This document discusses the principles and practices of asepsis, including hand hygiene and environmental cleaning. It defines medical and surgical asepsis, noting that medical asepsis aims to reduce pathogens between patients while surgical asepsis prevents any organism introduction. Key principles of both include maintaining cleanliness of healthcare providers, equipment, and patient surroundings. Proper hand hygiene, including rubbing with alcohol or washing with soap and water, is critical before and after contact with patients or surfaces. Thorough environmental cleaning and disinfection using appropriate agents and durations can reduce pathogens on surfaces.
This document discusses medical asepsis, hand hygiene, and patient care practices in home care and hospice settings. It defines asepsis and differentiates between medical and surgical asepsis. The key principles of medical asepsis are described, including maintaining cleanliness to reduce pathogen transmission between patients. Proper hand hygiene is emphasized as the most important practice, outlining the 5 moments when hand hygiene must be performed. Nursing bags can become contaminated and spread pathogens, so regular cleaning and disinfection is recommended.
This document discusses the principles and practices of asepsis, including the role of hands and the environment in disease transmission. It defines medical and surgical asepsis, with medical asepsis aiming to reduce transmission between patients using clean techniques, while surgical asepsis aims to prevent any organism using sterile techniques. Key principles of asepsis include hand hygiene, use of personal protective equipment, cleaning equipment and the environment, and ensuring healthcare providers are free from disease. However, hand hygiene compliance among healthcare providers is often low. The five moments for proper hand hygiene are outlined to reduce transmission of pathogens from hands.
The document discusses the infectious disease model known as the "Chain of Infection". It explains that the Chain of Infection helps explain how infection spreads and that it consists of multiple sequential links: an infectious agent, a reservoir, a mode of exit, transmission, entry, and a susceptible host. It notes that for infection to occur, all links in the chain must be present and stresses the importance of understanding each link and how they relate in order to identify strategies to break the chain and prevent infection transmission.
This document discusses asepsis, antisepsis, and sterilization techniques. It begins with definitions of asepsis as preventing contact with microorganisms and antisepsis as using chemical disinfectants. Next, it discusses the history starting with Louis Pasteur's germ theory of disease. It then focuses on Joseph Lister who pioneered antiseptic surgery through the use of carbolic acid. The document outlines proper surgical aseptic techniques including scrubbing, gowning, gloving, skin preparation, and draping. It emphasizes maintaining sterility in the operating room through limiting contamination sources and following strict protocols. Finally, it discusses optimizing the operation theatre structure and ventilation to establish different
This document provides information on hand hygiene techniques for healthcare workers. It defines a healthcare-associated infection and notes that they affect 1.4 million worldwide annually. Hand transmission is identified as the most common way pathogens spread between patients. The five steps of hand transmission are outlined. Proper hand hygiene requires 1-1.5 minutes of washing with soap and water, while alcohol-based handrub takes just 15-20 seconds. The document reviews the five moments for hand hygiene and provides examples of when handwashing and glove use are indicated in healthcare settings.
Infection Control Practice and Standard Safety Measures.pptxDeepti Kukreti
The document discusses infection control and standard safety measures in healthcare facilities. It covers topics like infection control programs, the chain of infection, hand hygiene, personal protective equipment, needlestick injury prevention, environmental cleaning, cleaning and sterilization of medical equipment, biomedical waste management, safe injection practices, and the roles and responsibilities of hospital infection control committees. The overall aim is to prevent healthcare-associated infections and protect both patients and healthcare workers from infections.
This document discusses medical asepsis, hand hygiene, and patient care practices in home care and hospice settings. It defines asepsis and differentiates between medical and surgical asepsis. The key principles of medical asepsis are described, including maintaining cleanliness to reduce pathogen transmission between patients. Proper hand hygiene is emphasized as the most important practice, outlining the 5 moments when hand hygiene must be performed. Nursing bags can become contaminated and spread pathogens, so regular cleaning and disinfection is recommended.
This document discusses the principles and practices of asepsis, including the role of hands and the environment in disease transmission. It defines medical and surgical asepsis, with medical asepsis aiming to reduce transmission between patients using clean techniques, while surgical asepsis aims to prevent any organism using sterile techniques. Key principles of asepsis include hand hygiene, use of personal protective equipment, cleaning equipment and the environment, and ensuring healthcare providers are free from disease. However, hand hygiene compliance among healthcare providers is often low. The five moments for proper hand hygiene are outlined to reduce transmission of pathogens from hands.
The document discusses the infectious disease model known as the "Chain of Infection". It explains that the Chain of Infection helps explain how infection spreads and that it consists of multiple sequential links: an infectious agent, a reservoir, a mode of exit, transmission, entry, and a susceptible host. It notes that for infection to occur, all links in the chain must be present and stresses the importance of understanding each link and how they relate in order to identify strategies to break the chain and prevent infection transmission.
This document discusses asepsis, antisepsis, and sterilization techniques. It begins with definitions of asepsis as preventing contact with microorganisms and antisepsis as using chemical disinfectants. Next, it discusses the history starting with Louis Pasteur's germ theory of disease. It then focuses on Joseph Lister who pioneered antiseptic surgery through the use of carbolic acid. The document outlines proper surgical aseptic techniques including scrubbing, gowning, gloving, skin preparation, and draping. It emphasizes maintaining sterility in the operating room through limiting contamination sources and following strict protocols. Finally, it discusses optimizing the operation theatre structure and ventilation to establish different
This document provides information on hand hygiene techniques for healthcare workers. It defines a healthcare-associated infection and notes that they affect 1.4 million worldwide annually. Hand transmission is identified as the most common way pathogens spread between patients. The five steps of hand transmission are outlined. Proper hand hygiene requires 1-1.5 minutes of washing with soap and water, while alcohol-based handrub takes just 15-20 seconds. The document reviews the five moments for hand hygiene and provides examples of when handwashing and glove use are indicated in healthcare settings.
Infection Control Practice and Standard Safety Measures.pptxDeepti Kukreti
The document discusses infection control and standard safety measures in healthcare facilities. It covers topics like infection control programs, the chain of infection, hand hygiene, personal protective equipment, needlestick injury prevention, environmental cleaning, cleaning and sterilization of medical equipment, biomedical waste management, safe injection practices, and the roles and responsibilities of hospital infection control committees. The overall aim is to prevent healthcare-associated infections and protect both patients and healthcare workers from infections.
Infection control practice and standard safety measuresVANITASharma19
The document discusses infection control and standard safety measures in healthcare facilities. It covers topics like infection control programs, the chain of infection, hand hygiene, personal protective equipment, needlestick injury prevention, environmental cleaning, cleaning and sterilization of medical equipment, biomedical waste management, safe injection practices, and the roles and responsibilities of hospital infection control committees. The overall aim is to prevent healthcare-associated infections and protect both patients and healthcare workers from infections.
Ic lecture for general hospital orientation program updatedNashwa Elsayed
This document provides an overview of an infection control orientation program. It discusses the importance of infection control in healthcare settings and the roles and responsibilities of an infection control department. It covers key aspects of an infection control program including standard and transmission-based precautions, healthcare-acquired infections, the chain of infection, multi-drug resistant organisms, isolation techniques, and management of exposures. It also addresses specific policies around hand hygiene, personal protective equipment, laboratory specimens, cleaning, waste disposal, and management of needlestick injuries.
Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds.
Standard safety measures are minimum practices to prevent disease transmission between patients and healthcare workers. They include hand hygiene, use of gloves, facial protection, gowns and caps, safe handling of sharps, respiratory hygiene, environmental cleaning, safe linen handling, proper waste disposal, and cleaning patient equipment. Implementing standard precautions helps create a safety culture and reduce risks associated with healthcare.
1) Hand hygiene should be performed before and after contact with patients, and before and after contact with the patient's environment or shared equipment to limit transmission of infectious agents.
2) There are 5 critical times for hand hygiene known as the "5 Moments" which are before touching a patient, before clean procedures, after body fluid exposure, after touching a patient, and after contact with the patient's surroundings.
3) Hand hygiene involves using alcohol-based hand rub or handwashing with soap and water at appropriate times depending on when hands are visibly soiled.
This document discusses infection control procedures that are important in dental clinics. It summarizes that standard precautions should be followed to prevent the transmission of infections between patients and dental staff. This includes proper hand hygiene, use of personal protective equipment, sterilization of instruments, cleaning of the clinical environment and waste management. Adhering to infection control protocols helps protect both patients and dental healthcare workers from exposure to bloodborne pathogens.
Health care-associated infections (HCAIs) are infections acquired during health care and were not present upon admission. Proper hand hygiene is the most effective way to prevent HCAIs. There are 5 moments when hand hygiene should be performed - before touching a patient, before clean procedures, after body fluid exposure risks, after touching a patient, and after touching the patient's surroundings. Hand rubbing with alcohol-based formulations for 20-30 seconds is the most effective method, while hand washing with soap and water is necessary when hands are visibly soiled. Strict adherence to hand hygiene protocols is needed to reduce HCAIs.
This document discusses infection control in dental clinics. It begins with terminology related to infection control, including definitions of infection, sterilization, disinfection, asepsis, antiseptics, and more. It then covers the history of infection control practices dating back to Joseph Lister's pioneering work in the late 19th century. The objectives, modes of transmission in dental clinics, and guidelines for infection control are outlined. Methods of sterilization like heat, chemicals, and newer technologies are described. Factors that impact the efficacy of sterilization processes are also summarized.
This document discusses universal precautions and current infection control practices in dental healthcare settings. It defines infection and explains why infection control is important in dentistry due to contact with blood, saliva and equipment. The aims of infection control are to prevent patient-to-patient, patient-to-practitioner and practitioner-to-patient transmission. Modes of transmission include direct contact, indirect contact and inhalation. Standard precautions including hand hygiene, PPE and sterilization of instruments are described.
The document discusses concepts of infection control, including definitions of community-acquired infections and nosocomial (hospital-acquired) infections. It notes that nosocomial infections can occur more than 48 hours after admission, after discharge, or among hospital staff. Risk factors for nosocomial infections include patient susceptibility, environmental factors, and transmission through healthcare workers or the hospital environment. Common sites of nosocomial infections are the urinary tract, respiratory tract, and surgical wounds. The document outlines methods for preventing nosocomial infections through aseptic technique, hand hygiene, cleaning and disinfection of equipment, and patient isolation when necessary.
This document provides an overview of infection control practices for dentistry. It begins with definitions of key terms like infection and infection control. It then discusses the history and development of infection control practices. The main sections cover universal precautions like hand washing, protective equipment, needle safety and post-exposure procedures. It also addresses sterilization methods, disinfection, management of medical waste and guidelines from organizations like OSHA and CDC. The goal is to prevent the transmission of infections between patients and healthcare workers.
An infection control program aims to restrict the spread of infections in healthcare facilities through applying research-based practices. The key components of an infection control program include standard and transmission-based precautions, healthcare worker education and protection, risk minimization, and surveillance. Standard precautions like hand hygiene and personal protective equipment are applied to all patients, while additional airborne, droplet, and contact precautions depend on the specific infection's transmission mode. Proper implementation of infection control measures can reduce patient and staff infections.
Basic infection control prevention 30 march 2020Gerinorth
This document discusses basic infection control and prevention measures focusing on hand hygiene and personal protective equipment (PPE). It emphasizes that hand hygiene is the most important measure to reduce cross-infection. It outlines the five indications for hand hygiene and the steps for proper hand washing and alcohol-based hand rub. The document also reviews PPE requirements for different transmission-based precautions and the proper procedure for donning and doffing PPE. It stresses educating nursing home residents and visitors on personal hygiene and hand hygiene. The document concludes with answering sample case scenarios on appropriate PPE and isolation measures for patients with MRSA and Clostridium difficile.
ANY WASTE GENERATED DURING THE DIAGNOSIS, TREATMENT OR IMMUNIZATION OF HUMA...ssuser3155141
BIOMEDICAL WASTE
IS DEFINED AS
“ANY WASTE GENERATED DURING
THE DIAGNOSIS, TREATMENT
OR IMMUNIZATION OF HUMANS
OR ANIMALS OR IN RESEARCH
ACTIVITIES PERTAINING THERTO
OR IN THE
PRODUCTION OR
TESTING OF BIOLOGI
This document discusses infection prevention and control (IPC) in healthcare settings. IPC is a scientific approach to prevent harm from infections to patients and healthcare workers. The goals of IPC are to prevent the spread of infections between patients, patients and healthcare workers, and among healthcare workers. Routine IPC practices include hand hygiene, aseptic techniques, safe handling of sharps, single-use devices, sterilization and disinfection of equipment, appropriate antibiotic use, management of blood and body fluids, and proper medical waste disposal. Adhering to IPC practices is important to reduce infection rates in healthcare facilities and protect patients and staff.
This document discusses different types of asepsis used in medical settings. It distinguishes between medical asepsis and surgical asepsis. Medical asepsis aims to reduce transmission of pathogens between patients through cleanliness, while surgical asepsis aims for sterility to prevent introduction of organisms into wounds or body cavities. The document outlines the different emphases, purposes, zones of control, handwashing procedures, gown uses, and goals of medical versus surgical asepsis. It also provides principles for maintaining aseptic technique.
The document discusses isolation precautions and barrier nursing techniques used to prevent the spread of infection in clinical settings. It defines isolation as techniques used to limit the spread of infection from infected to non-infected individuals. Barrier nursing refers to stringent infection control techniques used in nursing to protect medical staff and isolate infectious patients. The document outlines various isolation precautions like contact, airborne and droplet precautions. It emphasizes the importance of proper use of personal protective equipment, hand hygiene, environmental cleaning and other standard safety precautions to interrupt transmission of microorganisms in healthcare settings.
PREVENT NOSOCOMIAL INFECTION and preventNaomikibithe
This document provides information about preventing nosocomial (hospital-acquired) infections. It defines nosocomial infections and lists some common causes like urinary catheters and ventilators. The most common pathogens that cause these infections are described as Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli. Infection prevention and control methods like proper hand hygiene are crucial to breaking the chain of infection and protecting patients and healthcare workers. Standard safety precautions including handwashing, proper use of protective equipment, and environmental cleaning should be followed at all times with all patients.
