Standard Precaution

STANDARD
PRECAUTIONS
Ross Ibabao/ICCO
KJO Hospital
POLICY IC/PL 004

Standard Precaution
Standard Precautions represent the minimum
infection prevention measures that apply to all patient
care, regardless of suspected or confirmed infection
status of the patient, in any setting where healthcare is
delivered. These evidence-based practices are
designed to both protect healthcare personnel and
prevent the spread of infections among patients.
Standard Precautions replaces earlier guidance relating
to Universal Precautions and Body Substance Isolation.

Standard Precaution Include:
1) Hand Hygiene
2) Use of personal protective equipment (e.g., gloves,
gowns, facemasks), depending on the anticipated
exposure
3) Respiratory hygiene and cough etiquette
4) Sharp Safety or Safe injection practices, and
5) Waste Management and Safe handling of potentially
contaminated equipment or surfaces in the patient
environment.

IC/PL-12
Hand Hygiene
Ross Ibabao/ICCO
KJO Hospital

Hand Hygiene
Hospital patients get an estimated 722,000
infections each year. That’s about 1 infection for
every 25 patients. Infections that patients get in the
hospital can be life-threatening and hard to treat.
Hand hygiene is one of the most important ways to
prevent the spread of infections.

Ignaz Semmelweis,
1815-1865
 1840’s: General
Hospital of Vienna
 Divided into two clinics,
alternating admissions
every 24 hours:
 First Clinic: Doctors
and medical students
 Second Clinic:
Midwives
0
2
4
6
8
10
12
14
16
Maternalmortality,1842
First Clinic Second
Clinic
History

Maternal Mortality due to Postpartum Infection
General Hospital, Vienna, Austria, 1841-1850
0
2
4
6
8
10
12
14
16
18
1841 1842 1843 1844 1845 1946 1847 1848 1849 1850
MaternalMortality(%)
MDs Midwives
Semmelweis’ Hand
Hygiene Intervention
~ Hand antisepsis reduces the frequency of patient infections ~
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

The Inanimate Environment Can
Facilitate Transmission
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
X represents VRE culture positive sites

Self-Reported Factors for
Poor Adherence with Hand
Hygiene
 Handwashing agents cause irritation and
dryness
 Sinks are inconveniently located/lack of sinks
 Lack of soap and paper towels
 Too busy/insufficient time
 Understaffing/overcrowding
 Patient needs take priority
 Low risk of acquiring infection from patients
Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

Indications for Hand
Hygiene
 When hands are visibly dirty, do Hand
Washing for contaminated, or soiled,
wash with non-antimicrobial or
antimicrobial soap and water.
 If hands are not visibly soiled, use an
Alcohol-Based Hand Rub for routinely
decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.

Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good Better Best
Plain Soap Antimicrobial soap Alcohol-based
handrub

Fingernails and Artificial
Nails
 Natural nail tips should be kept to ¼ inch
in length
 Artificial nails should not be worn when
having direct contact with high-risk
patients (e.g., ICU, OR)
vol. 51, no. RR-16.

Gloving
 Wear gloves when contact with blood or
other potentially infectious materials is
possible
 Remove gloves after caring for a patient
 Do not wear the same pair of gloves for
the care of more than one patient
 Do not wash gloves
vol. 51, no. RR-16.

Education/Motivation
Programs
 Monitor healthcare workers (HCWs)
adherence with recommended hand
hygiene practices and give feedback
 Implement a multidisciplinary program to
improve adherence to recommended
practices
 Encourage patients and their families to
remind HCWs to practice hand hygiene
vol. 51, no. RR-16.

Administrative Measures
to Improve Hand Hygiene
 Make improved hand hygiene an
institutional priority
 Place alcohol-based handrubs at
entrance to patient room, or at bedside
 Provide HCWs with pocket-sized
containers
vol. 51, no. RR-16.

