Ip presentation final 23.01.08


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Ip presentation final 23.01.08

  1. 1. IP INFECTION PREVENTION Importance & purpose of IP practices 1
  2. 2. IP Principles have Two main aims• To reduce the rate of infection and disease transmission to patients• To protect health care providersUniversal Precautions are minimum levelof infection prevention required to preventthe transmission of infection within allhealth care settings 2
  3. 3. IP Universal Precautions applications• While handling blood, including dried blood• All other bodily fluids, secretion and excretions,• Non – intact skin: and• Mucous membranes 3
  4. 4. IP Universal Precautions Includes Good hygiene practices Safe handling of sharps Cleaning treatment Cleanliness of care areas Disposing of medical waste 4
  5. 5. IP Viral Transmission Risk Risk of acquiring HIV after being stuck with a needle from an HIV+ client 4 : 1000 or 0.4 % Risk of acquiring HBV after being stuck with a needle from an HBV+ client 27 - 37: 100 or 30 % 5
  6. 6. IP Accidental Exposure of HBV Infected Blood As little as 10-8 ml (0.00000001 ml)of HBV-infected blood can transmitHBV to a susceptible host.Source: Bond et al 1982 6
  7. 7. IP Infection Prevention Objectives To prevent major postoperative / post procedure infections To minimize the risk of transmitting infections such as Hepatitis ‘B’, ‘C’ and HIV not only to clients, but also to service providers and staff 7
  8. 8. IP Importance of Infection Prevention Practices• Prevents post procedure infections• Result in high quality and safe services• Prevents infections in service providers• Protect the community• Prevent antibiotic resistant• Lower the cost of health care services 8
  9. 9. IP Standard• Precautions Wash your hands• Wear gloves and other protective attires• Correctly process instruments• Maintain correct environmental cleanliness• Appropriate waste disposal practices• Prevent injuries with sharps 9
  10. 10. Handling Needles and Sharps ProcessingIP InstrumentsHand washing Waste Disposal Protective Barriers 10
  11. 11. IP Infection Prevention Principles Consider every person (clients and staff) infectious Wash hands - the most practical procedure for preventing cross- contamination (person to person) 11
  12. 12. IP Infection PreventionPrinciples (contd) Wear gloves before touching anything: wet/broken skin, mucous membranes, blood or other body fluids (secretions / excretions) or solid instruments and other items. Use physical barriers (protective goggles, face masks and aprons) if splashes and spills of any body fluids (secretions / excretions) are anticipated. 12
  13. 13. Infection Prevention Principles (contd)IP Use safe work practices, such as not recapping or bending needles and safely passing sharps instruments. Isolate patients only if secretions (airborne) and excretions (urine or feces) cannot be contained. 13
  14. 14. Infection PreventionIP Principles (contd) Process instruments and other items (decontaminate, clean, high-level disinfect or sterilize) using recommended infection prevention (IP) practices ..........and finally: 14 Properly disposing medical waste.
  15. 15. IP Handwashing Practices  Handwashing is the most important way to reduce the spread of infections. But it is often underemphasized, and 15 not performed
  16. 16. Hand- Washing16
  17. 17. IP Handwashing Rules Wash hands before and after examining any client ( direct contact ) Wash hands after removing gloves. Wash hands after exposure to blood or any body fluid (secretions and excretions) even if gloves were worn. 17
  18. 18. Types ofIP Handwashing  Routine Handwashing  Surgical Hand scrub  Alcohol Hand rub 18
  19. 19. Routine HandwashingIP Practices 1 Use plain or antiseptic soap. Vigorously rub lathered hands 2 together for 15 - 30 seconds. Rinse with clean running water 3 from a tap or bucket. 4 Dry hands with a clean towel or air dry 19 them
  20. 20. Process of Surgical HandIP scrub Remove all jewelry Wet hands and forearms thoroughly Clean under fingernail Apply antiseptic. Circular Motion. Continue for 3-5 minutes. Rinse each arm separately. Use sterile towel to dry 20
  21. 21. IP Surgical Hand scrub Supplies• Antiseptic or soap (plain) - If an antiseptic is not available, use plain soap followed by applying an alcohol solution and rub until dry two times.• Running water• Stick or brush for cleaning the fingernails• Soft brush or sponge for cleaning the skin• Sterile Towels (sterile towels to be provided for the operating room) 21
  22. 22. Process of Alcohol HandIP rub Formula 2 ml glycerin or propylene glycol in 100 ml of 60-90% alcohol Use 3 - 5 ml for each application and continue rubbing the solution over the hands for about 2 minutes, using a total of 6 - 10 ml 22 per scrub
  23. 23. IP Protective Barriers:GlovesWear gloves: - when performing a procedure in the clinic or operating room - when handling soiled gloves, instruments,and other items - when disposing of contaminated waste items (cotton gauze, dressings) 23