The document discusses hand hygiene in healthcare settings. It describes how Ignaz Semmelweis discovered in 1858 the importance of hand washing between patient examinations, which reduced mortality from puerperal fever. The document outlines the different types of normal and transient bacterial flora on hands and the importance of hand washing in removing pathogens. It discusses various hand hygiene agents like soap, alcohol, and chlorhexidine and proper techniques for hand washing, surgical asepsis, and donning and doffing of personal protective equipment to prevent transmission of infection.
Diabetes is a metabolic disease where the body cannot properly produce or use insulin, resulting in high blood glucose levels. There are four main types of diabetes: type 1, type 2, gestational diabetes, and prediabetes. Type 1 diabetes occurs when the immune system destroys insulin-producing beta cells, type 2 is most common and results from insulin resistance, gestational occurs during pregnancy, and prediabetes means high blood sugar that has not reached diabetic levels. Risk factors for type 2 diabetes include genetics, age, weight, and inactivity. While type 1 has no known prevention, type 2 can be prevented or delayed through lifestyle changes like diet and exercise as shown in diabetes prevention studies. Diabetes poses serious health risks and
Infection control practice and standard safety measuresVANITASharma19
The document discusses infection control and standard safety measures in healthcare facilities. It covers topics like infection control programs, the chain of infection, hand hygiene, personal protective equipment, needlestick injury prevention, environmental cleaning, cleaning and sterilization of medical equipment, biomedical waste management, safe injection practices, and the roles and responsibilities of hospital infection control committees. The overall aim is to prevent healthcare-associated infections and protect both patients and healthcare workers from infections.
Ic lecture for general hospital orientation program updatedNashwa Elsayed
This document provides an overview of an infection control orientation program. It discusses the importance of infection control in healthcare settings and the roles and responsibilities of an infection control department. It covers key aspects of an infection control program including standard and transmission-based precautions, healthcare-acquired infections, the chain of infection, multi-drug resistant organisms, isolation techniques, and management of exposures. It also addresses specific policies around hand hygiene, personal protective equipment, laboratory specimens, cleaning, waste disposal, and management of needlestick injuries.
Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds.
Standard safety measures are minimum practices to prevent disease transmission between patients and healthcare workers. They include hand hygiene, use of gloves, facial protection, gowns and caps, safe handling of sharps, respiratory hygiene, environmental cleaning, safe linen handling, proper waste disposal, and cleaning patient equipment. Implementing standard precautions helps create a safety culture and reduce risks associated with healthcare.
1) Hand hygiene should be performed before and after contact with patients, and before and after contact with the patient's environment or shared equipment to limit transmission of infectious agents.
2) There are 5 critical times for hand hygiene known as the "5 Moments" which are before touching a patient, before clean procedures, after body fluid exposure, after touching a patient, and after contact with the patient's surroundings.
3) Hand hygiene involves using alcohol-based hand rub or handwashing with soap and water at appropriate times depending on when hands are visibly soiled.
This document discusses infection control procedures that are important in dental clinics. It summarizes that standard precautions should be followed to prevent the transmission of infections between patients and dental staff. This includes proper hand hygiene, use of personal protective equipment, sterilization of instruments, cleaning of the clinical environment and waste management. Adhering to infection control protocols helps protect both patients and dental healthcare workers from exposure to bloodborne pathogens.
Health care-associated infections (HCAIs) are infections acquired during health care and were not present upon admission. Proper hand hygiene is the most effective way to prevent HCAIs. There are 5 moments when hand hygiene should be performed - before touching a patient, before clean procedures, after body fluid exposure risks, after touching a patient, and after touching the patient's surroundings. Hand rubbing with alcohol-based formulations for 20-30 seconds is the most effective method, while hand washing with soap and water is necessary when hands are visibly soiled. Strict adherence to hand hygiene protocols is needed to reduce HCAIs.
This document discusses infection control in dental clinics. It begins with terminology related to infection control, including definitions of infection, sterilization, disinfection, asepsis, antiseptics, and more. It then covers the history of infection control practices dating back to Joseph Lister's pioneering work in the late 19th century. The objectives, modes of transmission in dental clinics, and guidelines for infection control are outlined. Methods of sterilization like heat, chemicals, and newer technologies are described. Factors that impact the efficacy of sterilization processes are also summarized.
This document discusses universal precautions and current infection control practices in dental healthcare settings. It defines infection and explains why infection control is important in dentistry due to contact with blood, saliva and equipment. The aims of infection control are to prevent patient-to-patient, patient-to-practitioner and practitioner-to-patient transmission. Modes of transmission include direct contact, indirect contact and inhalation. Standard precautions including hand hygiene, PPE and sterilization of instruments are described.
The document discusses concepts of infection control, including definitions of community-acquired infections and nosocomial (hospital-acquired) infections. It notes that nosocomial infections can occur more than 48 hours after admission, after discharge, or among hospital staff. Risk factors for nosocomial infections include patient susceptibility, environmental factors, and transmission through healthcare workers or the hospital environment. Common sites of nosocomial infections are the urinary tract, respiratory tract, and surgical wounds. The document outlines methods for preventing nosocomial infections through aseptic technique, hand hygiene, cleaning and disinfection of equipment, and patient isolation when necessary.
This document provides an overview of infection control practices for dentistry. It begins with definitions of key terms like infection and infection control. It then discusses the history and development of infection control practices. The main sections cover universal precautions like hand washing, protective equipment, needle safety and post-exposure procedures. It also addresses sterilization methods, disinfection, management of medical waste and guidelines from organizations like OSHA and CDC. The goal is to prevent the transmission of infections between patients and healthcare workers.
An infection control program aims to restrict the spread of infections in healthcare facilities through applying research-based practices. The key components of an infection control program include standard and transmission-based precautions, healthcare worker education and protection, risk minimization, and surveillance. Standard precautions like hand hygiene and personal protective equipment are applied to all patients, while additional airborne, droplet, and contact precautions depend on the specific infection's transmission mode. Proper implementation of infection control measures can reduce patient and staff infections.
Basic infection control prevention 30 march 2020Gerinorth
This document discusses basic infection control and prevention measures focusing on hand hygiene and personal protective equipment (PPE). It emphasizes that hand hygiene is the most important measure to reduce cross-infection. It outlines the five indications for hand hygiene and the steps for proper hand washing and alcohol-based hand rub. The document also reviews PPE requirements for different transmission-based precautions and the proper procedure for donning and doffing PPE. It stresses educating nursing home residents and visitors on personal hygiene and hand hygiene. The document concludes with answering sample case scenarios on appropriate PPE and isolation measures for patients with MRSA and Clostridium difficile.
