth or on your skin. It is one of the most common
skin and mucous membrane antiseptic agents in use today
- Chlorhexidine was tested under different concentrations ranging from 0.2 to
5%
- Chlorhexidine is a better antiseptic than povidone iodine and sodium
hypochlorite .
- It is high to intermediate level disinfectant (According to concentration 0.2---
5%)

34

Examples of chemical Disinfectants

35
Considerations for Chemical Disinfectants
 Usage - disinfectant manufacturers must supply recommended usage for the
disinfectant to ensure that it is compatible with the medical
equipment/devices on which it will be used
 Contact time
 Shelf life
 Storage
 Appropriate dilution
 Required PPE
 Validation of activity ( test strips)

36

BHLD · Essen &

Cidix alcohol
Pasteurization
,

>
-
for anesthesia equipments >
-

Sterilization
↳ gas (135 )
%

 This is a method of thermal disinfection

 Minimum 71 degrees C for at least 30 minutes
 Also done with automatic pasteurizers or washer disinfectors
 Commonly used for respiratory equipment
 Advantages
 Not toxic
-

 fast
-

 moderate cost
-

 Disadvantages
 May cause burns form splashing
chem cal
·

&

 Hard to validate effectiveness -& g

 Needs a maintenance program to avoid contamination

37
 Indicators of Sterilization Process
 Chemical Indicators
 Biological Indicators
 Heat Sensitive Tape

38

Scenario Reprocessing Medical Equipment

You go to the
hospital for an What should
ultrasound test on be done with
your abdomen the syringe and
Is this a critical , needle ?
semi critical or non
critical item ?
How do you think it
would be able to be
reprocessed

39
Scenario
 A person in the reprocessing department is working in the soiled
decontamination area and they are short staffed in the sterile area of the
department. The manager is not there but your colleague suggests you float
between the 2 areas.
Is this ok ? no never ever
,

clan to dirty
If so why ? more only from
If not why not ?

40

Scenario

This tape is used to test

what ?
What colour should the
tape be ?

41
 Standard Precautions
Lecture 4: TRANSMISSION BASED • Previously called Universal Precautions
PRECAUTIONS & PPE • Assumes blood and body fluid of ANY patient
could be infectious
954958
• Recommends PERSONAL PROTECTIVE PEE
=

EQUIPMENT (PPE) and other infection control j

practices to prevent transmission in any 8-114
healthcare setting
Ayman Ya’akba
• Decisions about PPE use determined by type of
↳ risk assessment
clinical interaction with patient

Transmission-based Contact Precautions

Contact precautions help prevent transmission of infectious
precautions agents spread by contact with the patient or the patient’s
 Precautions that should always be used in addition to environment.
+
standard precautions, include contact precautions,
&
&Song > , m
droplet precautions, and airborne precautions.  Use single-patient rooms when possible.
[lm)
 Maintain ≥3 feet spatial separation between beds in rooms
& -

with more than one patient. -1598056 1034 =

 Wear a gown and gloves for all contact with the patient or
the patient’s environment.
&2)
-
5
..
When =o masks , ↑ S
I
-

 Wear personal protective equipment before entering the

patient’s room and discard it before exiting the patient’s
room.
examples of contact transmitted
diseases Droplet Precautions

 Chicken pox,  Droplet precautions help prevent transmission of

 Common cold, pathogens spread through close respiratory or mucous
 Conjunctivitis (Pink Eye)
membrane contact with respiratory secretions.
 Special air handling and ventilation are not required.
 Herpes simplex (cold sores),
 Healthcare workers should wear a mask prior to entering
 Influenza,
an infectious patient’s room.
 Measles,
 Patients should wear a mask when transported.
 Pertussis
 Mumps

Examples of droplet spread diseases

Airborne Precautions
 Airborne precautions help prevent transmission of infectious
 Common cold. agents suspended in the air.
 Flu.  Place patients in an airborne infection isolation room designed
 Meningococcal disease(bacterial infection meningitis, with monitored negative pressure, 12 air exchanges per hour,
septicaemia (blood poisoning) ). and air exhausted directly to the outside or re-circulated
 Rubella (German Measles) through high-efficiency particulate air filtration.
 Mumps  Facilities should establish a respiratory protection program.
 COVID-19
 Examples of Airborne
Airborne Precautions Diseases
 Respirator N95 or higher level masked patients in a
private room when airborne precautions cannot be  Anthrax.
achieved.  Chickenpox
 Healthcare workers should wear a mask prior to entering
 Influenza.
an infectious patient’s room.
 Meningitis
 Immune healthcare workers are the preferred providers
 Measles
for infectious patients with airborne diseases.

Types of PPE Used in Healthcare

Personal Protective Equipment
Settings
Definition
• Gloves – protect hands
“specialized clothing or equipment worn by an • Gowns/aprons – protect skin and/or clothing
employee for protection against infectious materials” • 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
 Do’s and Don’ts of Glove Use
Gloves
•Purpose – patient care, environmental services, other • Work from “clean to dirty”
•Glove material – vinyl, latex, nitrile, other • Limit opportunities for “touch contamination” -
protect yourself, others, and the environment
•Sterile or non-sterile • Don’t touch your face or adjust PPE with
•One or two pair contaminated gloves
•Single use or reusable • Don’t touch environmental surfaces except as
necessary during patient care

