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MEDICALASEPSIS,HANDHYGIENE,
ANDPATIENTCAREPRACTICES
INHOMECAREANDHOSPICE
ModuleF OBJECTIVES
- Describetheprinciplesandpracticeofasepsis
- Understandhandhygiene
- Understandtheroleoftheenvironmentindisease
transmission
DEFININGASEPSIS
MedicalAsepsis SurgicalAsepsis Definition CleanTechnique SterileTechnique Emphasis Freedom frommost pathogenicorganisms
Freedom fromallpathogenic organisms
Purpose Reducetransmission of pathogenicorganismsfrom onepatienttoanother
Prevent introductionofany organismintoanopen woundorsterilebodycavity
MEDICALASEPSIS
Measuresaimedatcontrollingthenumberof microorganismsand/orpreventingorreducingthe transmissionofmicrobesfromonepersontoanother: CleanTechnique
- Knowwhatisdirty
- Knowwhatisclean
- Knowwhatissterile
- Keepthefirstthreeconditionsseparate
- Remedycontaminationimmediately
PRINCIPLESOFMEDICALASEPSIS
Whenthebodyispenetrated,naturalbarrierssuchasskin andmucousmembranesarebypassed,makingthepatient susceptibletomicrobesthatmightenter.
- Performhandhygieneandputongloves
- Wheninvadingsterileareasofthebody,maintainthe sterilityofthebodysystem
- Whenplacinganitemintoasterileareaofthebody,make suretheitemissterile
PRINCIPLESOFMEDICALASEPSIS
Eventhoughskinisaneffectivebarrieragainstmicrobial invasion,apatientcanbecomecolonizedwithother microbesifprecautionsarenottaken.
- Performhandhygienebetweenpatientcontacts
- Whenhandlingitemsthatonlytouchpatient’sintactskin, ordonotordinarilytouchthepatient,makesureitemis cleananddisinfected(betweenpatients).
PRINCIPLESOFMEDICALASEPSIS
Allbodyfluidsfromanypatientshouldbeconsidered contaminated
- Bodyfluidscanbethesourceofinfectionforthepatient andyou
- Utilizeappropriatepersonalprotectiveequipment(PPE)
- Whenperformingpatientcare,workfromcleanestto dirtiestpatientarea.
PRINCIPLESOFMEDICALASEPSIS
Thehealthcareteamandtheenvironmentcanbeasource ofcontaminationforthepatient
- Healthcareproviders(HCP)shouldbefreefromdisease
- Singleuseitemscanbeasourceofcontamination
- Patientsenvironmentshouldbeascleanaspossible
SURGICALASEPSIS
Practicesdesignedtorenderandmaintainobjectsand areasmaximallyfreefrommicroorganisms:Sterile Technique
- Knowwhatissterile
- Knowwhatisnotsterile
- Keepsterileandnotsterileitemsapart
- Remedycontaminationimmediately
PRINCIPLESOFSURGICALASEPSIS
- Thepatientshouldnotbethesourceof
contamination
- Healthcarepersonnelshouldnotbethesourceof
contamination
- Recognizepotentialenvironmentalcontamination
REMEDYCONTAMINATION
- Everycaseisconsidereddirtyandthesame
infectioncontrolprecautionsaretakenforall
patients
- Whencontaminationoccurs,addressit
immediately
- Breaksintechniquearepointedoutandactionis
takentoeliminatethem.
