Hai &

Infection control
practices
A hospital-acquired infection (HAI), also known as
a nosocomial infection, is an infection that
is acquired in a hospital or other health care facility. ...
Such an infection can be acquired in hospital,
nursing home, rehabilitation facility, outpatient clinic, or
other clinical settings
List of the haisCatheter-associated urinary tract
infection (CAUTI)
Central line-associated bloodstream infection
(CLABSI)
Surgical site infection (SSI)
Ventilator-associated events (VAE
 Specimens of tissue or fluid are collected when
microbiological; biochemical or other laboratory
investigations are required to aid diagnosis.
 The results of such investigations may classify
the disease and determine diagnosis and
treatment.
General principles:
Successful collection of specimens will depend on
the following:
1. Collection at the appropriate time
2. Use of the correct technique
3. Use of the correct equipment
4. Safe transportation to the laboratory without
delay
Collection of specimens/swabs
• Samples should be collected before the start of
any treatment
TYPES OF INVESTIGATION:
• Bacterial – culture and sensitivity
• Viral – culture; serology; ideally taken in
hospital as viruses do not survive long outside
the body
• Serological – antigens and antibodies
• Mycosis – fungal
• Protozoa – malaria
 equipment required
Sterile Water Disposable
gloves as
necessary

Spatula Labelled Specimen

Container

Swab in Transport
Medium
Laboratory Request
Form
 DOCUMENTATION
The following information must be given when sending a specimen:

Persons’ name
•Address
•age/sex
•Date of specimen collection
•Time specimen collected
•Diagnosis
•Relevant history
•Any antibiotic therapy already
being administered
•Name of requesting doctor
 HOW TO TAKE A WOUND SWAB
1

When a swab is indicated, the patient should be given a concise

explanation of the need for microbiological investigation and what
the procedure involves, for example, that swabs are mainly used
to recover species from the surface layers rather than from the
deep tissues of a wound.
2
Before a representative sample is collected, any
contaminating materials such as slough, necrotic tissue,
dried exudate and dressing residue should be removed by
cleansing the wound with tap water, sterile saline or
debridement .
 3
Sterile swabs with cotton or rayon tips are usually used. If the
wound is moist a swab can be used straight from the packaging
– if the wound is dry, then the swab tip should be moistened with
sterile saline to increase the chances of recovering organisms
from the site Swabs with a transport medium that incorporates

charcoal enhance the survival of fastidious organisms.

4
Care should be taken to ensure that the swab only comes into
contact with the wound surface.
 5
The swab should be moved across the wound surface in a zig-zag motion at
the same time as being rotated between the Downward pressure to release
fluid from the wound surface has been advocated but this may be painful for
the patient.

6
A representative area of the wound should be sampled. If the wound is large, it
may not be feasible to cover the entire surface, but at least 1cm2 should be
sampled and material from both the wound bed and wound margin should be
collected.
 7
8

7
Immediately following collection, the swab should be
returned to its container (placed into the transport
medium) and accurately labelled

8
Any supporting documentation for the laboratory should
immediately be completed and a note
included in the patient’s records. It is important to provide
information to the laboratory staff that will aid their use of the
standard operating protocol, such as any underlying co-morbidities,
the patient’s age, ongoing treatment and wound location.
 9
Swabs must be transferred to the laboratory as
quickly as possible and ideally processed within four
hours of collection.

10
The laboratory report should list the potential pathogens
isolated and the amount of growth observed. The antibiotic
susceptibilities of any organisms present in the wound may be
included, but whether the isolates are of clinical significance or
whether antibiotic therapy is required is a matter of clinical
judgment. Spreading cellulites and clinical infections will require
systemic antibiotics.
 Action Rationale

Nose swab Moisten swab beforehand with To prevent discomfort to the

sterile water patient

Move swab from the anterior To swab the correct site and
nares and direct upwards into the obtain required sample
tip of the nose

Gently rotate the swab once

Sputum specimen Action Rationale

Use a clean, not necessarily Sputum is never free from

sterile container organisms due to passing
through the pharynx and mouth

Ensure that the specimen is To obtain the required sample

sputum NOT saliva

Encourage the person to cough To facilitate expectoration

deeply or request the help of a
physiotherapist
 Throat swab

Tonsilar fossa

Action Rationale
Sit the person facing a strong light and depress the their To ensure you can see the area to be swabbed. The
tongue with a spatula procedure is likely to make the individual gag – the
tongue moving to the roof of the mouth will contaminate
the specimen

