Ip presentation final 23.01.08
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1
IP INFECTIONPREVENTION
Importance & purpose of IP practices
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IP Principles have Two main aims
• To reduce the rate of infection and disease transmission to patients
• To protect health care providers
Universal Precautions are minimum level of infection prevention required to prevent the transmission of infection within all health care settings
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IP Universal Precautions applications
• While handling blood, including dried blood• All other bodily fluids, secretion and excretions,• Non – intact skin: and • Mucous membranes
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IP Universal Precautions Includes
Good hygiene practices Safe handling of sharps Cleaning treatment Cleanliness of care areas Disposing of medical waste
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IP Viral Transmission Risk Risk of acquiring HIV after being stuck with a needle from an HIV+ client
4 : 1000 or 0.4 % Risk of acquiring HBV after being stuck with a needle from an HBV+ client
27 - 37: 100 or 30 %
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IP Accidental Exposure of HBV Infected Blood
As little as 10-8 ml (0.00000001 ml) of HBV-infected blood can transmit HBV to a susceptible host.
Source: Bond et al 1982
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IP Infection PreventionObjectives
To prevent major postoperative / post procedure infections
To minimize the risk of transmitting infections such as Hepatitis ‘B’, ‘C’ and HIV not only to clients, but also to service providers and staff
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IP Importance of Infection Prevention Practices
• Prevents post procedure infections• Result in high quality and safe services• Prevents infections in service providers• Protect the community• Prevent antibiotic resistant• Lower the cost of health care services
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IP Standard Precautions
• Wash your hands• Wear gloves and other protective attires• Correctly process instruments• Maintain correct environmental cleanliness • Appropriate waste disposal practices• Prevent injuries with sharps
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IP
Hand washing
Protective Barriers
Handling Needles and Sharps
Waste Disposal
Processing Instruments
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IP Infection PreventionPrinciples
Consider every person (clients and staff) infectious
Wash hands - the most practical procedure for preventing cross- contamination (person to person)
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IPInfection PreventionPrinciples (cont'd)
Wear gloves before touching anything: wet/broken skin, mucous membranes, blood or other body fluids (secretions / excretions) or solid instruments and other items. Use physical barriers (protective goggles, face masks and aprons) if splashes and spills of any body fluids (secretions / excretions) are anticipated.
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IP
Infection PreventionPrinciples (cont'd)
Use safe work practices, such as not recapping or bending needles and safely passing sharps instruments.
Isolate patients only if secretions (airborne) and excretions (urine or
feces) cannot be contained.
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IPInfection PreventionPrinciples (cont'd)
Process instruments and other items (decontaminate, clean, high-level disinfect or sterilize) using recommended infection prevention (IP) practices
..........and finally:
Properly disposing medical waste.
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IPHandwashing Practices
Handwashing is the most important way to reduce the spread of infections. But it is often underemphasized, and not performed correctly.
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Hand-Washing
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IP Handwashing Rules
Wash hands after removing gloves.
Wash hands after exposure to blood orany body fluid (secretions and excretions)even if gloves were worn.
Wash hands before and after examining any client ( direct contact )
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IPTypes of Handwashing
Routine Handwashing Surgical Hand scrub Alcohol Hand rub
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IP Routine Handwashing Practices
Use plain or antiseptic soap.
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Vigorously rub lathered hands together for 15 - 30 seconds.
2
Rinse with clean running water from a tap or bucket.
3
Dry hands with a clean towel or air dry them
4
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IPProcess of Surgical Hand
scrub Remove all jewelry Wet hands and forearms
thoroughly Clean under fingernail Apply antiseptic. Circular Motion.
Continue for 3-5 minutes. Rinse each arm separately. Use sterile towel to dry
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•Antiseptic or soap (plain)- If an antiseptic is not available, use plain soap
followed by applying an alcohol solution and rub
until dry two times.
•Running water
•Stick or brush for cleaning the fingernails
•Soft brush or sponge for cleaning the skin
•Sterile Towels (sterile towels to be provided for the operating room)
Surgical Hand scrub SuppliesIP
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Process of Alcohol Hand rub
2 ml glycerin or propylene glycol in100 ml of 60-90%alcohol
Use 3 - 5 ml for eachapplication and continue rubbing thesolution over the hands for about 2 minutes,using a total of 6 - 10 ml per scrub
Formula
IP
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Protective Barriers:Gloves
Wear gloves:
- when performing a procedure in the clinic or operating room
- when handling soiled gloves, instruments,and other items
- when disposing of contaminated waste items (cotton gauze, dressings)
IP
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IP Types of gloves and their Uses
Surgical gloves Should be worn during all procedures in which
there will be contact with blood stream or tissues under the skin
Single use examination gloves:- To reduce the risk of exposing the service
providers to blood or body fluids Utility gloves:- Should be worn for handling contaminated
instruments, linens and medical waste.