RutalaWAandWeberDJ(2010)Lautenbacchetal.(eds.)inPracticalHealthcareEpidemiology
REASONSFORNONCOMPLIANCE
- Inaccessiblehandhygienesupplies
- Skinirritation
- Toobusy
- Gloveuse
- Didn’tthinkaboutit
- Lackedknowledge
WHENTOPERFORMHANDHYGIENE
Moments^ The 5 Consensus recommendations CDC Guidelines on Hand Hygiene in healthcare, 2002
1. Beforetouching a patient - **Before and after touching the patient
- Beforeclean /** asepticprocedure - Before donning sterile gloves for central venous catheterinsertion; also for insertion of other invasive devices that do not - require a surgical procedure using sterile glovesIf moving from a contaminated body site to another body site **during care of the same patient
- After bodyfluid** exposurerisk - After contact with body fluids or excretions, mucous membrane,non-intact skin or wound dressing - If moving from a contaminated body site to another body siteduring care of the same patient - **After removing gloves
- Aftertouching** a patient - • **Before and after touching the patientAfter removing gloves
- Aftertouching** patientsurroundin gs - After contact with inanimate surfaces and objects (includingmedical equipment) in the immediate vicinity of the patient - After removing gloves
HOWTO HANDRUB
Toeffectivelyreducethegrowth ofgermsonhands, hand rubbing mustbeperformedby followingalloftheillustrated steps. Thistakesonly20–30 seconds! http://www.who.int/gpsc/tools /HAND_RUBBING.pdf
credit:WHO
Toeffectivelyreducethegrowth ofgermsonhands, handwashing mustlastatleast15seconds and shouldbeperformedbyfollowing alloftheillustratedsteps. http://www.who.int/gpsc/tools/ HAND_WASHING.pdf
HOWTO HANDWASH
credit:WHO
HANDRUBBINGVSHANDWASHING
(^60) 15sec 30sec 1 min 2 min 3 min 4 min
5
4
3
2
1
0
Bacterial contamination (mean log 10 reduction)
Handwashing Handrubbing
Hand rubbing is:
- more effective
- faster
- better tolerated
Pittet and Boyce. Lancet Infectious Diseases 2001
SUMMARYOFHANDHYGIENE Handhygienemustbeperformedexactlywhere you aredeliveringhealthcare topatients(atthepointofcare). Duringhealthcaredelivery,thereare5moments(indications)whenitis essentialthat you performhandhygiene. Tocleanyourhands, you shouldprefer handrubbing withanalcoholbased formulation,ifavailable.Why?Becauseitmakeshandhygienepossiblerightat thepointofcare,itisfaster,moreeffective,andbettertolerated.
You shouldwashyourhandswithsoapandwaterwhenvisiblysoiled. You mustperformhandhygieneusingtheappropriatetechniqueandtime duration.
RutalaWAandWeberDJ(2010)Lautenbacchetal.(eds.)inPracticalHealthcareEpidemiology
DEFINITIONS
SpauldingClassificationofSurfaces:
1. Critical – Objectswhichenternormallysterile
tissueorthevascularsystemandrequire
sterilization
2. SemiCritical – Objectsthatcontactmucous
membranesornonintactskinandrequirehigh
leveldisinfection
3. NonCritical – Objectsthatcontactintactskinbut
notmucousmembranes,andrequirelowor
intermediateleveldisinfection
DISINFECTIONLEVELS
High – inactivatesvegetativebacteria,mycobacteria,
fungi,andvirusesbutnotnecessarilyhighnumbers
ofbacterialspores
Intermediate – destroysvegetativebacteria,most
fungi,andmostviruses;inactivates Mycobacterium
tuberculosis
Low destroysmostvegetativebacteria,somefungi,
andsomeviruses.Doesnotinactivate
Mycobacteriumtuberculosis
CATEGORIESOFENVIRONMENTALSURFACES
ClinicalContactSurfaces
- Nursingbag,countertops,BPcuffs,thermometers
- Frequentcontactwithhealthcareproviders’hands
- Morelikelycontaminated
HousekeepingSurfaces
- Floors,walls,windows,siderails,overbedtable
- Nodirectcontactwithpatientsordevices
- Riskofdiseasetransmission
STERILE/CLEANSUPPLIES
- Sterile/cleansuppliesandequipmentshouldbe
carriedinnursingbag/plasticcontainer
- Bagandsuppliesaretobemaintainedascleanas
possible
- Performhandhygienebeforeremovinganypatient
caresuppliesorequipment
- Carryonlysuppliesneededforthatpatient,and
removeonlythosearticlesthatareneededforcare.