ANY WASTE GENERATED DURING THE DIAGNOSIS, TREATMENT OR IMMUNIZATION OF HUMA...ssuser3155141
BIOMEDICAL WASTE
IS DEFINED AS
“ANY WASTE GENERATED DURING
THE DIAGNOSIS, TREATMENT
OR IMMUNIZATION OF HUMANS
OR ANIMALS OR IN RESEARCH
ACTIVITIES PERTAINING THERTO
OR IN THE
PRODUCTION OR
TESTING OF BIOLOGI
This document discusses infection prevention and control (IPC) in healthcare settings. IPC is a scientific approach to prevent harm from infections to patients and healthcare workers. The goals of IPC are to prevent the spread of infections between patients, patients and healthcare workers, and among healthcare workers. Routine IPC practices include hand hygiene, aseptic techniques, safe handling of sharps, single-use devices, sterilization and disinfection of equipment, appropriate antibiotic use, management of blood and body fluids, and proper medical waste disposal. Adhering to IPC practices is important to reduce infection rates in healthcare facilities and protect patients and staff.
This document discusses different types of asepsis used in medical settings. It distinguishes between medical asepsis and surgical asepsis. Medical asepsis aims to reduce transmission of pathogens between patients through cleanliness, while surgical asepsis aims for sterility to prevent introduction of organisms into wounds or body cavities. The document outlines the different emphases, purposes, zones of control, handwashing procedures, gown uses, and goals of medical versus surgical asepsis. It also provides principles for maintaining aseptic technique.
The document discusses isolation precautions and barrier nursing techniques used to prevent the spread of infection in clinical settings. It defines isolation as techniques used to limit the spread of infection from infected to non-infected individuals. Barrier nursing refers to stringent infection control techniques used in nursing to protect medical staff and isolate infectious patients. The document outlines various isolation precautions like contact, airborne and droplet precautions. It emphasizes the importance of proper use of personal protective equipment, hand hygiene, environmental cleaning and other standard safety precautions to interrupt transmission of microorganisms in healthcare settings.
PREVENT NOSOCOMIAL INFECTION and preventNaomikibithe
This document provides information about preventing nosocomial (hospital-acquired) infections. It defines nosocomial infections and lists some common causes like urinary catheters and ventilators. The most common pathogens that cause these infections are described as Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli. Infection prevention and control methods like proper hand hygiene are crucial to breaking the chain of infection and protecting patients and healthcare workers. Standard safety precautions including handwashing, proper use of protective equipment, and environmental cleaning should be followed at all times with all patients.
The document discusses hand hygiene in healthcare settings. It describes how Ignaz Semmelweis discovered in 1858 the importance of hand washing between patient examinations, which reduced mortality from puerperal fever. The document outlines the different types of normal and transient bacterial flora on hands and the importance of hand washing in removing pathogens. It discusses various hand hygiene agents like soap, alcohol, and chlorhexidine and proper techniques for hand washing, surgical asepsis, and donning and doffing of personal protective equipment to prevent transmission of infection.
Diabetes is a metabolic disease where the body cannot properly produce or use insulin, resulting in high blood glucose levels. There are four main types of diabetes: type 1, type 2, gestational diabetes, and prediabetes. Type 1 diabetes occurs when the immune system destroys insulin-producing beta cells, type 2 is most common and results from insulin resistance, gestational occurs during pregnancy, and prediabetes means high blood sugar that has not reached diabetic levels. Risk factors for type 2 diabetes include genetics, age, weight, and inactivity. While type 1 has no known prevention, type 2 can be prevented or delayed through lifestyle changes like diet and exercise as shown in diabetes prevention studies. Diabetes poses serious health risks and
This document discusses fast food and making healthier choices. It begins with a survey about fast food consumption habits. It then covers topics like portion size, calories, and fat content in fast food. A pop quiz asks which meal has the least fat. Fast food facts are presented on increasing spending and eating out frequency. The risks of too much fast food like weight gain and disease are covered. Maintaining energy balance through diet and exercise is emphasized as the key to healthy weight. The document ends with suggestions for making healthier fast food choices.
This document discusses strategies for scoring assessments and ensuring reliable scoring. It covers:
1. Different item types like multiple choice and constructed response and how they are scored.
2. The importance of reliability in scoring and how moderation can improve consistency between scorers.
3. Techniques for moderation like having multiple raters score a sample of responses and calibrating scores.
4. Issues that can arise in scoring like borderline responses and how to address them.
This document provides information on tractor and machinery safety. It outlines the necessary training for employees using tractors and other machinery, including training on tractor operation, hitching, roll over protection, PTOs, and skid steers. The document also discusses safety procedures for tractors, PTOs, skid steers, batteries, hydraulics, and machine guarding. It provides details on 29 CFR 1928 regulations regarding roll over protection, road travel, and guarding of moving machine parts. The goal is to help farmers understand how to safely operate tractors and machinery and avoid common accidents.
This chapter introduces SQL (Structured Query Language) as the standard language for relational database management systems. It discusses the history and development of SQL, the SQL standards, and the basic components and statements in SQL for defining schemas, querying and manipulating data, and enforcing data integrity. These include the data definition language (DDL) for creating tables, the data manipulation language (DML) for queries, inserts, updates and deletes, and data control language (DCL) for security. Examples are provided to illustrate how to define tables and relationships, and write queries using SQL statements.
This document provides an overview of common plant pests and diseases, their causes, and symptoms. It discusses that fungi, fungus-like organisms, bacteria, viruses, viroids, and phytoplasmas can all cause plant diseases. Examples are given of different types of diseases that affect leaves like powdery mildews, downy mildews, rusts, and leaf spots. It also discusses diseases that cause cankers, diebacks, and issues with roots and stems, giving the examples of fireblight, apple canker, and Phytophthora root rot. A wide range of virus symptoms are described affecting leaves, flowers, and fruit. The aim is to allow for better recognition of pest and disease symptoms
This document summarizes key education initiatives in India. It discusses (1) an online in-service teacher training program that has reached over 41,000 secondary school teachers in Maharashtra, (2) a holistic career guidance project that has reached over 100 million students across 5 states, and (3) a life skills curriculum that reaches 3.4 million students annually. It then focuses on reimagining vocational education in light of the National Education Policy 2020 and the need to promote vocational education opportunities for at least 50% of learners by 2025.
This document discusses strategies for quitting smoking. It begins by outlining the health risks of smoking and benefits of quitting. Nicotine is highly addictive due to its effects on dopamine levels in the brain. Quitting can be difficult due to withdrawal symptoms and cravings triggered by habits and stress. However, benefits include improved health, taste, and savings over time. The document provides tips for preparing to quit such as setting a date and learning coping strategies to stay smoke-free.
The document discusses the global media and communications industries and cultures of consumption. It analyzes the structure of these industries, highlighting their increasing consolidation and the growing market power of a small number of large firms. It also examines theories of consumption from Baudrillard and Fine, discussing how consumption serves as a means of social differentiation and identity construction. Consumption is shaped not just by individual choice but broader social, cultural, and political forces like leading firms, state policies, and media images.
This document discusses strategies for quitting smoking. It begins by outlining the health risks of smoking and benefits of quitting. Nicotine is highly addictive due to its effects on dopamine levels in the brain. Quitting leads to withdrawal symptoms but also significant health improvements over time, including reduced risk of heart disease and cancer. The document provides tips for preparing to quit, such as setting a date and removing cigarettes from your environment. Quitting is difficult due to both chemical addiction and behavioral habits but can greatly improve a person's long term health outcomes.