Alcohol and Flammability
 Alcohols are flammable
 Alcohol-based handrubs should be
stored away from high temperatures or
flames
 Europe: fire incidence low
 U.S.: one report of flash fire
 Application is key: Let It Dry!
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol.
51, no. RR-16.

Summary
Alcohol-Based Handrubs:
What benefits do they provide?
 Require less time
 More effective for standard
handwashing than soap
 More accessible than sinks
 Reduce bacterial counts on hands
 Improve skin condition

Healthcare providers should practice hand hygiene at key
points in time to disrupt the transmission of microorganisms
to patients including:
5 Moments of Hand Hygiene
5 Moments of Hand Hygiene

PREVENTION
IS PRIMARY!
Protect patients…protect healthcare personnel…
promote quality healthcare!

1) Hand Hygiene
exposure.
environment.

IC/PL-12
Personal Protective
Equipment (PPE)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
Ross Ibabao/ICCO
KJO Hospital

What is Personal Protective
Equipment?
“specialized clothing or equipment worn
by an employee for protection against
infectious materials” (OSHA)
PPE Use in Healthcare Settings

Regulations and
Recommendations for PPE
 OSHA issues workplace health and safety
regulations. Regarding PPE, employers must:
 Provide appropriate PPE for employees
 Ensure that PPE is disposed or reusable PPE is
cleaned, laundered, repaired and stored after use
 OSHA also specifies circumstances for which
PPE is indicated
 CDC recommends when, what and how to use
PPE

Types of PPE Used in
Healthcare Settings
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from
airborne infectious agents
• Goggles – protect eyes
• Face shields – protect face, mouth, nose, and
eyes

Factors Influencing PPE Selection
• Type of exposure anticipated
– Splash/spray versus touch
– Category of isolation precautions
• Durability and appropriateness for the
task
• Fit

Gloves
• Purpose – patient care, environmental
services, other
• Glove material – vinyl, latex, nitrile,
other
• Sterile or non-sterile
• One or two pair
• Single use or reusable

Do’s and Don’ts of Glove Use
• Work from “clean to dirty”
• Limit opportunities for “touch
contamination” - protect yourself,
others, and the environment
– Don’t touch your face or adjust PPE with
contaminated gloves
– Don’t touch environmental surfaces except
as necessary during patient care

Do’s and Don’ts of Glove Use
(cont’d)
 Change gloves
 During use if torn and when heavily soiled (even
during use on the same patient)
 After use on each patient
 Discard in appropriate receptacle
 Never wash or reuse disposable gloves

Gowns or Aprons
• Purpose of use
• Material –
– Natural or man-made
– Reusable or disposable
– Resistance to fluid penetration
• Clean or sterile

Face Protection
• Masks – protect nose and mouth
– Should fully cover nose and mouth and
prevent fluid penetration
• Goggles – protect eyes
– Should fit snuggly over and around eyes
– Personal glasses not a substitute for
goggles
– Antifog feature improves clarity

Face Protection
 Face shields – protect face, nose, mouth,
and eyes
 Should cover forehead, extend below chin and
wrap around side of face

Respiratory Protection
• Purpose – protect from inhalation of
infectious aerosols (e.g.,
Mycobacterium tuberculosis)
• PPE types for respiratory protection
– Particulate respirators
– Half- or full-face elastomeric respirators
– Powered air purifying respirators (PAPR)
– N-95

Elements of a Respiratory
Protection Program
• Medical evaluation
• Fit testing
• Training
• Fit checking before use

Key Points About PPE
• Don before contact with the patient,
generally before entering the room
• Use carefully – don’t spread
contamination
• Remove and discard carefully, either at
the doorway or immediately outside
patient room; remove respirator outside
room
• Immediately perform hand hygiene

Sequence for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves

How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back

How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit

How to Don a Particulate
Respirator
• Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face

How to Don Eye and Face
Protection
• Position goggles over
eyes and secure to the
head using the ear pieces
or headband
• Position face shield over
face and secure on brow
with headband
• Adjust to fit comfortably

