Universal Precaution 2556

1 1 (Accidental Prevention) 3 3 3 4 2 (Use of Protective Barriers) 9 9 (gloves) 9 (gown) 11 (apron) 11 - (mask) 11 (goggles) 12 12 12 3 (Hygiene and Sanitation) 16 16 16 Universal Precautions 20 20 (disinfection) 21 (sterilization) 21 26 29 32 32 37 37 40

4 41 43 1. 43 2. 43 3. 44 4. 44 44 1. 44 2. 45 3. - 45 4. 45 5. 46 6. 46 7. (hemodialysis) 48 8. endoscope 52 9. 52 10. 52 11. 53 12. 53 13. 54 5 (Guideline for Isolation Precautions) 55 Standard Precautions 55 Transmission-Based Precautions 57 Airborne Precautions 57 Droplet Precautions 58 Contact Precautions 59 61 63 66

67 68 76 76 76 78 (incident report) 80 83 University Precaution 85

- 1 -

UNIVERSAL PRECAUTIONS

(blood and body fluids) blood-borne pathogens HIV (Human Immunodeficiency Viruses) window period (Centers for Disease Control and Prevention : CDC) Universal Precautions

Universal Precautions (blood and body fluids)

Universal Precautions 1.

2. 3.

Universal Precautions 4.

- 2 -

Universal Precautions 3 (sharp injuries) (skin contact) mucous membrane

1.

2. -

3. (hygiene and sanitation) aseptic technique

- 3 -

1 (Accidental Prevention)

Universal Precautions

1.

1.1 1.2 1.3

2. 3. 4. 5.

1.

2. 3. 4.

- 4 -

1. 2. 3. 4.

1.

1.1 (disposable) (single-handed method) ()

1.2 (re-use) (EMG) 2% cresol (lysol) 2% cresol 30

1.3 (needle holder) 1.2 1.1

- 5 -

1.4 2% cresol 30 (clamp)

1.5 ampoule 70% alcohol (hematocrit tube) 1) 2) 3) 2. 2.1 10% povidone iodine solution 2.2 2.3 2.4 3. 3.1 3.1.1 - 24 2 48 ( 2 )

- 6 -

3.1.2 anti HIV 72 anti HIV 1 3 6 ( + 12 ) 3.2

3.2.1 anti HIV 24-48 3.2.2 3.1 3.2.3 3.1 3 6 3.2.4 3.1 3.2.5 3.3 3.3.1 3.3.2 3.3.3 ()

24 3.3.4 anti HIV 72 3 6 (+ 12 ) ( 3.3 ) 3.4 anti HIV 3.4.1 HBsAg 30 hepatitis B immunoglobulin 1 7 hepatitis B

- 7 -

3.4.2 HBsAg immunoglobulin hepatitis B profile 3.5 6 3.5.1 3.5.2 3.5.3 HIV HIV anti HIV 3.5.4 HIV , HBV

- 8 -

1

HIV, HBV

HIV HBV

1. 6 1.1 follow up 1.2 lab 1.3 anti HIV 12

2.

1. HBsAg +ve 1.1

HBIG 1.2

2. HBsAg -ve

- 9 -

2 (Use of Protective Barriers)

1. (gloves) 2. (gown) 3. (apron) 4. - (mask) 5. (goggles) 6. 7.

4

1. very high cerebrospinal fluid (CSF) 2. high blood , semen , synovial fluid , amniotic fluid

pericardial fluid 3. moderate vaginal cervical secretion

4. very low

(gloves)

- 10 -

3 1. sterile gloves invasive procedure (disposable) (reusable) 2 1.1 1.2 2. non-sterile examination gloves

3. general-purpose utility gloves

1.

2. 3.

4. 70% alcohol

5. (contamination)

- 11 -

1. (disposable) () 2. (reuse)

.

. . 0.5 % sodium

hypochlorite 30

(gown)

(apron) 0.5% sodium hypochlorite 30

- (mask) - (airborne pathogens) -

- 12 -

(goggles)

1. 2.

3.

4. (face shield)

-

- 13 -

2.1

Sterile

1. - + - + + +/- + -

2. + - - +/- + + + -

3. + - - + + + + -

4. (cut down) + - - - + - +/- -

5. / remove foreign + - - - + + +/- -

body

6.

