Download THE PREVENTION OF NOSOCOMIAL INFECTION

Practical lesson № 2.
Infectious safety
Nosocomial infections
Prevention of nosocomial infections
After studying the topic the student should know:
• Definition of nosocomial infection.
• The priority problems of nosocomial infections in modern health care.
• Features of nosocomial infection.
• Forms of nosocomial infection (endogenous and exogenous).
• Sources of nosocomial infection.
• The route of transmission of nosocomial infection.
• The prevention of nosocomial infection.
• The definition of asepsis
• Prevention of Direct Contact with the infected person (Barrier nursing)
• The rules of hygiene of the medical staff
• Three levels of hand treatment (wash)
• Types of medical waste
• The definition of disinfection. Types of disinfection.
• Disinfection medical equipment. Scheme of processing of medical equipment
• The definition of sterilization. Types of sterilization.
After studying the topic the student should be able:
• Treating the hands by hygienic way
•
Wear sterile gloves
• Remove sterile gloves
• Current trend, public awareness, and rising cost of health care have increased the
importance of infection prevention and control. Increases in drug-resistance
microorganisms and concern about occupational exposure to tuberculosis (TB), human
immune deficiency virus (HIV), and hepatitis have increased concern about transmission
of infections.
• NATURE OF INFECTION
• An infection is the invasion of a susceptible host (e.g. patients) by potentially harmful
microorganisms (pathogens), resulting in disease. The principal infecting agents are
bacteria, viruses, fungi, and protozoa (Table 1). It is important to know the difference
between an infection and colonization. Colonization is the presence and growth of
microorganisms within a host but without tissue invasion or damage.
• All person have microorganisms on their skin, but usually no disease results. Disease or
infection results only if pathogens grow or multiply and alter normal tissue function. An
infectious disease transmitted directly from one person to another is considered a
contagious or communicable disease. If the pathogens multiply and cause clinical signs
and symptoms, the infections is symptomatic. If clinical signs and symptoms are not
present, the illness is termed asymptomatic. Hepatitis C is a communicable disease that
is often asymptomatic. It is most efficiently transmitted through the direct entry of the
blood into the skin through a percutaneous exposure, even if the source (patient) is
asymptomatic.
• «Infection» is a biological phenomenon characterized by the interaction of a
pathogenic microorganism with a macroorganism (human).
• “Infectious process" - a complex of adaptive reactions of the organism in
response to the introduction and proliferation of the pathogen. Reactions
aimed at restoration of homeostasis and disturbed biological equilibrium with
the environment.
• Microorganism that can cause infectious disease is called a pathogen.
Properties of pathogen:
• Invasiveness - the ability of the pathogen to penetrate through the skin and
mucous membranes into the internal environment of a macroorganism.
• Toxigenicity — the ability of microbes to produce toxins.
CHAIN OF INFECTION
The presence of a pathogen does not mean that an infection will begin. The process resulting in an infection is referred to as the chain of infection.
Components of the chain include:
1) Infectious agent (pathogen)
2) Reservoir - a place where microorganisms survive, multiply, and wait to transfer to a susceptible host. Common reservoirs are humans and animals,
insects, food, water. Frequent reservoirs for health care-associated infections include health care workers (especially their hands), patients' body
excretions and secretions, equipment, and the health care environment. There are two types of human reservoirs: those with acute or symptomatic
disease and who show no signs of disease but are carriers of the disease. Human can transmit microorganisms in either case.
3) Portal of exit
•
After microorganisms find a site in which to grow and multiply, they must find a portal of exit if they are to enter another host. Microorganisms exit
through a variety of sites such as skin and mucous membranes, respiratory tract, gastrointestinal tract, urinary tract, and in blood.
4) Rout of transmission
•
Many times there is little that you are able to do about the infectious agent or the susceptible host, but by practicing infection prevention and control
techniques, such as hand hygiene, you interrupt the rout of transmission.
5) Portal of entry. Organisms are able to enter the body through the same routes they use for exiting. Common portals of entry include broken skin,
mucous membranes, genitourinary (GU) tract, gastrointestinal (GI) tract, and respiratory tract.