Haemophilus influenzae is a gram-negative bacterium that is a major human pathogen. Type b strains cause serious invasive diseases like meningitis in children under 5 years old. H. influenzae requires heme and NAD factors to grow in the laboratory and is susceptible to several antibiotics like ceftriaxone. A vaccine containing the H. influenzae type b capsule prevents disease.
This document provides an overview of principles of oncology including the etiology, pathology, classification, staging, and management of cancer. It discusses that cancer develops from altered cell growth mechanisms and is a multistage genetically regulated process. Tumors are classified based on their topographic site, histology, and anatomic extent (staging). Staging involves assessing the tumor size (T), lymph node involvement (N), and distant metastasis (M). A multidisciplinary approach is used in cancer management, which may involve surgery, radiation, chemotherapy, and other therapies, with the main goals being cure, prolonged survival, or symptom relief.
This document provides guidance on proper etiquette and behavior. It identifies four objectives: identifying employer expectations, discussing appropriate work habits, identifying good citizenship skills, and identifying appropriate interviewing skills. The document then discusses differences between manners and etiquette, general manners like being considerate and respectful, personal manners when meeting new people like shaking hands firmly and introducing others, telephone courtesy like taking complete messages, positive personal relations, and reasons for maintaining a positive attitude.
This document provides guidance on writing critically in academic work. It explains that critical writing involves engaging in a scholarly conversation by building on but not just repeating what other scholars have said. Critical writing demonstrates higher-order thinking skills like analysis and evaluation. It involves questioning an author's arguments, methodology and conclusions rather than just describing their work. The document provides examples of descriptive versus critical writing and suggests asking questions of sources as a way to produce more critical analysis.
The stomach is located in the upper left portion of the abdomen between the T10 and L3 vertebrae. It can be divided into four anatomical regions: the cardia, fundus, corpus, and antrum. The stomach receives blood supply from the celiac artery and drains into the portal vein system. It is innervated by both the parasympathetic and sympathetic nervous systems. The parasympathetic supply comes from the vagus nerves and is responsible for motor and secretomotor functions while the sympathetic supply from T5-T10 mediates vasomotor and motor functions of the pyloric sphincter. The stomach acts as a reservoir and uses peristaltic movements and gastric juices to
Verbal communication can take either spoken or written form, with spoken communication generally being more informal and spontaneous while allowing body language, and written generally being more formal and allowing more time for planning. Non-verbal communication conveys information without words through gestures, facial expressions, and other body language. New technologies have also provided additional channels for both verbal and non-verbal communication. Effective communication depends on understanding different forms and adapting to various situations and languages.
Global drug use is increasing. The number of people using opiates increased from 19.4 million in 2016 to 29.2 million in 2017, and opioid use increased from 34.3 million to 53.3 million over the same period. New data led to increases in estimates of opiate and opioid use in South Asia and Asia. Cocaine and cannabis remain the most widely used drugs worldwide. Global opium and cocaine production are increasing while seizures of these drugs are also rising. New psychoactive substances and non-medical use of tramadol and pharmaceutical opioids are emerging trends.
This document provides an overview of cancer biology. It discusses how cancer is caused by the accumulation of genetic mutations over time that disrupt normal cell growth regulation. Key points covered include: the genetic and molecular basis of cancer; common properties of cancer cells like uncontrolled growth; the role of oncogenes and tumor suppressor genes; how mutations in growth factors, receptors, and cell cycle regulators can cause cancer; and the multi-hit model of carcinogenesis. The document also examines specific cancer-causing mutations and molecular mechanisms.
1. PRINCIPLES AND PRACTICES OF ASEPSIS
Module E
Role of hands and the environment in
disease transmission
2. OBJECTIVES
• Describe the principles and practice of asepsis
• Understand hand hygiene
• Understand the role of the environment in disease
transmission
3. DEFINING ASEPSIS
Medical Asepsis Surgical Asepsis
Definition Clean Technique Sterile Technique
Emphasis Freedom from most
pathogenic organisms
Freedom from all pathogenic
organisms
Purpose Reduce transmission of
pathogenic organisms from
one patient-to -another
Prevent introduction of any
organism into an open
wound or sterile body cavity
4. MEDICAL ASEPSIS
Measures aimed at controlling the number of
microorganisms and/or preventing or reducing the
transmission of microbes from one person-to-another:
Clean Technique
• Know what is dirty
• Know what is clean
• Know what is sterile
• Keep the first three conditions separate
• Remedy contamination immediately
5. PRINCIPLES OF MEDICAL ASEPSIS
When the body is penetrated, natural barriers such as skin
and mucous membranes are bypassed, making the patient
susceptible to microbes that might enter.
• Perform hand hygiene and put on gloves
• When invading sterile areas of the body, maintain the
sterility of the body system
• When placing an item into a sterile area of the body, make
sure the item is sterile
6. PRINCIPLES OF MEDICAL ASEPSIS
Even though skin is an effective barrier against microbial
invasion, a patient can become colonized with other
microbes if precautions are not taken.
• Perform hand hygiene between patient contacts
• When handling items that only touch patient’s intact skin,
or do not ordinarily touch the patient, make sure item is
clean and disinfected (between patients).
7. PRINCIPLES OF MEDICAL ASEPSIS
All body fluids from any patient should be considered
contaminated
• Body fluids can be the source of infection for the patient
and you
• Utilize appropriate personal protective equipment (PPE)
• When performing patient care, work from cleanest to
dirtiest patient area.
8. PRINCIPLES OF MEDICAL ASEPSIS
The healthcare team and the environment can be a source
of contamination for the patient
• Health care providers (HCP) should be free from disease
• Single use items can be a source of contamination
• Patients environment should be as clean as possible
10. SURGICAL ASEPSIS
Practices designed to render and maintain objects and
areas maximally free from microorganisms: Sterile
Technique
• Know what is sterile
• Know what is not sterile
• Keep sterile and not sterile items apart
• Remedy contamination immediately
11. PRINCIPLES OF SURGICAL ASEPSIS
• The patient should not be the source of
contamination
• The operating room (OR) team should not be the
source of contamination
• The surgical scrub should be done meticulously
• The OR technique of the surgeon is very important
• Recognize potential environmental contamination
13. REMEDY CONTAMINATION
• Every case is considered dirty and the same
infection control precautions are taken for all
patients
• When contamination occurs, address it
immediately
• Breaks in technique are pointed out and action is
taken to eliminate them.
14. Rutala WA and Weber DJ (2010) Lautenbacch et al.(eds.) in Practical Healthcare Epidemiology
16. WHAT IS HAND HYGIENE
• Handwashing
• Antiseptic Handwash
• Alcohol-based Hand Rub
• Surgical Antisepsis
17. WHY IS HAND HYGIENE SO IMPORTANT?
• Hands are the most common mode of pathogen
transmission
• Reduces the spread of antimicrobial resistance
• Prevents healthcare-associated infections
18. HAND-BORNE MICROORGANISMS
Healthcare providers contaminate their hands with
100-1000 colony-forming units (CFU)of bacteria
during “clean” activities (lifting patients, taking vital
signs).