6.1 active bleeding + - - - + + + +/-

6.2 active bleeding + - - - + - +/- -

7. blood exchange + - - + + - + -

8. hemodialysis + - - + + - +/- -

9. peritoneal dialysis + - - + + - +/- -

10. paracentesis + - - +/- + - +/- -

11. urethral catheterization + - - - - - - -

12. + - - - + + - -

13. + - - + + + + +

14. + - - + + + + +/-

15. PR - + - - - - - -

16. PV + - - - - - - -

17. CPR - +/- - - +/- - - -

18. - + - - + + +/- +/-

- 14 -

2.1

Sterile

1. + - - - + +/- + -

2. scrub + - - - + + +/- -

3. scrub burn + - - + + + +/- -

4. +/- +/- - - + - - -

5.

+ - - - - - - -

6. self inflating

lung bag - + - - +/- - - -

7. - - - - - - - -

8. - - - - - - - -

9. / - + - - - - - -

10.

- + - + + + + -

11. - + - - - - - -

12. skin preparation - + - - - - - -

13. - + - - - + - -

/

14.

/ +* + - - - + - -

15. + - - + + + - -

16. - + - + + +/- - -

- 15 -

2.1

Sterile

1. - - + - - - - -

2.

- + + - + + - -

3. - - + - + + - +

: + - + / - * sterile techniqe sterile

- 16 -

3 (Hygiene and Sanitation)


1.

2.

1.

2. (invasivel procedures)

3.

4.

- 17 -

5. 6.

1.

2.

1. 2. (

) 3. ( 3-5 )

2 10-30

4. 5.

- 18 -

3.1

1. (normal hand washing)

10

2. (hygienic hand washing)

- - - -

7.5% povidone iodine scrub 4% chlorhexidine scrub

30

3. (surgical hand washing)

7.5% povidone iodine scrub 4% chlorhexidine scrub

3-5 ( / )

- 19 -

3.1 ()

4.

0.5% chlorhexidine + 70% alcohol 70% isopropyl alcohol ( 1% glycerol oil ) desmanol

20-30 ( ) - surgical scrub 2-3 5

- -

- -

- 20 -


1. 2. 3.

1. (cleaning)

2. (disinfection)

(disinfectant) (antiseptic)

3. (sterilization) sterile

1. (non critical items)

2. (semi critical items) (mucous membrane) bronchoscope () gastroscope () () tubercle bacilli

3. (critical items)

- 21 -

(disinfection) 2 1. (physical method)

1.1 (cleaning) 1.2 (boiling) 10 20 20

1.3 (pasteurization) 65 C 10 2. (chemical disinfection)

1. 2. 3.

(sterilization) 2 1. (physical method) 1.1 (heat) 1.1.1 (incineration) 400-600 C 1.1.2 (autoclaving) (moist heat) 2 121 C 15 30

- 22 -

3.2

1. 2 2. 2 2 3.

1 7

-

2 3 8

1.1.3 (hot air) (dry heat) hot air

160 C 1-3

3.3

(C) () (C) ()

140 3 170 1

150 2.5 180 0.5

160 2

1.2 (radiation) 1.2.1 (ultraviolet rays)

UV UV 1) 2) 3) 4)

- 23 -

1.2.2 (gamma rays) sulfonamide, barbiturates, heparin (recycle)

1.3 (filtration) 0.22-0.45 0.01-0.1

1.4 (microwave)

2. (chemical method) 2.1 (gaseous sterilization)

ethylene oxide gas cardiac catheter fibre-optic, scopes, polyvinyl chloride (PVC) 24 Low Temperature Steam and Formaldehyde (LTSF) formaldehyde 1:200 6-12 ( 2-4 ) ethylene oxide ethylene oxide

LTSF

- 24 -

1.

2. critical items

3. (steam sterilizer) ethylene oxide

4. sterilizer spore test steam sterilizer (autoclave) spore Bacillus stearothermophilus ethylene oxide gas sterilizer dry heat sterilizer spore Bacillus subtilis

5. (implant) spore test spore test incubate 48

6. spore test () sterilizer spore test sterilizer

7. sterilizer 8. 9.

lot/load number spore test steilizer

2.2 (chemical disinfection and sterilization)

- 25 -

3.4

high level intermediate level low level

- vegetative form - Mycobacterium spp. TB - spore

+ + +

+ + -

+ - -

+ + +

- lipid and medium size* - non-lipid and small size**

+ +

+ -

- -

+ - * lipid containing virus :- Herpes, Influenza, Mumps, Vaccinia, Newcastle disease virus, HBV, HIV ** non-lipid viruses :- Poliomyelitis, Coxsackie, ECHO, Adenovirus, Rhinovirus

1. 2.