How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs

How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn;
perform hand hygiene before donning
new gloves
• Limit surfaces and items touched

“Contaminated” and “Clean”
Areas of PPE
• Contaminated – outside front
• Areas of PPE that have or are likely to have
been in contact with body sites, materials, or
environmental surfaces where the infectious
organism may reside
• Clean – inside, outside back, ties on
head and back
• Areas of PPE that are not likely to have been in
contact with the infectious organism

Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

Where to Remove PPE
• At doorway, before leaving patient room
or in anteroom*
• Remove respirator outside room, after
door has been closed*
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub

How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand

How to Remove Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for
both gloves
• Discard

Remove Goggles or Face
Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or
disposal

Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
• Discard

Removing a Mask
• Untie the bottom,
then top, tie
• Remove from face
• Discard

Removing a Particulate
Respirator
 Lift the bottom
elastic over your
head first
 Then lift off the top
elastic
 Discard

Hand Hygiene
• Perform hand hygiene immediately after
removing PPE.
– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
• Wash hands with soap and water or use
an alcohol-based hand rub
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub

What Type of PPE Would You
Wear?
• Giving a bed bath?
• Generally none
• Suctioning oral secretions?
• Gloves and mask/goggles
or a face shield –
sometimes gown
• Transporting a patient in a
wheel chair?
• Generally none required
• Responding to an
emergency where blood is
spurting?
• Gloves, fluid-resistant
gown, mask/goggles or a
face shield
• Drawing blood from a vein?
• Gloves
• Cleaning an incontinent
patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?
• Gloves, gown,
mask/goggles or a face
shield
• Taking vital signs?
– Generally none

Respiratory Hygiene and
Cough Etiquette
Ross Ibabao/ICCO
KJO Hospital

Respiratory Hygiene and Cough Etiquette
To prevent the transmission of all respiratory infections in
healthcare settings the following infection control
measures should be implemented at the first point of
contact with a potentially infected (e.g. ER, OPD)
person. They should be incorporated into infection
control practices as one component of Standard
Precautions.

Visual Alerts
Post visual alerts at the entrance to outpatient facilities
(e.g., emergency departments, physician offices,
outpatient clinics) instructing patients and persons who
accompany them (e.g., family, friends) to inform
healthcare personnel of symptoms of a respiratory
infection when they first register for care and to practice
Respiratory Hygiene/Cough Etiquette.
Cover your cough

Respiratory Hygiene/Cough Etiquette
The following measures to contain respiratory secretions are
recommended for all individuals with signs and symptoms of a respiratory
infection:
1. Cover your mouth and nose with a tissue when coughing
or sneezing;
2. Use in the nearest waste receptacle to dispose of the
tissue after use;
3. Perform hand hygiene after having contact with respiratory
secretions and contaminated objects/materials.

Healthcare facilities should ensure the availability of materials for
adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for
patients and visitors:
1. Provide tissues and no-touch receptacles for used
tissue disposal.
2. Provide conveniently located dispensers of alcohol-
based hand rub; where sinks are available, ensure that
supplies for hand washing (i.e., soap, disposable
towels) are consistently available.

Masking and Separation of Persons with
Respiratory Symptoms
Offer masks to persons who are coughing,sneezing (surgical
masks) may be used to contain respiratory secretions
(respirators such as N-95 or above are not necessary for this
purpose). When space and chair availability permit,
encourage coughing persons to sit at least three feet away (1
meter) from others in common waiting areas.

Droplet Precautions
Advise healthcare personnel to observe Droplet Precautions
(i.e., wearing a surgical or procedure mask for close contact),
in addition to Standard Precautions, when examining a
patient with symptoms of a respiratory infection, particularly if
fever is present. These precautions should be maintained
until it is determined that the cause of symptoms is not an
infectious agent that requires Droplet Precautions.