6) Susceptible host. Susceptible to an infection depends on the individual' degree of resistance to pathogens. Although everyone is constantly in contact
with large numbers of microorganisms, an infection does not develop until an individual becomes susceptible to the strength and numbers of those
microorganisms.
Rout of transmission
CHAIN OF INFECTION
The transmission
mechanism
Transmission
Fecal-oral rout (food)
Alimentary (food);
Water;
Contact-household
Aerogenic
(respiratory) rout:
Vector-borne (blood)
rout
Contact rout
Transfer factors
The localization of the pathogen
Food
Water
Dishes, utensils, dirty
hands, etc.
Airborne;
The air
Air-dust
Dust
Bite of blood-sucking Blood-sucking
arthropods
Blood, blood products
Parenteral
Syringes, surgical
tool
The digestive tract
Wound
Contact-sexual
Blood system
Soil
The secret glands, the
presence of blood
components
etc.
Respiratory system
Skin and mucous membranes
Fecal-oral rout
Nosocomial infections
Nosocomial infection (hospital) - is any clinical microbial disease, affecting the patient as a result of hospitalization or
hospital visits in order to receive treatment.
Nosocomial infection is a disease developed in a patient 48 hours after admission, and healthcare worker involved in the
treatment and care of patients in the hospital.
The problem of nosocomial infection and infection control is a priority for a number of reasons, which include the
following:
• mortality of nosocomial infection in medical hospitals took the first place;
• infection acquired patients in the hospital, greatly increases the cost of his treatment, because it involves the use of costly
antibiotics and increases the duration of hospitalization;
• infection - the main cause of illness and death in newborns, especially premature (for example, 25% of premature infants
in the intensive care unit develops sepsis, making the frequency of death 2 times higher and hospitalization longer);
• disability due to nosocomial infection has significant financial problems for the patient and his family.
• In the United States of 120000 or more patients infected with NI, killed about 25% of cases and, according to experts, NI
represent the leading cause of deaths. Obtained in recent years evidence suggests that NI significantly lengthen the
duration of stay of patients in hospitals, and caused damage every year is from 5 to 10 billion dollars in the United States.
There are two forms of nosocomial infection (classification):
1. Endogenous infection (self-infection, or auto infection).
• The causative agent of the infection is present in the patient at the time of
admission to hospital but there are no signs of infection. The infection
develops during the stay in hospital as a result of the patient’s altered
resistance
2. Exogenous infection (Cross-contamination followed by cross-infection):
• During the stay in hospital the patient comes into contact with new
infective agents, becomes contaminated, and subsequently develops an
infection.
Sources of hospital infection - sick man:
1) patients with acute or chronic form of infectious diseases.
2) infection carriers (carriers do not get sick, but they can pass the infection to
others);
3) medical staff.
THE PREVENTION OF NOSOCOMIAL INFECTION:
Two basic principles govern the main measures that should be taken in order
to prevent the spread of nosocomial infections in health-care facilities:
1. Separate the infection source from the rest of the hospital:
• Identification and isolation on admission of infectious patients
• preventive medical examination of personnel
2. Cut off any route of transmission (Aseptic techniques):
• Clinical hygiene of medical staff
• Collection and disposal/decontamination of waste
• Cleaning
• Disinfection
• Sterilization
• ASEPSIS
Efforts to minimize the onset and spread of infection are based on the principles of Aseptic
technique. Aseptic technique is an effort to keep the patient as free from exposure to
infection-causing pathogens as possible. The term asepsis means the absence of diseaseproducing microorganisms. The two types of aseptic technique are medical asepsis and
surgical asepsis.
• Medical asepsis includes procedures used to reduce the number of and prevent the spread
of microorganisms. Hand hygiene, barrier techniques, and routine environmental cleaning
are examples of medical asepsis.
• Surgical asepsis, or sterile technique, includes procedures to eliminate all microorganisms
from an area. Sterilization destroys all microorganisms and their spores.
Nurses in the operating room, labor and delivery, and at the bedside practice sterile
technique when using sterile instruments and supplies for patients care.
Surgical asepsis demands the highest level of asepsis technique and requires that all areas be
kept free of infectious microorganisms.
Health care workers are responsible for providing a safe environment for patient. It is easy to
forget key procedural steps or to take shortcuts that break aseptic procedures when hurried.
