5.5 Sterilization
5.5.1 Sterilisation process
Sterilization refers
to the process of eliminating or killing all forms of microorganisms, including
bacteria, viruses, fungi, and spores. It is commonly used in various fields,
such as healthcare, food production, and laboratory settings, to ensure that
objects, surfaces, or substances are free from any viable microorganisms that
could cause contamination or infection.
There are different
methods of sterilization, each with its own set of advantages, disadvantages,
and appropriate applications. Here are some commonly used
sterilization methods:
1.
Heat
Sterilization: Heat can be used to sterilize objects by denaturing the proteins
and enzymes of microorganisms. The two primary methods of heat
sterilization are:
·
Dry
Heat: This method involves using hot air or an open flame to raise the
temperature and achieve sterilization. It is suitable for materials that can
withstand high temperatures, such as glassware and metal instruments.
·
Moist
Heat: Moist heat, typically in the form of steam under pressure, is used to
achieve sterilization. Autoclaving, which involves subjecting objects to
high-pressure steam at around 121°C (250°F), is the most common moist heat
sterilization method.
2.
Chemical
Sterilization: Some chemicals can be used to sterilize objects by disrupting
the metabolic processes or damaging the genetic material of microorganisms.
Examples of chemical sterilization agents include ethylene oxide and hydrogen
peroxide plasma. This method is often used for heat-sensitive materials or
equipment.
3.
Radiation
Sterilization: Ionizing radiation, such as gamma rays, X-rays, or electron
beams, can be used to sterilize objects. The radiation damages the DNA or
cellular structures of microorganisms, rendering them unable to reproduce. This
method is commonly used for medical supplies, pharmaceuticals, and certain food
products.
4.
Filtration:
Sterilization through filtration involves passing a liquid or gas through a
filter with pore sizes small enough to trap microorganisms. This method is
often used for heat-sensitive liquids, such as vaccines or enzymes, as well as
for sterilizing air and gases.
a)
Hot air sterilization
Hot air
sterilization, also known as dry heat sterilization, is a method of
sterilization that uses hot air to kill microorganisms. It is commonly used for
materials that can withstand high temperatures, such as glassware, metal
instruments, and certain powders.
In the hot air
sterilization process, the items to be sterilized are placed in a specialized
sterilizer or oven and exposed to high temperatures. The typical temperature
range for hot air sterilization is between 160°C and 180°C (320°F to 356°F),
and the sterilization time can vary depending on the material and size of the
objects being sterilized. It may range from 1 to 2 hours or longer.
During the process,
the hot air acts by denaturing proteins and oxidizing microorganisms,
effectively destroying their cellular structure and causing their death. It is
important to ensure that the entire item reaches the desired temperature to
ensure effective sterilization.
Hot air sterilization
has several advantages:
1.
No
need for chemicals: Unlike some other sterilization methods, hot air
sterilization does not require the use of chemicals, making it environmentally
friendly and suitable for materials that cannot tolerate exposure to chemical
sterilants.
2.
Compatibility
with heat-resistant materials: It is particularly suitable for heat-resistant
materials such as glass, metal, and certain powders that can withstand high
temperatures without degradation or loss of functionality.
However, there are
also limitations to hot air sterilization:
1.
Longer
sterilization times: Compared to other sterilization methods, hot air
sterilization typically requires longer sterilization times, especially for
larger or denser objects. This can affect the overall efficiency and turnaround
time in certain settings.
2.
Limited
use for heat-sensitive materials: Heat-sensitive materials, such as plastics or
certain types of medical equipment, may not be suitable for hot air
sterilization due to the high temperatures involved, which can cause damage or
deformation.
b)
Course of steam sterilization
The process of steam
sterilization, also known as autoclaving, involves using high-pressure steam to
eliminate microorganisms and achieve sterilization. It is a widely used method
in various industries, including healthcare, laboratories, and food production.
Here are the main steps involved in the course of steam sterilization:
1.
Preparation:
Before beginning the steam sterilization process, it is essential to ensure
that the items to be sterilized are properly prepared. This includes removing
any visible dirt or debris from the surfaces of the objects and packaging them
appropriately. The packaging materials used should be suitable for steam
sterilization and allow the penetration of steam.
2.
Loading
the sterilizer: Once the items are prepared, they are loaded into the
sterilizer chamber. It is important to arrange the items in a way that allows
proper steam circulation and ensures that all surfaces come into contact with
the steam.