3.

4.

5. 6. 7.

8.

- 26 -

3.5

.

1.

- 70% alcohol - 10% povidone iodine solution

-

2. hemoculture

- 10% povidone iodine solution -

3. - 2.5% Tr. iodine 70% alcohol - 10% povidone iodine solution

- 2.5% Tr. iodine 70% alcohol

4. - -

- 4% chlorhexidine scrub - 7.5% povidone iodine scrub - 4% chlorhexidine scrub 7.5% povidone iodine scrub 0.5% Tr. chlorhexidine 10% povidone iodine solution

- -

- 0.5 Tr. chlorhexidine 10% povidone iodine solution

5. - -

- 2.5% Tr.iodine - triple dye

- -

- 27 -

.

1.

- - 2

2.

- chlorhexidine 1.5% + cetrimide 15% (1: 100) - 1% chlorhexidine solution

-

3. - 7.5% povidone iodine scrub - (douche)

4. - 1% chlorhexidine obstetric cream - 1% chlorhexidine solution

- 2

/

5. perineum - - speculum

6. vaginal paint - 10% povidone iodine solution

-

7. - chlorhexidine 1.5% + cetrimide 15% (1: 100)

- perineum

- 28 -

.

1. (clean wound) -

-

2. (contaminated wound)

- - 10% povidone iodine solution 0.5% Tr. chlorhexidine 70% alcohol

-

3. (dirty wound) - - 10% povidone iodine solution 0.5% Tr. chlorhexidine 70% alcohol

- (wet dressing) 3 - 4

- 29 -

3.6

.

/ 1. -

- - 70% alcohol 0.5%

sodium hypochlorite solution

-

-

-

2. () * 1 2

- - 2 % cresol solution 0.5% sodium hypochlorite solution

-

3.

-

- ()

0.5% sodium hypochlorite solution 2% cresol solution

4. 3.

- - 0.5%

sodium hypochlorite solution 2% cresol solution

- - 20

30

-

- 30 -

.

/ 1. 2. 3. 4. - -

- - 2 % glutaraldehyde solution - - - 2% cresol solution 0.5% sodium hypochlorite solution

- - 30 * 1 - - - - 30

- 20 pasteurization -

- 31 -

.

/ 1.

2.

3.

4.

5. -

6. 1. 5.

-

- -

-

- - 0.5% sodium

hypochlorite solution 2% cresol solution

-

- 2 1 1

- - -

-

-

-

-

-

- ()

- 0.5% sodium hypochlorite solution 2% cresol solution 30

-

-

- 2

-

-

-

-

- 30

- 32 -

3.7

/ 1. -

-

- -

-

2. 1

- - 0.5% sodium hypochlorite solution 2% cresol solution

- - 20 30

3. (reusable)

-

- - 0.5% sodium hypochlorite solution -

- 30

4. () *

- - - 0.5% sodium hypochlorite solution

- - 30

5. - 4 - 4

3.8

/ 1. bronchoscope, gastroscope colonoscope , endoscope

- 2% glutaraldehyde solution - 2% glutaraldehyde solution

- - 30 4 - 60 - 3-10

2. cystoscope, peritoneoscope

- - - 2% glutaraldehyde solution

- - 3-10

- 33 -

/ 3. proctoscope , gmoidoscope

- 2% glutaraldehyde solution - -

- - 30

4. 4.1 ET tube , suction , tracheostomy tube

4.2 oxygen, mask, self inflating lung bag, airway

4.3 corrugated tube, humidifier, nebulizer

- - 2% cresol solution - 0.5% sodium hypochlorite soln - 2% glutaraldehyde solution -

- - 2% glutaraldehyde solutio - 0.5% sodium hypochlorite solution

- - 2% glutaraldehyde solution -

- 30

( tracheostomy tube

20 2 )

- - 30

- - 1

-

5. laryngoscope - - blade - fibre-optic

- 70% alcohol

-

70% alcohol ( fibreoptic glutaraldehyde )

- 34 -

/ 6. soft contact lenses, tonometer biprisms

- 3-6% hydrogen peroxide soln

- 2-3

7. catheter, rubber tube ( )

- - 2% glutaraldehyde solution - 2% glutaraldehyde solution - ()

- - 30 - 3-10

-

8. forceps , artery forceps , curettage , set


- - 3-10 * 20

9. transfer forceps

- - 2% glutaraldehyde solution

- 14

10. ,


- - 3-10

11. drain

- -

- -

12. suction

-

- -

- 35 -

/ 13.

