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Flashcards in SPR L12 Infection Prevention and Control Deck (16):
1

    Infection Prevention and Control

Learning Outcomes for general perusal

Aim - Develop a knowledge base for safe practice that minimises transmission of infection

  • Outline the measures available for preventing the transmission of infection (hand hygiene, aseptic technique, use of PPE)
  • Recognise which patients require isolation and different forms of isolation
  • Describe the difference between cleaning, disinfection and sterilisation and when each is needed

Relevance of the topic = 

  • Healthcare associated infection is a major cause of preventable harm
  • Simple measures routinely applied are most effective
    • benefits include
      • surgery
      • cancer treatment
      • most modern healthcare 
      • hospitals

2

Measures available to prevent infection

Briefly outline these

Define the following

  1. Universal precautions
  2. Isolation
  3. Aseptic technique

Isolate the infected, routine hand hygiene, aseptic technique, PPE

  1. an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens (US department of labor)
  2. the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonised patient to susceptible persons

  3. a procedure used by medical staff to prevent the spread of infection. The goal is to reach asepsis, which means an environment that is free of harmful microorganisms. Each healthcare setting has its own set of practices for achieving asepsis.

3

Measures available to prevent infection - Isolate the infected, routine hand hygiene, aseptic technique, PPE

Hand hygiene

​Outline this method of infection prevention

  • History- Ignaz Semmelweis and the birth of infection control1
  • Confirmed by repeated studies- usually as part of multi-modal interventions
  • WHO five moments

4

Measures available to prevent infection - Isolate the infected, routine hand hygiene, aseptic technique, PPE

Aseptic technique

  1. What is this technique called?
  2. What is the main infection risk to the patient?
  3. What needs to be identified?
  4. What needs to be created?
  5. What is the safest way to protect a key part?

  1. Aseptic non-touch technique (ANTT)
  2. the health professional”
  3. ‘Key Parts’- the critical parts of equipment that if contaminated present a high risk of infection
  4. an ‘Aseptic field’- a controlled safe working space to help maintain asepsis of key parts
  5. not to touch it

5

Measures available to prevent infection - Isolate the infected, routine hand hygiene, aseptic technique, PPE

PPE- Personal Protective Equipment

Give examples of PPE

  • Gloves and aprons
  • Gowns
  • Masks
  • Surgical
  • fit-tested particulate filters
  • Whole body protective equipment
  • Built in respirators

6

Isolation

Isolation- confirmed or suspected

  1. What is the hierarchy of infectiousness matched with?
  2. Give examples of those who would need to be kept in isolation 

  1. with increasingly secure patient settings

2.

  • Ebola/ Viral haemorrhagic fevers
    • High level isolation unit
  • Open pulmonary TB (MDR)
  • Measles/ Chicken pox
    • ‘source isolation’- single room, with lobby, at negative pressure to the corridor
  • Infective diarrhoeal illness
    • Single room with en-suite toilet
  • Multi-Drug Resistant (MDR) organisms
    • Single room (with/ without ensuite)
    • May also be nursed in ‘open’ wards using universal precautions 

7

Isolation

Ventilated patient rooms: Airborne infections such as TB, Chicken Pox, Measles

  1. What is negative pressure?
    1. What type of isolation is this?
    2. What does it prevent transmission of?
  2. What is positive pressure?
    1. What type of isolation is this?
    2. What does it prevent transmission of?

  1. a pressure gradient which moves air away from the ward corridor towards the patient (ie the air pressure in the room is less than that of the corridor)
    1.  ‘Source’ isolation
    2. airborne infections FROM the patient
  2. a pressure gradient which moves air away from the patient towards the ward corridor
    1. ‘protective’ isolation
    2. infection TO the patient

8

Cleaning, disinfection and sterilisation - the different types of decontamination

Define the following:

  1. Decontamination
  2. Cleaning
  3. Disinfection
  4. Sterilisation
  5. Autoclave

  1. the process of cleansing an object or substance to remove contaminants such as micro-organisms or hazardous materials
  2. the physical removal of visible organic material or soil from objects, environmental surfaces or skin
  3. A process to reduce the number of viable microorganisms from an object, environment or skin (i.e. a relative process)
  4. A process to render a product free from viable microorganisms. Complete killing or removal, including bacterial spores (i.e. an absolute process)
  5. a high vacuum, high temperature, porous load steam steriliser

9

Cleaning, disinfection and sterilisation

Cleaning 

  1. What do the surfactant molecules allow?
  2. Give examples of solutions used and for what

  1. allow penetration and spreading of water, with hydrophobic tails and hydrophilic heads- allow fats to be bound then rinsed away
  2. soap and water for hands, general purpose detergent for the environment, detergent in sinks or ultrasonic baths for equipment and instruments

10

Cleaning, disinfection and sterilisation

Disinfection (chemical)

  1. ​What is used for disinfection of skin and equipment?
  2. What is used for disinfection of skin only?
  3. What are chlorine releasing agents (bleach) used for?
    1. Give an example of another halogen used

  1. Alcohol, >70% isopropyl alcohol by volume
  2. Chlorhexidine 2%  (a cell membrane active biocide)
  3. Environment and equipment
  4. Iodine is used with alcohol for skin decontamination

11

Cleaning, disinfection and sterilisation

Automated Washer-Disinfectors

  1. What is this the main method of disinfection for?
  2. When is it carried out?
  3. Describe the process

  1. for thermally or pressure sensitive equipment (e.g. endoscopes)
  2. Before sterilisation for surgical instruments
  3. Controlled engineered and monitored process. Cleaning with detergent (washing) followed by Thermal Disinfection (e.g >900C for a minute)

12

Cleaning, disinfection and sterilisation

Sterilisation

Give some example methods

  • Heat
    • moist heat at pressure- autoclave
  • Gamma radiation
    • industrially packaged often single use items
  • Chemicals
    • Too specialist/ dangerous for routine hospital use

13

Cleaning, Disinfection and Sterilisation

The Autoclave - principles

​Outline the main principles with using the autoclave

If medical equipment is to be re-used it should ideally be autoclaved

  • Clean and disinfect first, then pack, then sterilise
  • Heat sterilisation is simpler, safer and less expensive than other methods of sterilisation
  • Moist heat is more penetrating into porous loads than dry heat
  • Increased pressure increasing temperature which reduces process time

14

Cleaning, Disinfection and Sterilisation

The Autoclave - Typical Autoclave 

  1. What is the vaccum like?
  2. What temperature is it?
  3. How long for?
  4. What does the total process time?

 

  1. 2.2bar
  2. 1340C
  3. 3 minutes at these conditions sufficient to sterilise
  4. 20-25 mins

15

Summary of decontamination

 

  • Clean or disinfect skin- yours and patients
  • Clean then disinfect the environment
  • Clean, then disinfect then sterilise equipment
  • Use single use equipment
  • Reusable equipment/ instruments must be sterilised-autoclaved
  • If equipment cannot be autoclaved then use an automated washer disinfector

16

Benefits of Infection prevention including cleaning, disinfection and sterilisation

 

Outline the benefits

  • Most healthcare innovations since the mid-19th century
  • Operative surgery
  • Low mortality childbirth
  • Immunosuppressive therapies
    • cancer treatment
  • Hospitals
    • allowing specialists and their skills to concentrate
  • Public health