3.
Setting
sterilization parameters: The sterilizer settings, including temperature,
pressure, and sterilization time, are set according to the specific
requirements of the items being sterilized. The temperature typically ranges
between 121°C and 134°C (250°F to 273°F), and the pressure is set to achieve
the desired temperature.
4.
Pre-vacuum
or gravity displacement: In some autoclaves, a pre-vacuum stage is applied
before the steam enters the chamber. This helps to remove air and enhances
steam penetration. Alternatively, in gravity displacement autoclaves, the steam
displaces the air from the chamber through the bottom, ensuring effective
sterilization.
5.
Sterilization
phase: Once the desired temperature and pressure are reached, the sterilization
phase begins. The items are exposed to high-pressure steam for a specified
period, typically ranging from 15 to 30 minutes, depending on the load and
sterilization requirements. The exposure time ensures that the microorganisms
are effectively killed.
6.
Drying
phase: After the sterilization phase, the steam is vented from the chamber, and
a drying phase follows. The drying time can vary but is typically around 15 to
30 minutes. During this phase, the remaining moisture is removed from the
items, preventing the growth of microorganisms.
7.
Cooling:
Once the drying phase is complete, the chamber is allowed to cool down
gradually. This ensures that the items can be safely removed without causing
damage or injury.
8.
Unloading:
After the sterilizer has cooled sufficiently, the items can be safely removed
from the chamber. It is important to handle the sterilized items properly to
maintain their sterility until they are ready for use.
c)
Comparison of the different sterilization
processes
Here's a comparison
of different sterilization processes:
1.
Steam Sterilization (Autoclaving):
· Method:
High-pressure steam
·
Advantages:
Effective sterilization, wide range of applications, suitable for most
materials, no residue from chemical sterilants
·
Disadvantages:
Not suitable for heat-sensitive materials, longer sterilization times, requires
water and steam supply
2.
Ethylene Oxide Sterilization:
· Method:
Ethylene oxide gas
·
Advantages:
Low temperatures, suitable for heat-sensitive materials, good penetration, wide
range of applications
·
Disadvantages:
Long sterilization times, potential toxicity of gas, residue removal required
3.
Dry Heat Sterilization:
· Method:
Hot air
·
Advantages:
No need for chemical sterilants, suitable for heat-resistant materials
·
Disadvantages:
Longer sterilization times, not suitable for heat-sensitive materials
4.
Radiation Sterilization (e.g., Gamma
irradiation):
· Method:
Ionizing radiation
·
Advantages:
Effective sterilization, good penetration, no residue or chemical exposure
·
Disadvantages:
Specialized equipment required, limited application to certain materials,
potential hazards if mishandled
5.
Chemical Sterilization (e.g., Hydrogen
Peroxide Plasma):
· Method:
Chemical sterilants
·
Advantages:
Low temperatures, suitable for heat-sensitive materials, short sterilization
times, good penetration
·
Disadvantages:
Reliance on chemical substances, residue removal required, limited application
to certain materials
5.5.2
Instrument preparation Storage of used instruments
Instrument
preparation and proper storage are crucial for maintaining the cleanliness and
sterility of medical or laboratory instruments. Here are some guidelines for
instrument preparation and storage:
Instrument
Preparation:
1.
Immediate
Cleaning: After use, instruments should be cleaned as soon as possible to
prevent the drying of organic matter, which can make cleaning more challenging.
Follow
the manufacturer's instructions for proper cleaning procedures.
2.
Disassembly:
Disassemble instruments if possible, following the manufacturer's guidelines.
This allows for thorough cleaning of all parts and helps prevent the buildup of
debris or residue in hard-to-reach areas.
3.
Cleaning:
Use an appropriate cleaning solution or detergent recommended for instrument
cleaning. Follow the manufacturer's instructions for dilution and soaking
times. Use brushes or other cleaning tools to remove visible debris or stains.
Ensure that all surfaces of the instrument are thoroughly cleaned.
4.
Rinse
and Dry: After cleaning, rinse the instruments with clean water to remove any
cleaning solution or detergent residue. Properly dry the instruments using a
lint-free cloth or by air drying. Make sure the instruments are completely dry
before storage to prevent the growth of microorganisms.
5.
Inspection
and Maintenance: Inspect the instruments for any damage or signs of wear.
Repair or replace damaged instruments as necessary. Follow the manufacturer's
guidelines for maintenance and sharpening of instruments.
a) Storage of Used
Instruments:
1.
