1. HYGIENIC AND PREVENTIVE PROCEDURES Dragica Kopić, MD Department Of Anesthesiology and Intensive Treatment, University Hospital Split, Croatia

2. The principal task of health care institution To provide a good health care service To prevent hospital infection; and To prevent hospital infection transmission and spreading

3. Transmission of infection from patient to health care workers, and the other way around, occurs: By direct contact and touch By fecal - oral transmission (food and drink) By air (inhalation) By blood

4. The infections are caused by: bacteria, viruses, fungi … They are present in: water, air, patient’s environment, and Patient can be a source of infection, too.

5. Asepsis Method we use to control microbes transmission from one place to another, from one patient to the other one, or from patient to health care workers. To achieve asepsis we use: disinfection sterilization

6. Disinfection The process of destroying majority of microorganisms Bacterial spores may survive and contaminate Highly effective disinfectants, acting in prolonged time (6-10 h) can eliminate bacterial spores.

7. Disinfection techniques are applied on: Health care providers’ hands Patients’ skin and mucous membranes Instruments and equipment Working surfaces, floors, walls Air in rooms All patients’ requisites and equipment Patients’ clothes, health care workers clothes and footwear.

8. Self protection measures Regular and proper hand cleaning Appropriate use of protective clothing and footwear Appropriate use of masks and gloves Appropriate handling of sterile materials

9. Hand cleaning This is the most important and the most effective preventive method against spreading microbes between health care workers and patients in the hospital. The basic condition for proper hand hygiene is that nails do not overgrow finger cushion. Jewelry and long artificial nails are strictly prohibited

10. Hand cleaning There are three levels of hand cleaning: – standard, – hygienic disinfection, – surgical disinfection.

11. Standard hand washing Hands have to be cleaned: Before handling food Before meal Before feeding patient After use of bathroom Swab taken of unwashed hands

12. Standard cleaning Hands are washed in hot water and with soap over one minute period. Swab from washed hands

14. Hygienic hand disinfection or antisepsis Before and after dealing with patient Before performing invasive procedure Before and after wound dressing, handling urinary catheters, tubes, iv lines etc. Before and after gloves usage After contact with blood and other patient secretions and excretions After contact with patient with know hospital bacterial colonization

15. Hand disinfection is made in two steps Hygienic hand washing with antiseptic soap over one minute period Hygienic scrubbing with alcohol based antiseptic lasting one minute. Swab after hand desinfection

16. Surgical hand antisepsis Goal of surgical disinfection or antisepsis is to eradicate microbes. Procedure of surgical hand cleaning is in principle the same as hygienic disinfection The difference is in duration of hand washing, surgical one lasts longer, 2-3 minutes, and The are to be washed is larger, includes wrists and forearm Common antiseptic substances are chlorine based antiseptics - chlorhexidine; iodine based and alcohol based ones.

18. Proper hand washing algoritam Scrub palm to palm Apply alcohol antiseptic to the palm

19. Scrub palm to palm with crosed fingers Scrub right palm to left forearm and vice versa Proper hand washing algoritam

20. Hook the fingers of apposite hands with flexed fingers Dry for 20-30 seconds Proper hand washing algoritam

21. Hand disinfection sequence and duration 3 minutes 2 minutes 1 minutes

22. Medical protective clothing and footwear Protective clothing and footwear consist of: caps, masks, protective goggles gloves coats, gowns and operating theatre footwear.

23. Protective clothing and footwear

24. How to glove, One

25. How to glove, Two

26. How to glove, Three

27. How to wear sterile gloves