Do’s and Don’ts of Glove Use (cont’d) Gloves

You should always inspect your gloves for tears or
 Change gloves punctures before putting them on. If a glove is
• During use if torn and when heavily soiled (even during use damaged, don't use it!
on the same patient)
• After use on each patient
 Discard in appropriate receptacle
• Never wash or reuse disposable gloves
 Gowns or Aprons Face Protection
• Purpose of use: Protect clothes • Masks – protect nose and mouth
from fluids and blood splashes o Should fully cover nose and mouth and
• Material – prevent fluid penetration
o Natural or synthetic • Goggles – protect eyes
o Should fit snuggly over and around eyes
o Reusable or disposable
o Personal glasses not a substitute for goggles
o Resistance to fluid penetration o Antifog feature improves clarity
or not
• Clean or sterile

Face Protection Respiratory Protection

 Face shields – protect face, nose, mouth, and eyes  Purpose – protect from inhalation of infectious
 Should cover forehead, extend below chin and wrap around aerosols (e.g., Mycobacterium tuberculosis)
side of face  PPE types for respiratory protection
• Particulate respirators
• Half- or full-face elastomeric respirators
• Powered air purifying respirators (PAPR)
 Key Points About PPE
Sequence* for Donning PPE
• Don before contact with the patient, generally before
entering the room
• Gown first
• Use carefully – don’t spread contamination • Mask or respirator
• Remove and discard carefully, either at the doorway or • Goggles or face
immediately outside patient room; remove respirator shield
outside room
• Gloves
• Immediately perform hand hygiene

How to Don a Gown How to Don a Mask

• Select appropriate type and size • Place over nose, mouth and
• Opening is in the back chin
• Secure at neck and waist • Fit flexible nose piece over
nose bridge
• If gown is too small, use two
gowns • Secure on head with ties or
elastic
o Gown #1 ties in front
• Adjust to fit
o Gown #2 ties in back
 How to Don Eye and Face
How to Don a Particulate
Protection
Respirator
• Select a fit tested respirator • Position goggles over eyes and
• Place over nose, mouth and chin secure to the head using the ear
• Fit flexible nose piece over nose pieces or headband
bridge • Position face shield over face
• Secure on head with elastic and secure on brow with
• Adjust to fit headband
• Perform a fit check –
o Inhale – respirator should collapse • Adjust to fit comfortably
o Exhale – check for leakage around face

“Contaminated” and “Clean” Areas of PPE

How to Don Gloves??

• Don gloves last  Contaminated – outside front

• Select correct type and size • Areas of PPE that have or are likely to have been
in contact with body sites, materials, or
• Insert hands into gloves environmental surfaces where the infectious
• Extend gloves over isolation organism may reside
gown cuffs  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 Where to Remove PPE
• Gloves
• Face shield or • At doorway, before leaving patient room or in anteroom*
goggles • Remove respirator outside room, after door has been
• Gown closed*

• Mask or respirator
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub

How to Remove Gloves (1) How to Remove Gloves (2)

• Slide ungloved finger

• Grasp outside edge near wrist under the wrist of the
• Peel away from hand, turning remaining glove
glove inside-out • Peel off from inside,
• Hold in opposite gloved hand creating a bag for both
gloves
• Discard

PPE Use in Healthcare Settings

Remove Goggles or Face Shield Removing Isolation Gown
• Grasp ear or head pieces • Unfasten ties
with ungloved hands • Peel gown away from neck and
shoulder
• Lift away from face
• Turn contaminated outside
• Place in designated toward the inside
receptacle for reprocessing • Fold or roll into a bundle
or disposal • Discard

Removing a Particulate
Removing a Mask Respirator
• Untie the bottom, then top, • Lift the bottom elastic
tie over your head first
• Remove from face • Then lift off the top elastic
• Discard • Discard
 What Type of PPE Would You Wear?
 Suctioning oral secretions? Quizz
• Gloves and mask
• Goggles or a face shield  Drawing blood from a vein? QUESTION 1: WHICH PRECAUTIONS ARE TO BE USED
• Gloves ALWAYS FOR ALL PATIENTS AT ALL TIME ?
• sometimes gown
 Transporting a patient in a  Taking vital signs?
• Generally none
 A. TRANSMISSION BASED PRECAUTIONS
wheel chair?
• Generally none required
 B. STANDARD PRECAUTIONS
 Responding to an emergency
where blood is spurting?
• Gloves,
• fluid-resistant gown,
• mask
• Goggles or a face shield

Quizz Quizz
QUESTION 2: WHEN ARE TRANSMISSION BASED QUESTION 3: WHICH TRANSMISSION BASED PRECAUTIONS
PRECAUTIONS USED ? ARE RECOMMENDED FOR COVID-19 ?

 CONTACT PRECAUTIONS

 DROPLET PRECAUTIONS
Answer: When we are aware of the particular transmission route
followed by a specific disease  AIRBORNE PRECAUTIONSAnswer

Answer:CONTACT & DROPLET

PLUS AIRBORNE WHEN AEROSOL GENERATING
PROCEDURES ARE IMPLEMENTED
Quizz Quizz
QUESTION 4: WHICH PPE ARE USED FOR CONTACT QUESTION 5: WHICH PPE ARE USED FOR DROPLET
PRECAUTIONS ? PRECAUTIONS ?

Answer
Answer
Gloves + Gown
Gloves + Gown

Quizz Quizz
QUESTION 6: WHICH PPE ARE USED FOR CONTACT + QUESTION 7: WHICH PPE ARE USED FOR AIRBORNE
DROPLET PRECAUTIONS ? PRECAUTIONS ?

Answer
Answer
Respirator (N95)
Gloves + Gown + Mask + Googles or Faceshield