- Becarefulnottoreachintothenursingbagwith
potentiallycontaminatedgloves
NURSINGBAGS
RECOMMENDATIONSFORASEPSIS INPROCEDURES
WOUNDCARE
- Woundcareisperformedusingcleantechnique
- Cleanglovesusedtoremoveolddressings
- Glovesremoved,handhygieneperformed
- Newglovesdonnedforapplicationofnewdressing
- “Notouchtechnique”canbeusedchangingsurfacedressings
- Useonlysterileirrigationsolutions
- Solutionsareonetimeuseandremainingamountmustbediscarded
- Soileddressingshouldbecontainedwithinplasticbagand discardedinpatient’strash - Ifdisposalisnotpossibleinhome,transportsoileddressingsforfinal disposal.
INFUSIONTHERAPY
- Followthe2011GuidelinesforPreventionof
IntravascularCatheterrelatedInfections
- SeeSummaryofRecommendations
PHELBOTOMY
- Allvenousaccessdoneusingsafetyengineered
device
- Steriletechniquemustbefollowed
- Norecappingneedles
- Disposedofneedlesimmediatelyinsharps
containeratpointofuse
BLOODANDBLOODPRODUCTSTRANSPORT
Product Temperature Blood andPackRedBloodCells 110°C Platelets 110°C(ifstoredcold),or2024°C(if stored atroomtemperature) LiquidPlasma 110°C
FDARegulation(21CFR600)
- Temperaturemustbemonitoredusingtemperaturesensitivetags orthermometers
- Protectproductagainstdirectexposuretoicepacksorcoolants
SPECIMENCOLLECTIONANDTRANSPORT
- Specimensshouldnotbehandcarriedtothe
employee’svehicle
- Specimensshouldbeplacedinaplasticziplocklab
specimenbagbearingabiohazardlabel
- Specimensshouldbeplacedinasecondary
specimenbagfortransportation
- Secondaryspecimenbagmaybetransportedinthe
cleansectionofthevehicle
URINARYCATHETERINSERTIONANDMANAGEMENT
Followthe2009CDCGuidelineforthePreventionof
CatheterAssociatedUrinaryTractInfections
- SeeSummaryofRecommendations
INTERMITTENTURINARYCATHETERS
- Cleantechniqueisconsideredadequateforpatient
doingselfI/Ocatheterization.
- Reusablecathetersbyasinglepatient
- washinsoapandwater
- boilfor15minutes
- jarofwaterandmicrowaving(highfor15min)
- thoroughlydraincatheterandstoreinziplock bag
MAINTENANCEOFLEGBAGS
- Emptybagandrinsewithtapwater
- Cleanbagwithsoapywaterandrinse
- Soak30minutesinvinegarsolution
- Soakcapinalcohol
- Emptybag,drainandairdrybyhanging Alternative:
- Rinsebagwithtapwater
- Instillbleachsolution(1tspto1pintwater)throughtubing
- Agitatebrieflyandletbaghang30minutes
- Empty,drainandletairdrybyhanging
TRACHEOSTOMYCARE
- Usecleantechniqueunlesstracheostomyislessthan
onemonthold
- Suctioncathetersarechangedatleastdaily.
- Flushthecatheterwithsalineafteruse.
- Suctioncanistersandtubingshouldonlybeusedfor
onepatientanddiscardedwhennecessary.
- Suctiontubingshouldberinsedwithtapwaterafter
eachuse.Disinfecttubingonceaweekwitha1:10
bleachwatersolution.
RESPIRATORYTHERAPY
TRACHEALSUCTIONCATHETERS
HydrogenPeroxideMethod
- Cleanwithsoapandwater
- Rinsewithtapwater
- Flushwith3%hydrogen peroxide
- Placeincontainerof3% hydrogenperoxide;soakfor 20minutes
- Rinseandflushwithsterile waterbeforeuse
- Storeinnewcleanplasticbag
BoilingMethod
- Cleanwithsoapandwater
- Boilinwaterfor10minutes
- Driedoncleantowelorpaper towels
- Allowtocoolbeforeuse
- Storeinanewcleanplasticbag
ENTERALFEEDING
- Unopenedenteraltherapystoredatroom
temperature
- Fordilutedorreconstitutedformulas:
- Followlabelinstructionsforpreparationstorageand stability
- Mostarestableifcoveredandrefrigeratedfor24hours
- Checkexpirationdates
