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Prevention of Nosocomial Infection

PharMed Parto Co.,Ltd.Atrineh Saziba Co., LtdDr. Farzan Ravanasa

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Our Ultimate Aim / Take Home MessageTo inform you that staff safety and patient safety are

no longer mutually exclusive

Yesterday’s thinking

Today’s thinking

Tomorrow’s thinking (congruent thinking)

PATIENTSAFETY

STAFFSAFETY

PATIENTSAFETY

STAFFSAFETY

PATIENTSAFETY

STAFFSAFETYSAFETY

FORALL

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Methods of Decontamination depends mainly on the type of material, the level of decontamination and the microorganisms involved

Cleaning: ◦ allows the physical removal of microorganisms◦ allows prevents inactivation of the disinfectant by organic matter◦ complete surface contact during further decontamination procedure

Through cleaning of items is a prerequisite before disinfection and sterilization is commenced

Disinfection:◦ by heat or chemicals will destroy microorganism but not bacterial

spores ◦ chemical disinfection does not necessarily kill all microorganisms

present but reduces them to a level not harmful to health Antiseptics:

◦ the agents must have effective antimicrobial activity◦ must not be toxic to living tissues ◦ chemicals used to kill microorganisms on skin or living tissue

Sterilization:◦ a process which achieves the complete destruction or removal of all

microorganisms , including bacterial spores

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Spaulding classification of chemical disinfectants

Level of disinfection Spores TB

Vegetative

bacteriaFungi

Nonlipid & small viruses

Lipid & medium-

size viruses

High + * + + + + +

Inter-mediate - + + + +/- +

Low - - + +/- +/- +

* high-level disinfectants may not be able to kill large numbers of spores

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Class of item Use of item Example Decont.

level needed

CriticalEnter vascular

system or sterile body tissues

Hypodermic needle,

Scalpels and other surgical instruments,

Biopsy forceps

Sterilization

Semi-critical

Comes in contact with intact mucous

membranes

Vaginal spec., Anaesthetic

equipment, flex. Endoscopes

High-level disinfection(by heat or chemicals)

Non-critical

Touches only intact skin

Blood pressure cuff, Baby

weigh scale, Examining table top

Intermediate-level or low-

level disinfection

Spaulding classification of medical devices

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Using Deconta-

minating

Cleaning

Sterilizing

Sorting / Packing Disinfecting

Instrument Cycle

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Disinfectant Classes :- Aldehydes or Aldehyde releasing agents : Glutaraldehyde(Cidex),Formaldehyde- Alcohols : ethanol,n-propanol,isopropanol- Alkylamines or Alkylamine derivatives - Chloramides or Chlorine releasing agents : Hypochlorite sodium(Vitex) , Halamid- Guanidine or Guanidine derivatives - Heavy metal compounds Silver compounds- Organic acids : Peracetic acid,Salicilic acid,Acetic acids- Inorganic acids : HCl- Peroxide compounds : Hydrogen peroxide- Phenols and phenol derivatives : Chlorhexidine,Chloroxylenol(Dettol) ,Triclosan- Quternary ammonium compounds : Benzalkanium Chloride,deconex® and micro 10 ,…

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Cleaning and Disinfection

Automated procedure (chemical and thermal) instrument washer – disinfector Washer – disinfector for anesthetic and respiratory equipment Bed pan and urinal washer – disinfector

Manual procedure- precleaning soaking brushing rinsing drying

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Method of Sterilization Dry heat sterilization: Oven 170°C for 2h Moist heat sterilization:

Autoclaving at 134-138°C for 3 min Autoclaving at 121-124°C for 15 min Autoclaving at 115°C for 30 min

Chemical sterilization :Aldehide compound, Peracetic acid Ethylene oxide Gamma or UV way Prion sterilization:

Autoclaving at 134°C for ≥ 18 min Soaking in 1 N NAOH for 1 h

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Standard Precautions

1- Hand Hygiene - Hand Washing (plain soap) - Antiseptic hand rub Alcohol-based hand rub 1- Liquid 2- Gel - Surgical hand antisepsis 1- Betadin or Chlorhexidine 4% 2- Alcohol-based hand rub

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2- Gloves - Anti bacterial gloves(Nano silver) - Preventive needle stick gloves - Latex or Latex-free gloves

3- Masks - Anti bacterial Masks(Nano silver) - N95

4- Shields or Eye protectors

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5 -Devives for prevention of Needle Sticks & Sharps Injuries

$1.8 billion is spent annually in the US to treat worker who have actually contracted viruses from needle-sticks. Between US$600 and US$4000 per incident (not including cost of microsurgery, rehabilitation and litigation)

Healthcare workers in the United States report between 600,000 and 1 million sharps injuries per year

70% of sharps injuries go unreported 41% of sharp injuries occur after use and prior to disposal of a sharp

device Real chance of acquiring HIV through occupational exposures but the

risk of acquiring and dying from Hepatitis B is much greater. Scalpel blade injuries are in the top five common type of sharps

injury and second only to needle-stick 7-11% of sharps injuries are caused by scalpel blades

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Infection Rates The chances of infection rates from a single contaminated

needlestick or sharp instrument injury are as follows:

◦ HIV at 0.2% to 0.5% Currently there is no vaccine or treatment available to

either prevent or cure HIV

◦ HBV at 30% (Hepatitis B) Post-exposure prophylaxis with hepatitis B

immunoglobulin and initiation of hepatitis B vaccine is highly effective in preventing infection

◦ HCV at 3% to 10% (Hepatitis C) Currently no vaccines or cures for HCV and neither

immunoglobulin nor antiviral therapy is recommended as post-exposure prophylaxis

Of those infected with HCV, 85% develop an infection, 70% of whom develop liver disease which often leads to cirrhosis and liver transplants

Culver, J. (1997). "Preventing transmission of blood-borne pathogens: a compelling argument for effective device-selection strategies." Am J Infect Control 25(5): 430-3.

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Standards for scalpel blade removal

Single-handed Device

Re-sheathing

Forceps

Hand

Extracted from the AS/NZ Standards 3825-1998 pages 6 & 7.

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New Product Range

FLASK

CASSETTE 3in1

Non Sterile Sterile

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Snapit

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Thank you