Quickly but gently swab the tonsillar fossa or any area To obtain the required sample
with a lesion or visible exudate

Avoid touching any other area of the mouth or tongue To prevent contamination
 Wound swab

Action Rationale

Take the swab before To collect the maximum

cleaning the wound number of organisms

Rotate the swab gently To collect the sample

once
STORAGE OF
VACCINES
COLD CHAIN
Is the process used to maintain optimal
conditions during the transport, storage and
handling of vaccines, starting at the
manufacturer and ending with the
administration of the vaccine to the client.
 WHO Policy on use of opened
vials of vaccines
• Opened vials can be used in subsequent immunization
sessions and should be discarded at the end of each day.

• Measles, yellow fever and BCG vaccines discarded after 6 hrs.

• Opened vials discarded immediately if there is any

suspicion of contamination.
 Estimation of the quantity of
vaccine needed:
• Number of children to be immunized during the next 12
months.

• Number of doses needed per child for each vaccine.

• Estimated index of vaccine use (wastage factor i.e. No. of

immunizations given & amount of vaccine used- from
previous records).
 Estimation of the quantity of vaccine
needed:
• Number of vaccine deliveries planned during the next
12 months (fewer deliveries, larger and costive cold
chain).
• Amount of reserve vaccine stock to be kept in the main
store (for outbreaks, delay in arrival of vaccine delivery).
• Balance of vaccine stock remaining in the main store (stock
remaining should be added to the amount needed,
balanced to avoid overcrowding & expiry of vaccines)
 Vaccine stock records
• All vaccine storage units must keep Complete & updated
stock record.
• Information to be recorded:
1. Name of vaccine, batch number, expiry date & vial size.
2. Quantity received and source of supply.
3. Quantity issued & to whom sent.
4. For BCG, measles & mumps: quantities of diluent received
& issued.
5. Balance in stock after each transaction.
6. Date of transaction.
7. Physical stock check at the end of each page.
 Equipment for vaccine
transportation – cold box
• Isolated container with a tight fitting lid.

• Temperature inside is maintained by icepacks.

Uses :

• Collection & transport large quantities of vaccine.

• Storage during maintenance periods (cleaning).

• Emergency storage (breakdown of cold chain, power

failures).
• Cold box is loaded by icepacks.

• Diphteria, pertussis , tetanus vaccines, isolated from ice to

not freeze, put in the centre.

• Vaccines, thermometers, cold chain monitors put.

• OPV, measles,BCG at the bottom and closest to icepacks.

 Vaccine carriers
• Insulated box with a tight fitting insulated lid.
• uses:
• transportation of small quantities during working day.
• storage of small quantities during working day to avoid
frequent opening of refrigerators .
• storage of small quantities for emergencies .
• same loading instructions.
Vaccine carriers and icepacks
 Control & monitoring of temperature
• Should be a routine activity.
• At the start and end of each working day.
• Monitoring devices include:
1. Thermometers.
2. Temperature record sheets.
3. Refrigerator or freezer thermostat.
4. Cold chain monitor card (CCM).
5. Vaccine vial monitor (VVM).
6. Freeze watch indicator.
7. Vaccine shake test.
 Thermometers
• Every piece of cold chain should be fitted with a
thermometer.
• Different types may be used, commonly mercury
thermometer.
 Temperature record sheets
• Record temperature of
refrigerator or freezer.
Twice daily: in the
morning and
afternoon.
Any malfunctions then
should be reported.
 Refrigerator or freezer thermostat

• Used to control storage temperature.

• Thermostat is set to a suitable temperature.

• Store all other routinely

recommended vaccines in a refrigerator
between 35°F and 46°F (2°C and 8°C). The
desired average refrigerator vaccine storage
temperature is 40°F (5°C)
 Cold chain monitor card
• Designed to follow the vaccines from the point of manufacture to
the end.Kept together with the vaccine batch.

• Four windows containing indicators, their color change

consequently when temperature rises.

 Vaccine vial monitor (VVM)

• Applied directly to each vaccine vial by the manufacturer.

• Tells the potency and efficiency by change in color.