- - -

-

- 30

14. - -

- - - 2% glutaraldehyde solution

- - 3-10

15. - -


- - 30

16. () *

- - - 70% alcohol - - 0.5 % sodium hypochlorite

- - alcohol - 30 ()

17.

- -

- cuff ()

- 36 -

cleaning - detergent

disinfection - 20 - 2% glutaraldehyde solution 1030 - 0.5% Tr. Chlorhexidine - 70% alcohol - 0.5% sodium hypochlorite solution 30 - 2% cresol solution 30

sterilization * heat - autoclave - hot air oven * gas - ethylene oxide - formaldehyde * 2% glutaraldehyde solution 3-10

- 37 -

1. (1) (2)

/ (3) 2. 2.1 2.2 0.5% sodium hypochlorite 2% cresol 30

2.3 0.5% sodium hypochlorite 30 3.

1. - 2.

1. (household waste)

2.

3. 4. 5.

- 38 -

5.1

5.2

5.3 5.4

5.5

1. 2. 3. 4. 3 4 2 5. 6.

1. 2. - 3. 4.

- 39 -

4.1 4.2

2% cresol 0.5% sodium hypochlorite 30 5. 2

3 1) 2)

3)

() 1.

()

cresol sodium hypochlorite cresol sodium hypochlorite 2% cresol 0.5% sodium hypochlorite 30 2. 3.

1. 0.5% sodium hypochlorite 30 2. 3.

- 40 -

6

() ( ) () () () ()

- EMG () - () - - syringe - urine bag ( disposable )

- - ()

- - ( )

- - - - ( ) *

- - - - - - - -

- - - - - ( )

3/4 3/4 2 06.00-09.00 .

2 4 12.30-14.00 .

( )

:-

- 41 -

4

Universal Precautions 1. 2. 3. 1. 1.1 1.1.1

1.1.2 (air-borne infection)

1.1.3

1.1.4 -

1.1.5 () 1.2 1.2.1 1.2.2 1.2.3

- 42 -

1.2.4 1.2.5 1.2.6 / / 1.2.7 1.3

1.3.1 1.3.2 1.3.3

1.3.4

-

1.3.5

1.3.6

2. 2.1 2.2

/

2.3

- 43 -

2.2 2.5

3. 3.1 3.2 ( 3 32) 3.3 3.4 3.5

1. 1.1 (disposable) 1.2 70% alcohol 10 % povidone iodine solution 1.3 vacuum

1.4

1.5

2. 2.1

2.2 2.3 HIV, HBV, HCV blood-borne transmission P (request)

- 44 -

3. 3.1 - 3.2

3.3 3.4

4. 1.1 1.2

( 3 29) 4.3 1. 1.1 1.1.1 1.1.2 1.1.3 1.2 1.2.1 1.2.2 2 1.3 1.3.1 (non-touch technique) 1.3.2 1.3.3

- 45 -

1.3.4 0.5% sodium hypochlorite 30 0.5% Virkon 10 1.3.5 - 0.5% sodium hypochlorite 30 1.3.6 minor surgery xylocaine xylocaine

2. -

3. - 3.1 - 3.2 endotracheal tube, air way, catheter, suction slip joint, suction catheter, three way, extension tube 3.3 3.3.1 laryngoscope 70% alcohol blade slip joint 2 % glutaraldehyde 10 3.3.2 corrugated tube 0.5 % sodium hypochlorite 30 3.4 (single dose)

4. 4.1 - face shield 4.2

- 46 -

4.2.1 0.5% sodium hypochlorite 10 24 4.2.2 4.2.3 tray 4.2.4 sterile tape 4.2.5 sterile autoclave 4.3 cassette sterile autoclave 4.4 4.5 70% alcohol

5. 5.1 70-80 C 10 5.2 . shiotz tonometer 70% alcohol . applanation tonometer 70% alcohol . gonio lens contact lens 70% alcohol

6. 6.1 6.2 6.3 6.4 syringe

- 47 -

4.1

Sterile

-

1. investigation radiology 1.1 barium enema 1.2 fistulography 1.3 IVP 1.4 cystography 1.5 hystero salphingo- graphy 1.6 lymphangio- graphy 1.7 endoscopic retrograde cholangio- pancreato- graphy 1.8 bronchography 1.9 dacryocysto- graphy 1.10 t-tube cholangiography