  24. 24. IP Types of gloves and their Uses Surgical gloves Should be worn during all procedures in which there will be contact with blood stream or tissues under the skin Single use examination gloves:- To reduce the risk of exposing the service providers to blood or body fluids Utility gloves:- Should be worn for handling contaminated instruments, linens and medical waste. 24
  25. 25. IP Protective Barriers: Goggles, Face Masks, Aprons Wear protective goggles, face masks, and aprons if splashes and spills of any body fluids are likely. 25
  26. 26. IP26
  27. 27. What parts of the field are sterile?27
  28. 28. IP Processing of Instruments and other Items • Decontamination • Cleaning • Sterilization or High-level disinfection • Storage 28
  29. 29. IP Decontamination• Definition It is the first step in processing instruments and kills viruses and many other microorganisms making instruments and other items safer to handle by staff who clean them. • Bleach ( Sodium Hypo chlorite) • It is inexpensive, • kills HIV, hepatitis B & hepatitis C quickly • Can be used to decontaminate large surfaces 29
  30. 30. IP Processing Soiled Instruments and Other Items Decontamination Place instruments and reusable gloves in 0.5% chlorine solution after use Soak for 10 minutes and rinse immediately Wipe surfaces (exam tables) with chlorine solution 30
  31. 31. Instructions for PreparingIP Dilute Chlorine Solutions % Concentrate Total Parts (TP) (H O) = 2 ( % Dilute )-1 To make a 0.5% chlorine solution from 5% bleach mix: 1 part bleach to parts water 31
  32. 32. Instructions for Preparing Chlorine Solution from PowderIP % Dilute desiredGram / Liter = ( % Concentration of chlorine in bleach ) x 1000 powderTo make a 0.5% chlorine solution froma 35% chlorine powder mix:15 Tea spc (14.2 grams) ofpowder to 1 liter of water 32
  33. 33. Processing SoiledIP Instruments & Other Items Cleaning Wash with detergent and water Scrub instruments until visibly clean Thoroughly rinse with clean water 33
  34. 34. High LevelIP Disinfection  Disinfection: Process that eliminates all microorganisms but does not reliably kill all bacterial endospores which cause diseases such as tetanus and gas gangrene. 34
  35. 35. IP Methods of HLDBoiling: Soaking in Chemicals:• Boil instruments • Steam instruments, and other items for gloves, and other items 20 minutes for 20 minutes Steaming:• (sufficient up to • An alternative to this is HLD 18,000 ft / 5,500 mtr by use of chemical altitude) disinfectant. Soak for 20 minutes. 35
  36. 36. Boiling TipsIP Always boil for 20 minutes in a pot with a lid. Start timing when the water begins to boil. Do not add anything to the pot after timing begins. 36 Air dry before use or storage.
  37. 37. IP Steaming Tips Always steam for 20 minutes. Be sure there is enough water in the bottom pan for the entire steam cycle. Bring water to a rolling boil. Start timing when steam begins to come out between pans. Do not add anything to the pan after timing starts. 37 Air dry and store in the covered steamer pans.
  38. 38. IP Chemical High-level Disinfection TipsCover all items completely with high - leveldisinfectant. -- Soak for 20 minutes- Rinse with boiled water- Air dry before use and storage 38
  39. 39. Preparing a High-Level Disinfected ContainerIPBoil (if small) ......... orFill a clean container with 0.5% chlorine solution - Soak for 20 minutes - Pour out solution. (The chlorine solution can then be transferred to a plastic container and reused.) -39 Rinse thoroughly with boiled water
  40. 40. SterilizationIP  Definition: Process that eliminates all microorganisms including bacterial endospores. 40
  41. 41. IP Methods of Sterilization Steam (autoclave) or Dry heat (oven) Chemical 41
  42. 42. Standard Conditions for HeatIP Sterilisation Steam Sterilization121°C (250 ° F) at 106 kPa (15 lbs/square inch) pressure - 20 minutes for Allow all items to dry unwrapped items before removal to dry sterile container - 30 minutes for wrapped items 42
  43. 43. Standard Conditions for HeatIP Sterilization Dry Heat By Electrical Oven170° C. (340° F.) for 1 hour ..... or 160° C. (320° F.) for 2 hours 43
  44. 44. IP Chemical Sterilization  Soak items in Glutaraldehyde for 10 hours  Rinse in sterile water  Store in a sterile container 44
  45. 45. Sterilization of VariousInstruments 45
  46. 46. Sterilization of variousIP instruments Instrumen Sterilization Time/press t/Item ure 46
  47. 47. Sterilization of VariousIP Instruments 47
  48. 48. Processing MVA EquipmentIP Step 3: P roc essing syringes Syringes should be soaked in 0.5% Chl ori ne for 20 minutes, then rinsed and dried Syringes should be reassembled when dry, lubricated, and stored in a clean, dry cont ainer Do NOT boil syri nges. Step 4: S torage Pl ace cannulae in separate steril e (or HLD) container usi ng steri le pi ckups Use s teril e forceps to remove it ems from contai ner Avoid contam inating other cannulae in container. Do NOT autoclave either syringes or cannulae! 48