Sterilization:
Before storage, ensure that the instruments are properly sterilized using an
appropriate sterilization method, such as steam sterilization or chemical
sterilization, depending on the instrument type and material.
2.
Packaging:
Once sterilized, the instruments should be properly packaged to maintain their
sterility. Use sterilization wrap, pouches, or containers that are compatible
with the sterilization method used. Follow the manufacturer's
instructions for proper packaging techniques.
3.
Labeling:
Clearly label the packages with the contents, sterilization date, and
expiration date, if applicable. This helps in identifying and tracking the
instruments, as well as ensuring that they are used within their designated
shelf life.
4.
Storage
Environment: Store the sterilized instruments in a clean, dry, and
well-ventilated area. Ensure that the storage location is protected from dust,
moisture, and direct sunlight. Consider using dedicated storage cabinets or
trays that are designed to keep instruments organized and protected.
5.
Rotation
and Inventory: Implement a system for inventory management and instrument
rotation to ensure that the oldest sterilized instruments are used first.
Regularly check the inventory, discard expired items, and replenish as needed.
b)
Cleaning the instruments
Cleaning instruments
is a critical step in the instrument preparation process. Here are guidelines
for cleaning instruments effectively:
1.
Wear
Personal Protective Equipment (PPE): Put on appropriate PPE, including gloves,
protective eyewear, and a lab coat or gown, before handling contaminated
instruments. This protects you from potential exposure to microorganisms or
hazardous materials.
2.
Pre-Cleaning:
Start by pre-cleaning the instruments immediately after use. This involves
removing visible debris or organic matter from the instruments. Use a
disposable cloth or brush to gently scrub the surfaces, paying attention to
hard-to-reach areas.
3.
Use
Enzymatic Cleaner: Enzymatic cleaners are specifically formulated to break down
and remove organic material, such as blood, tissue, or protein, from
instruments. Dilute the enzymatic cleaner according to the manufacturer's
instructions, and immerse the instruments in the solution for the recommended
time.
4.
Ultrasonic
Cleaning (if available): If an ultrasonic cleaner is available, it can enhance
the cleaning process. Place the instruments in the ultrasonic cleaner filled
with a suitable cleaning solution. The high-frequency sound waves produced by
the cleaner create agitation, helping to dislodge and remove stubborn debris.
5.
Manual
Cleaning: After pre-cleaning and enzymatic soaking, perform a thorough manual
cleaning of the instruments. Use a soft brush or instrument-specific brushes to
clean all surfaces, joints, hinges, and crevices. Pay attention to serrations,
grooves, and lumens, ensuring that all areas are cleaned effectively.
6.
Rinse
Thoroughly: Rinse the instruments with clean water to remove any remaining
cleaning solution or debris. Multiple rinses may be necessary to
ensure complete removal.
7.
Inspect
for Residue or Stains: After cleaning and rinsing, visually inspect the
instruments for any remaining residue, stains, or discoloration. If necessary,
repeat the cleaning process or use specialized cleaning agents to address
stubborn stains.
8.
Dry
the Instruments: Properly dry the instruments to prevent moisture accumulation
and the growth of microorganisms. Use a lint-free cloth to dry the instruments
thoroughly, paying attention to hinges and joints where moisture can be
trapped. Alternatively, use a designated drying cabinet or sterilizer with a
drying function.
c)
preparation for sterilization
Preparation for
sterilization is an essential step to ensure effective sterilization of
instruments or equipment. Here are the general guidelines for preparing items
for sterilization:
1.
Cleaning:
Thoroughly clean the items before sterilization. Remove any visible debris,
organic material, or contaminants using appropriate cleaning methods and
detergents. Follow the manufacturer's instructions for cleaning, if available,
as different items may require specific cleaning protocols.
2.
Disassembly
(if applicable): Disassemble instruments or equipment as instructed by the
manufacturer, if possible. This allows for better access to all surfaces and
ensures thorough cleaning and sterilization.
3.
Inspection:
Inspect the items for any damage, wear, or signs of deterioration. Discard or
repair items that are damaged or compromised to maintain safety and
effectiveness.
4.
Packaging:
Select appropriate packaging materials based on the sterilization method and item
being sterilized. Common packaging options include sterilization wrap, pouches,
or containers. Ensure the packaging material is suitable for the sterilization
process, allows proper penetration of the sterilant, and provides a barrier
against recontamination after sterilization.