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Protective Barriers:Goggles, Face Masks, Aprons
Wear protective goggles, face masks, and aprons if splashes and spills of any body fluids are likely.
IP
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IP
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What parts of the field are sterile?
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IP Processing of Instruments and other Items
•Decontamination •Cleaning •Sterilization or High-level disinfection
•Storage
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IP Decontamination
• Definition It is the first step in processing
instruments and kills viruses and many other microorganisms making instruments and other items safer to handle by staff who clean them.
• Bleach ( Sodium Hypo chlorite)• It is inexpensive, •kills HIV, hepatitis B & hepatitis C
quickly•Can be used to decontaminate large
surfaces
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IP Processing Soiled Instruments and Other Items
DecontaminationPlace instruments and reusable
glovesin 0.5% chlorine solution after use
Soak for 10 minutes and rinse immediately
Wipe surfaces (exam tables) with chlorine solution
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Instructions for PreparingDilute Chlorine Solutions
% Concentrate
% Dilute
Total Parts (TP) (H2O)
= ( ) - 1
To make a 0.5% chlorine solutionfrom 5% bleach mix:
1 part bleach to parts water
IP
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IP
Instructions for PreparingChlorine Solution from Powder
% Dilute desired
% Concentration of chlorine in bleach powder
Gram / Liter
= () x 1000
To make a 0.5% chlorine solution from a 35% chlorine powder mix:
15 Tea spc (14.2 grams) of powder to 1 liter of water
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IPProcessing Soiled Instruments & Other Items
Cleaning
Wash with detergent and water
Scrub instruments until visibly clean
Thoroughly rinse with clean water
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IPHigh Level
Disinfection
Disinfection:
Process that eliminates all microorganisms but does not reliably kill all bacterial endospores which cause diseases such as tetanus and gas gangrene.
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IP Methods of HLD
Boiling:•Boil instruments and other items for
20 minutes
•(sufficient up to 18,000 ft / 5,500 mtr altitude)
Soaking in Chemicals:• Steam instruments, gloves, and other items
for 20 minutes
Steaming:•An alternative to this is HLD by use of chemical disinfectant. Soak for 20 minutes.
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IPBoiling Tips
Always boil for 20 minutesin a pot with a lid.
Start timing when the water begins to boil.Do not add anything to
the potafter timing begins.
Air dry before use or storage.
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IP Steaming Tips
Always steam for 20 minutes.
Be sure there is enough water in thebottom pan for the entire steam cycle.Bring water to a rolling
boil.
Start timing when steam begins to come out between pans.
Do not add anything to the pan after timing starts.
Air dry and store in the covered steamer pans.
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IP Chemical High-level Disinfection Tips
-
Cover all items completely with high - level disinfectant.
- Soak for 20 minutes
- Rinse with boiled water
- Air dry before use and storage
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IPBoil (if small) ......... or
Fill a clean container with 0.5% chlorine solution- Soak for 20 minutes- Pour out solution. (The chlorine solution can then be transferred to a plastic container and reused.)- Rinse thoroughly with boiled water
Air dry and use for storage of HLD items.
Preparing a High-Level Disinfected Container
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IP
Definition: Process that eliminates all
microorganisms including bacterial endospores.
Sterilization
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IP Methods of Sterilization
Chemical
Steam (autoclave) or
Dry heat (oven)
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Standard Conditions for Heat Sterilisation
121°C (250 ° F) at 106 kPa (15 lbs/square inch) pressure
- 20 minutes for unwrapped items
- 30 minutes for wrapped items
Allow all items to dry before removal to dry sterile container
IPSteam Sterilization
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160° C. (320° F.) for 2 hours
Standard Conditions for HeatSterilization
170° C. (340° F.) for 1 hour ..... or
IP
Dry HeatBy Electrical
Oven
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Chemical Sterilization
Soak items in Glutaraldehyde for 10 hours
Rinse in sterile water
Store in a sterile container
IP
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Sterilization of Various Instruments
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Sterilization of various instrumentsI
PInstrument/Item
Sterilization Time/pressure
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Sterilization of Various InstrumentsIP
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Processing MVA EquipmentIP
Syringes should be soaked in 0.5% Chlorine for 20 minutes, then rinsed and driedSyringes should be reassembled when dry, lubricated, and stored in a clean, dry containerDo NOT boil syringes.
Step 3: Processing syringes
Step 4: S torage
Place cannulae in separate sterile (or HLD) container using steri le pickupsUse s terile forceps to remove items from containerAvoid contaminating other cannulae in container.
Do NOT autoclave either syringes or cannulae!
