PS28 2015: Infection control

 

List:

·        Definitions

·        Hand hygiene

·        Attire

·        Equipment classification

·        Anaesthetic equipment

·        Sharps

 

Definitions:

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

 

Hand hygiene:

If soiled

·     Wash hands with soap

If not soiled

·     Anti-microbial solution:

o  Alcohol 60-95% (kills microbes)

o  Chlorhex 2-4% (preventing regrowth)

o  Water (required for denaturing)

N.B. the most important infection control measure

 

Attire:

In theatre

·     Scrubs

·     Shoes

·     Hat

Body fluid contact

·     Gown

·     Mask

·     Goggles

·     Gloves

 

Equipment classification:

Critical

·     Penetrates skin or mucous membranes

-> cleaning then sterilization
(e.g. vascular access, laryngoscope blade)

Semi-critical

·     Touches mucous membranes

-> cleaning then disinfection
(e.g. flexible bronchoscope)

Non-critical

·     Touches skin

-> cleaning only
(e.g. laryngoscope handle)

 

Anaesthetic equipment:

Airway

·     Face mask: semi-critical

·     Laryngoscope blade: critical

·     Laryngoscope handle: non-critical (but disinfect if bloody)

·     Flexible bronchoscopes: semi-critical

Vascular access

PIVC:

·     Alcohol if <24 hours, alcohol + chlorhex if >24 hours

·     No evidence that cannulas should be routinely replaced

CVC:

·     Proceduralist: hat, facemask, sterile gown and gloves

·     Patient: alcohol + chlorhex + sterile full body drape

Other:

·     Ports: alcohol + allow to dry

Regional

·     Ensure chlorhex cannot be injected into neural tissue

·     Neuraxial and regional catheter: as for CVC

·     Regional single shot: sterile gloves + no-touch technique

·     If ultrasound: sterile gel + sterile needle entry site

Drugs

·     Beware preservative-containing solutions

·     Beware the outside of an ampoule: it is dirty

·     Beware the rubber seal of a vial: it is not sterile

·     Only 20μm filter needles effectively exclude microbes

·     Ampoule splitting increases risk of infection and error

Machine

·     Machine: periodic decontamination

·     Tubing: new filter per patient, new tubing if respiratory virus

·     Breathing bag: non-critical

·     Sampling line: re-usable if connected to the circuit via a filter

Ultrasound

·     Diagnostic: non-critical, bare probe ok, needs cleaning

·     Interventional: semi-critical, needs probe cover, needs disinfection

·     Internal: semi-critical (N.B. probe, shaft, socket, handle, cable)

·     Bare probe + body fluid = needs sterilization

 

Sharps:

Disposal

·     Into sharps bin

·     Immediately after use

·     No re-sheathing or bending

Needle-stick injuries

·     Risk of HBV 30%, HCV 3%, HIV 0.3% if virus present

·     Wash with water and antiseptic

·     Report ASAP to infection control team

·     All staff should be vaccinated against HBV

 

 

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