5.
Labeling:
Clearly label each package with necessary information such as the item's
contents, date of sterilization, expiration date (if applicable), and any other
relevant information required for tracking and identification purposes.
6.
Sterilization
Indicators: Place appropriate sterilization indicators, such as chemical
indicators or biological indicators, inside the packaging to monitor the
effectiveness of the sterilization process. These indicators help ensure that
the sterilization conditions were met and the items are indeed sterilized.
7.
Sterilization
Method Selection: Choose the appropriate sterilization method based on the type
of item, its compatibility with the sterilization process, and the required
level of sterilization. Common sterilization methods include steam
sterilization (autoclaving), ethylene oxide sterilization, chemical
sterilization, radiation sterilization, or other validated sterilization
techniques.
8.
Load
Configuration: Arrange the items in the sterilization equipment following the
manufacturer's guidelines or standard operating procedures. Ensure proper
spacing and adequate exposure to the sterilant to ensure uniform and effective
sterilization.
9.
Sterilization
Parameters: Set the sterilization parameters such as time, temperature,
pressure, or exposure to the sterilant according to the manufacturer's
instructions or established guidelines. Ensure that the sterilization
parameters are accurately set and comply with the recommended standards.
10.
Record
Keeping: Maintain proper documentation and records of the sterilization
process, including details of the items sterilized, sterilization cycle
parameters, dates, and any relevant quality control checks or results.
d)
Verification of sterilization
Verification of
sterilization is an essential aspect of quality control to ensure that the
sterilization process has effectively eliminated or inactivated microorganisms.
Here are some methods commonly used for verifying sterilization:
1.
Chemical
Indicators: Chemical indicators, such as autoclave tape or strips, are placed
on the outside or inside the packaging of the items being sterilized. These
indicators change color when exposed to specific sterilization conditions, such
as temperature or pressure. They provide a visual indication that the items
have been through the sterilization process. However, they do not guarantee the
sterility of the items and should be used in conjunction with other
verification methods.
2.
Biological
Indicators (BIs): Biological indicators consist of a known number of highly
resistant microorganisms (e.g., Geobacillus stearothermophilus for steam
sterilization) placed within a carrier or on a test strip. BIs are considered
the most reliable method for sterilization verification. After a sterilization
cycle, the BIs are incubated to determine whether any viable microorganisms
survived the process. A negative result confirms the effectiveness of
sterilization, while a positive result indicates a potential sterilization
failure.
3.
Physical
Monitoring: Monitoring the physical parameters of the sterilization process is
crucial. This includes monitoring the time, temperature, pressure, and other
relevant parameters specific to the chosen sterilization method. Specialized
sterilization equipment often has built-in monitoring systems or recorders to
track and document the sterilization cycle parameters. Regular calibration of
the monitoring equipment is necessary to ensure accuracy.
4.
Sterility
Testing: Sterility testing involves sampling the sterilized items and
subjecting them to a growth medium to determine if any viable microorganisms
are present. This method provides a direct assessment of the sterility of the
items. However, sterility testing is time-consuming and usually performed on a
sample basis rather than testing every single item.
5.
Visual
Inspection: After sterilization, visually inspect the packaging and items for
any signs of damage, moisture, or other issues that could compromise the
sterility. Any damaged or compromised packages should be reprocessed or
discarded.
e)
Used instruments.
When it comes to used
instruments, there are several important considerations for their handling,
cleaning, and further processing. Here are some guidelines:
1.
Immediate
Handling: After use, handle used instruments with caution to avoid injury or
exposure to potentially harmful substances. Wear appropriate personal
protective equipment (PPE) such as gloves and protective eyewear.
2.
Pre-Cleaning:
Immediately after use, conduct pre-cleaning of the instruments to remove any
visible debris or organic material. This can be done by wiping or rinsing the
instruments using water or a suitable cleaning solution.
3.
Disassembly
(if applicable): Disassemble the instruments, if possible and as instructed by
the manufacturer, to ensure thorough cleaning and disinfection of all
components and hard-to-reach areas.
4.
Cleaning:
Thoroughly clean the instruments using an appropriate cleaning agent or detergent.
Follow the manufacturer's instructions for dilution, soaking times, and
cleaning techniques. Use brushes or other cleaning tools to remove any residual
debris or stains.
5.
Rinse:
After cleaning, rinse the instruments with clean water to remove any cleaning
solution or detergent residue.
6.