Vaccine vial monitors (VVM)
 Vaccine vial monitor (VVM)
Vaccine with darker VVMs must be selected for
administration first.
 Vaccine shake test
• To determine whether vaccines (Diphteria, pertussis , tetanus
vaccines,and hepatitis B vaccines) has been frozen, sedimentation occurs
faster.

• After freezing, vaccine is no longer a uniform cloudy liquid, forms flakes.

• “frozen control sample” is used for comparison.

• Both “tested” and “control” vaccine vials should be produced by the

same manufacturer.
 Breakdowns and
emergency:
• Any interruption of the cold chain is an emergency.
Technical faults in refrigerator:

• If refrigerator stops, transfer vaccines to a cold box.

• Check plugs, thermostat.

• Call for help.

Plan for cold chain emergencies:

• Always prepare your plan.

• Define at least two people who know what to do and when.

BMW
 BIO-MEDICAL WASTE
DEFINITION

Any waste which is

generated during the
diagnosis, treatment
and immunization of
human beings or
animals or in
research activities .
Soiled Waste: Items contaminated with blood,
body fluids like dressings, plaster casts, cotton
swabs and bags containing residual or discarded
blood and blood components.

Expired or Discarded Medicines: Pharmaceutical waste

like antibiotics, cytotoxic drugs including all items
contaminated with cytotoxic drugs along with glass or
plastic ampoules, vials etc.
Chemical Liquid Waste : Liquid waste generated due to
use of chemicals in production of biological and used
or discarded disinfectants, Silver X - ray film developing
liquid, discarded Formalin, infected secretions,
aspirated body fluids , liquid from laboratories an d
floor washings, cleaning, house - keeping and
disinfecting activities etc.

Discarded linen, mattresses, beddings contaminated

with blood or body fluid
Contaminated Waste (Recyclable) : Wastes generated from
disposable items such as tubing, bottles, intravenous tubes and
sets, catheters, urine bags, syringes (without needles and fixed
needle syringes ) and gloves.
Waste sharps including Metals: Needles, syringes with fixed
needles, needles from needle tip cutter or burner, scalpels,
blades, or any other contaminated sharp object that may cause
puncture and cuts. This includes both used, discarded and
contaminated metal sharps
Classification continue…
7. WASTES WITH HIGH CONTENT
OF HEAVY METALS:
It represents a subcategory of
hazardous chemical waste, and is
usually highly toxic.
It includes
Batteries,
Broken thermometer,
Blood-pressure gauges.
 Sources continue…
OTHER SOURCES:
1. Households:
 The domestic sector generates biomedical waste to
a small extent which is less than about 0.5% of the
total waste generated in ahousehold.

 The type of biomedical waste generated in a

household are syringes, cotton swabs, discarded
medicines, bandages, plaster, sanitary napkins,
diapers etc.
 SOURCES OF BIOMEDICAL WASTE:
• It is generated primarily from health
care establishments, including
• Hospitals,
• Nursing homes,
• Veterinary hospitals,
• Clinics and general practitioners,
• Dispensaries,
• Blood blanks,
• Animal houses and research institute.
 COLOR CODING FOR SEGREGATION OF
BIOMEDICAL WASTE: -
COLOR WASTE TREATMENT

Yellow Human &Animal anatomical waste / Incineration / Deepburial

Micro-biology waste and soiled
cotton/dressings/linen/beddings etc.
Red Tubing's, Catheters, IV sets. Autoclaving / Microwaving /
Chemical treatment

Blue / Waste sharps Autoclaving / Microwaving /

White ( Needles, Syringes, Scalpels, blades etc. Chemical treatment &
) Destruction / Shredding

Black Discarded medicines/cytotoxicdrugs, Disposal in securedlandfill

Incineration ash, Chemicalwaste.
 Recommended concentration/dilution of Chemical disinfectants
DISINFECTANT CONTAMINATED GROSSLY
( Acontact period 0f 30 minutes is CONDITION CONTAMINATED
required for effective disinfection) CONDITION
Sodium hypochlorite 5% 20 ml / L 200 ml /L
available chlorine as liquid
bleach
Tincture of Iodine/Povidone Iodine 2.5 % 2.5 %