Stop the spread of germs that can make you
and others sick!
To help stop the spread of germs:
1. Avoid close contact with people who are sick.
2. Stay home when you are sick.
3. Cover your mouth and nose with a tissue when you cough or sneeze.
4. Wash your hands often with soap and water. If soap and water are not
available, use an alcohol-based hand rub.
5. Avoid touching your eyes, nose or mouth.
6. Clean and disinfect frequently touched surfaces at home, work or
school, especially when someone is ill.
7. Get plenty of sleep, be physically active, manage your stress, drink
plenty of fluids, and eat nutritious food.

Sharp Safety
Preventing Needle sticks and Other Sharps
Injuries…
Everything You Need to Know
Ross Ibabao/ICCO
KJO Hospital

What Strategies Exist to Eliminate Sharps
Injuries?
 Eliminate or reduce the use of needles
and other sharps
 Use devices with safety features
to isolate sharps
 Use safer practices to minimize
risk for remaining hazards

Injuries Related to Work Practices
 Injuries occur because of the following:
 Passing or transferring equipment
 Recapping contaminated needles
 Colliding with coworkers
 Decontaminating/processing used equipment
 Injuries occur from sharps left in unusual places:
 Laundry
 Mattresses
 Tables, trays, or other surfaces

How do sharps injuries happen?

What devices are involved with sharps
injuries?

The Sharps Safety Continuum
 Prepare to use the device the moment the
sharps are first exposed
 Take precautions while using sharps
 Take precautions during cleanup
 Take precautions during disposal

Sharps Safety Practices
 Be prepared
 Be aware
 Dispose with care

 Organize equipment at the point of use
 Make sure work space has adequate lighting
 Keep sharps pointed away from the user
Before Beginning a Procedure
Be Prepared

 Locate a sharps disposal container, or have
one nearby
 Assess the patient’s ability to cooperate
 Get help if necessary
 Ask the patient to avoid sudden movement
Before Beginning a Procedure (cont’d)
Be Prepared

Be Aware
 Maintain visual contact with sharps during use
 Be aware of staff nearby
 Control the location of sharps to avoid injury to
yourself and others
During a Procedure

During a Procedure (cont’d)
 Do not hand pass exposed sharps from one
person to another
 Use predetermined neutral zone for
placing/retrieving sharps
 Alert others when sharps are being passed
Be Aware

During a Procedure (cont’d)
 Activate safety feature of devices with
engineered sharps injury prevention features
as soon as procedure is completed
 Observe audible or visual cues that confirm the
feature is locked in place
Be Aware

Clean Up and Dispose with Care
 No recapping
 Be accountable for sharps you use
 Check procedure trays, waste materials, and
bedding for exposed sharps before handling
 Look for sharps/equipment left behind
inadvertently
During Cleanup

Clean Up and Dispose With Care
 Transport reusable sharps in a closed
container
 Secure the container to prevent spillage
 No passing of sharps item
During Cleanup (cont’d)

 Inspect container
 Keep hands behind sharps
 Never put hands or fingers into sharps
container
While Disposing of Sharps

 If you are disposing sharps with attached tubing
 Be aware that tubing attached to sharps can recoil and
lead to injury
 Maintain control of both tubing and the device during
disposal
While disposing of Sharps (cont’d)

 Visually inspect sharps container for overfilling
 Replace containers before they become overfilled
 Keep filled containers for disposal in a secure area
After Disposing of Sharps

 Handle carefully
 Keep hands behind sharps at all times
 Use mechanical device if you cannot safely pick up sharps
by hand
If You Find Improperly Disposed Sharps in
Work Environment

Sharps Injuries in the Operating Room
 Cuts/needle sticks occur in as many as 15% of
operations
 Risk increases with longer, more invasive, higher blood loss procedures
 Suture needle injuries are most frequent
 Fingers used to manipulate needles and tissue
 Up to 16% of injuries occur while passing sharps