- + - + +

+

+

+ +

+

+ - + - - - -

- - -

- - - - - - -

- - -

-

+/- - - - - -

- - -

+/- +/- +/- + +

+

+

+ +

+

+/- -

+/- + +

+

+

+ +

+

- - - - - - -

- - -

- - - - - - -

- - -

- 48 -

4.2 ()

Sterile

2. interventional radiology 2.1 angiography 2.2 embolization 2.3 percutaneous transhepatic biliary drainage 2.4 percutaneous nephrostomy

+ + +

+

- - - -

- - - -

+ + +

+

+ + +

+

+ + +

+

- + - -

- - - -

: + - +/-

7. (hemodialysis) 1. 1.1 hemodialysis machine

- 0.5% sodium hypochlorite

- 37% formaldehyde solution 0.5% sodium hypochlorite 0.06% peracetic acid + 0.8% H2 O2 90 C (heat program) 1.2 dialyzer blood line - dialyzer dialyzer 4% formaldehyde peracetic acid - dialyzer 0.5% sodium hypochlorite

- blood line dialyzer - HBsAg anti HCV positive

- 49 -

- dialyzer blood line 1.3 A-V fistula needle 1.4 set A-V fistula double lumen set sterile ( 1 set 1 ) 1.5 dialysate 0.5% sodium hypochlorite 1.6 (reverse osmosis) - (culture) - 40% formaldehyde 1 2. 2.1 2.2 Hepatitis B virus 2.3 2.4 mask 2.5 start off hemodialysis aseptic technique 2.6 off A-V fistula needle 2.7 A-V fistula 2.8 2.9 dialyzer blood line

2.10 0.5% sodium hypochlorite 2.11 dialyzer blood line mask 2.12

- 50 -

3. 3.1 chronic hemodialysis HBsAg, anti HBs, anti HCV, anti HIV 6 3.2 3.3 A-V fistula 4% chlorhexidine scrub 70% alcohol sterile 10% povidone iodine solution sterile mask 3.4 double lumen catheter exit site povidone iodine ointment exit site 3.5 double lumen catheter aseptic technique catheter sterile 70% alcohol 10% povidone iodine solution sterile mask double lumen catheter 70% alcohol sterile 3.6 hemodialysis 4. 4.1 4.2 2 4.3 0.5% sodium hypochlorite 30 4.4

- 51 -

CAPD (Continuous Ambulatory Peritoneal Dialysis) 1. 1.1 transfer set 1.2 70% alcohol 1.3 2. 2.1 2.2 dialysate 2.3 sterile mask mask 2.4 aseptic technique sterile 2.5 mask 2.6 dialysate sanitary drain (P.D.bag) ( ) 3. 3.1 aseptic technique 3.2 3.3 exit site discharge 3.4 contamination transfer set 4. 4.1 4.2 2 4.3 dialysate 0.5% sodium hypochlorite 30 4.4

- 52 -

8. endoscope 8.1 - 8.2 endoscopy detergent 8.3 endoscopy 2% glutaraldehyde 30

9. 1. 2 - safety cabinet 3. 4. mouth pipette mechanical pipette 5. 70% alcohol 6. 7. 8. 0.5% sodium hypochlorite 30 9. 0.5% sodium hypochlorite 2% cresol 10. 11.

10. 10.1 2 - 10.2 10.3

- 53 -

10.4 0.5% sodium hypochlorite 2% cresol 10.5 10% formalin

11. 11.1 11.2 0.5 % sodium hypochlorite 2% cresol 30 11.3 0.5% sodium hypochlorite 30 11.4 0.5% sodium hypochlorite

12. 12.1 - 12.2 () (10% formalin) 12.3 12.4 10% formalin - 0.5% sodium hypochlorite 2% cresol 30 ( 10% formalin 10% formalin ) 12.5 12.6

- 54 -

13. 13.1 13.2 - 13.3

- 55 -

5

(Guidelines for Isolation Precautions)

(Isolation Precautions)

1. 2.

3.

(Airborne) (Droplet) (Contact)

4.