EthylAlcohol 70 % 70 %

IsopropylAlcohol 70 % 70 %

Gluteraldehyde 2 % 2.5 % 2.5 %

Formaldehyde 40 % 5% 10 %

Savlon 5% 10 %

Dettol 4.8 %v/v 4% 10 %

Cresol 2.5 % 5%
It uses chemicals to destroy pathogenic organisms
from any inanimate object.
● Sharps contaminated with blood and body fluids.
● Instruments, equipment that are used to cut, pierce
or enter the natural orifices like needles, syringes
and endoscopes
● Contaminated floors, surfaces, clothes, beds,
beddings, enamel, crockery and bed pans
● Wet mopping of intensive care units, operation
theatres, wards and patient waiting areas.
*It uses heat to decontaminate
instruments and equipment and the
temperatures in this process may rise to
extremely high levels.
*Most of the microbes are destroyed
at temperatures below 100°C.
1. Autoclave
2. Hydroclave
3. Incinerator
4. Microwave
 -where air is pushed out of the
autoclave by steam under
pressure.
-This system operates at
temperatures of 121°C and has
a cycle time of approximately
60 - 90 minutes.

Here vacuum pumps are utilized to

evacuate the air in the chamber of
autoclave and steam under
pressure is pushed in, which is able
to penetrate the waste material
more thoroughly. This technology
thus reduces the cycle time to 30 -
60 minutes and the temperatures
- This is asteam
sterilization
technology in which
the steam is used as
an indirect heating
source thus allowing
total dehydration of
waste material.
- The holding time for waste is 15 minutes at
132°C or 30 minutes at 121°C.
- The organic components of the waste are hydrolyzed
and the waste matter is reduced by weight and volume.
- Incineration is a high heat system
process of burning combustible solids
at very high temperature in a
furnace.
- It employs combustion of waste
material in stages, followed by
cleaning of the flue gasthrough a
number of pollution control
devices.
- The end product is devoid of
infectious organisms and organic
compounds of waste, which is
aesthetically acceptable.

- Based on the type of fuel

consumed the division could
be-
● Conventional incinerator using
wood/charcoal
● Electrical incinerator
 -This low heat system uses
microwaves to heat up
the waste material from
inside, unlike the external
heat given in autoclave and
hydro clave.
-Microwaves are electromagnetic
waves that lie between the 300
to 300,000 mega hertz range in
the electromagnetic radiation
spectrum.

-They are able to penetrate materials and create vibrations in all

the dipole molecules suchas water in the waste materials.
-This vibration generates friction, which in turn produces heat
to disinfect the waste material.
DISINFECTION
AND
STERILIZATION
Sterilization: complete killing of all forms of
microorganisms, including bacterial spores

Disinfection: killing or removing of harmful

vegetative microorganisms.
 Key points
•Cleaning, disinfection, and sterilisation are the
backbone of infection prevention and control
•Proper cleaning essential before any disinfection or
sterilisation process
•Failure to sterilise or disinfect reusable medical
devices properly may spread infections
•Steam sterilisation effective only when
preceded by Thorough pre-cleaning, proper
packaging/loading, and careful monitoring of
autoclaves
 Decontamination
Decontamination (sometimes abbreviated is the process of
cleansing an object or substance to remove contaminants such
as micro-organisms or hazardous materials, including
chemicals, radioactive substances, and infectious diseases. The
purpose of decontamination is to prevent the spread of micro-
organisms and other noxious contaminants that may threaten the
health of human beings or animals, or damage the environment.
 Pre-Cleaning/Cleaning

Everyone responsible for handling and

reprocessing contaminated items must:
– Receive adequate training and periodic
retraining
– Wear appropriate personal protective
equipment (PPE)
– Receive adequate prophylactic
vaccinations
 Classification
Divided hospital instruments into
general categories based on the
risk of infection involved in their
use
 Critical items
 Semi critical item
 Non critical items
 Critical Items
• Enter normally sterile tissues, the
vascular system, or equipment
through which blood flows
• Items must be properly and safely
pre-cleaned and sterilised before
use
 Critical Items - Examples

• Implants
• Prosthetic devices
• Surgical instruments
• Needles
• Cardiac catheters
• Urinary catheters
• Biopsy forceps of endoscope
 Semi-critical Items

• Contact mucous
membranes but do
not penetrate soft
tissue or body
surfaces
• Meticulous physical
cleaning followed by
appropriate high-
level disinfection
Semi-critical Item - Examples