 Needleless/no sharps alternatives
 Use alternative cutting methods such as blunt electrocautery and laser
devices when appropriate
 Substitute endoscopy surgery for open surgery when possible
 Engineering controls
 Use round-tipped scalpel blades instead of sharp-tipped blades
 Use blunt suture needle
 Work practice controls
 Use instruments rather than fingers
 Give verbal announcement when passing sharps
 Use “neutral zone” to avoid hand-to-hand passing of sharps
Sharps Injuries in the Operating Room

 Wash needle sticks and cuts with soap in a running
water
 Flush splashes to the nose, mouth, or skin with water
 Irrigate eyes with clean water, saline, or sterile irrigants
 Report the incident to your supervisor
 Immediately seek medical treatment (ER)
 Report to ICP (2176/2097)
If you experienced a needlestick or sharps injury or were
exposed to the blood or other body fluid of a patient
during the course of your work, immediately follow
these steps:

Post Exposure Prophylaxis
Post Exposure Prophylaxis.pdf
2. IC PL 002 EMPLOYEE MEDICAL
SCREENING AND
VACCINATION(1).pdf

Conclusion
Preventing Sharps Injuries
Your Role

You are Part of the Prevention
Process when You
 Adhere to safe practices and assist and support
coworkers in safer practices
 Report injuries or blood/body fluid exposures, sharps
injury hazards, and near misses
 Participate in training for devices and properly use
sharps safety features
 Participate in surveys (e.g., safety culture) and device
evaluations

Waste Management
EHS/PL-002
Ross Ibabao/ICCO
KJO Hospital

Key Concepts
• Definitions of medical waste can be confusing
• Medical waste regulations and guidance should
be based on scientific analysis.

Background
Expert at the CDC stated: “there is no epidemiologic evidence
to suggest that most hospital waste is any more infectious
than residential waste. Moreover, there is no epidemiologic
evidence that hospital waste disposal practices have caused
diseased in the community; therefore, identifying wastes for
which special precautions are indicated in largely a matter of
judgment about the relative risks of disease transmission.
Unfortunately, some confusion remains, compounded by
inconsistent, specific, and occasionally conflicting definitions
of “Medical Waste” or “Infectious Waste.” This is promoted by
input from individuals with a little knowledge of infectious
disease transmission or related microbiology.

Background
Hospital and other healthcare settings have recognized the
potential occupational risk of disease transmission and
therefore use caution when handling and disposing of waste.
Healthcare “Infectious” waste may include:
1. Microbiological laboratory waste
2. Hazardous waste
3. Blood and body fluids
4. Sharps
5. Pathology waste
6. Pharmaceutical waste
7. And certain waste from patients who are placed in
isolation room

Waste Terminology
• Terms such as “biomedical waste,” “regulated waste,” “red
bag waste,” “ medial waste,” “ and “infectious waste” have
been used interchangeably.
• Category of waste my vary from state to state and even
agency to agency.
• To reduce the confusion, the term ‘infectious waste” is used
here to refer to “waste that is capable of producing an
infectious diseases. (APIC)

• Cont.
• A common misconception is to assume that the presence
of a pathogen will result in infection from waste.
Pathogenic are found in many different day to day
settings. Household garbage, bed linens, soiled diaper,
and unwashed hands are all example of environment in
which pathogen can routinely be found both within and
outside the healthcare setting.
• A number studies have shown that although hospital
waste can have a greater variety of organisms than
residential waste, those from households are more
heavily contaminated
Waste Terminology

For a waste to be capable of causing
infection, the following specific factors
are necessary:
1.Dose
2.Host susceptibility
3.Presence of pathogen
4.Virulence of pathogen
5.Portal of entry
Note: Concisely, all five of these factors must be present for
infection to occur from waste.

