PS28 2015: Infection control

 

List

·         Definitions

·         Equipment classification

·         Hand hygiene

·         Attire

·         Preventing surgical site infection

·         Smelly anaesthetic equipment

·         Invasive procedures

·         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

 

Equipment classification:

Critical

·      Penetrates skin or mucous membranes

-> cleaning then sterilization)

Semi-critical

·      Touches mucous membranes

-> cleaning then disinfection)

Non-critical

·      Touches skin

-> cleaning)

 

Hand hygiene: *the most important infection control measure*

Hand washing

·      When physically soiled

Antimicrobial gel/spray

·      When not physically soiled

o  Alcohol 60-95% for the kill
(not 100% because denaturing requires water)

o  Chlorhex 2-4% for preventing regrowth

 

Attire:

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

 

Preventing surgical site infection:

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

 

Smelly anaesthetic equipment:

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*

 

Invasive procedures:

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

 

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% assuming present

·      Wash with water and antiseptic

·      Report ASAP to infection control team

·      (All staff should be vaccinated against HBV)

 

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