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Healthcare Associated Infection Control and Biocides
Najat Rashid, Ramnik Sood
CHAPTER 1:
Standard Precautions
PURPOSE
TARGET POPULATION
MANAGERS OF HEALTHCARE FACILITIES
INFECTION CONTROL COMMITTEE (ICC)
INFECTION CONTROL TEAM (ICT)
ICT Member Responsibilities
IC Standard Precautions
Interventions and Practices Considered
Facility Design and Planning should Ensure
ENVIRONMENT
Transport
Ventilation
Operating Room
Special Air Handling for Airborne Precautions
PROTECTIVE ENVIRONMENT
WATER
ROUTINE CLEANING
WASTE MANAGEMENT
PRECAUTIONS ACCORDING TO THE TRANSMISSION RISK
Airborne Transmission
Droplet Transmission
Contact Transmission
INFECTIOUS AGENT
Sources of Infection
Reservoirs
Portal of Exit
Means of Transmission
Portal of Entry
A Susceptible Host
Major Outcomes Considered
CHAPTER 2:
Handwash
SUBSTANCES USED
Soaps and Detergents
Water Temperature
Antibacterial Soap
TECHNIQUES
Soap and Water
Solid Soap
Hand Antiseptics
Handwashing with Wipes
Effectiveness
Drying
INFECTION CONTROL TIPS ON HAND WASHING
Handwashing is Recommended
Procedure
Washing with Liquid Soap and Water
Surgical Handwashing
Method of Washing
Method of Applying an Alcohol Handrub
Handwashing Equipment
How to Perform Handwashing (Fig. 2.6)
Improper Handwashing
CHAPTER 3:
Antimicrobial Prophylaxis in Surgery
PURPOSE
ETIOLOGY OF SURGICAL SITE INFECTIONS
Risk of Infection
Patient and Operation Factors
Anesthetic Factors
Wound Status
Risk Factors that Increase the Rate of SSI
Common Surgical Pathogens
PROPHYLACTIC ANTIBIOTICS ADMINISTRATION
Timing of Initial Dose
Dosing
Duration
Additional Intraoperative doses
Postoperative Antibiotic Prophylaxis
Procedure
Recommendation
PREVENTION OF SSI
CHAPTER 4:
Central Venous Catheter Insertion
PURPOSE
EQUIPMENTS
For Insertion (Fig. 4.1)
For Maintenance of Ports
For Administration of Medications/Fluid/ Blood Products
For Dressing Change
For Tubing Change
For Blood Sampling
For Central Venous Pressure Measurement
For Removal of Catheter
INSERTION
TYPES OF CENTRAL VENOUS CATHETERS
Type of CVC Inserted Depends on the
Standard Precautions
PREPROCEDURE
PROCEDURE
Insertion of Catheter
Maintenance of Heparin Lock
Administration of Medications/Fluid/ Blood Products
Tubing and Infusion Plug Change
Dressing Change
Blood Sampling
CVP Measurement using Water Manometer
CVC Removal
COMPLICATIONS OF CENTRAL VENOUS THERAPY
If Catheter is Disconnected
CENTRAL VENOUS CATHETERS (CVC) AND HEALTHCARE-ASSOCIATED INFECTION (HAI)
Equipment
Aseptic Technique
Either
Cutaneous Antisepsis
Catheter Site Care
Accessing CVC
Dressing Change
CHAPTER 5:
Healthcare-associated Pneumonia
PROPOSED STRATEGIES TO PREVENT PULMONARY NOSOCOMIAL INFECTIONS
Prevention of Colonization
Prevention of Person-to-person Transmission of Bacteria Hygiene
Standard Precautions
Sterilization or Disinfection and Maintenance of Equipment and Devices
General Measures
Mechanical Ventilators
BREATHING CIRCUITS, HUMIDIFIERS, HEAT AND MOISTURE EXCHANGERS
Breathing Circuits with Humidifiers
Ventilator Breathing Circuits with HMEs
Oxygen Humidifiers
Small-volume Medication Nebulizers: In-line and Hand-held Nebulizers
Mist Tents
Other Devices Used in Association with Respiratory Therapy
Anesthesia Machines and Breathing Systems or Patient Circuits
Pulmonary-function Testing Equipment
Room-air “Humidifiers” and Faucet Aerators
Care of Patients with Tracheostomy
Suctioning of Respiratory Tract Secretions
Precautions for Prevention of Aspiration while Removing Devices
Prevention of Aspiration Associated with Enteral Feeding
Prevention or Modulation of Oropharyngeal Colonization
