Download Patient and Health Care worker Safety

Patient and Health Care worker
Safety
Antoinette Barton-Gooden
Objectives
 Identify infection control hierarchies.
 Discuss occupational control measures in maintaining patient
and health care worker safety.
 Describe the classification system that guides some control
measures.
 List waste management strategies.
Pre-amble
 Disinfection and sterilization are essential for ensuring that medical and
surgical instruments do not transmit infectious pathogens to patients.
 Multiple studies in many countries have documented lack of compliance
with established guidelines for disinfection and sterilization.
 Failure to comply with scientifically-based guidelines has led to
numerous outbreaks.
 Health-care policies must identify, primarily on the basis of the items'
intended use, whether cleaning, disinfection, or sterilization is
indicated. (CDC,2008)
What are some health hazards?
 Patients
 Health Care Workers
Infection control hierarchies
 Administrative measures
 Environmental controls
 Use of personal protective equipment
Infection control hierarchies
 The first and most important level of the hierarchy,
administrative measures, impacts the largest number of
people.
 It is intended primarily to reduce the risk of uninfected
people who are exposed to people with the
organism/disease.
Infection control hierarchies cont’d.
 The second level of the hierarchy is the use of environmental
controls to reduce the organisms.
 The first two control levels of the hierarchy also minimize
the number of areas in the health care setting where
exposure may occur.
Infection control hierarchies cont’d.
 The third level of the hierarchy is the use of personal
protective equipment in situations that pose a high risk of
exposure.
Infection control measures
 Sterilization: destroys or eliminates all forms of microbial life
and is carried out in health-care facilities by physical or
chemical methods. Steam under pressure, dry heat, gas,
hydrogen peroxide gas plasma, and liquid chemicals are the
principal sterilizing agents used in health-care facilities.
Infection control measures
 Disinfection: describes a process that eliminates many or all
pathogenic microorganisms, except bacterial spores, on inanimate
objects.
 In health-care settings, objects usually are disinfected by
liquid chemicals or wet pasteurization. Each of the various
factors that affect the efficacy of disinfection can nullify or
limit the efficacy of the process.
Infection control measures
 Cleaning is the removal of visible soil (e.g., organic and inorganic
material) from objects and surfaces and normally is
accomplished manually or mechanically using water with
detergents or enzymatic products. Thorough cleaning is
essential before high-level disinfection and sterilization
because inorganic and organic materials that remain on the
surfaces of instruments interfere with the effectiveness of
these processes.
 Decontamination removes pathogenic microorganisms from objects so
they are safe to handle, use, or discard.
Infection control measures
 Chemical Disinfectants: Alcohol
 Ethyl alcohol and isopropyl alcohol are germicidal
characteristics.
 These alcohols are rapidly bactericidal rather than
bacteriostatic against vegetative forms of
 bacteria; they also are tuberculocidal, fungicidal, and
virucidal but do not destroy bacterial spores.
 Must be 60-90% in water to be effective against the listed
organisms (CDC, 2008.p.38).
Infection control measures
 Chlorine and Chlorine Compounds: Hypochlorites,
the most widely used of the chlorine disinfectants, are
available as liquid (e.g., sodium hypochlorite) or solid (e.g.,
calcium hypochlorite). The most prevalent chlorine products
in the United States are aqueous solutions of 5.25%–6.15%
sodium hypochlorite usually called household bleach.
 They have a broad spectrum of antimicrobial activity, do not
leave toxic residues, are unaffected by water hardness, are
inexpensive and fast acting (CDC, 2008.p.40).
Infection control measures
 Formaldehyde: is a disinfectant and sterilant in both its liquid
and gaseous states.
 Formaldehyde is sold and used principally as a water-based
solution called formalin.
 The aqueous solution is a bactericide, tuberculocide,
fungicide, virucide and sporicide.
 The Occupational Safety and Health Administration (OSHA)
indicated that formaldehyde should be handled in the
workplace as a potential carcinogen and set an employee
exposure standard for formaldehyde that limits an 8-hour
time-weighted average exposure concentration of 0.75 ppm.
Infection control measures
 Glutaraldehyde : is a high level disinfectant and chemical
sterilant .
 The aqueous solutions of glutaraldehyde are acidic and
generally in this state are not sporicidal. Only when the
solution is “activated” (made alkaline) by use of alkalinating
agents to pH 7.5–8.5 does the solution become sporicidal.
 Once activated, these solutions have a shelf life of minimally
14 days.
When to use what??
Classification system:
 Critical Items: confer a high risk for infection if they are
contaminated with any microorganism.
 They enter sterile tissue or the vascular system must be
sterile because any microbial contamination could transmit
disease.
 This category includes surgical instruments, cardiac and
urinary
 catheters, implants, and ultrasound probes used in sterile
body cavities.
Classification system
 Most of the items in this category should be purchased as
sterile or be sterilized with steam if possible. Heat-sensitive
objects can be treated hydrogen peroxide gas plasma; or if
other methods are unsuitable, by liquid chemical sterilants.
Germicides categorized as chemical sterilants eg. 2.4%
glutaraldehyde-based formulations.
Classification system
 Semicritical Items: come in contact with mucous membranes or
nonintact skin. Eg.respiratory therapy and anesthesia equipment, some
endoscopes, laryngoscope blades, cystoscopes etc.
 These medical devices should be free from all microorganisms; however,
small numbers of bacterial spores are permissible.
 Intact mucous membranes, such as those of the lungs and the
gastrointestinal tract, generally are resistant to infection by common
bacterial spores but susceptible to other organisms eg. bacteria,
mycobacteria, and viruses.
 Semicritical items minimally require high-level disinfection using
chemical disinfectants. Eg.Glutaraldehyde
Classification system
 Noncritical Items: are those that come in contact with
intact skin but not mucous membranes.
 Noncritical items are divided into noncritical patient care
items and noncritical environmental surfaces. Examples of
noncritical patient-care items are bedpans, blood pressure
cuffs, crutches etc.
 In contrast to critical and some semicritical items, most
noncritical reusable items may be decontaminated where
they are used and do not need to be transported to a central
processing area.
Waste Management
 See UHWI policy Infection control policy (2007).
Bibliography
 CDC guidelines for disinfection and sterilization in
healthcare facilities (2008)