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  1. 1. Prevention of Hospital Infection Exogenous infection
  2. 2. Hospital Infection <ul><li>Surgical wards </li></ul><ul><li>Operation Theaters </li></ul><ul><li>Surgical Instruments </li></ul>
  3. 3. Surgical wards <ul><li>Should be well ventilated and cleaned </li></ul><ul><li>The floor should be scrub washed once a week </li></ul><ul><li>Preop. Pts should not be mixed with postop. Pts. </li></ul><ul><li>Severely infected cases should be isolated </li></ul><ul><li>Immuno suppressed pts also isolated </li></ul>
  4. 4. Operation Theaters <ul><li>Adjacent to ICU </li></ul><ul><li>Height – 3M. Floor area 10 sqM. </li></ul><ul><li>Anaesthetic room -10 Sqm. </li></ul><ul><li>Minimise bacterial contamination </li></ul><ul><li>The concept Site – away from the wards of zones : a) outer zone – reception area. b) clean zone – between the reception and OR. C) asceptic zone – OR . D) dirty zone – disposal area and space for cleaning of instruments </li></ul><ul><li>0 </li></ul>
  5. 5. Air flow of OR <ul><li>Filtered air – directed vertically or horizontally </li></ul><ul><li>Ideal – laminar flow </li></ul><ul><li>Restrict entry of nonessential personnel & their movements </li></ul><ul><li>Temperature – 20 - 22 °C </li></ul>
  6. 6. Other Measures <ul><li>Wearing of disposable nonwoven fabric </li></ul><ul><li>Masks </li></ul><ul><li>Head & beard cover </li></ul><ul><li>Preparation of the surgical team </li></ul><ul><li>Preparation of the patient </li></ul><ul><li>Preoperative hospitalisation minimised </li></ul><ul><li>Skin infection treated </li></ul><ul><li>Hair removal </li></ul><ul><li>Skin preparation, Drapes </li></ul>
  7. 7. Disinfection <ul><li>The process that reduces the no. of viable microorganisms, but does not affect the spores </li></ul>
  8. 8. Disinfection <ul><li>Three levels of disinfection </li></ul><ul><li>1. Low: reduces the overall no. of vegetative microorganisms. Does not destroy TB bacilli or bacterial spores .Application – environmental surfaces </li></ul><ul><li>2. Intermediate : kills TB bacilli, most viruses,and some fungi but only some spores. Application – horizontal surfaces,floors </li></ul><ul><li>3. High: kills most forms of microbial life including TB bacilli but not some spores. Application – flexible endoscopes </li></ul>
  9. 9. Disinfection <ul><li>Heat disinfection </li></ul><ul><li>1) Pasteurization </li></ul><ul><li>2) Boiling </li></ul><ul><li>3) Low temperature steam disinfection </li></ul>
  10. 10. Chemical disinfection <ul><li>Chemical disinfectants are used to reduce the pathogenic microbes of inanimate objects, which are heavily contaminated. </li></ul><ul><li>Alcohols, aldehydes, halogens, phenolics and quaternary ammonium compounds </li></ul>
  11. 11. Chemical disinfectants <ul><li>Alcohol – isopropyl alcohol & ethyl alcohol – kills most vegetative bacteria in less than 30 seconds , relatively inactive against spores and fungi. 70% alcohol is usually used. </li></ul><ul><li>Aldehydes – glutaraldehyde & formaldehyde – good activity against spores, bacteria, virus and fungi . 2% glutaraldehyde rapidly inactivates HIV and hepatitis B after exposure for 10 minutes. </li></ul>
  12. 12. Chemical disinfection <ul><li>Diguanides – e.g. chlorhexidine – good activity against gm + ve organisms , moderate activity against gm- ve organisms, poor activity > TB bacilli, spores , fungi & viruses . Used as an antiseptic for skin & mucous memb. </li></ul><ul><li>Halogens e.g. hypochlorites and chlorine – active against bacteria including spores ,fungi, hepatitis B & HIV virus </li></ul>
  13. 13. Chemical disinfection <ul><li>Iodophores -1% available Iodine mixed with alcohol excellent skin preparation </li></ul><ul><li>Phenolics – e.g phenol &chlorxylenol surface cleaning – Hexachlorophene – preparation of surgeon's hands </li></ul><ul><li>Quaternary ammonium compounds – good detergent properties – savlon when mixed with chlorhexidine </li></ul>
  14. 14. Sterilization <ul><li>Complete removal of all microbes including spores </li></ul><ul><li>Methods : Heat method – dry or moist </li></ul><ul><li>Ionization radiation </li></ul><ul><li>Ethylene oxide gas </li></ul>
  15. 15. Heat Methods <ul><li>Dry heat – Hot air ovens which have controlled cycles, such as 160 °C for 1 hour – suitable for killing bacteria on materials which are not penetrable by steam e.g. glassware, powder such as talc, oils & petroleum jelly. </li></ul><ul><li>Moist heat – Steam under pressure – simplest is domestic pressure </li></ul><ul><li>High pressure vacuum autoclaves </li></ul><ul><li>Low temp. steam(73°C) & formaldehyde – suitable for heat sensitive materials and equipment with plastic component </li></ul>
  16. 16. Ionising Radiation <ul><li>Gamma rays – lethal, noncharged, ultrashort, wavelength rays with great penetrating power from a radioactive isotope such asCobalt-60 e.g.Disposable syringes, sutures and rubber gloves </li></ul><ul><li>The radiation dose 2.5 mrad – kills bacteria by ionising their DNA. </li></ul>
  17. 17. EthyleneOxide <ul><li>It should be used with suitable humidity at the correct temp. for sufficient time </li></ul><ul><li>CO2 is mixed with ethylene oxide to reduce Highly toxic inflammable gas – kills all types of microbes including spores. </li></ul><ul><li>the risk of explosion </li></ul><ul><li>It diffuses well through items such as plastic materials, swabs and paper. </li></ul>