–Flexible fiberoptic endoscopes

–Respiratory therapy equipment
–Anaesthesia equipment
–Endotracheal tubes
–Bronchoscopes
–Vaginal specula
–Cystoscope
–Hand-piece
 Non Critical Items

• Direct contact with the patients intact

skin (unbroken skin)
• Little risk of pathogen transmission
directly to patient
• Clean and disinfect using a low to
intermediate level disinfectant
Examples of Non Critical Items
Items which are in contact with intact
skin
– Bedpans
– Blood pressure cuffs
– Crutches
– Stethoscopes
– Face mask
– X-ray machine
 Disinfection
A process that eliminates many or all pathogenic
microorganisms on inanimate objects, with the
exception of bacterial spores
– Reduction in numbers of pathogens on inanimate
surfaces/objects For items that will contact intact
skin or mucous membrane
• Use physical or chemical agents or both Level of
disinfection
–High-level
–Intermediate-level
–Low-level
 Chemical disinfectants in health care
Agents Spectrum Uses Advantages Disadvantages

Alcohols (60-90%) Low- to Used for Fast acting. Volatile, flammable,

including intermediate-level decontaminating No residue. and an irritant to
ethanol and disinfectant. the outside of some Non-staining. mucous
isopropanol semi-critical and Low cost. Widely membranes.
noncritical items, available in many Inactivated by
e.g., oral and rectal countries for organic matter.
thermometers and medicinal and May harden rubber,
stethoscopes. Also research purposes. cause glue to
to disinfect small deteriorate, or
surfaces such as crack acrylate
rubber stoppers of plastic.
multi-dose vials.
Alcohols with
detergent are safe
and effective for
spot disinfection of
countertops, floors,
and other surfaces.
 Chemical disinfectants in health care
Agents Spectrum Uses
Chlorine and chlorine Low- to high-level Used for disinfecting
compounds: the most disinfectant. tonometers and for spot
widely used is an aqueous disinfection of
solution of sodium countertops and floors.
hypochlorite 5.25-6.15% Can be used for
(domestic bleach) at a decontaminating blood
concentration of 100-5000 spills. Concentrated
ppm free chlorine hypochlorite or chlorine
gas is used for disinfection
of large and small water
distribution systems, such
as dental appliances,
hydrotherapy tanks, and
water distribution systems
in haemodialysis centres.
Advantages
Low cost, fast acting.
Readily available in most
settings. Available as
liquid, tablets or powders.
Disadvantages
Corrosive to metals in high
concentration (>500 ppm).
Inactivated by organic
material.
Decolourises or bleaches
fabrics. Releases toxic
chlorine gas when mixed
with ammonia. Irritant to
skin and mucous
membranes.
Unstable if left uncovered,
exposed to light, or
diluted; store in opaque
container.
 Chemical disinfectants in health care
Agents Spectrum Uses Advantages Disadvantages

Aldehydes High-level Widely used as high- Good material Allergenic and

disinfectant. level disinfectant for compatibility. irritating to skin and
Glutaraldehyde: ≥2% heat-sensitive semi- respiratory tract.
alkaline or acidic critical items such as Must be monitored
solutions. Also endoscopes. for continuing efficacy
formulated with levels when reused.
phenol-sodium-
phenate and
alcohol.
 Chemical disinfectants in health
care
Agents Spectrum Uses Advantages Disadvantages

Peracetic acid 0.2- High-level Used in automated Rapid sterilisation cycle Corrosive to some
0.35% and other disinfectant/sterilant. endoscope time at low metals.
stabilised organic acids. reprocessors. Can be temperature (30-45 Unstable when
used for cold min. at 50-55oC). Active activated. May be
sterilisation of heat- in presence of organic irritating to skin,
sensitive critical items, matter. conjunctivae and
e.g., haemodialysers. Environmentally- mucous membranes.
Also suitable for manual friendly by-products
instrument processing (oxygen, water, acetic
when properly acid).
formulated.
 Chemical disinfectants in health care
Agents Spectrum Uses Advantages Disadvantages

Hydrogen peroxide High-level Can be used for cold No activation. No Not compatible with
7.5%. disinfectant/sterilant. sterilisation of heat- odour. brass, copper, zinc,
sensitive critical Environmentally- nickel/silver plating.
items. Requires 30 friendly by-products
minutes at 20oC. (oxygen, water).