Pittet D et al. The Lancet Infect Dis 2006
19. TRANSMISSION OF PATHOGENS ON HANDS
FIVE ELEMENTS
• Germs are present on patients and surfaces near patients
• By direct and indirect contact, patient germs contaminate
healthcare provider hands
• Germs survive and multiply on healthcare provider hands
• Defective hand hygiene results in hands remaining
contaminated
• Healthcare providers touch/contaminate another patient or
surface that will have contact with the patient.
20. HAND HYGIENE COMPLIANCE IS LOW
Author Year Sector Compliance
Preston 1981 General Wards
ICU
16%
30%
Albert 1981 ICU
ICU
41%
28%
Larson 1983 Hospital-wide 45%
Donowitz 1987 Neonatal ICU 30
Graham 1990 ICU 32
Dubbert 1990 ICU 81
Pettinger 1991 Surgical ICU 51
Larson 1992 Neonatal Unit 29
Doebbeling 1992 ICU 40
Zimakoff 1993 ICU 40
Meengs 1994 Emergency Room 32
Pittet 1999 Hospital-wide 48
<40%
Pittet and Boyce. Lancet Infectious Diseases 2001
21. REASONS FOR NONCOMPLIANCE
• Inaccessible hand hygiene supplies
• Skin irritation
• Too busy
• Glove use
• Didn’t think about it
• Lacked knowledge
22. WHEN TO PERFORM HAND HYGIENE
The 5
Moments
Consensus recommendations
CDC Guidelines on Hand Hygiene in healthcare, 2002
1. Before
touching
a patient
• Before and after touching the patient
2. Before
clean /
aseptic
procedure
• Before donning sterile gloves for central venous catheter
insertion; also for insertion of other invasive devices that do not
require a surgical procedure using sterile gloves
• If moving from a contaminated body site to another body site
during care of the same patient
3. After body
fluid
exposure
risk
• After contact with body fluids or excretions, mucous membrane,
non-intact skin or wound dressing
• If moving from a contaminated body site to another body site
during care of the same patient
• After removing gloves
4. After
touching
a patient
• Before and after touching the patient
• After removing gloves
5. After
touching
patient
surroundin
gs
• After contact with inanimate surfaces and objects (including
medical equipment) in the immediate vicinity of the patient
• After removing gloves
23. HOW TO
HAND RUB
To effectively reduce the growth
of germs on hands, hand
rubbing must be performed by
following all of the illustrated
steps. This takes only 20–30
seconds!
http://www.who.int/gpsc/tools
/HAND_RUBBING.pdf
credit: WHO
24. To effectively reduce the growth
of germs on hands, handwashing
must last at least 15 seconds and
should be performed by following
all of the illustrated steps.
http://www.who.int/gpsc/tools/
HAND_WASHING.pdf
HOW TO
HAND WASH
credit: WHO
25. HAND RUBBING VS HANDWASHING
0 15sec 30sec 1 min 2 min 3 min 4 min
6
5
4
3
2
1
0
Bacterial
contamination
(mean
log
10
reduction)
Handwashing
Handrubbing
Hand rubbing is:
• more effective
• faster
• better tolerated
Pittet and Boyce. Lancet Infectious Diseases 2001
26. SUMMARY OF HAND HYGIENE
Hand hygiene must be performed exactly where you are delivering healthcare
to patients (at the point-of-care).
During healthcare delivery, there are 5 moments (indications) when it is
essential that you perform hand hygiene.
To clean your hands, you should prefer hand rubbing with an alcohol-based
formulation, if available. Why? Because it makes hand hygiene possible right at
the point-of-care, it is faster, more effective, and better tolerated.
You should wash your hands with soap and water when visibly soiled.
You must perform hand hygiene using the appropriate technique and time
duration.
27. Rutala WA and Weber DJ (2010) Lautenbacch et al.(eds.) in Practical Healthcare Epidemiology
28. DEFINITIONS
Spaulding Classification of Surfaces:
1. Critical – Objects which enter normally sterile
tissue or the vascular system and require
sterilization
2. Semi-Critical – Objects that contact mucous
membranes or non-intact skin and require high-
level disinfection
3. Non-Critical – Objects that contact intact skin but
not mucous membranes, and require low or
intermediate-level disinfection
29. DISINFECTION LEVELS
High – inactivates vegetative bacteria, mycobacteria,
fungi, and viruses but not necessarily high numbers
of bacterial spores
Intermediate – destroys vegetative bacteria, most
fungi, and most viruses; inactivates Mycobacterium
tuberculosis
Low - destroys most vegetative bacteria, some fungi,
and some viruses. Does not inactivate
Mycobacterium tuberculosis
30. CATEGORIES OF ENVIRONMENTAL SURFACES
Clinical Contact Surfaces
• Exam tables, counter tops, BP cuffs, thermometers
• Frequent contact with healthcare providers’ hands
• More likely contaminated
Housekeeping Surfaces
• Floors, walls, windows, side rails, over-bed table
• No direct contact with patients or devices
• Risk of disease transmission
31. SURVIVAL OF PATHOGENS ON SURFACES
Pathogen Survival
MRSA 7 days – 7 months
VRE 5 days – 4 months
Acinetobacter 3 days -5 months
C. difficile (spores) 5 months
Norovirus 12 – 28 days
HIV Minutes to hours
HBV 7 days
HCV 16 hours – 4 days
Kramer A, et al (2006). BMC Infect Dis; 6:130; CDC
32. SELECT, MIX, AND USE DISINFECTANTS CORRECTLY
• Right product
• Right dilution
• Right preparation – not before low level
disinfection
• Right application method
• Right contact time
• Wear appropriate PPE (gloves, gown, mask, eye
protection)
33. LIQUID DISINFECTANTS
Disinfectant Agent Use Concentration
Ethyl or isopropyl alcohol 70% - 90%
Chlorine (bleach) 100 ppm
Phenolic UD
Iodophor UD
Quaternary ammonium
compound (QUAT)
UD
Improved/Accelerated hydrogen
peroxide
0.5%, 1.4%
UD = Manufacturer’s recommended use dilution
34. CLEANING RECOMMENDATIONS
Clean and disinfect surfaces using correct technique
• Clean to dirty
• Prevent contamination of solutions
• Don’t use dried out wipes
• Physical removal of soil (elbow grease)
• Contact time
• Correct type of cleaning materials
36. OTHER ENVIRONMENTAL ISSUES
Blood and Body Fluid Spills
• Promptly clean and decontaminate
• Use appropriate PPE
• Clean spills with dilute bleach solution (1:10 or
1:100) or an EPA-registered hospital disinfectant
with a TB or HIV/HBV kill claim.
37. REFERENCES
• CDC Guidelines for Hand Hygiene in Healthcare
Settings – Recommendations of the Healthcare
Infection Control Practices Advisory Committee
and the HICPAC/SHEA/APIC Hand Hygiene Task
Force. MMWR October 25, 2002, 51(RR-16).
• CDC Guidelines for Environmental Infection Control
in Health-care Facilities, HICPAC, MMWR June 6,
2003, 52(RR-10).
Editor's Notes
Welcome to Module E, Principles and Practices of Asepsis
There are three main objectives for the this module.