Failure to follow proper techniques place patients at risk for an infection that can seriously
impair their recovery and may even lead to death.
CLINICAL HYGIENE OF MEDICAL STAFF
•
Keep your body clean.
•
Take shower every day.
•
Wear special clothes: a medical bathrobe, a medical cap, shoes.
•
Use protectors: gloves, mask, goggles.
•
Wash your hands
Medical bathrobe
•
Special clothes of a modern medical worker – a medical bathrobe.
•
There are many microbes on clothes. Caps, bathrobe, trousers and shoes are most contaminated with microbes.
•
On medical bathrobe the hospital microbes can be found in a few hours of wearing, especially on the sleeves, on the area of abdomen and on the hips.
•
It is necessary to have a special room where a doctor can change clothes.
•
Work clothing and personal clothing must be kept separately.
•
Doctors must wear a bathrobe over their own clothes and it must fully cover personal clothes of a doctor.
•
Sleeves must be short in order to make hand wash easier.
Medical cap
•
Hair - is a huge area that can collect and then distribute microorganisms.
•
It is necessary to wear a cap in the surgical department. The hair must be hide under the medical cap.
•
It is necessary to replace medical cap daily.
Shoes (footwear)
•
Footwear must be closed in order to protect feet against contact with blood and other biological fluids. Shoes must be made of nonwoven fabric, so that it can be exposed to cleaning and disinfection.
Protectors
•
Working in aseptic and infected areas medical staff should wear protective disposable masks. Mask should be replaced every 2 hours, and after each surgery.
•
All the dirty work must be done in oilcloth aprons. Apron is worn over the bathrobe.
•
In case of contact with the patient doctors must wear rubber disposable gloves.
HAND WASHING
• Hands – are the most likely source of infection. It is necessary for every medical worker to care for them.
• Skin microflora
•
Resident microflora (constant). It is impossible to destroy completely this microflora.
•
Transient microflora (temporary). It is received through any contact with the environment.
• As the hands of health-care workers are the most frequent vehicle of nosocomial infections, hand hygiene—including both hand washing and hand
disinfection—is the primary preventive measure. Thorough hand washing with adequate quantities of water and soap removes more than 90% of
the transient, i.e. superficial, flora including all or most contaminants. An antimicrobial soap will further reduce the transient flora, but only if used
for several minutes.
The points to be kept in mind while washing hands are:
• Cut short nails. A long nail will give roof to the dirt and microorganisms.
•
Remove the jewelry of any type. Open the tap and wet hands and forearm. Always hold the hands below the elbow level, because hands are
considered to be more contaminated then the elbows, hence the water should flow from the area of least contamination (the elbows) to the area of
more contamination (the hands).
• Apply soap or detergent.
• Wash hands thoroughly. Make sure that the interdigital space are cleaned by washing each finger separately. Use brush to dislodge the dirt from
under the nail beds.
• Rinse hands by keeping the hands well below the elbow level. The water flows from elbow to the hands.
• Repeat the procedure (application of soap and rinsing with water) to ensure thorough cleanliness.
• Dry the arms and hands, starting at the elbows and working towards the hands.
• Discard the towel.
• Turn off the water tap using a paper towel because the handle is contaminated.
• While washing, if the hands touch the sink or other objects accidentally, the whole procedure needs to be repeated.
MEDICAL WASTE, classification
• CLASS "A". Not dangerous
waste
• CLASS «Б". Dangerous waste.
• CLASS «B». Dangerous waste
• CLASS «C". Extraordinarily
dangerous wast
• CLASS «Д». Radioactive waste
MEDICAL WASTE
CLASS "A". Not dangerous waste
It is non-toxic waste, not having contact with body fluids of patients,
infectious patients.
Not dangerous CLASS "A" is formed:
1. In the wards in all structural units of hospital.
2. In administrative quarters
3. In the buffet, in the nutrition unit. In the territory of hospital
4. Territory infectious, dermatovenerologic, tuberculous hospitals is
exception.
Not dangerous CLASS "A“ is collected in a disposable package (packages,
cans) white colour.
CLASS «Б". Dangerous waste. Dangerous
waste is potentially infected waste,
contaminated by secretions and blood of
patients.