Hydrogen peroxide High-level For disinfecting Fast-acting (high-level Not compatible with
7.5% and peracetic disinfectant/sterilant. haemodialysers. disinfection in 15 brass, copper, zinc,
acid 0.23% min.). No activation and lead. Potential for
required. No odour. eye and skin damage.
 Chemical disinfectants in health care
Agents Spectrum Uses Advantages Disadvantages

Phenolics Low- to intermediate- Has been used for Not inactivated by Leaves residual film on
level disinfectant. decontaminating organic matter. surfaces. Harmful to the
environmental surfaces environment. No
and non-critical items. activity against viruses.
Concerns with toxicity Not recommended for
and narrow spectrum of use in nurseries and
microbicidal activity. food contact surfaces.
 Chemical disinfectants in health care
Agents Spectrum Uses Advantages Disadvantages

Iodophores (30-50 ppm Low-level disinfectant. Used on some non-critical Relatively free of toxicity Inactivated by organic
free iodine) items, e.g., hydrotherapy or irritancy. matter. Adversely affects
tanks; however, main use silicone tubing. May stain
is as an antiseptic. some fabrics.

Quaternary ammonium Low-level disinfectant Used mainly on Stable with good Relatively narrow
compounds unless combined with environmental surfaces. detergent properties microbicidal spectrum, but
other agents. Can be used on skin. (cationic detergent). range of activity can be
Usually non-irritating. expanded when combined
with other agents, e.g.,
alcohols.
 Sterilisation - 1

• The complete elimination or destruction of all

forms of microbial life
• Includes large numbers of highly resistant
bacterial spores
 Sterilisation - 2

• Store in clean, dry place

• Protect wrapping
• Inspect before use
 Steam Sterilisation
• Requires direct contact of an item with
steam at a required temperature and
pressure for a specified time
• Most reliable
• Non-toxic
• Has broad-spectrum microbiocidal activity
• Good penetrating ability
• Cheap and easy to monitor for efficacy
• 2 main types: gravity and pre-vacuum
Gravity Displacement Autoclaves

• Steam introduced to purge out

air and build pressure
• Raise temperature normally to
121°C at 15 pounds/square inch
and maintain it for 15-45
minutes
• For sterilising liquids and items
in wraps that steam can
penetrate
 High-Vacuum Autoclaves

• Air is first vacuumed out and then

steam introduced
• Faster and better penetration
throughout the load
• Pressure and temperature higher;
134°C at about at 30 pounds/inch2
• Processing time about three minutes
• Not suited for liquids due to need for
vacuum
 Factors Influencing Steam
Sterilisation
• Proper loading must occur
• All items in load must have contact with
steam
• Items in load must be free from grease
and oil
 Practical Tips
• A wide range of sterilisers is available
• Always sterilise items for the correct time
using a clock or timer
• Air in the steriliser and load results in
inadequate steam penetration
• Never sterilise single use items
 Low-Temperature
• Mixture of steam (50-80°C) and
formaldehyde vapour
• To process heat-resistant or heat-
sensitive medical devices in specialised
equipment
• Devices pre-cleaned and wrapped in
standard material and processed in a
three-hour cycle
• Cannot be used for liquids
• Formaldehyde must be purged/
neutralised well
 Flash Sterilisation

• Only to process a critical surgical item:

a) in an emergency
b) when accidentally contaminated, or
c) when other means of sterilisation unavailable
• Never to be used for implantable items or to
compensate for shortage of key instruments
 Dry Heat Sterilisation - 1

• Require hot-air ovens

• For glassware, metallic items, powders and
oil/grease
• Time two hours at 160°C and one hour at 180°C
• Plastics, rubber, paper and cloth cannot be
placed in them due to fire risk
 Dry Heat Sterilisation - 2

Advantages
• Can be used for powders, anhydrous oils
• Inexpensive
• No corrosive effect on instruments
Disadvantages
• High temperature damages some items
• Penetration of heat slow, uneven
 Ethylene Oxide (EO)

