Antoinette Barton-Gooden Patient and Health Care worker Safety

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)