Places of formation:
• Operating rooms
• Resuscitation department
• Treatment rooms, dressings rooms,
manipulation rooms
• Infectious and dermatovenerologic
departments
• Anathomyc-and-pathology department
• Microbiological laboratories
• Vivarium
Dangerous waste CLASS «B» is collected
in a disposable hermetic package
(packages, cans) yellow colour.
Marking - Dangerous waste. Class «B»,
code of department, name of the
hospital, date, name of the responsible for
collection of waste.
CLASS «C". Extraordinarily dangerous waste
CLASS «C» is waste contacted with sick of
especially dangerous infections.
Places of formation waste CLASS «C»:
1. departments for patients with especially
dangerous and quarantine infections
2. tuberculosis hospital
and departments
3. mycological hospitals
4. materials from patients with anaerobic infection.
Waste CLASS «C» is collected in a disposable
hermetic package red colour (packages and hard
packing).
Marking - "Extraordinarily dangerous waste. Class
C,code of department, name of the hospital, date,
name of the responsible for collection of waste.
CLASS "D” - analogous to industrial
Waste CLASS «D» is
• expired medicines,
• used disinfectants,
• waste from pharmaceutical and diagnostic
products,
• cytostatic drug and other chemicals,
• mercury-containing objects,
• medical apparatus and equipment.
Waste CLASS «D» is collected in a disposable
hermetic package (packages, cans) black
colour.
Marking - Waste. Klass D, code of department,
name of the hospital, date, name of the
responsible for collection of waste.
•
CLASS «Д». Radioactive waste
Waste CLASS «E» is all kinds of
waste containing radioactive
components.
Places of formation:
1. Diagnostic laboratories or
departments
2. Radioisotope laboratory
3. X-ray rooms
Collection, storage and removal
waste of this class carry out in
accordance with the rules for work
with radioactive substances.
Collection and disposal/decontamination of medical waste
2 ways:
• centralized way
• decentralized way
•Scheme centralized way
• Scheme decentralized way
Waste collection in place of formation
waste collection in place of formation
Waste disinfection
Recycling of waste in a medical
organization in a special equipment
Waste transportation from place of collection in
the places temporary storage
Transportation of waste from hospital in specialized
neutralizing organization
Recycling of waste in a special organizations
Disinfection
• Disinfection - is the destruction of pathogenic and conditionally pathogenic microorganisms in the air, onsite equipment and medical products in the treatment-and-prophylactic institution.
Objectives of disinfection:
1. Prevention of nosocomial infections (HI).
2. Interruption ways of transmission infection, the destruction of the infectious agent.
OBJECT of DISINFECTION
1. All types of surfaces in hospital (walls, floor, furniture, etc.).
2. Medical products.
3. Hands of medical personnel.
4. Skin of the patient.
5. Objects for nursing.
6. Indoor air.
7. Bed linen.
8. Tableware.
9. Medical waste and other objects that may be factors of transmission of nosocomial infections.
TYPES OF DISINFECTION:
1. Preventive disinfection is aimed at preventing the occurrence of
infections, in the absence of the focus of infection. It is provided in the
treatment-prophylactic institution, is carried out by medical personnel
(orderlies, junior medical personnel, nurses).
2. Focal disinfection (antiepidemic) is carried out in the case of
appearance of infectious disease or at the suspicion on it.
Preventive disinfection is carried out in
three forms:
Preventive planned disinfection is carried out in the hospital
continuously; is carried out according to the plan maked accordingly with
peculiarity of hospital departments.
2. Preventive disinfection on epidemic indications is carried out with the
occurrence of nosocomial infection in one from hospital departments (or
in one from chambers). For example, the patient is ill by the influenza in
the one ward. Purpose - prevent the spread of infectious agents in other
departments.
3. Preventive disinfection on sanitary and hydenic indications is carried
out once at the contamination.
Focal disinfection is carried out in two forms:
1. Focal current disinfection – is conducted constantly in a treatmentprophylactic institution or at home surrounded by the patient (or
Bacillicarrier) after detection in a patient of nosocomial infection and
before discharge (or transfer to another Department/hospital).
2. Focal final disinfection – is carried out once after, after discharge or
death, the hospitalization the patient in an infectious hospital.