Infectious waste category
1. Contaminated Sharps – have come into contact with potentially infectious
materials.
2. Microbiologic Cultures and Stocks of Infectious Agents – untreated
cultures, stocks, and amplified microbiological populations pose the
greatest potential for infectious disease transmission because they contain
high concentrations of potentially pathogenic organism
3. Animal Waste – discarded material originating from animals inoculated with
infectious agents during research, production of biological, or
pharmaceutical testing should be considered infectious waste.
4. Blood and Blood Products – as defined by OSHA known or suspected to be
contaminated with a transmissible agent must be handled carefully. Small
amount, dried on dressings or other disposable items represent an
insignificant hazard once they are properly contained.
5. Selected isolation waste – treated in isolation should be classified as
infectious waste.

Integrated Waste Management Policy
EHS PL 002,6 - INTEGRATED WASTE MANAGEMENT.pdf

1) Hand Hygiene
exposure.
environment, (Cleaning, Disinfection And Sterilization)

Process of CSSD
 Rinsing -> Cleaning ->Disinfection->Sterilization
 Non-Critical - Departmental
 Rinsing ->Cleaning ->low level disinfection (minuten)
 Semi Critical – Rinsing (Department)
 Cleaning (water+Prolystica)
 Disinfection (Anioxyde)
 Rinsing (water)
 Drying (with minuten)

Process of CSSD
 Critical – Rinsing (Departmental)
 Cleaning – Manual - (water+Prolystica)
 Cleaning – Mechanical – (water+prolystica+liquijet)
(Disinfection)
 Sterilization
○ Steam
○ Gas
 Hydrogen peroxide

Key points - 1
 Cleaning, disinfection, and sterilisation are the
backbone of infection prevention and control
 Proper cleaning essential before any disinfection
or sterilisation process
 Failure to clean, disinfect and sterilise reusable
medical devices properly may spread infections
 The type and level of device decontamination
depends upon the nature of the item and its
intended use
December 1, 2013 117

Key points - 2
 Steam sterilisation effective only when
preceded by
 Thorough pre-cleaning, proper packaging/loading,
and careful monitoring of autoclaves.
 Chemical disinfectants must be selected, used,
and discarded to minimise harm.
 Those responsible for processing contaminated
items must be fully trained and wear protective
clothing when necessary.
 Clearly written policies and procedures must be
available on-site for training personnel and for
monitoring their performance.
118

Cleaning
Cleaning is the first step in reprocessing a device.
The purpose of cleaning and rinsing is to remove
all visible debris from an item and to reduce the
number of particulates, micro-organisms and
potential pathogens.

Disinfection
A process that eliminates many or all pathogenic
microorganisms on inanimate objects, with the
exception of bacterial spores

Sterilisation
 The complete elimination or destruction of
all forms of microbial life
 Includes large numbers of highly resistant
bacterial spores
 Store in clean, dry place
 Protect wrapping
 Inspect before use

Single-Use Devices (SUD’s)
 Single-use items must be safely discarded
after use
 e.g., injection needles
 No reprocessing before carefully
considering the following:
 Is device undamaged and functional?
 Can it be disassembled for reprocessing?
 Can its sterility be validated, if needed?
 Is the reprocessing cost-effective?
 Is an authorised person onsite willing to be
responsible for any negative consequences?

Critical Items
 Enter normally sterile tissues, the vascular
system, or equipment through which
blood flows
 Items must be properly and safely pre-
cleaned and sterilised before use

Critical Items - Examples
 Implants
 Prosthetic devices
 Surgical instruments
 Needles
 Cardiac catheters
 Urinary catheters
 Biopsy forceps of endoscope

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

Semi-critical Item -
Examples
 Flexible fiber optic endoscopes
 Respiratory therapy equipment
 Anaesthesia equipment
 Endotracheal tubes
 Bronchoscopes
 Vaginal specula
 Cystoscope
 Hand-piece

Non Critical Items
 Direct contact with the patients intact skin
(unbroken skin)
 Little risk of pathogen transmission
directly to patient
 Clean and disinfect using a low to
intermediate level disinfectant

