1 Prevention of Nosocomial Infection PharMed Parto Co.,Ltd. Atrineh Saziba Co., Ltd Dr. Farzan Ravanasa

2 Our Ultimate Aim / Take Home Message To inform you that staff safety and patient safety are no longer mutually exclusive Yesterday’s thinking Today’s thinking Tomorrow’s thinking (congruent thinking) PATIENT SAFETY STAFF SAFETY PATIENT SAFETY STAFF SAFETY PATIENT SAFETY STAFF SAFETY FOR ALL

3 Methods of Decontamination depends mainly on the type of material, the level of decontamination and the microorganisms involved Cleaning: ◦ allows the physical removal of microorganisms ◦ allows prevents inactivation of the disinfectant by organic matter ◦ complete surface contact during further decontamination procedure  Through cleaning of items is a prerequisite before disinfection and sterilization is commenced Disinfection: ◦ by heat or chemicals will destroy microorganism but not bacterial spores ◦ chemical disinfection does not necessarily kill all microorganisms present but reduces them to a level not harmful to health Antiseptics: ◦ the agents must have effective antimicrobial activity ◦ must not be toxic to living tissues ◦ chemicals used to kill microorganisms on skin or living tissue Sterilization: ◦ a process which achieves the complete destruction or removal of all microorganisms, including bacterial spores

4 Spaulding classification of chemical disinfectants Level of disinfection SporesTB Vegetati ve bacteria Fungi Nonlipid & small viruses Lipid & medium- size viruses High+ *+++++ Inter- mediate -++++/-+ Low--++/- + * high-level disinfectants may not be able to kill large numbers of spores

5 Class of item Use of itemExample Decont. level needed Critical Enter vascular system or sterile body tissues Hypodermic needle, Scalpels and other surgical instruments, Biopsy forceps Sterilization Semi- critical Comes in contact with intact mucous membranes Vaginal spec., Anaesthetic equipment, flex. Endoscopes High-level disinfection (by heat or chemicals) Non- critical Touches only intact skin Blood pressure cuff, Baby weigh scale, Examining table top Intermediate- level or low- level disinfection Spaulding classification of medical devices

6 Using Deconta- minating Cleaning Sterilizing Sorting / Packing Disinfecting Instrument Cycle

7 Disinfectant Classes : -Aldehydes or Aldehyde releasing agents : Glutaraldehyde(Cidex),Formaldehyde - Alcohols : ethanol,n-propanol,isopropanol - Alkylamines or Alkylamine derivatives -Chloramides or Chlorine releasing agents : Hypochlorite sodium(Vitex), Halamid - Guanidine or Guanidine derivatives - Heavy metal compounds Silver compounds - Organic acids : Peracetic acid,Salicilic acid,Acetic acids - Inorganic acids : HCl - Peroxide compounds : Hydrogen peroxide - Phenols and phenol derivatives : Chlorhexidine,Chloroxylenol(Dettol),Triclosan -Quternary ammonium compounds : Benzalkanium Chloride,deconex ® and micro 10,…

8 Cleaning and Disinfection Automated procedure (chemical and thermal) - instrument washer – disinfector - Washer – disinfector for anesthetic and respiratory equipment - Bed pan and urinal washer – disinfector Manual procedure - precleaning - soaking - brushing - rinsing - drying

9 Method of Sterilization Dry heat sterilization: Oven 170°C for 2h Moist heat sterilization:  Autoclaving at °C for 3 min  Autoclaving at °C for 15 min  Autoclaving at 115°C for 30 min Chemical sterilization :Aldehide compound, Peracetic acid Ethylene oxide Gamma or UV way Prion sterilization:  Autoclaving at 134°C for ≥ 18 min  Soaking in 1 N NAOH for 1 h

10 Standard Precautions 1- Hand Hygiene - Hand Washing (plain soap) - Antiseptic hand rub Alcohol-based hand rub 1- Liquid 2- Gel - Surgical hand antisepsis 1- Betadin or Chlorhexidine 4% 2- Alcohol-based hand rub

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13 2- Gloves - Anti bacterial gloves(Nano silver) - Preventive needle stick gloves - Latex or Latex-free gloves 3- Masks - Anti bacterial Masks(Nano silver) - N95 4- Shields or Eye protectors

14 5- Devives for prevention of Needle Sticks & Sharps Injuries $1.8 billion is spent annually in the US to treat worker who have actually contracted viruses from needle-sticks. Between US$600 and US$4000 per incident (not including cost of microsurgery, rehabilitation and litigation) Healthcare workers in the United States report between 600,000 and 1 million sharps injuries per year 70% of sharps injuries go unreported 41% of sharp injuries occur after use and prior to disposal of a sharp device Real chance of acquiring HIV through occupational exposures but the risk of acquiring and dying from Hepatitis B is much greater. Scalpel blade injuries are in the top five common type of sharps injury and second only to needle-stick 7-11% of sharps injuries are caused by scalpel blades

15 Infection Rates The chances of infection rates from a single contaminated needlestick or sharp instrument injury are as follows: ◦ HIV at 0.2% to 0.5%  Currently there is no vaccine or treatment available to either prevent or cure HIV ◦ HBV at 30% (Hepatitis B)  Post-exposure prophylaxis with hepatitis B immunoglobulin and initiation of hepatitis B vaccine is highly effective in preventing infection ◦ HCV at 3% to 10% (Hepatitis C)  Currently no vaccines or cures for HCV and neither immunoglobulin nor antiviral therapy is recommended as post-exposure prophylaxis  Of those infected with HCV, 85% develop an infection, 70% of whom develop liver disease which often leads to cirrhosis and liver transplants Culver, J. (1997). "Preventing transmission of blood-borne pathogens: a compelling argument for effective device-selection strategies." Am J Infect Control 25(5):

16 Standards for scalpel blade removal Single- handed Device  Re- sheathing  Forceps  Hand Extracted from the AS/NZ Standards pages 6 & 7.

17 New Product Range FLASK CASSETTE 3in1 Non Sterile Sterile

18 Snapit

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