  49. 49. IP Effectiveness of Methods for Processing Instruments Method Effectiveness End point (removal/inactivation of microbes) Decontamination Kills HBV 10 minute soak and HIV Cleaning (water Up to 50% Until visibly only) clean Cleaning Up to 80% Until visibly (detergent clean and rinsing with water) Sterilization 100 % High pressure steam (autoclave), dry heat, chemical High-level Disinfection * 95% (does not Boiling, steaming *Prior decontamination inactivate Or chemical and thorough cleaning some endopores) required. 49
  50. 50. Waste Disposal50
  51. 51. WasteIP Disposal Types of waste  General Waste  Medical Waste  Hazardous Chemical Waste 51
  52. 52. Four Aspects of Medical WasteIP Management  Sorting  Handling  Interim Storage  Disposal: Incinerator is always the best method of disposal medical waste. 52
  53. 53. IP Disposal of SharpsCollect sharp items in puncture proof containersTransport securely to disposal place  Decontaminate and bury in safe placeBurn in high temperature incinerator or 53
  54. 54. Waste DisposalPractices Place contaminated items in leak-proof container or plastic bag. Dispose by incineration or burial. 54
  55. 55. Antiseptics andIP Disinfectants Antiseptics: A chemical agent used on the skin and mucous membranes to remove or kill microorganisms without causing damage or irritation to the skin and mucous membranes . 55
  56. 56. IP Disinfectant Definition: A chemical agent used to kill microorganisms on inanimate objects, such as instruments and surfaces. Disinfectants are not meant to be used on the skin or mucous membranes. 56
  57. 57. IP Uses of antiseptics  Surgical hand scrub  Skin, cervical and vaginal preparation  Hand washing in high risk situation: 57
  58. 58. Skin Preparation Prior toIP Surgical Procedure Purpose: To minimize the number of microorganisms on the skin or mucous membranes by: - Washing with soap and water - Applying antiseptics 58
  59. 59. Skin Preparation Prior toIP Surgical Procedure 59
  60. 60. Skin Preparation Prior toIP Surgical Procedure Purpose: To minimize the number of microorganisms on the skin or mucous membranes by: - Washing with soap and water - Applying antiseptics 60
  61. 61. Skin Preparation Prior toIP Surgical Procedure 61
  62. 62. Skin and Mucous MembraneIP Preparation Do not shave hair ! Clip with scissors if necessary. Ask the client about allergic reactions. Wash first with soap and water if visibly soiled. Apply antiseptic starting from the operation site and working outward in a circular motion for several inches. 62
  63. 63. IP Cervical and Vaginal Preparations Apply antiseptic solution liberally to the cervix and vagina (2 times) It is not necessary to prep the external genital area if it appears clean. - If heavily soiled, it is better to have the client wash her genital area thoroughly with soap and water before starting the procedure.63
  64. 64. IP Management of sharp injuries  Wash needle sticks and cuts with soap and water  Flush splashes to the nose, mouth or skin with water  Irrigate splashes to the eyes with water or saline64
  65. 65. Avoid dipping hands in aIP basin containing stand water 65
  66. 66. IP66
  67. 67. Conclusion IP can’t be a stand-alone practice; it needs to be integrated into all areas of the clinical reproductive health environment. IP principles can be adapted to any environment. IP is important; it’s cheap; you can do it!67
  68. 68. Hand Washing Wet hands with running water Rub hands together with soap & lather well, covering all surfaces, for 30 seconds Weave fingers & thumbs together 7 slide them back & forth Rinse hands under a stream of clean, running water until all soap is gone Blot hands dry with a clean personal towel or air dry 68
  69. 69. Usually left out parts duringHand Washing69
  70. 70. Hand Washing70
  71. 71. Hand Washing71
  72. 72. Steps of Surgical Hand washing1. Remove all jewelry, watch etc. on hands forearms & wrist2. Wet hands & forearms thoroughly3. Clean all finger nails with soft nailbrush4. Apply antiseptic soap/solution5. Using a circular motion, continuing from finger tips to elbow, create lather & wash between fingers6. Repeat for the second hand & arm 72
  73. 73. Steps of Surgical Hand washing contd……7. Continue washing for 3 – 5 minutes8. Rinse each arm separately, fingertips first, holding your hands above the level of your elbow.9. Use a sterile towel to dry hands or air dry10. Keep hands above the level of waist and do not touch any thing. 73
  74. 74. Steps of Putting on SterileSurgical Gloves74
  75. 75. Steps of Putting on SterileSurgical Gloves75
  76. 76. Steps of Putting on SterileSurgical Gloves76
  77. 77. Processing Instruments, gloves and other items Decontamination Soak in 0.5% Chlorine solution 10 minutes THROUGHLY WASH & RINSE Wear gloves & other protective barriers Preferred Acceptable Methods Methods STERILIZATION HIGH LEVEL DISINFECTIONAUTOCLAVE CHEMICAL BOIL CHEMICAL15lbs/in ² Soak in Lid on 20 Soak in CIDEXpressure CIDEX for 8- minutes for 20 min.121˚C,20 min. 10 hours. Rinse withunwrapped 30 Rinse with water boiled formin wrapped sterile water 20 minutes 77 COOL & DRY (use immediately or Store)