Prevention of Gastric Colonization
Prevention of Postoperative Pneumonia
Other Prophylactic Procedures for Pneumonia
Prevention and Control of HA Legionnaires Disease
Routine Culturing of Water Systems for Legionella spp
Care of Medical Devices, Equipment, and Environment
Nebulizers and Other Devices
Cooling Towers
Water-distribution System
Inappropriate Antibiotic Therapy
Excessive Sedation Avoidance
Semirecumbent Position
Enhancement of Host Defence by Cytokines Administration
Prevention and Control Hospital Acquired (HA) Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus Infections
Prevention and Control of HA Influenza
When a Facility Outbreak of Influenza is Suspected or Recognized
Staff Education and Involvement in Infection Prevention
Infection and Microbiologic Surveillance
CHAPTER 6:
Endotracheal Tube Insertion
TYPES OF TRACHEAL TUBE
PURPOSE
ADVANTAGES OF ENDOTRACHEAL INTUBATION
DISADVANTAGES OF ENDOTRACHEAL INTUBATION
EQUIPMENTS
Standard Precautions
PROCEDURES
Auscultating for Bilateral Breath Sounds
Removal of Endotracheal Tube
RISK FACTORS
VENTILATOR-ASSOCIATED PNEUMONIA (VAP)
Diagnosis
Microbiology
Prevention
INFECTION CONTROL GUIDANCE
CHAPTER 7:
Oropharyngeal and Nasopharyngeal Suctioning
PURPOSE
EQUIPMENTS
STANDARD PRECAUTIONS
PROCEDURE
Presuctioning Technique
Suction of the Nasopharynx and Nostrils
Suction of the Oropharynx and Mouth
CHAPTER 8:
Oxygen Administration
PURPOSE
TYPE OF OXYGEN SYSTEM
Methods of Administration
EQUIPMENTS
Standard Precautions
Procedure
Equipment and Accessories Cleaning and Sterilization
CHAPTER 9:
Care of Endoscopy
PURPOSE
TYPES OF ENDOSCOPY
COMPLICATIONS
Responsibility
Standard Precautions
PATIENT PREPARATION AND PROCEDURE
Gastroscopy
Colonoscopy
Sigmoidoscopy
Flexible Sigmoidoscopy
Rigid Sigmoidoscopy
Bronchoscopy
Cystoscopy
Blue Light Cystoscopy
ENDOSCOPY AND HEALTHCARE-ASSOCIATED INFECTION
Cleaning Process
Mechanical Cleaning
Between Cases
Disinfection
Accessories
CHAPTER 10:
Care of Laryngoscope
PURPOSE
GENERAL REQUIREMENTS
Standard Precautions
PREPROCEDURE
FLEXIBLE LARYNGOSCOPY
RIGID LARYNGOSCOPY
LARYNGOSCOPE AND HEALTHCARE-ASSOCIATED INFECTION
Cleaning and Sterilization of Laryngoscope
CHAPTER 11:
Nebulization Therapy
PURPOSE
TYPES OF NEBULIZERS
Equipments
Standard Precautions
PROCEDURE
For a Small Volume Nebulizer
For a Large Volume Nebulizer
NEBULIZER AND HEALTHCARE-ASSOCIATED INFECTION
CARE OF THE COMPRESSOR
DOCUMENTATION
CHAPTER 12:
Tube Feeding Care
PURPOSE
TYPES OF FEEDING TUBES
Nasogastric Tube
Nasojejunal Tube
Gastrostomy or Gastric Feeding Tube
Gastrojejunostomy Feeding Tube
Jejunostomy Feeding Tube
PRELIMINARY ASSESSMENT
Preparation of Patient and Unit
EQUIPMENTS
Standard Precautions
PROCEDURE
For NG Insertion of Tube
For NG Feeding
Aftercare of the Patient and Articles
For Removal of NG Tube
Note:
Gastrostomy Tube Feeding
Aftercare
Risk
HEALTHCARE-ASSOCIATED INFECTION IN TUBE FEEDING
Education
Preparation and Storage of Feeds
Administration of Feeds
Flushing the Feeding Tube
Care of the Insertion Site
CHAPTER 13:
Blood Collection
VENIPUNCTURE
EQUIPMENTS (FIG. 13.1)
STANDARD PRECAUTIONS
PREPROCEDURE
Techniques to Prevent Hemolysis
Risks
Venipuncture and Healthcare-associated Infection
Trouble Shooting Hints for Blood collection
FINGERSTICK
HEELSTICK PROCEDURE (INFANTS)
CAPILLARY BLOOD COLLECTION
Blood Culture Collection
Equipment (Fig. 13.6)
Procedure (Fig. 13.6)
CHAPTER 14:
Lumbar Puncture/Spinal Tap
PURPOSE
EQUIPMENTS (FIG. 14.2)
Standard precautions
PREPROCEDURE
PROCEDURE
POSTPROCEDURE CARE
PUNCTURE SITE
RISKS OF THE PROCEDURE
LUMBAR PUNCTURE AND HEALTHCARE-ASSOCIATED INFECTION
CHAPTER 15:
Bone Marrow Aspiration and Biopsy
PURPOSE
EQUIPMENT (FIG. 15.2)
Standard Precautions
PREPROCEDURE
PROCEDURE
MARROW ASPIRATION FROM THE STERNUM
RISKS
CHAPTER 16:
Hemodialysis Care
PURPOSE
TYPES OF HEMODIALYSIS
Conventional Hemodialysis
Daily Hemodialysis
Nocturnal Hemodialysis
EQUIPMENT AND SUPPLIES
STANDARD PRECAUTIONS
PREPROCEDURE
Preparations for Hemodialysis
Caring for the Access
PROCEDURE
Predialysis
Dialysis
Post-dialysis
Post-dialysis Washout
RISKS
HEMODIALYSIS AND HEALTHCARE-ASSOCIATED INFECTION
Standard Precautions
Equipment, Supplies and Environmental Surfaces
Sterilization, Disinfection and Cleaning
Internal Pathways of Hemodialysis Machines
Pressure Transducer Filter Protectors
Routine Laboratory Testing
Hepatitis B Vaccination
Training and Education
CHAPTER 17:
Urinary Catheterization
CATHETER TYPES
SEX DIFFERENCES
CATHETER MAINTENANCE
EFFECTS OF LONG-TERM USE
COMBATING INFECTION
PURPOSE
Standard Precautions
PROCEDURE
Emptying the Drainage Bag
APPLICATION OF CONDOM DRAINAGE
OBSERVATION
RECORDING
CHAPTER 18:
Urine Collection for Culture and Sensitivity in Catheterization Patients
PURPOSE
URINE SAMPLES
ASEPTIC TECHNIQUE
EQUIPMENT REQUIRED
STANDARD PRECAUTIONS
PROCEDURE
PRECAUTION
PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
Also consider
CHAPTER 19:
Care of Medical Dressing
PURPOSE
TYPES OF DRESSING
EQUIPMENTS
STANDARD PRECAUTIONS
PREPROCEDURE
PROCEDURE
PREVENTION AND MANAGEMENT OF WOUND INFECTION
To Prevent Wound Infection
Protocol 1: Wound Toilet and Surgical Debridement
Protocol 2: Management of Tetanus-Prone Wounds
Tetanus Vaccine
Tetanus Immune Globulin (TIG)
Adult and Children
Protocol 3: Antibiotic Prophylaxis and Treatment
Antibiotic Prophylaxis
DOCUMENTATION
CHAPTER 20:
Prevention of Tuberculosis
PURPOSE
INFECTIOUSNESS
LATENT TUBERCULOSIS INFECTION (LTBI)
ACTIVE TUBERCULOSIS DISEASE
Risk Factors for Active TB Disease in Persons with LTBI
Symptoms of Active Pulmonary TB Disease
Tuberculosis Diagnostic Tool
TB AND INFECTION CONTROL PLAN
Administrative Measures
Engineering Controls
Use of Respiratory Protective Equipment
Patient Criteria for Negative Pressure Rooms Admission
Patient Criteria for Negative Pressure Rooms Discontinuing
Negative Pressure TB Isolation Room
Healthcare Workers TB Screening
Baseline TB Screening Consists of Two Components
Serial TB Screening for HCWs
HCWs with Signs or Symptoms of Active TB Disease
Personal Protective Equipment
Infection Control Team (ICT)
CHAPTER 21:
Healthcare-associated and Community-acquired Methicillin-resistant Staphylococcus aureus
DEFINITION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
IDENTIFICATION
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ORIGIN
MRSA RISK FACTORS
AT HOSPITAL CARE
COMMUNITY-ASSOCIATED MRSA
HOW DOES MRSA SPREAD?
MRSA SYMPTOMS
MRSA DIAGNOSIS
MRSA TREATMENT
Home treatment
HOSPITAL TREATMENT
HOSPITAL ADMISSION
Admission Rationale
Room Assignment
MRSA CONTROL
Also consider
MRSA PREVENTION
Prevention in the hospital
Prevention in the community
NURSING MEASURES
HOSPITAL DISCHARGE
DISCHARGE TO HOME
CARE FOR FAMILY MEMBERS OF INFECTED PERSON
CHAPTER 22:
Prevention of Meningococcal Meningitis
EXPOSURE
APPLICABILITY
PURPOSE
PREPLACEMENT
VACCINE
Type of vaccine
ANTIBIOTIC CHEMOPROPHYLAXIS
Whom to give prophylaxis
Procedure for the institution of prophylaxis
CHAPTER 23:
Protocol for Vancomycin-resistant Enterococcus
CAUSES
RISK FACTORS
SYMPTOMS
PATIENT PLACEMENT
TREATMENT
STANDARD PRECAUTIONS
RISK ASSESSMENT
RISK FACTORS FOR ACQUISITION (COLONIZATION OR INFECTION)
RISK FACTORS FOR TRANSMISSION
ROUTINE ENVIRONMENTAL AND EQUIPMENT CLEANING
PROCEDURE
SURVEILLANCE AND NOTIFICATION