Methods of disinfection:
1. Mechanical method (soil removal):
• wet cleaning rooms and equipment
• tapping out of clothes, bedclothes
• dust removal, repair of rooms
• scrubbing the hands of personnel.
2. Chemical method - with using
disinfectants.
• irrigation
• wiping
• total immersion
• spraying
3. Physical method - thermal, most reliable and
harmless to personnel.
• using of sunlight
• bactericidal lamp
• ironing, calcination by high temperature
• incineration of waste
• boiling
• pasteurization
• tyndalization (fractional pasteurization)
• air method (in a dry-heat tool cabinet)
• steam method (steam treatment - autoclaving)
• processing the objects in special chamber by high
pressure.
4. Combined method - a different combination of
physical and chemical methods of disinfection.
5. Biological method - the destruction of pathogens
using microbies-antagonists (bacteriophages).
Disinfection efficiency depends on:
1. the stability of the microorganism
2. quantity of microbies
3. concentration of disinfectant
4. presence of organic substances on the objects (blood, feces, sputum)
5. exposition
6. method of processing (wiping, irrigation, total immersion in disinfectant)
7. texture of processed objects
Quality control of disinfection
1. Visual control – the assessment of sanitary condition of the rooms, result
current and general cleaning, at the proper concentration of disinfectants.
2. Chemical control - determination of the concentration of ready disinfectants,
express test - paper test-strips and control color scale.
3. Bacteriological control - taking wash-out and inoculation. This analysis is
conducted by laboratorian from Hygiene and Epidemiology Center.
Types of disinfectants:
1.For disinfection of medical products.
2. For disinfection of rooms, furniture and objects of nursing for patients.
3. Dermal antiseptics.
Requirements for disinfectants:
1. Wide spectrum of actions
2. low toxicity
3. Good solubility in water
4. Activity in small concentrations
5. Minimum time of effective exposure
6. Stability at the storage (expiration date)
7. Convenient transportation
8. Disinfectant should not damage
processed objects.
Safety rules when working with disinfectants
1. Proper storage of disinfectants.
2. Labelling - the name, appointment, date of manufacture and expiration
date.
3. Observance the rules of personal hygiene (a special gown, kerchief,
respirater, goggles, rubber gloves, removable shoes)
4. Use ventilation at the preparing solutions
First aid for poisoning by disinfectants
1. After contact with skin - wash them immediately with water.
2. Eye contact - rinse immediately with water, to inject drops into the eye
(30% albucid, 2% novocaine solution – 1-2 drops.
3. In case of irritation of the respiratory tract - to go to another room or
fresh air, rinse the mouth and nasopharynx with water (if necessary
appoint hearty, soothing, antitussives remedies).
STERILIZATION
Sterilization - is the complete destruction of microorganisms and their spores by exposure to
physical factors and chemicals matters.
All products are subjected to sterilization in contact with a wound surface, blood, certain types of
medical instruments.
Methods of sterilization:
1. Physical method - steam , air , gasperlenovy , radiation .
2. Chemical method - the disinfectant solution , gas , plasmative .In clinical practice most commonly
used thermal ( physical) method of sterilization:
1 . Autoclaving – the influence of steam under pressure
3 . Dry-heat method - the influence of dry air; use hot-air-sterilizer with different modifications.
Sterilization of medicine products is carried out in a centralized sterilization departments ( CSSD )
Scheme of processing of medical equipment
medical equipment (object)
Medical objects of
nursing for patients
Reusable medical
equipment (heater,
thermometer, etc.)
Disinfection
Disposable medical equipment
(bandage material , syringes and
other)
Disinfection
Utilization
Medical instruments
Disinfection
Pre-sterilization
processing
Sterilization
The main stages of processing MEDICAL TOOLS:
1 stage. disinfection
2 stage. pre-sterilization
3 stage. control of sterilization processing
4 stage. sterilization
1 stage. Disinfection of instruments of medical appointment
Equipment:
• disinfectant solution
• 1 сontainer (for lavage)
• 2 сontainer (for disinfection)
• medical trays
• instruments after use in assembled form
Some solutions allow to wash off and disinfect the tools in 1 сontainer (2 properties at the
same time).
Indispensable condition - сonduct disinfection immediately after manipulation.