Disinfection/Sterilization:
Depending on the intended use and the level of decontamination required, the
instruments may need to undergo disinfection or sterilization. Follow the
appropriate guidelines and protocols for the specific instrument and intended
use. Disinfection methods may include chemical disinfection or immersion in a
high-level disinfectant solution. Sterilization methods can include steam
sterilization, ethylene oxide sterilization, or other validated sterilization
techniques.
7.
Packaging:
Once the instruments have been disinfected or sterilized, package them in
appropriate sterilization wraps, pouches, or containers suitable for the chosen
sterilization method. Label the packages with necessary information, including
the contents, date of sterilization, and expiration date if applicable.
8.
Storage:
Store the sterilized instruments in a clean and dry environment, protected from
dust, moisture, and direct sunlight. Use dedicated storage cabinets or trays to
keep instruments organized and prevent recontamination.
9.
Regular
Inspection: Periodically inspect the stored instruments to ensure they remain
clean, dry, and free from damage. Replace or repair any
damaged instruments promptly.
10.
Proper
Handling: When retrieving sterilized instruments for use, handle them with care
to maintain their sterility. Follow proper aseptic techniques, such as using
sterile gloves and instruments, when transferring instruments to a sterile
field.
5.6
Hygiene requirements for rooms and furnishings:
5.6.1
the areas in the hospital
Hygiene requirements
for rooms and furnishings in hospitals are crucial to maintain a clean and safe
environment that minimizes the risk of healthcare-associated infections. Here
are some key considerations for hygiene in different areas of the hospital:
1.
Patient Rooms:
·
Regular
Cleaning: Patient rooms should undergo regular cleaning, including surfaces,
floors, and high-touch areas (such as bed rails, call buttons, and remote
controls) using appropriate disinfectants.
·
Linen
Management: Proper handling, laundering, and storage of patient linens are
essential to prevent cross-contamination. Linens should be changed regularly
and handled with care to avoid dispersing microorganisms.
·
Hand
Hygiene: Adequate hand hygiene facilities, including sinks with soap and water
or alcohol-based hand sanitizers, should be readily available in patient rooms
for both healthcare staff and patients.
2.
Operating Rooms:
·
Sterility:
Operating rooms require stringent cleanliness and adherence to aseptic
techniques to maintain sterility. Thorough cleaning and disinfection protocols
should be followed before and after each procedure.
·
Air
Quality: Proper ventilation systems are crucial in operating rooms to control
airborne contaminants. The air should be regularly filtered, and temperature
and humidity levels maintained within recommended ranges.
·
Surgical
Instrument Cleaning: Instruments used in surgical procedures should undergo
meticulous cleaning and sterilization to prevent the transmission of pathogens.
3.
Critical Care Units:
·
Enhanced
Cleaning: Critical care units, such as intensive care units (ICUs) or neonatal
intensive care units (NICUs), often have patients with higher vulnerability to
infections. Therefore, more rigorous cleaning and disinfection practices should
be implemented, including frequent cleaning of surfaces, equipment, and patient
care items.
·
Hand
Hygiene: Strict adherence to hand hygiene protocols is crucial in critical care
units due to the higher risk of transmission of multidrug-resistant organisms.
4.
Public Areas:
·
Regular
Cleaning: Public areas, including waiting rooms, hallways, and common areas,
should be cleaned regularly, paying attention to frequently touched surfaces
such as doorknobs, handrails, and elevator buttons.
· Waste Management: Adequate waste management systems
should be in place to properly dispose of general waste, medical waste, and
sharps. Waste
receptacles should be properly sealed and emptied regularly.
5.
Restrooms:
·
Cleaning
and Disinfection: Restrooms require frequent cleaning and disinfection to
maintain hygiene. Pay special attention to high-touch surfaces, such as
faucets, door handles, and toilet seats.
·
Hand
Hygiene Facilities: Handwashing facilities or hand sanitizers should be readily
available in restrooms to encourage proper hand hygiene practices.
5.6.2
Disinfection of hospital rooms adjoining rooms
Disinfection of
hospital rooms adjoining other rooms is an important aspect of preventing the
spread of infections within healthcare facilities. Here are some key
considerations for disinfection in hospital rooms adjoining other rooms:
1.
Cleaning
and Disinfection Protocol: Develop a comprehensive cleaning and disinfection
protocol specific to adjoining rooms. This protocol should outline the
procedures, products, and frequencies for cleaning and disinfection.