Fecal specimen
Perianal or rectal swabs
OUTBREAK MANAGEMENT
CHAPTER 24:
Intramuscular Injection
SITES
Deltoid muscle
Vastus lateralis muscle
Ventrogluteal muscle
PURPOSE
EQUIPMENTS
STANDARD PRECAUTIONS
General safety practices
Perform hand hygiene before
Perform hand hygiene after
PREPROCEDURE
PROCEDURE
Aftercare
COMPLICATIONS
DOCUMENTATION
CHAPTER 25:
Intravenous Cannula
INDICATIONS AND SITES
STANDARD PRECAUTIONS
PROCEDURE IN INTRAVENOUS INSERTION
MAINTENANCE OF INTRAVENOUS LINES
ADDING ADDITIVES TO THE INTRAVENOUS FLUID
CHAPTER 26:
Blood Transfusion
PURPOSE
BLOOD PRODUCT
EQUIPMENT AND SUPPLIES
Blood Unit or Blood Components
Intravenous Solutions
Component Infusion Sets Leukocyte-Reduction Filters
Pressure Infusion Devices
Blood Warmers
STANDARD PRECAUTIONS
Preprocedure
IDENTITY CHECK OF PATIENT AND BLOOD/BLOOD PRODUCTS
Collection of Blood and Blood Products
Prior to Administration of Blood and Blood Products
Administration of Blood and Blood Products
Rapid Infusion and Blood Warmers
Following Administration of Blood and Blood Products
THE HOSPITAL TRANSFUSION COMMITTEE
BLOOD TRANSFUSION AND HEALTHCARE-ASSOCIATED INFECTION
SCREENING DONATED BLOOD
CHAPTER 27:
Administration of a Medicine
BIOAVAILABILITY OF THE DRUG
ROUTES OF ADMINISTRATION
Oral Administration
Sublingual
Rectal administration
Topical Administration
Parenteral Administration
Intramuscular and Subcutaneous Injection
Intravenous Injection
Administration of Drugs via Enteral Feeding Tubes
DRUG IDENTIFICATION
SAFETY MEASURES
DOSE
ESSENTIALS OF MEDICATION ORDER
FACTORS WHICH MODIFY THE DOSAGE OF THE DRUG (TABLES 27.1 TO 27.4)
DRUG AND FLUID CALCULATIONS
CALCULATION OF IV INFUSION FLOW RATE/DROP RATE
GOOD PRACTICE IN CALCULATIONS
GENERAL SAFETY PRECAUTIONS FOR THE PREPARATION AND STORAGE OF MEDICATIONS
GUIDANCE FOR PRACTICE OF ADMINISTRATION OF MEDICINES
WHEN TO DISCARD MEDICATIONS
STORAGE OF MEDICINES IN THE WARD/DEPARTMENT
STORAGE OF MEDICINES AND MANAGEMENT
MEDICATION ADMINISTRATION AND HEALTHCARE-ASSOCIATED INFECTIONS
DOCUMENTATION
CHAPTER 28:
Eye Care
PURPOSE
EQUIPMENTS
STANDARD PRECAUTIONS
TYPES OF EYE INJURIES
Foreign Bodies
Procedure
BLEPHARITIS
Type of Blepharitis
Procedure
To clean eyelids
STYE
Chemical Injuries
EYE CARE GENERAL PROCEDURES
Eye Swabbing
Equipment
Standard Precautions
Procedure
Eye Irrigation
Equipments Required
Standard Precautions
Procedure
Instillation of Eyedrops
Equipment
Standard Precautions
Procedure
Instillation of Eye Ointments
Equipment
Standard Precautions
Procedure
Eye Compress
Cold Compress (Fig. 28.11)
Warm Compress
CONTACT LENS CARE
Equipment
Procedure
Inserting Rigid Lenses
Removing Rigid Lenses
Inserting Soft Lenses
Procedure
Removing Soft Lenses
Cleaning Lenses
Special Consideration
TYPES OF OVER THE COUNTER (OTC) EYE CARE PRODUCTS
CHAPTER 29:
Care of Preterm Baby
EQUIPMENT
Standard Precautions
Bilirubin lights
ECG and Blood Pressure Monitor
Cardiopulmonary Monitor
Central Line
C-PAP (Continuous Positive Airway Pressure)
Endotracheal Tube
Incubator
Intravenous Line
Mechanical Ventilator
Nasal Cannula Or Nasal Prongs
Oxygen Hood
Pulse Oximeter
Radiant Warmer
Scanners
Umbilical Catheter
Management (Fig. 29.3)
MONITORING
General Routine Assessment
Respiratory Assessment
Transitional (first 6–12 hours after birth) and ongoing Assessment and Care
Evaluation: Prior to NICU Discharge
Evaluation: Outpatient
PRETERM BABY AND INFECTION
NEONATAL INTENSIVE CARE UNIT AND HEALTHCARE-ASSOCIATED INFECTIONS
HAND HYGIENE
HAND WASHING PROCEDURE
PROCEDURE OF HAND HYGIENE WITH ALCOHOL-BASED HAND RUBS
GUIDELINES FOR THE PREVENTION OF INTRAVASCULAR CATHETER-RELATED INFECTIONS