• Performance the procedure. Algorithm
1. Dress the special clothing (gown, mask, gloves).
2. Prepare a disinfectant solution, pour it in the containers.
3. In first сontainer (for lavage) washed the instrument without disassembling.
4. Disassemble all instruments, immerse in 2 сontainer (for disinfection) with
disinfectant solution, filling internal channels of instruments.
5. Close the container by lid. Leave at the time required for disinfection.
6. Take off the gloves, immerse in a container with disinfectant.
7. Put on other gloves, derive the instrument at the end of the exposition time.
8. Put on instrument in the medical tray.
9. Wash out the instrument under running water.
9. To prepare reusable instruments for further processing (for sterilization).
10. Disposable syringes put into packet yellow colour for utilization.
11. Pour out used disinfectant in sewerage.
12. Take off the gloves and put in disinfectant solution, wash and dry your
hands.
• 2 stage. Pre-sterilization processing
If the instrumentation has been in contact with mucous membranes and wounds,
including operating, the disinfection insufficiently. Sterilization is required. Presterilization processing is carried out before sterilization.
The purpose of pre-sterilization processing - remove all small particles, medicinal
products and protein contamination remaining after the operation or manipulation.
Specially prepared solutions uses during pre-sterilization processing.
The solution includes:
• water,
• hydrogen peroxide,
• cleaning agent.
Medical instrumentation are soaked in disassembled, all items are completely
submerged in the solution with the filling of all cavities.
Pre-sterilization processing. Algorithm
Equipment:
• special solution
• medical trays
• brush for washing tools
• сontainer with distilled water
• dry-heat Cabinet
• instruments after use in assembled form
Algorithm:
•
Dress the special clothing (gown, mask, gloves).
•
Prepare a disinfectant solution
•
Immerse the instruments in special solution.
•
Process the instruments by brush.
•
Wash out the instrument under running water.
•
Rinse tools in distilled water.
•
To dry in a dry-heat cabinet.
• To reduce the time of processing surgical instruments can be used are special
solutions. They allow perform the disinfection and pre-sterilization processing at
the same time.
• The method of physical processing can be used to lighten the work of nurses,
reduce the risk of infection contamination, reduce the processing time of surgical
instruments.
• For example, apparatus of ultrasound processing.
3 stage. Сontrol of sterilization processing.
• Контроль качества дезинфекции и
предстерилизационной очистки
проводят ежедневно, под руководством старшей
медицинской сестры (биологический и
химический анализ).
Фенолфталеиновая проба - на наличие моющего
средства (розовое окрашивание)
2. Амидопириновая проба - на скрытую кровь
(сине-зелёное окрашивание)
3. Азопирамовая проба - на скрытую кровь, на
наличие моющего средства, хлора
• Если пробы на кровь или на остатки щелочных
компонентов моющих средств, оказываются
положительными, всю партию изделий повторно
очищают до получения отрицательных
результатов.
Quality control disinfection and pre-sterilization processing is
carried out daily, under the guidance of senior nurse (biological
and chemical analysis).
• 1 test. Phenolphthalein test – for the presence of detergent (pink
coloration).
• 2 test. Amidopyrine test – for the occult blood (blue-green color).
• 3 test. Azopiram test – for the occult blood, for the presence of
detergent, chlorine.
If tests on blood or on the remnants of detergents is positive, the
medical instruments cleans again (to negative results).
4 stage. Sterilization
• Стерилизация - это уничтожение микроорганизмов
и их спор путём воздействия
физических факторов и химических веществ.
• Оборудование и инструменты, которые проникают в
стерильные ткани организма или сосуды,
контактируя с кровью или инъекционными
растворами, относятся к «критическим»
предметам. Они должны пройти стерилизацию,
чтобы все виды микроорганизмов полностью
.
уничтожились
• Sterilization - is the destruction of
microorganisms and their spores by exposure
to physical factors and chemicals matters.
• Medical device and instruments, penetrating
into sterile tissue or the vessels, contacting
with blood or injectable solutions is "critical"
items. They must to undergo sterilization in
order to all kinds of microorganisms were
destroyed.
МЕТОДЫ СТЕРИЛИЗАЦИИ.
Methods of sterilization.