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IP Effectiveness of Methods for Processing Instruments
Method Effectiveness(removal/inactivation ofmicrobes)
End point
Decontamination Kills HBV and HIV
10 minute soak
Cleaning (water only)
Up to 50% Until visiblyclean
Cleaning(detergentand rinsing withwater)
Up to 80% Until visiblyclean
Sterilization 100 % High pressure steam (autoclave),dry heat, chemical
High-level Disinfection **Prior decontaminationand thorough cleaningrequired.
95% (does not inactivatesome endopores)
Boiling, steamingOr chemical
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Waste Disposal
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IP
Types of waste
General Waste Medical Waste Hazardous Chemical
Waste
Waste Disposal
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IP
Four Aspects of Medical Waste Management
Sorting Handling Interim Storage Disposal: Incinerator is always
the best method of disposal medical waste.
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IP
Collect sharp items in puncture proof containers
Transport securely to disposal place
Burn in high temperature
incinerator or
Decontaminate and bury in safe place
Disposal of Sharps
54
Waste Disposal
Practices Place contaminated items in leak-proof
container or plastic bag. Dispose by incineration or burial.
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IPAntiseptics and
Disinfectants
Antiseptics: A chemical agent used on the
skin and mucous membranes to remove or kill microorganisms without causing damage or irritation to the skin and mucous membranes .
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IP Disinfectant
Definition:A chemical agent used to kill microorganisms on inanimate objects, such as instruments and surfaces. Disinfectants are not meant to be used on the skin or mucous membranes.
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IP
Surgical hand scrub Skin, cervical and
vaginal preparation Hand washing in
high risk situation:
Uses of antiseptics
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Skin Preparation Prior to Surgical ProcedureIP
Purpose:
To minimize the number of microorganisms on the skin or mucous membranes by:
- Washing with soap and water
- Applying antiseptics
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Skin Preparation Prior to Surgical ProcedureIP
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Skin Preparation Prior to Surgical ProcedureIP
Purpose:
To minimize the number of microorganisms on the skin or mucous membranes by:
- Washing with soap and water
- Applying antiseptics
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Skin Preparation Prior to Surgical ProcedureIP
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Skin and Mucous MembranePreparationIP
Do not shave hair ! Clip with scissors if necessary.
Ask the client about allergic reactions.
Wash first with soap and water ifvisibly soiled.
Apply antiseptic starting from the operation site and working outwardin a circular motion for several inches.
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Cervical and VaginalPreparations
IP
Apply antiseptic solution liberally to the cervix and vagina (2 times)
It is not necessary to prep the external genital area if it appears clean.
- If heavily soiled, it is better to have
the client wash her genital area
thoroughly with soap and water before starting the procedure.
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IP
Wash needle sticks and cuts with soap and water
Flush splashes to the nose, mouth or skin with water
Irrigate splashes to the eyes with water or saline
Management of sharp injuries
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IPAvoid dipping hands in a basin containing stand water
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IP
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Conclusion
IP can’t be a stand-alone practice; it needs to be integrated into all areas of the clinical reproductive health environment.
IP principles can be adapted to any environment.
IP is important; it’s cheap; you can do it!
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Hand Washing
Wet hands with running water Rub hands together with soap & lather
well, covering all surfaces, for 30 seconds
Weave fingers & thumbs together 7 slide them back & forth
Rinse hands under a stream of clean, running water until all soap is gone
Blot hands dry with a clean personal towel or air dry
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Usually left out parts during Hand Washing
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Hand Washing
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Hand Washing
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Steps of Surgical Hand washing
1.Remove all jewelry, watch etc. on hands forearms & wrist
2.Wet hands & forearms thoroughly3.Clean all finger nails with soft nailbrush4.Apply antiseptic soap/solution5.Using a circular motion, continuing
from finger tips to elbow, create lather & wash between fingers
6.Repeat for the second hand & arm
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Steps of Surgical Hand washingcontd……
7. Continue washing for 3 – 5 minutes
8. Rinse each arm separately, fingertips first, holding your hands above the level of your elbow.
9. Use a sterile towel to dry hands or air dry
10. Keep hands above the level of waist and do not touch any thing.
74
Steps of Putting on Sterile Surgical Gloves
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Steps of Putting on Sterile Surgical Gloves
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Steps of Putting on Sterile Surgical Gloves
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Processing Instruments, gloves and other items Decontamination
Soak in 0.5% Chlorine solution 10 minutes THROUGHLY WASH & RINSE
Wear gloves & other protective barriersPreferred Acceptable Methods Methods
AUTOCLAVE15lbs/in ² pressure 121˚C,20 min. unwrapped 30 min wrapped
CHEMICALSoak in CIDEX for 8-10 hours. Rinse with sterile water
CHEMICALSoak in CIDEX for 20 min. Rinse with water boiled for 20 minutes
COOL & DRY (use immediately or Store)
BOILLid on 20 minutes
STERILIZATION
HIGH LEVEL DISINFECTION