GUIDELINES FOR THE PREVENTION OF MECHANICAL VENTILATOR-RELATED INFECTIONS
CHAPTER 30:
Neonatal Phototherapy
TYPES OF NEONATAL PHOTOTHERAPY
PURPOSE
INDICATIONS
Preterm Infant
Term Infant
EQUIPMENT
Standard Precautions
PREPARATION OF EQUIPMENT
PROCEDURE
MONITORING: DURING INTENSIVE PHOTOTHERAPY IN HOSPITAL
CONTRAINDICATIONS
MECHANISM
TECHNIQUE
ADVERSE EFFECTS
DOCUMENTATION
CHAPTER 31:
Defibrillation
PURPOSE
EQUIPMENTS
Standard Precautions
CONTRAINDICATIONS
PROCEDURE
Paddle Placement
Lead Placement
Electrode Pad Placement
Assess Rhythm to Confirm VF/VT
AFTERCARE
COMPLICATIONS, PREVENTION AND MANAGEMENT
DOCUMENTATION
POINTS TO BE CONSIDERED
CHAPTER 32:
Care of Blood Pressure
PURPOSE
Standard Precautions
PREPROCEDURE
Position of the Subject
Position of the Arm
PROCEDURE
Ambulatory Blood Pressure Monitoring
BLOOD PRESSURE APPARATUS AND HEALTHCARE-ASSOCIATED INFECTION
Cleaning, Disinfection and Sterilization of the cuff
SINGLE PATIENT CUFFS BARRIERS
Disposable Single-patient BP Cuffs
CHAPTER 33:
Care of Bedpan
PURPOSE
RESPONSIBILITY
TYPES OF BEDPAN
Regular Bedpan
Fracture or Slipper Bedpan
Urinals
Variations
EQUIPMENTS
Standard Precautions
PROCEDURE
Urinal
Bedpan
CHAPTER 34:
Enema
PURPOSE
CONTRAINDICATIONS OF ADMINISTERING ENEMAS
TYPES OF ENEMAS
EQUIPMENTS (FIG. 34.1)
Standard Precautions
PREPROCEDURE
PROCEDURE
Preparation (Tables 34.1 and 34.2)
RISK
CHAPTER 35:
Care of Perineum
PURPOSE
EQUIPMENTS
Standard Precautions
PREPROCEDURE
PROCEDURE
Perineal Care for the Female Patient
Perineal Care for the Male Patient
AFTER PROVIDING PERINEAL CARE
SPECIAL CONSIDERATIONS
CHAPTER 36:
Bed Bath
PURPOSES
EQUIPMENTS
Standard Precautions
PREPROCEDURE
SPECIAL CONSIDERATIONS
PROCEDURE
AFTERCARE
BED BATH AND HEALTHCARE-ASSOCIATED INFECTIONS
CHAPTER 37:
Sitz Bath
PURPOSE
EQUIPMENTS (FIG. 37.1)
Standard Precautions
PREPROCEDURE
PROCEDURE
SPECIAL CONSIDERATION
SITZ BATH AND HAI
CHAPTER 38:
Baby Bath
PURPOSE
EQUIPMENT
Standard Precautions
GENERAL RULES
PROCEDURE
SPONGE BATH
PORTABLE TUB OR SINK BATH
CHAPTER 39:
Surgical Hair Removal
PURPOSE
RESPONSIBILITY
Standard Precautions
PROCEDURE
SHAVING OF PARTS
CRITERIA OF ANTI-MICROBIAL AGENTS
CRITERIA OF SKIN PREPARATION
CHAPTER 40:
Mouth Care
PURPOSE
EQUIPMENTS
Standard Precautions
PROCEDURE
DENTURE CARE
GUM CARE
TONGUE CLEANING
CHAPTER 41:
Hot Water Bag
PURPOSE
EQUIPMENTS
Standard Precautions
PREPROCEDURE
PROCEDURE
AFTERCARE OF THE PATIENT
Observation
DOCUMENTATION
CHAPTER 42:
Operating Room Sanitation
PURPOSE
OPERATING ROOM EQUIPMENTS
OPERATING MICROSCOPES
Tips to Increase the Life of the Microscope
Preparation of the Microscope for the Surgical Use
SURGICAL PROTECTIVE CLOTHING
OPERATING ROOM SANITATIONS
Standard Precautions
Routine Cleaning
Before Surgery is Begun
Cleaning During Procedures
Between Cases (Following Each Operation)
At the End of the Day's Schedule
Remove Soiled Linen from
Remove Trash and Debris
Clean Overhead lights
Clean the Operating Room Table
Clean Operating Room Furnishings
Clean Operating Room Walls
Clean Operating Room Floor
Arrange Operating Room Furnishings
Inspect for Cleaning Errors
Weekly Cleaning and Checking
Surgical Environments
Temperature and Humidity
Ventilation Systems Air Condition Grills
CHAPTER 43:
Infection Control Practices and Precaution in Operating Room
OPERATING ROOM ENVIRONMENTAL MONITORING
Operating Room Personnel
Sterile Surgical Drapes
Sterile Items within a Sterile Field
A Sterile Field Monitoring
HANDWASHING (OR USING AN ANTISEPTIC HAND RUB)
Barrier protection
Gloves
Masks, Goggles, Face Masks
Gowns
Minimizing Potential Exposure
Elimination of Needle Stick Injuries
Elimination of Other Penetrating Injuries
