· Definitions
· Equipment classification
· Hand hygiene
· Attire
· Preventing surgical site infection
· Smelly anaesthetic equipment
· Invasive procedures
· Sharps
|
Asepsis |
· Prevention of microbial contamination of sterile tissues and objects |
|
Decontamination |
· Killing microbes to render an object safe for use |
|
Cleaning |
· Remove organic matter and kill many microbes |
|
Disinfection |
· Kill all microbes except spores |
|
Sterilisation |
· Kill all microbes |
|
Critical |
· Penetrates skin or mucous membranes -> cleaning then sterilization) |
|
Semi-critical |
· Touches mucous membranes -> cleaning then disinfection) |
|
Non-critical |
· Touches skin -> cleaning) |
|
Hand washing |
· When physically soiled |
|
Antimicrobial gel/spray |
· When not physically soiled o
Alcohol 60-95% for the kill o Chlorhex 2-4% for preventing regrowth |
|
In theatre |
· Scrubs · Shoes (closed toe, no heel, +/- overshoe) · Hat |
|
Body fluid contact |
· Gown · Mask: o Over nose and mouth o Both the upper and lower tapes tied o Replace between cases o If performing a sterile procedure: protects the patient o If standing around: protects you and possibly the patient · Goggles · Gloves: o Wear when expecting to touch body fluids o Remove and do hand hygiene when finished o Don’t touch clean things with grubby gloves |
|
Doors |
· Keep closed to prevent turbulence-induced bug contamination |
|
Temperature |
· Hypothermia causes wound infections |
|
Antibiotics |
· According to local guidelines |
|
Restrictive transfusion |
· Reduces wound infection rate |
|
Airway equipment |
· Face mask: semi-critical · Laryngoscope blade: critical · Laryngoscope handle: non-critical (but disinfect if bloody) · Flexible bronchoscopes: semi-critical |
|
Anaesthesia machine |
· Machine itself: periodic decontamination according to policy · Breathing circuit: new filter for each patient; new circuit if Tuberculosis & ‘Rona · Breathing bag: non-critical · Sampling line: re-usable if connected to the circuit via a filter |
|
Surfaces, monitoring, spaghetti |
· Clean between each patient |
|
External ultrasound probe |
· Diagnostic: non-critical, bare probe ok, needs cleaning · Interventional: semi-critical, needs probe cover, needs disinfection · N.B. bare probe + body fluid = needs sterilization (e.g. orthophthalaldahyde) |
|
Internal ultrasound probe |
· Semi-critical = cleaning + disinfection · All of it: probe, shaft, socket, handle, cable |
*Do not re-use items designed for single use*
|
Peripheral vascular access |
· Gloves · Disinfect skin (alcohol if <24 hours, alcohol + chlorhex if >24 hours) · Keep tip and shaft sterile · Plug: there is no evidence that cannulae should be routinely replaced · Plug: short cannulae last ~1-2 days, long cannulae in the forearm last ~7-10 day |
|
Central venous cannulation |
· Self: hat + facemask + sterile gown + sterile gloves + sterile US probe cover · Patient: alcohol with chlorhex + full body drape |
|
Vascular access ports |
· Wipe with alcohol 70% · Allow to dry |
|
Neuraxial |
· Self: as for CVC · Patient: as for CVC; ensure chlorhex cannot be injected neuraxially |
|
Regional |
· If single shot: gloves + single use needle and syringe + no-touch technique · If ultrasound: sterile gel + keep needle entry site sterile + protect probe from contamination |
|
Drugs for injection |
· Ampoule splitting: increases risk of infection and error, hence not supported · Beware preservative-containing solutions · Beware the dirty outside part of the ampoule · Beware the rubber stopper of the vial: the lid does not keep it sterile · Only 20μm filter needles effectively exclude microbes |
|
Disposal |
· Into sharps bin · Immediately after use · No re-sheathing or bending |
|
Needle-stick injuries |
· Risk of HBV 30%, HCV 3%, HIV 0.3% assuming present · Wash with water and antiseptic · Report ASAP to infection control team · (All staff should be vaccinated against HBV) |
Feedback welcome at ketaminenightmares@gmail.com