Isolation Precautions 2 I. Standard Precautions II. Transmission-Based Precautions

I. Standard Precautions standardprecautions (mucous membrane)

1)

- 56 -

2) -

3)

- - -

(one-handed scoop technique)

syringe - holder clamp

syringe

4)

5)

6)

2% cresol 0.5% sodium hypochlorite 30

- 57 -

II. Transmission-Based Precautions Transmission Based Precautions Standard Precautions

Transmission-Based Precautions 3 1. Airborne Precautions 2. Droplet Precautions 3. Contact Precautions

1. Airborne Precautions 5 (droplet nuclei) (TB) (Measles) (Chicken pox)

1)

negative pressure 6-12

2)

- (particulate respirator)

3)

- 58 -

4)

-

5)

- - 2% cresol 0.5% sodium hypochlorite

6) Standard Precautions

2. Droplet Precautions 5 3 (Rubella) (Mumps) (Pneumonia) (Pertussis)

1)

3 2)

- 3

3)

4) -

- 59 -

5)

- - 2% cresol 0.5% sodium hypochlorite

- 3


3. Contact Precautions enteric infections, skin or wound infections , abscess, viral hemorrhagic infections , Herpes simplex / zoster

1)

2)

wound drainage

3)

- 60 -

4)

enteric infection 2% cresol 0.5% sodium hypochlorite 30

2% cresol 0.5% sodium hypochlorite 30

5)

6)


- 61 -

(Isolation Precautions)

I. Standard Precautions

Standard Precautions

II. Transmission-Based Precautions

1. Airborne Precautions Standard Precautions Airborne Precautions

5 (airborne droplet nuclei)

- Measles - Varicella (including disseminated zoster) * - Tuberculosis

2. Droplet Precautions Standard Precautions Droplet Precautions

5 (large particle droplets) 3

2.1 Invasive Haemophilus influenzae type b disease meningitis, pneumonia sepsis 2.2 Invasive Neisseria meningitidis disease meningitis , pneumonia sepsis 2.3

- Diphtheria (pharyngeal) - Mycoplasma pneumonia - Pertussis - Pneumonic plague - Streptococcal pharyngitis , pneumonia scarlet fever

2.4 droplets transmission - Adenovirus infection ** - Influenza - Mumps

- 62 -

- Parvovirus B 19 - Rubella

3. Contact Precautions Standard Precautions Contact Precautions

3.1 (gastrointestinal) (respiratory) (skin) (wound) (multidrug resistant bacteria)

3.2 Clostridium difficile 3.3 enterohemorrhagic

Escherichia coli , shigella , hepatitis A, 3.4 Respiratory syncytial virus, parainfluenza virus, enteroviral infections 3.5 - Diphtheria (cutaneous)

- Herpes simplex infections (neonatal mucocutaneous) - Impetigo - Major (noncontained) abscesses, cellulitis, decubiti - Pediculosis - Scabies - Staphlococcal furunculosis (infants) (young children) - Herpes zoster infections (disseminated immunocompromised host) *

3.6 Viral hemorrhagic conjunctivitis 3.7 Viral hemorrhagic infections (Ebola , Lassa , Marburg)

:- * :- Standard & Airborne & Contact Precautions ** :- Standard & Droplet & Contact Precautions

- 63 -

5.1 5.1

-

AIDS - - +/- +/- - Bronchiolitis + - +/- - - Bronchitis - +/- - - - Brucellosis - draining lesion - - +/- +/- - - other - - - - - - Burns

- major (> 20%) + + + + - - minor - - +/- +/- Chickenpox + + + + Chlamydia trachomatis infection - - - +/- - Cholera + - +/- +/- Conjunctivitis - - - +/- - Coxsackie virus disease + - +/- +/- 7 - Diarrhoea +/- - +/- +/- - Encephalitis + - +/- +/- 7 - Enterocolitis +/- - +/- +/- - Food poisoning - Salmonella + - +/- +/- - - other - - - - - - Hepatitis +/- - +/- +/- -

- 64 -

5.1 ()

-

Herpes simplex

- Encephalitis - - - - - - - Disseminated + - +/- +/- - - Mucocutaneous - - - +/- - - Neonatal + - +/- +/- - Herpes zoster - Disseminated + + + + - Influenza + + - - - Measles + + - - 5 Meningitis - Viral +/- - +/- +/- 7 - - Haemophilus influenzae + + - - 24 - - Meningococcal + + - - 24 - ( Meningococcemia) - other - - - - - - Multiple resistant bacteria

- Gastrointestinal + - +/- +/- - - Respiratory + +/- +/- +/- - - Skin + - +/- +/- - - Urinary + - - +/- - Mumps + +/- - - 9

Pertussis + +/- - - 7 - Plague - Bubonic - - +/- +/- 3 - - Pneumonia + + +/- +/- 3 - Rabies + +/- +/- +/- - Rubella + +/- - - 7 -

- 65 -

5.1 ()