Describe the principles and practices of aspesis
Understand hand hygiene
Understand the role of the environment in disease transmission
Asepsis is the condition of being free from disease producing microorganisms. Aseptic technique refers to all those procedures that reduce or eliminate pathogens and their actions or minimize their areas of existence. There are two types of asepsis, Medical and Surgical.
Medical asepsis, also referred to as clean technique, is used during most routine patient care activities and non-surgical procedures. With medical asepsis, emphasis is placed on removing most of the pathogenic organisms to reduce transmission from one patient to another.
Conversely, surgical asepsis, also called sterile technique, is used only during surgical procedures. Unlike medical asepsis, the goal of surgical asepsis is to ideally remove all pathogenic organisms and prevent the introduction of any organism into a normal sterile body site.
Medical asepsis is based on several measures with the goal of controlling the number of microorganisms, not making things sterile. To achieve medical asepsis we must understand what is dirty, what is clean, what is sterile, how to keep these things separate, and how to remedy any contamination that might occur. When approaching each patient care activity, consider the following principles as a framework to guide your practice.
When performing invasive procedures, like placing an IV or giving an injection, one of the bodies’ first lines of defense against invading microorganisms is bypassed: the skin. When we bypass the skin, we increase the susceptibility of the patient to invading microorganisms. For example, when placing an IV into the patient’s bloodstream (which is a sterile system) we perform hand hygiene and put on gloves to prevent our normal body flora from contaminating the insertion site. Next we decontaminate the patient’s skin using an antiseptic. This reduces the level of microbial burden at the insertion site so microbes are not carried through the skin during the insertion. Finally, we use a sterile IV catheter and sterile solutions so we do not introduce any additional microbes into the bloodstream.
The second principle of asepsis is focused on preventing the transfer of microorganisms from one patient to another via healthcare provider hands and shared equipment. All of us are colonized with many different types of bacteria, some helpful and some potentially pathogenic. When we fail to take the opportunity to perform hand hygiene between patients or clean and disinfect shared patient equipment like blood pressure cuffs between patients, we are creating opportunities for cross contamination that can introduce new, harmful microbes to patients.
The third principle of asepsis is recognizing that any body fluid is potentially contaminated. This means that if it is wet and not yours you should use the appropriate personal protective equipment (PPE) and perform hand hygiene after handling potentially contaminated fluids, and when performing patient care activities. Remove gloves and perform hand hygiene between dirty and clean patient care activities. For example, follow a wound dressing change with glove removal and hand hygiene before performing an injection on the same patient. By doing so, you can feel confident that you have not introduced any more microbes at the injection site.
The final principle of asepsis is that healthcare providers and the environment can also be a source of contamination. Healthcare providers can reduce their opportunities of transmitting disease by staying up to date on vaccinations, maintaining good personal hygiene, and performing hand hygiene appropriately.
Additionally, single use items can be a source of contamination if they are reused on another patient. For example, many sterile solutions used for irrigation do not have bacteriostatic or bacteriocidal compounds that prevent growth of microbes once they have been opened. Because of this, any excess fluid left in the bottle should be discarded - not stored for later use. It is important that you read the labels and follow manufacturers’ instructions for use.
The environment is also a potential source of contamination for the patient. If surfaces and shared patient equipment are not cleaned appropriately, they can be a source of cross-transmission. The role of the environment is discussed later in this section.
Now that we have reviewed medical asepsis, let’s move on to surgical asepsis. More stringent requirements are used during surgery because the risk of infection increases during surgery.
Measures that keep and maintain objects and areas maximally free of microorganisms so that normally sterile body sites are not contaminated are the basis of surgical asepsis. Understanding which equipment and areas are sterile, and which are not, and keeping these two separate so as not to introduce contamination is critical to achieving surgical asepsis.
While in the surgical environment, there are several principles which help maintain a sterile environment. First, the patient should not be a source of contamination. The skin around the surgical site is meticulously cleaned using a chemical antiseptic, like chlorhexadine alcohol solution, and all other areas of skin are covered by a sterile drape.
Similarly, operating room personnel should not be a source for contamination. Sterile operating room personnel (those working in the sterile field) should perform a surgical hand scrub, gown and glove, and only contact sterile items. Unsterile operating room personnel should only contact unsterile items and should not have direct contact with sterile operating room personnel.
What is sterile in the operating room? Gowns are sterile in front from chest high level to the operative level. A sterile healthcare provider should keep hands in sight and at or above waist level at all times and should avoid direct contact with non-sterile personnel or equipment. Similarly, non-sterile personnel should avoid contact with sterile personnel and items, and stay at least one foot beyond the sterile field. Sterile areas should also be kept continuously in view, and sterile personnel should not turn their back to the sterile field. All items used within the sterile field must be sterile. Articles of doubtful sterility should be considered non-sterile. Tables are sterile only at the operative level.
Contamination occurs when sterile gowns and drapes are permeated, when non-sterile items are brought into the sterile field, and when sterile personnel drop their hands or body below the level of the table.
Once there has been a breach in sterility, it is important that the contamination is recognized quickly and steps are taken to remedy the situation promptly.
Two of the primary practices of aseptic technique are appropriate hand hygiene and disinfection of surfaces and shared equipment. This diagram demonstrates how both hands and the environment play a role in the transmission of disease between two patients. The left side of the diagram shows transmission by the hands of the healthcare provider and the right side shows transmission by environmental surfaces and shared equipment. We are first going to cover hand hygiene followed later by environmental disinfection. We will cover high-level disinfection and sterilization in later modules.
Hand hygiene is a general term that applies to routine hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.
Hand hygiene substantially reduces potential pathogens on the hands and is considered a primary measure for reducing the risk of transmitting organisms to patients and health care personnel. Hospital-based studies have shown that noncompliance with performing hand hygiene is associated with health care-associated infections, the spread of multi-drug resistant organisms, and has been a major contributor to outbreaks. Studies have shown that the prevalence of health care-associated infections decreases as hand hygiene measures improve.
All of us have bacteria on our hands, even after performing hand hygiene. These bacteria are normal resident bacteria that generally reside in deeper layers of skin and are not likely to be removed during routine hand hygiene and are less likely to be associated with healthcare-acquired infections. When we provide patient care or have contact with the immediate patient environment, we pick up transient, potentially pathogenic microorganisms on our hands. In the study cited above, the researchers found that healthcare providers contaminate their hands with an additional 100 to 1000 bacteria during clean activities like taking vital signs. By performing appropriate hand hygiene, we remove these transient microorganisms so they cannot be transmitted to other patients.
In the study sited above, the researchers found that healthcare providers contaminate their hands with an additional 100-1000 CFU of bacteria during clean activities like taking vital signs. By performing appropriate hand hygiene, we remove these transient microorganisms so they cannot be transmitted to other patients.
Transmission of health care-associated pathogens from one patient to another via healthcare provider hands requires five sequential steps:
1. Organisms are present on the patient’s skin, or have been shed onto inanimate objects immediately surrounding the patient;
2. Organisms must be transferred to the hands of the healthcare provider;
3. Organisms must be capable of surviving for at least several minutes on the healthcare provider’s hands;
4. Hand washing or hand antisepsis by the healthcare provider must be inadequate or entirely omitted, or the agent used for hand hygiene
inappropriate; and
5. The contaminated hand or hands of the caregiver must come into direct contact with another patient or with an inanimate object that will come into direct contact with the patient.