1. Физический метод - паровой, воздушный,
гласперленовый, инфракрасный,
ультрофиолетовый, ультрозвуковой.
2.
Химический метод - газовый, плазменный.
Стерилизация изделий медицинского назначения
осуществляется в централизованных
стерилизационных отделениях (ЦСО).
1. Physical method:
• steam,
• air,
• glasperlenovy,
• ultrasonic,
• ultraviolet radiation,
• infra-red.
2. Chemical method:
• chemical solution,
• gas.
Sterilization of medicine products is carried out in a
centralized sterilization departments.
centralized sterilization departments
В клинической практике чаще всего применяется термический (физический)
In clinical practice most commonly used physical method of sterilization.
Физический паровой метод стерилизации (автоклавирование ) обработка горячим паром под избыточным давлением
• Physical steam method
sterilization (аutoclaving) –
processing with hot steam under
overpressure.
Все медицинские изделия , стерилизуемые паром под давлением, помещают в
специальную упаковку:
All products are sterilized by steam under pressure, is put in special packaging:
Стерилизационные упаковки
1.
Многоразовые стерилизационные коробки
(биксы)
2.
Упаковки из двухслойной хлопчатобумажной
ткани
3. Крафт-пакеты из плотной бумаги
Все 3 вида упаковок маркируют.
Sterilization packaging:
1. Reusable metal sterilizing box
2. Package of two layers cotton cloth
3. Kraft paper-bags of dense paper.
All kinds of special packages are marking.
ПОНЯТИЕ ОБ АВТОКЛАВИРОВАНИИ.
The notion of autoclaving.
Для лечебных учреждений рекомендуется
два режима стерилизации:
1. первый режим - температура 132° С,
давление 2 атмосферы, время 20 минут,
предназначен для стерилизации изделий из
тканей, стекла, изделий
из корозийностойкого металла.
2. второй режим - щадящий, температура
120° С , давление 1,1 атмосферы, время
45 минут, рекомендуется для изделий из
тонкой резины, латекса и отдельных видов
полимеров.
Two regimes of sterilization (for autoclaving) are
recommended use in treatment-and-prophylactic institution:
1. First regime sterilization is designed for products of fabric,
glass, corrosion-resistant metal. Temperature 132 ° C,
pressure of 2 atm, time 20 minutes.
2. Second regime sterilization (sparing regime) is
recommended for the products of thin rubber, latex and
certain types of polymers. Temperature of 120° C, pressure
of 1.1 atmospheric, time 45 minutes.
СТЕРИЛИЗАЦИЯ ГОРЯЧИМ ВОЗДУХОМ
(в сухожаровом шкафу).
Hot air sterilization (in a dry-heat cabinet)
3. Сухожаровой метод - воздействие сухого воздуха,
используются
сухожаровые шкафы разной модификации
Рекомендуется для изделий из металла и
стекла, температура 180° С, экспозиция
60 минут.
Контроль стерилизации осуществляется с
помощью индикаторов, контроля
температуры и давления.
Ведётся журнал учёта стерилизации.
Dry-heat method - the influence of dry air; use hot-airsterilizer with different modifications.
This type of sterilization is recommended for metal
products and glass. Temperature - 180 ° C, exposition
- 60 min.
Control of sterilization is carried out by indicators of
temperature and pressure control.
Conduct a journal of sterilization.
Chemical method - sterilization of chemical solutions.
Химический метод - Стерилизация растворами
химических средств.
• Это вспомогательный метод, потому что
медицинские изделия нельзя стерилизовать в
упаковке, после стерилизации инструменты
необходимо промыть стерильной жидкостью .
• Метод следует применять для стерилизации
изделий из термолабильного материала.
• This is a helper method because of a medical product
cannot be sterilized in the package, after sterilization, the
instruments must be rinsed by sterile fluid.
• This method is used for sterilization of thermolabile
products from the material.
• For example, eye pipettes, rubber balloon for enemas.
Сроки стерильности.
Terms of sterility.
1. биксы без фильтра - хранят 3
суток
2. биксы с фильтром - 20 суток
3. упаковки из двухслойной
хлопчатобумажной ткани или
крафт-пакеты -до 3 суток
в стерильных условиях
1. Metal sterilizing box without filter - keep 3
days.