-

Salmonellosis +/- - +/- +/- - Scabies +/- - +/- +/- 24 - Shigellosis +/- - +/- +/- - Staphylococcal diseases - Skin +/- - +/- +/- - - Enterocolitis +/- - +/- +/- - - Pneumonia + +/- +/- +/- 48 - - Scalded skin syndrome + - +/- +/- 48 - - Toxic shock syndrome - - +/- + - - MRSA + - + + - Streptococcal diseases - Skin +/- - +/- +/- 24 - - Endometritis +/- - +/- +/- 24 - - Pharyngitis +/- - - - 24 - - Pneumonia +/- +/- +/- +/- 24 - - Scaret fever +/- - - - 24 - Tuberculosis

- Pulmonary + +/- +/- - 2 - - Extrapulmonary - - +/- +/- -

:- + - +/-

- 66 -

- - - -

-

- (incident report)

- 67 -

----------------------------

1. aldehydes :- glutaraldehyde 2%, formalin 4%, 10%, 40%

2. chlorine chlorine compound :- sodium hypochlorite 0.5-1% (chlorine )virkon 0.5-1% (chlorine ), mediklene powder (chlorine ), sodium dichloroisocyanurate (NaDCC) (chlorine - pureen, steri-tab)

3. alcohols :- ethyl alcohol 70%

4. iodine :- povidone iodine 10% solution, povidone iodine 7.5% Scrub

5. phenol :- cresol 2% solution

6. diguanides :- 0.5%, 1% chlorhexidine solution 0.5%, 1% chlorhexidine tincture, 4% chlorhexidine scrub, 1% chlorhexidine obstetric cream

7. chlorhexidine + cetrimide :- 1:30 , 1:100 chlorhexidine + cetrimide solution, 1:30 chlorhexidine + cetrimide in 70% alcohol

8. oxidizing agents :- 3% hydrogen peroxide

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6.1

alcohol 70% (ethyl alcohol) intermediate level formalin (formaldehyde) high level glutaraldehyde intermediate to high level cidex , pose dex , glutacep,

glutarex , neodex , pentadex

chlorine and chlorine compound intermediate to high level posechlorite, chlorex-HC, virkon, steri-tab, pureen, mediklene

povidone iodine intermediate level betadine, septidine, cavodine

cresol intermediate level lysol chlorhexidine low level hibitane, hibiscrub , hexene,

biosep chlorhexidine + alcohol low to intermediate level hydrogen peroxide low to high level chlorhexidine + cetrimide low level savlon , hibicet

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glutaraldehyde solution

intermediate to high level

2% glutaraldehyde solution (sterilization) 3-10 (disinfection) 30 TB 1

1. activator (buffer) 2% glutaraldehyde 28

2. sterilization disinfection

3.

1. 2.

endoscope, thermometer, endotracheal tube, airway

3.

4.

formaldehyde solution : formalin

intermediate to high level - 4% formalin hemodialysis 24

- 10% formalin - 40% formalin

- 70 -

1. formaldehyde

2. 3. 4.

sodium hypochlorite solution

- intermediate level (5,000 ppm)

- high level (10,000 ppm available chlorine)

- 5,000-10,000 ppm available chlorine HIV, HBV 30 - 100-1,000 ppm available chlorine 30

- - 24 - 3 ( solid form )

1. 2. 3. 4. 5,000-10,000 ppm available chlorine

- sodium hypochlorite 5% 100 ml. 900 ml. sodium hypochlorite 0.5% 1,000 ml. (1 ) available chlorine 5,000 ppm - sodium hypochlorite 5% 200 ml. 800 ml. sodium hypochlorite 1% 1,000 ml. (1 ) availble chlorine 10,000 ppm

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virkon

intermediate level to high level hypochlorite - 0.5% (1:200) virkon available chlorine 5,000 ppm 10-30

- 1% (1:100) virkon available chlorine 10,000 ppm 10-30

1. chlorine 2. 3.

4. 30 5. 6. 7

7. detergent

- virkon 50 (1) 10 0.5%

- virkon 50 (1) 5 1%

sodium dichloroisocyanurate (NaDCC) : chlorine steri-tab

intermediate to high level chlorine

Steri-tab NaDCC 3 / - 3 tab : 1 available chlorine 0.5% (5,760 ppm) 30 - 6 tab : 1 available chlorine 1% (11,520 ppm) 30

1. 2. 3. 4.

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3 1.

2. stainless steel 3.

pureen

intermediate level chlorine pureen 1 NaDCC 500 mg.