STERILIZATION METHOD IN OPERATING ROOM
Steam Sterilization
Types of steam sterilizers
Ethylene Oxide (Gas) Sterilization
Ionizing Radiation Sterilization
Cold Chemical Sterilization
WRAPPING GOOD FOR STERILIZATION
Fabric Wrappers
Paper and Unwoven Fabrics
PACKAGES IDENTIFICATIONS
STORAGE AND HANDLING OF STERILE SUPPLIES
Shelf Life
WRAPPED ITEMS SELF-LIFE (UNDER IDEAL CONDITIONS)
OPERATING ROOM WASTE DISPOSAL
ASPECTS OF WASTE MANAGEMENT
CHAPTER 44:
Ward Cleaning
DEFINITIONS
Cleaning
Disinfection
High Level Disinfection
Sterilization
Decontamination
PURPOSE
RESPONSIBILITIES
GENERAL CLEANING REGULATION
HOSPITAL FUNCTIONAL AREA RISK CATEGORIZATION STATUS
Very High Risk
High Risk
Moderate Risk
Low Risk
CLASSIFICATION OF INFECTION RISK FROM EQUIPMENT OR ENVIRONMENT AND SUGGESTED LEVEL OF DECONTAMINATION
Low Risk
Intermediate Risk
High Risk
CLEANING METHODS
MANUAL CLEANING
ENVIRONMENTAL CLEANING
DISINFECTION
THERMAL METHODS
MOIST HEAT AT 70–100°C
CHEMICAL METHODS
DISINFECTION OF SURFACES
STERILIZATION
STEAM STERILIZATION
Method
DRY HEAT
Method
ETHYLENE OXIDE GAS
STERILIZATION PROCESS
Autoclaving is Preferred
STORAGE
PROTECTION OF STERILE ITEMS AGAINST RECONTAMINATION
Cleaning Element Specifications
EQUIPMENT REQUIRED
Standard Precautions
PATIENT ROOM
PREPROCEDURE
PROCEDURE
Perform High Dusting
Clean Ledges and Sills
Clean and Disinfect Patient Restroom Empty and Line Wastebaskets
Clean the Bed
Clean Furniture
Clean Furnishings
Spot-clean Walls
Dust Mop Floor
Place “Wet Floor” Sign
Wet Mop Floor
Clean Door Hardware and Metal Plates
LAUNDRY SERVICES
SORTING PROCEDURES
WASHING PROCESSES
Fumigation
CHAPTER 45:
Sterilization Process
PURPOSE
Standard Precautions
STERILIZATION CATEGORIES AND METHODS
High Temperature/Pressure Sterilization
Steam Autoclave
Application
Chemical Sterilization
Ethylene Oxide (EtO) GAS
Low Temperature Hydrogen Peroxide Plasma
Glutaraldehyde
Steris System 1 Sterile Processing System
CIDEX OPA Solution: Alternative to Glutaraldehyde
VHP-MD Series
Chlorine Dioxide
Ozone
Radiation sterilization
Gamma, Beta Sterilization
E-beam Radiation
X-ray Sterilization
SAFE USAGE OF AUTOCLAVE
Protocol
Pre-loading
Loading
Opening
Liquids Autoclaving Additional Practices
Dry Loads Autoclaving Additional Practices
Autoclave Loading
Packaging
Autoclave Monitoring
Heat Sensitive Tape Monitoring
Biological Indicators
Procedure
Prepare a Test Pack for Steam Sterilizer Containing (Fig. 45.3)
Autoclave Maintenance
Daily and Weekly Maintenance
Yearly Maintenance
Quality Control
CHAPTER 46:
Sharps Handling
GENERAL PRECUATIONS
STANDARD PRECAUTIONS
PROMPT DISPOSAL
SHARPS CONTAINERS
HANDLING CONTAINERS
CHAPTER 47:
Blood Spill Care
EQUIPMENTS
Clean-up Kit (Fig. 47.1)
Clean-up Materials (Fig. 47.1)
STANDARD PRECAUTIONS
PROCEDURE
CHAPTER 48:
Healthcare Facilities and Waste Management
DEFINITIONS
Biomedical Waste
Medical Waste
Clinical Waste
Hospital Waste
Pathological Waste
Infectious Waste
Hazardous Waste
Radioactive Waste
Pressurized Waste
General Waste
Recyclable Waste
PURPOSE
HEALTH IMPACT
RESPONSIBILITY
EQUIPMENTS
Standard Precautions
WASTE CLASSIFICATION
Non-medical Waste (or non-hazardous waste)
Medical Waste (Hazardous waste)
BIOHAZARD SYMBOL
SEGREGATION AND COLOR CODING OF CLINICAL WASTE
MANAGEMENT OF MEDICAL WASTE STEPS
Handling
Bag Filling
Medical Waste Labeling
Medical Waste Storage
Interim Storage
Characteristics of Medical Waste Storage Areas at Healthcare Facilities
Medical Waste Collection
Requirements for Decontamination of Laboratory Infectious Materials by Autoclaving
Laboratory Head is Responsible for Meeting the following Mandatory Requirements
General Waste Collection Requirements