Examples of Non Critical Items
Items which are in contact with intact skin
 Bedpans
 Blood pressure cuffs
 Crutches
 Stethoscopes
 Face mask
 X-ray machine

Disinfection
 Reduction in numbers of pathogens on
inanimate surfaces/objects
 For items that will contact intact skin or
mucous membrane
 Use physical or chemical agents or both
 Level of disinfection
 High-level
 Intermediate-level
 Low-level

High-level Disinfectants - 1
 Active against vegetative bacteria, viruses
(including the non-enveloped ones), fungi,
and mycobacteria
 May have some activity against bacterial
spores
 With extended contact times
 HLDs are used to disinfect heat-sensitive
and semi-critical devices
 Such as flexible fibreoptic endoscopes
130December 1, 2013

High-level disinfectants - 2
 HLDs typically require 10-45 minutes
contact time
 Depends on the temperature
 After disinfection, items require thorough
rinsing/flushing with sterile or filtered water
to remove any chemical residues
 They must then be dried with an alcohol rinse or
by blowing clean, filtered air through the
device’s channels prior to storage
131December 1, 2013

Intermediate-level Disinfectants
 Active against vegetative bacteria,
mycobacteria, fungi and most viruses
 May fail to kill spores, even after
prolonged exposure
132December 1, 2013

Low-level Disinfectants
 Active against vegetative bacteria (except
mycobacteria), some fungi, and only
enveloped viruses
 In many cases, washing with
unmedicated soap and water would be
sufficient in place of LLD
 70% Alcohol, Minuten Spray
133December 1, 2013

Spaulding Classification
Divided hospital instruments into general
categories based on the risk of infection
involved in their use
 Critical items
 Semi critical item
 Non critical items
SPAULDING CLASSIFICATION .pdf

Chemical Indicators
 External Chemical Indicator
○ process indicator - autoclave tape
○ distinguishes processed from unprocessed
medical devices
○ secures pack
○ labels pack
 Check external indicator to ensure it has
changed color before using any package
 If the indicator did not change, do not use
135December 1, 2013

Biological Indicators
 Requires routine monitoring daily
 Test must be dated and labeled
 Once removed from the steriliser the test
pack opened, BI labeled, crushed and
incubated in the incubator
 Records of time, date of incubation and
staff initials is required and then time and
date and initials of the staff reading the
final BI result
136December 1, 2013

Biological Monitoring
 Steam Geobacillus stearothermophilus
 Dry heat B.atrophaeus (formerly
B.subtilis)
 EO B.atrophaeus
 New low temperature sterilisation
technologies
○ Plasma sterilisation (Sterrad) B.atrophaeus
○ Peracetic acid - Geobacillus
stearothermophilus
137December 1, 2013

References - 1
 Guidelines for Environmental Infection Control in
Health-Care Facilities. MMWR 2003; 52(RR10):1-
42.
http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HC
F_03.pdf
 Ontario Ministry of Health & Long-Term Care.
Provincial Infectious Diseases Advisory Committee
(PIDAC) Best Practices for Cleaning, Disinfection
and Sterilization in All Health Care Settings, 2010.
http://www.publichealthontario.ca/en/BrowseByTopi
c/InfectiousDiseases/PIDAC/Pages/PIDAC_Docum
ents.aspx

References - 2
 Rutala WA, Weber DJ. Guideline for Disinfection
and Sterilization in Healthcare Facilities, 2008.
Centers for Disease Control and Prevention,
Atlanta, GA.
http://www.cdc.gov/hicpac/pdf/guidelines/Disinfectio
n_Nov_2008.pdf
 Snyder, OP. Calibrating thermometers in boiling
water: Boiling Point / Atmospheric Pressure /
Altitude Tables. http://www.hi-
tm.com/Documents/Calib-boil.html
 Sattar A. Allen Denver Russell Memorial Lecture,
2006. The use of microbicides in infection control: a
critical look at safety, testing and applications. J
Appl Microbiol 2006; 101:743-753.

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