- 1 tab : 1 available chlorine 140 ppm 30 - 2 tab : 1 available chlorine 280 ppm 30 syringe feeding

pureen 30 ()

24

mediklene powder

intermediate level

(detergent + disinfectant) 30 (6 ) 5 available chlorine 600 ppm 10

10

chlorine

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stainless PVC nylon

ethyl alcohol 70%

intermediate level

70% TB 30 ( disinfection) (antiseptic)

1. 2.

3.

4. 5.

1. 2. 7 3.

povidone iodine

intermediate level - 7.5% povidone iodine scrub

- 10% povidone iodine solution

1.

2. 3. 4.

- 74 -

lysol (50% cresol)

intermediate level phenolic polio, HBV TB HIV

2% cresol solution 30 1.

2. 3.

1. 2. 3. 4. hyperbilirubinemia

chlorhexidine

Low level TB

- 1% chlorhexidine solution (in water) catheter 30

- 0.5% chlorhexidine tincture (in 70% alcohol) 2 - 4% chlorhexidine scrub - 1% chlorhexidine obstetric cream

- solution 7 - tincture 1

1. 2. 3. sodium nitrite 4

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chlorhexidine + cetrimide

low level - 1:100 in water

30 - 1:30 in water - 1:30 in alcohol 70% 2

- solution 7 - tincture 1

1. 2. 3. sodium nitrite 4

hydrogen peroxide

oxidizing agent Mycobacteria

3-6 % solution 1.

2.

- 76 -

1. 2. 3. 4.

1. 2. ( ) ion low level chlorhexidine + cetrimide 3. (aseptic technique) 4. 5.

1. 2. 3. 4. 5. 6. Pseudomonas spp. 7. 8. 9.

- 77 -

10. 11.

- 78 -

6.2

- autoclave

-

-

-

-

-

-

-

- -

- hot air oven

-

-

-

- ethylene oxide - formaldehyde

-

vascular transplants,

valve prosthesis

-

-

- -

- 79 -

6.2 ()

- hydrogen peroxide plasma

-

-

-

- -

-

-

- high level disinfectant glutaraldehyde

- endoscope

-

-

-

- 6-10 .

-

- 80 -

(INCIDENT REPORT)

----------------------------------- 1. (//) 2. / / 3. . 4. ( () / () /

/ / ( ) / ( ) ( , , ) / / /

- 81 -

() 5. () () () () () () ( ) () 6. () () () 7. () () 8. (Infectious Diseases) (Clinical Immunology) :- () ()

- 82 -

9. () AZT (Zidovudine) ( ) () () () ( ) () ( ) () ( ) () ( )

- 83 -

- . :

. 2541. - . :

, . . : , 2538

- . : ,. , 2540.

- . : () - : , 2533.

- (). . - : , 2539.

- (). . - 2 : , 2539.

- . . , . . : ... , 2541.

- . . : ... , 2541. - . . : ... ,

2541. - . .: () .

2 : , 2541 : 55-76. - CDC . Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;

36 (SUO2) : 001 - CDC . Perspectives in disease prevention and health promotion update : Universal precautions for

prevention of transmission of Human Immunodeficiency Virus , Hepatitis B Virus , and other bloodborne pathogens in health-care settings. MMWR 1988 ; 37 (24) : 377-388.

- CDC. Recommendations for prevention of transmission of Human Immunodeficicncy Virus and Hepatitis B Virus to patients during exposure-prone invasive procedures.MMWR 1991; 40(RR08) : 1-9.

- CDC. Guidelines for prevention of transmission of Human Immunodeficiency Virus and Hepatitis B Virus to health-care and public-safety workers. MMWR 1989 : 38 (NO. S-6).

- 84 -

- CDC. Universal precautions for prevention of transmission of HIV and other bloodborne infections.Hospital infections program. Updated 06/05/1999.

- CDC. Prevention Guidelines. Part II : RECOMMENDATIONS FOR ISOLATION PRECAUTIONS IN HOSPITALS Hospital Infection Control Practices Advisory Committee. January, 1996.

- Gina Pugliese. Universal precautions : policies , procedures , and resources. American hospital publishing Inc., an American hospital association company, 1991.

- Sandra Berenger. Infection control practice for limited resource countries . Hunter area health service . Hunter region mail centre NSW 2310. Australia. (Copy)

- Schaffer SD, Garzon LS, Heroux DL, Komiewicz DM. Isolation Precautions. In : Pocket Guide to Infection Prevention and Safe Practuce. St.Louis : Mosby , 1996 : 81-115

- 85 -

Universal Precaution

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

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Universal Precaution 2556

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