• Colourless, flammable, explosive and toxic gas

• Processing cycles overnight or longer
• Parametric release is not possible
– EO and relative humidity cannot readily be measured
• Spores of Bacillus atrophaeus used as biological
indicators to monitor process
 Ethylene Oxide (EO) Gas
Sterilisation
• Used for heat or moisture sensitive
items
• Prevents normal cellular metabolism
and replication
 EO Sterilisation
Advantages Disadvantages
• Items not damaged
by heat or moisture • Cost
• Not corrosive, not • Toxic properties of
damaging to ethylene oxide
delicate
instruments, scopes • Aeration required
• Permeates porous • Longer process
materials
• Dissipates from
material
 Hydrogen Peroxide Gas Plasma
• Highly reactive/charged particles from
hydrogen peroxide generated under
vacuum
• Can be used to sterilise heat- and
moisture-sensitive items
– Some plastics, electrical/electronic devices,
and corrosion-susceptible metal alloys
• Not compatible with cellulose (linen,
paper), devices with dead-end lumens,
powders and liquids
• Special wrapping required
 Fumigation

• For rooms contaminated with some pathogens

– Such as MRSA and Clostridium difficile
• Release of hydrogen peroxide, chlorine dioxide
gas or possibly ozone in sealed rooms
• Spore strips (biological indicators) placed
strategically to monitor process
• Special equipment required
• Risk of damage to sensitive items
 Pasteurisation and Boiling

• Semi-critical items can be pasteurised

– 65-77°C, 30 min
– Example: respiratory therapy equipment
• Must be retrieved carefully for safe
transport and storage
 Filtration

• Removal of microbes from air or

heat-sensitive liquids
• Disinfectant-impregnated filters
may inactivate trapped
microorganisms
• Example: High-efficiency particulate
air (HEPA) filters
• All filters must be checked for
integrity and replaced as necessary
 Automated Endoscope
Reprocessors
• Alternative to manual reprocessing of
heat-sensitive devices
• Minimise exposure of staff to pathogens
and disinfectants
• Require access to reliable electric and
water supplies, specific chemicals, regular
maintenance
• Biofilm build-up must be avoided
 Ultraviolet (UV) Light
• UV lamps useful for chemical-free disinfection of
air and water and also possibly for
decontamination of environmental surfaces
• Broad-spectrum microbicidal action
• Require regular cleaning and periodic
replacement
 Microwaves

• Heating from rapid rotation of water molecules

• Limited use except for disinfecting soft contact
lenses and urinary catheters for intermittent self-
catheterisation
• May be used in emergencies to treat water for
drinking or to ‘disinfect’ small water-immersible
plastic or glass items
Sterilisation Process Monitoring

Recommended practices state that both

biological and chemical indicators shall be used
to monitor the sterilisation process
• Mechanical monitoring
• Chemical monitoring
• Biological monitoring
 Chemical Indicators

• External Chemical Indicator

• process indicator - autoclave tape
• distinguishes processed from unprocessed medical
devices
• secures pack
• labels pack
• Check external indicator to ensure it has
changed color before using any package
• If the indicator did not change, do not use
 Biological Indicators

• Requires routine monitoring daily

• Test must be dated and labeled
• Once removed from the steriliser the test pack
opened, BI labeled, crushed and incubated in the
incubator
• Records of time, date of incubation and staff
initials is required and then time and date and
initials of the staff reading the final BI result
 Practical Tips - 1
• Develop a policy for chemical disinfection
• Disinfectants may be supplied ready to use or
may need to be diluted
• Label bottles or containers with the name and
concentration of disinfectant and, for diluted
disinfectants, the date of dilution/preparation
• Prepare dilutions with clean water
• Prepare small amounts at a time to avoid
wastage
 Practical Tips - 2
• Do not mix freshly made diluted solution with old
solution
• Wash and dry the container before filling with new
solution
• Clean, rinse and dry items thoroughly before
disinfecting
• After disinfection, rinse thoroughly with clean
water to remove all chemical residues
• Alcohol solutions can be allowed to dry without
rinsing
• Development of reprocessing protocols for
instruments and equipment based on generally
recognised standards and manufacturer's
recommendations
• Use of clean water for cleaning items thoroughly
• Maintenance, use, and monitoring of equipment,
e.g., autoclaves
• Discarding items that cannot be cleaned or
reprocessed adequately
• Storing reprocessed items away from potential
sources of contamination
 Staff Training and Protection