Medical Waste Transportation
Transport Vehicles and Containers
Medical Waste Treatment
Incineration Treatment
Autoclave treatment
Chemical Disinfection with Grinding Treatment
Mechanical Treatment
Microwave Treatment
Irradiation Treatment
Encapsulation Treatment
Sanitary Landfill or Waste Burial Pit Treatment
MEDICAL WASTE TREATMENT DEVICES
AMB Ecosteryl Device
AMB Ecosteryl Types
Ecosteryl Technology Advantages
Ecosteryl Waste Treatment Process (Fig. 48.4)
Cutting Edge Technology
Ecosteryl Environmental Performance and Control
Ozonator Devices
Ozonator Waste Treatment Process
Environmental
Ease of Operation
CISA Innovative System
System Description
Concept
Drainage Treatment
Vacuum Pump
Machine Construction
Hydraulic System (Fig. 48.11)
LIQUID WASTES: BIOLOGICAL AND CHEMICAL
Liquid Biological Wastes
Liquid Chemical Wastes
Mixtures of Chemical and Biological Liquid Wastes
DISPOSAL OF DENTAL WASTE
Amalgam
Amalgam Separators
Silver
Dental Unused Film
Lead
Dental Used X-ray Fixer
Dental X-ray Film
Lead Foil
Developer
Cleaners for Developer Systems
Traps and Filters
Reusable Traps
Used Linen Management
MANAGEMENT OF REUSABLE INSTRUMENTS
Purchasing Medical Equipment
Selection of Product/Process for Reprocessing
Environmental Issues
Occupational Health and Safety Issues
Transportation and Handling of Contaminated Medical Equipment/ Devices
Disassembling and Cleaning Reusable Medical Equipment
Disinfection of Reusable Medical Equipment
Sterilization of Reusable Medical Instrument
Packaging and Storage of Reprocessed Medical Instrument
Monitoring the Sterilization Process
Preventative Maintenance
HIGH LEVEL DISINFECTION
Purpose
Procedure
COMPRESSED GAS CYLINDERS
Basic Compressed Gas Cylinders Categories
Definitions
Labeling
Gas Cylinders Unique Hazards
General Safety Requirements
Valves and Regulators (Fig. 48.13)
Valve and Regulator Maintenance
Gas Leak Checking
Minor Leaks
Major Leaks
Inspection
Storage Requirements
Disposal Compressed Gas Cylinders
Responsibility of the Users
Transportation of Cylinders
WASTE MANAGEMENT STAFF PROTECTION MEASURES
Primary Prevention
Secondary Prevention
Personal Hygiene
Hand Wash
Vaccination
Staff Training
Waste Management Committee
Waste Management: Reasons for Failure
Steps Towards Improvement
CHAPTER 49:
Hospital Admission and Discharge
PURPOSE
ADMISSION NURSE RESPONSIBILITIES
TYPES OF HOSPITAL ADMISSION
PATIENT RIGHTS AND RESPONSIBILITIES
PREPROCEDURE
PROCEDURE
HOSPITAL DISCHARGE
CHAPTER 50:
Handling Dead Bodies
PRECAUTIONS (WIDELY DISSEMINATED TO ALL STAFF) INVOLVED
GENERAL RECOMMENDATIONS FOR ALL RELATED PERSONS
Vaccination
Personal Protection Equipment and Personal Hygiene
Accidental Exposure to Blood or Body Fluids
Clinical Waste Management
Disinfection of Contaminated Surfaces
WARD STAFF PRECAUTIONS
Dead Bodies Under Category 1
Dead Bodies Under Category 2 or 3
MORTUARY STAFF PRECAUTIONS
Dead Bodies Under Category 1
Dead Bodies Under Category 2
Dead Bodies Under Category 3
Dead Bodies Under Unknown Category
CHAPTER 51:
Protocol for Surveillance of Hospital Acquired Infection
PURPOSE
TYPES OF SURVEILLANCE PROGRAMS
Alert Organism Surveillance
Surveillance Main Methods
Incidence and Prevalence of HAI
Alert Condition Surveillance
Alert Organism Surveillance
Prevalence Surveys
Incidence Surveillance
Numerator Data
Denominator Data (Population at Risk)
SURVEILLANCE DATA COLLECTION AND MANAGEMENT
Epidemiologic Principles should be Applied During HAI Surveillance
Surveillance Data Quality
Outbreak Surveillance
Minimal Requirements for Surveillance
Syndromic Surveillance
Important Concepts of Syndromic Surveillance
CHAPTER 52:
Infection Control Committee and Infection Control Team
COMMITTEE MEMBERS
Responsibilities
INFECTION CONTROL TEAM (ICT)
Committee Members
Responsibilities
CHAPTER 53:
Basic Microbiology and Biocides
MICROORGANISMS
Pathogens
RIGHT BIOCIDE
DISINFECTION
STERILIZATION
BIOCIDES
Disinfectants
Antiseptics
BACTERIA AND ITS STRUCTURE
Bacteria
Structure of a Typical Bacterial Cell
Gram-positive and Gram-negative Bacteria
Acid-fast Bacteria
Aerobic and Anerobic Bacteria/Organisms
Psychrophilic, Mesophilic and Thermophilic Bacteria/Organisms
BIOFILM
FUNGI
Chitin
Types of Fungi
VIRUSES
PROTOZOA
Protozoans are Pathogenic
FEW DISEASES CAUSED BY BACTERIA, FUNGI, VIRUSES AND PROTOZOANS
Prions
DRUG/BIOCIDE RESISTANCE
Reasons for Drug/Biocide Resistance
EFFLUX MECHANISM
TYPES OF BIOCIDES
Alcohols
Mode of Action
Aldehydes
Mode of Action
Biguanides
Mode of Action
Mode of Action
Phenols
Mode of action
Bisphenols
Mode of Action
Halogens
Iodine Compounds
Mode of Action
Heavy Metals
Mode of Action
Peroxygens
Mode of Action
Quaternary Ammonium Compounds
Mode of Action
Action of Different Biocides and Biocides Products (Fig. 53.39)
Areas of Disinfection and Related Bioshields Products
SKIN DISINFECTION
Skin
Infection
Surgical Site Infections (SSI)
Skin Needs to be Disinfected
Transmission of Pathogens
Hand Hygiene
Timings of Hand Hygiene
Hand Hygiene is Also Required
Criteria to Select the Right Antiseptic for Hand Hygiene
BIOSHIELDS
Handrubs
Handwash
Antiseptics
Skin Preparations
ENVIRONMENT AND SURFACE DISINFECTION
Necessity to Sterilize the Operation Theaters (OT)
Classical Methods Generally Used for OT Disinfection
Difficulties Faced in OT Disinfection
ENVIRONMENT AND SURFACE DISINFECTANTS FROM BIOSHIELDS
Aerosept™
Composition
Activity
Benefit
Applications
Usage Directions
Labsafe™
Composition
Benefits
Applications
Usage Directions
Linosafe™
Composition
Benefits
Applications
Usage Directions
Microlyse®
Composition
Contact Time
Applications
Benefits
Usage Directions
Silvicide®
Composition
Contact Time
Benefits
Applications
Usage Directions
Surfax™
Composition
Benefits
Applications
Usage Directions
Totasep™
Composition
Contact Time
Benefits
Applications
Usage Directions
INSTRUMENT DISINFECTION
Spaulding Scheme for Instrument Disinfection
Critical Instruments
Semicritical Instruments
Noncritical Instruments
Acitar™
Composition
Contact Time
Benefits
Applications
Usage Directions
Clenzyme™
Composition
Benefits
Usage Directions
ENDOMAX™
Composition
Activity
Contact Time
Benefits
Applications
Usage Directions
Novacide®
Composition
Contact Time
Benefits
Applications
Usage Directions
Opahyde™
Composition
Applications
Benefits
Usage Directions
RISK AND SAFETY STATEMENTS
ALCOHOLS
Hazards Identification
Safety Measures
Accidental Release Measures
ALDEHYDES (Glutaraldehyde, Orhto-phthalaldehyde, etc.)
Hazard Identification
Safety Measures
Accidental Release Measures
BIGUANIDES (Monomeric: Chlorhexidine Gluconate Solution)
Hazards Identification
Safety Measures
Accidental Release Measures
BIGUANIDES (Polymeric: Polyhexamethylene Biguanide)
Hazard Identification
Safety Measures
Accidental Release Measures
PHENOLS
Hazards Identification
Safety Measures
Accidental Release Measures
Toxicological Information
BISPHENOLS (TRICLOSAN)
Hazards Identification
Safety Measures
Accidental Release Measures
QUATERNARY COMPOUNDS (Benzalkonium Chloride Solution, Didecyldimethyl ammonium chloride, etc.)
Hazards Identification
Safety Measures
Accidental Release Measures
SODIUM HYPOCHLORITE
Hazards Identification
Safety Measures
Accidental Release Measures
Glossary
INDEX
TOC
Index
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