2. Metal sterilizing box with filter - 20 days.
3. Package of two layers cotton or kraft paper-bags
- to 3 days, in sterile conditions.
• Annex 1
• Brief information in tables
Types of
waste
Characteristic of waste
Places of formation of waste
color
packaging
CLASS "A“
Not
dangerous
waste
It is non-toxic waste, not having contact with body fluids
of patients, infectious patients
Not dangerous CLASS "A" is formed:
1. In the wards in all structural units of hospital.
2. In administrative quarters
3. In the buffet, in the nutrition unit. In the territory of hospital
4. Territory infectious, dermatovenerologic,
tuberculous hospitals is exception.
white
colour
CLASS “Б"
Dangerous
waste
Dangerous waste is potentially infected waste,
contaminated by secretions and blood of patients.
Operating rooms; Resuscitation department; Treatment rooms,
Dressings rooms, Manipulation rooms; Infectious and
dermatovenerologic departments
Anathomyc-and-pathology department; Microbiological laboratories
Vivarium
yellow
colour
CLASS «В".
Extraordinar
ily dangerous
waste
The type of waste is contacted with sick of especially
dangerous infections
1. departments for patients with especially dangerous and quarantine
infections
2. tuberculosis hospital
and departments
3. mycological hospitals
4. materials from patients with anaerobic infection.
red colour
CLASS «С” analogous to
industrial
expired medicines, used disinfectants,
waste from pharmaceutical; cytostatic drug and other
chemicals, mercury-containing objects,
medical apparatus and equipment
CLASS «E»
Waste CLASS «E» is all kinds of waste containing
radioactive components.
black
colour
1. Diagnostic laboratories or departments
2. Radioisotope laboratory
3. X-ray rooms
The steps of collecting waste
the name of the stage
characteristics of the stage
The first stage of waste
collection
1.
2.
3.
The second stage, the
third stage of waste
collection, storage and
transportation.
Nursing staff transports waste from place of collection in the places temporary storage (Sanitary room) and puts in a hermetic,
waterproof container on wheels. Container volume 20 - 50 liters.
Fourth stage
Transportation of waste from places temporary storage in a specially ground on the territory of treatment-and-prophylactic institutions,
equipped by containers (at the end of the working day).
Fifth stage. Recycling of
waste
Centralized export of waste is carried from the territory of hospital in special machine with closed truck body daily.
Waste CLASS «A» may be buried in ordinary landfills for disposal of hard waste.
Waste CLASS «B» and «C» must be destroyed in special plants for waste neutralization of hospital by thermal methods.
Transportation, waste neutralization and burial waste CLASS «D» is carried out in accordance with hygiene requirements of waste
neutralization and burial of toxic industrial waste.
Removal of waste CLASS «E» is carried out in accordance with the rules for work with radioactive substances and other sources of
ionizing radiation.
Disposable medical products are collected in a soft hermetic package with marking for each class of waste.
Needles and other sharp instruments are collected in a hard package.
Wastes of Class "B" and «C» should be exposed to compulsory disinfection before collection in disposable packaging in the places
of primary collection
Disinfection
Preventive disinfection
is aimed at preventing the occurrence of infections, in the absence of the
focus of infection. It is provided in the treatment-prophylactic institution,
is carried out by medical personnel (orderlies, junior medical personnel,
nurses).
1. Preventive planned disinfection is carried out in the hospital
continuously; is carried out according to the plan maked accordingly with
peculiarity of hospital departments.
2. Preventive disinfection on epidemic indications is carried out with the
occurrence of nosocomial infection in one from hospital departments (or
in one from chambers).
For example, the patient is ill by the influenza in the one ward. Purpose prevent the spread of infectious agents in other departments.
3. Preventive disinfection on sanitary and hydenic indications is
carried out once at the contamination.
Focal disinfection (antiepidemic) is carried out
in the case of appearance of infectious disease or
at the suspicion on it.
1. Focal current disinfection – is conducted
constantly in a treatment-prophylactic institution
or at home surrounded by the patient (or
Bacillicarrier) after detection in a patient of
nosocomial infection and before discharge (or
transfer to another Department/hospital).
2. Focal final disinfection – is carried out once
after, after discharge or death, the hospitalization
the patient in an infectious hospital.