Adherence of healthcare providers to recommended hand hygiene procedures has been reported with great variation, and in some cases is unacceptably poor. A meta-analysis of 34 studies of hand hygiene practices of healthcare providers found, across all studies, there was average hand hygiene compliance rate of 40%.
Some of the most frequent reasons given for the lack of hand hygiene were:
products were inaccessible,
the products caused skin irritation,
healthcare providers were too busy and it interfered with patient care,
they were wearing gloves and felt hands were not contaminated,
they just didn’t think about it, and
they lacked the knowledge of when and how to perform hand hygiene.
This table demonstrates the correspondence between the WHO 5 Moments of Hand Hygiene and the CDC Guidelines on Hand Hygiene.
The use of an alcohol based hand rub is preferential to hand washing when hands are not visibly soiled. You should not use alcohol based hand rubs after providing care to patients with diarrhea. Review the steps for hand rubbing shown here.
Hand washing with antiseptic soap and water should be used when hands are visibly soiled and after providing care patients with diarrhea. Review the steps for hand washing shown here.
Why is hand rubbing with an alcohol-based hand sanitizer preferred over hand hygiene with antiseptic soap and water? When compared side by side using 15-30 seconds of use, hand rubbing was significantly more efficient in reducing hand bacterial contamination.
In summary, hand hygiene should occur where care is delivered. Healthcare providers should know the indications for when to perform hand hygiene. Caregivers should preferentially choose to use an alcohol based hand rub over and hand washing, unless their hands are visibly soiled or they provided care to a patient with diarrhea. Healthcare providers should use the correct technique and duration.
In addition to hand hygiene, one of the most important concepts to understand is the role of the environment in disease transmission in healthcare settings. Patients colonized or infected with epidemiologically important pathogens shed these microorganisms into the environment and contaminate surfaces and shared patient equipment in their immediate surroundings. This pathway can be disrupted by adequately and thoroughly disinfecting the contaminated surfaces. Failure to do so poses a risk for transmission of infection.
The Spaulding classification scheme is used to classify surfaces and objects in healthcare based on the intended use and type of disinfection they require. Critical objects are items that enter normally sterile tissue, like surgical instruments, and require sterilization; semi-critical objects are items, like endoscopes, which have contact with mucous membranes and non-intact skin and require high-level disinfection; and finally, we have non-critical objects, like exam tables and blood pressure cuffs, which are in contact with intact skin and require only low-level disinfection.
There are three levels of disinfection: High, Intermediate, and Low. High level disinfection kills all microorganisms except for small numbers of bacterial spores. Intermediate level disinfection kills all non-spore forming bacteria including Mycobacterium tuberculosis, as well as most fungi and viruses. Low level disinfection also kills most microorganisms, with the exception of spores and Mycobacterium tuberculosis.
There are two categories of environmental surfaces. Clinical contact surfaces have a high potential for direct contamination from patient secretions, especially during procedures that generate spray or splatter. These surfaces also have frequent contact with the contaminated hands of healthcare providers and patients. These surfaces can become a reservoir for contamination of instruments, patient care devices, and healthcare provider bare or gloved hands.
Once epidemiologically important pathogens are on surfaces, many can live for quite some time. According to numerous studies published in the literature, many of these pathogens can live from days to several months on dry surfaces. The human immunodeficiency virus does not survive well outside of the host, while hepatitis C virus can survive for up to 4 days, and hepatitis B virus can survive up to a week on a surface.
When approaching the task of disinfection, it is important that you always select the right product for the right microbe. For instance, after providing care to a patient you suspect of having C. difficile or norovirus, clean environmental surfaces with a dilute bleach solution that is able to inactivate these germs. When using a disinfectant product that requires mixing or dilution, the process must be repeatedly accurate and monitored.
Be sure to prepare the surface appropriately. In some instances, there may be heavy soiling of a surface (like a blood spill) that needs to be removed so that the disinfectant can have direct, full contact with the surface. Use a disposable wipe or microfiber cloth to apply the disinfectant to the surface with enough moisture to allow the surface to remain wet for at least 1 minute, and according to manufacturer’s instructions for use.
Finally, it is important that healthcare providers utilize the appropriate personal protective equipment (PPE) when disinfecting surfaces.
These are examples of commonly used disinfectants in healthcare. A quaternary ammonium compound is the most commonly used product, but there are new products on the market including an improved hydrogen peroxide, a very robust disinfectant that has the fastest contact time to kill many different pathogens, including a claim against norovirus. Most of these preparations come in ready to use forms that do not require any additional mixing or dilution.
When cleaning a patient area or room it is important to use the correct technique. Here are some considerations:
Cleaning and disinfecting of surfaces should move from clean to dirty to avoid possible contamination of surfaces that may not be soiled.
To avoid contaminating cleaning and disinfecting solutions, a cleaning cloth should never be re-dipped into the clean solution. Rather, the used cloth should be discarded and a new cloth obtained to adequately remove pathogens from surfaces. The same is true for disposable wipes.
If the cloth does not provide a minimum wet time of one minute, a new wipe should be obtained.
Nothing can replace good old-fashioned elbow grease to physically remove the bioburden from the surface being cleaned.
Personnel performing the cleaning and disinfection should know what the contact time is for the disinfectants. Follow the manufacturer’s recommendation for the area that can be cleaned per wipe. Centers for Medicare and Medicaid Services (CMS) surveyors and accrediting organizations place heavy emphasis on this during surveys, and personnel should be able state the contact time of the disinfectant they are using and know what the institutional policy and expectation is for this practice.
Make sure that you are using the correct type of cleaning materials. If you have an item that has to be cleaned in a certain way per manufacturer instructions (e.g. with a special cloth or disinfectant), make sure that it is available and part of the cleaning process.
In addition to correct technique, it is also important that all of the surfaces in the room are adequately cleaned. The Environmental Hygiene Study group has tracked the thoroughness of cleaning. Across all healthcare settings representing over 110,000 objects, an average of 32% of the surfaces in rooms are cleaned. It is important that daily and post-discharge cleaning are monitored and feedback is given to the personnel performing the cleaning to ensure that all surfaces are cleaned thoroughly.
Another important process to know and understand is how to clean-up blood and body fluid spills. OSHA requires, as part of the bloodborne pathogen standard, that there be a formalized process for remediating these spills. The first step is to clean and decontaminate the area promptly. If the spill contains large amounts of blood or body fluids (e.g. >10 ml), first apply a 1:10 dilute bleach solution to the area, followed by cleaning the visible matter with a disposable absorbent material. Once the visible contamination has been removed, the area should be decontaminated using a dilute bleach solution of either a 1:10 or 1:100 concentration, or an EPA-registered hospital disinfectant labeled as tuberculocidal or with specific label claims against HIV and hepatitis B. All articles used to clean-up the spill should be disposed of in the appropriate, labeled containers.
The following references were used in the preparation of this module.
Congratulations, you have completed this module, and may continue to the next module.