CHAPTER 6 Microbiology-Related Procedures 6-2

Introduction Medical waste Requires special handling Infectious Non-infectious Requires special handling Proper procedures necessary for obtaining culture from appropriate body site without contamination 6-3

Infectious Waste Disposal Solid or liquid wastes may cause disease if improperly handled, treated, transported, stored, or disposed Examples of waste: body fluid, items coming in contact with body fluids/blood Handle with gloves Place in biohazard container for disposal in sanitary landfill per local/state rules and regulations 6-4

Types of Infectious Waste Non-sharp Biological liquid wastes Pathological wastes Patient care items Sharp Needles or IV tubing with needle attached Scalpel blades Glassware (Continues) 6-5

Types of Infectious Waste Disposal of non-sharp items Wearing gloves, place waste in red infectious waste biohazard bags If bag ¾ full, seal, place in disposal container Discard liquids per local/state Department of Health regulations Place liquids in leakproof container in red infectious biohazard bags Remove gloves/wash hands (Continues) 6-6

Types of Infectious Waste Disposal of sharp items Wearing gloves, place sharps in disposable sharps container located at point of use Never recap needles Seal container when ¾ full Never force instruments into sharps container Never place sharps container in normal waste disposal Wash hands after completing task 6-7

Applying Non-Sterile Disposable Gloves Gloves are not always needed; do not waste/misuse PPE Donning non-sterile gloves Wash and dry hands Remove one glove from box; slide glove onto other hand; with gloved hand, remove another glove and slide onto bare hand Interlace fingers, push down between fingers to ensure proper fit 6-8

Removing Non-Sterile Disposable Gloves Remove immediately after use Grip one glove at base of palm; pull off inside out, place in palm of other glove Slip bare fingers under other glove at wrist Push glove down and off holding first glove inside Place gloves in appropriate receptacle Wash and dry hands 6-9

Applying Sterile Gloves Two methods Open Closed Open (see text for complete instructions) Wash and dry hands before and after gloving Dispose of gloves in appropriate container (Continues) 6-10

Applying Sterile Gloves Closed Allows donning of gloves without possibility of sterile outside of glove touching skin of health care worker Used by personnel who are scrubbed for operating room, or wearing sterile gown for performing of procedure See text for complete instructions of procedure 6-11

Asepsis Absence of microorganisms Two types Medical: reduces number, growth, and spread of microbes Surgical: eliminates microbes/spores from object/area 6-12

Medical Asepsis Includes Hand washing Gloving Changing bed linens daily Cleaning furniture daily Cleaning floor daily 6-13

Surgical Asepsis Surgical hand scrub Sterilization of instruments Surgical attire Proper handling of sterile equipment/ instruments Establishing/maintaining sterile field Used for: OR, delivery room, diagnostic/therapeutic interventions 6-14

Hand Hygiene for Surgical Asepsis Requires careful scrubbing of hands, nails, wrists, forearms before donning sterile gloves Requires 3- to 6-minute scrub Since skin is not sterile, donning of sterile gloves is required to obtain/maintain sterility of field Refer to text for specific instructions 6-15

Sterile Principles Guidelines designed to determine areas and items of sterility and actions that might cause contamination Sterile field may be created by using sterile drapes, gloves, and gowns if procedure is performed in area where sterility is not possible (e.g., insertion of IV at jugular site at bedside) 6-16

Maintenance of Sterile Field Sterile objects must be dry and should not touch non-sterile objects Maintain visual contact with sterile field Items below waist level are considered contaminated See text/tables for specific instructions 6-17

Specimen Collection Use aseptic technique Note date, time, site, antibiotics (if applicable), collection method, possibility of infectious organisms Transport immediately or refrigerate Blood and CSF should be kept at room temperature (Continues) 6-18

Specimen Collection Refer to text for specific information for each type of culture Blood culture Use aseptic phlebotomy procedures Transport to lab immediately or store at room temperature or place in incubator at 35˚C; never refrigerate (Continues) 6-19

Specimen Collection CSF culture Sputum culture Obtained by physician or specially trained personnel only; 8–15 mL of fluid withdrawn; transport immediately Sputum culture Obtain prior to antibiotic regimen; specimen should be expelled after deep cough; transport immediately or refrigerate (Continues) 6-20

Specimen Collection Wound culture Urine specimen Needle aspiration or deep tissue culture is preferred over swab; transport immediately or refrigerate Urine specimen Avoid bacterial contamination from distal urethra; clean-catch specimen, catheterization or suprapubic aspiration; transport immediately or refrigerate (Continues) 6-21

Specimen Collection Stool specimen Throat culture Best performed on fresh specimen May use transport medium Transport immediately or refrigerate Throat culture Use sterile swab Do not touch tongue, sides of mouth, or uvula Transport immediately (Continues) 6-22

Specimen Collection Nasal specimen Reminder Use nasal swab Insert at depth of 2–3 cm Transport immediately Reminder Refer to text for specific instructions for each specimen collection Proper specimen collection assists with determination of diagnosis 6-23

Summary Disposal of medical waste, sharps Donning and removal of non-sterile gloves Donning and removal of sterile gloves Gloving does not replace hand washing Obtaining culture specimens using aseptic technique (blood, CSF, sputum, wound, urine, stool, throat, nasal) (Continues) 6-24

Summary Proper transportation/storage of specimens Asepsis (medical/surgical) Maintaining sterile field Specimen collection Refer to textbook for specific instructions concerning obtaining specimens for each type of culture 6-25