• Written and up-to-date policies and

procedures must be available on-site for
training/monitoring staff responsible for
device reprocessing
• Train staff fully and retrain as necessary;
maintain written records
• The staff must also be provided with:
– Personal protective equipment (PPE)
– Prophylactic vaccinations
5 MOMENTS OF HAND HYGIENE
AND
HAND WASHING TECHNIQUES
By the end of this presentation you will be able to:
• Identify who should practice hand hygiene
• Describe what hand hygiene is
• Identify where hand hygiene practice should take place
• Explain why hand hygiene is important
• Describe when hand hygiene is to be performed
• Describe how to perform hand hygiene using various methods
• Describe tips for success for effective of hand hygiene
What is Hand Hygiene?
Hand Hygiene includes
cleaning hands with soap and
water or alcohol-based hand
rub in order to remove germs,
also known as
microorganisms.
Is Hand Hygiene Effective?

Nurse’s glove while Hand of an employee

caring for an while in common
isolation patient work area

After washing with After using Alcohol

soap and water Based Hand Rub
 Who should practice Hand Hygiene?

Hand hygiene is important not only for healthcare

providers; everyone needs to be practicing appropriate
and effective hand hygiene regardless of work setting.
 Where should you perform Hand Hygiene?
• Busy health care providers need access to hand hygiene
products where patient or patient environment contact is
taking place.
• Hand hygiene is important in all work settings, including Acute
Care, Long Term Care Facilities, Community and Corporate
sites.
• Providing alcohol-based hand rub at the point of care (within
arm’s reach) is an important system support to improve hand
hygiene.
• This enables health care providers to quickly and easily fulfill
the 4 Moments for Hand Hygiene.
 Points of Care

The patient
The Health Care provider

Care involving
contact
Why do we need to learn about Hand Hygiene?
• Hand hygiene is the most important way to prevent
the spread of germs.
• Hand hygiene helps keep you healthy by reducing the
number of germs on your hands and helps reduce
the spread of germs to your family, friends,
coworkers, patients, residents or clients.
• Using appropriate hand hygiene prevents
contamination of the patient’s, client’s, or resident’s
environment.
 When do you perform Hand Hygiene

There are 4 moments when hand hygiene is

performed.
1. Before initial patient or patient
environment contact
2. Before aseptic or clean procedure
3. After body fluid exposure risk
4. After patient or patient environment
contact
Remember...hand hygiene prevents carrying germs into and
out of the patient’s environment.
Moment 1. Before contact with a patient or
patient environment

Before shaking hands Before transferring

Clean your hands when entering or

before touching the patient.
Moment 1. Before contact with a patient or
patient environment

Before taking temperature, Before making someone

blood pressure or pulse comfortable in bed

This will protect the patient from harmful

organisms carried on your hands.
Moment 1. Before contact with patient or patient
environment
Before contact with…

Clean your hands when entering or before

touching any object or furniture in the
patient’s environment.
Moment 1. Before contact with patient or patient
environment
Before contact with…

Home environment Treatment area or clinic

room
This is to protect the patient environment from harmful
organisms carried on your hands.
 Moment 2. Before aseptic/clean procedure
Clean your hands before…

Handling dressings or Performing invasive

touching open wounds procedures
 Moment 3. After body fluid exposure
Clean your hands after…

Contact with blood, Removal of gloves Contact with

bodily fluids, non- contaminated items
intact skin or mucous
membranes,

Clean your hands immediately after an exposure risk to body

fluids (and after glove removal).
 Moment 3. After body fluid exposure
Clean your hands after…

Performing invasive Using a tissue to wipe

procedures your nose or toilet use

This can help protect yourself and the health care

environment from harmful patient organisms.
 Moment 4. After contact with a patient

Shaking hands Transferring Making someone

comfortable in bed

Help protect yourself and the Clean your hands when

health care environment from leaving the environment after
harmful patient organisms. touching patient.
Moment 4. After contact with the patient environment
Clean your hands after…

Contact with room Contact with equipment Contact with wheelchair

or stretcher

Clean your hands when leaving after touching any

object or furniture in the patient’s environment
Moment 4. After contact with the patient environment
Clean your hands after…

Contact with home Contact with treatment

environment area or clinic room

Help protect yourself and the health care

environment from harmful patient organisms.
 Let’s Review
The 4 Moments of Hand Hygiene are:
1. Before initial patient or patient
environment contact
2. Before aseptic or clean procedures
3. After body fluid exposure
4. After contact with patient or patient
environment