2.
High-Touch
Surfaces: Pay special attention to high-touch surfaces in adjoining rooms, such
as doorknobs, light switches, bed rails, bedside tables, and other frequently
touched surfaces. These surfaces should be cleaned and disinfected regularly
using appropriate disinfectants.
3.
Separation
of Clean and Dirty Areas: Establish clear separation between clean and dirty
areas. Designate specific cleaning equipment and supplies for each area to
prevent cross-contamination. Avoid using the same cleaning tools in both
adjoining rooms.
4.
Disposable
or Dedicated Cleaning Equipment: Consider using disposable cleaning supplies or
dedicated equipment, such as microfiber cloths or mop heads, for each room.
This helps to prevent the transfer of microorganisms between rooms.
5.
Terminal
Cleaning: Perform thorough terminal cleaning of the rooms when a patient is
discharged or transferred. Terminal cleaning involves a more extensive cleaning
and disinfection process to ensure that all surfaces, including floors, walls,
and ceilings, are thoroughly cleaned.
6.
Disinfectant
Selection: Choose appropriate disinfectants with proven efficacy against
healthcare-associated pathogens. Follow the manufacturer's instructions for the
correct dilution, contact time, and application method. Ensure that the
disinfectant is compatible with the surfaces in both adjoining rooms.
7.
Disinfection
Frequency: Determine the appropriate frequency for disinfection based on the
risk level and patient population in the adjoining rooms. High-risk areas or
rooms with patients who are known or suspected to have infectious diseases may
require more frequent disinfection.
8.
Environmental
Services Staff Training: Provide comprehensive training to environmental
services staff on proper cleaning and disinfection techniques, including the
specific requirements for adjoining rooms. Ensure they understand the
importance of following protocols and using appropriate personal protective
equipment (PPE) during cleaning and disinfection activities.
9.
Monitoring
and Auditing: Regularly monitor and audit the adherence to the cleaning and
disinfection protocols in both adjoining rooms. This helps identify any gaps or
areas that require improvement and ensures consistent compliance with
established guidelines.
10.
Collaboration
and Communication: Encourage effective communication and collaboration between
healthcare staff in both adjoining rooms. Promptly communicate any concerns or
issues related to infection prevention and control to the appropriate personnel
for timely resolution.
A) Implementation of ongoing disinfection
Implementing ongoing
disinfection practices is essential in maintaining a clean and safe environment
in various settings, including hospitals. Here are some key steps to consider
for implementing ongoing disinfection:
1.
Develop
a Disinfection Plan: Create a comprehensive disinfection plan that outlines the
areas to be disinfected, the frequency of disinfection, and the appropriate
disinfection methods and products to be used. Consider the specific needs and
risks of different areas within the facility.
2.
Identify
High-Touch Surfaces: Identify high-touch surfaces in the facility that are more
likely to harbor and spread pathogens. These surfaces may include doorknobs,
handrails, light switches, elevator buttons, countertops, and equipment
surfaces. Prioritize regular disinfection of these surfaces.
3.
Select
Appropriate Disinfectants: Choose disinfectants that are effective against a
broad spectrum of pathogens commonly found in healthcare settings. Ensure that
the disinfectants are registered with appropriate regulatory authorities and
follow the manufacturer's instructions for dilution, contact time, and
application methods.
4.
Train
Staff: Provide comprehensive training to staff responsible for ongoing
disinfection. Train them on proper disinfection techniques, including correct
dilution, application methods, contact times, and safety precautions. Emphasize
the importance of following protocols consistently.
5.
Establish
Cleaning Schedules: Create a cleaning schedule that includes routine
disinfection of high-touch surfaces, equipment, patient care areas, restrooms,
waiting rooms, and common areas. Determine the frequency of disinfection based
on the risk level and usage patterns of each area.
6.
Provide
Adequate Supplies: Ensure that an ample supply of disinfectants, wipes, sprays,
or other appropriate disinfection products is available in designated areas
throughout the facility. Encourage staff to use these supplies as necessary for
ongoing disinfection.
7.
Promote
Hand Hygiene: Reinforce the importance of hand hygiene among staff, patients,
and visitors. Prominently place hand sanitizers or handwashing stations at
convenient locations throughout the facility to encourage regular hand hygiene
practices.
8.
Regular
Inspection and Auditing: Regularly inspect and audit the ongoing disinfection
practices to ensure compliance with established protocols. Provide feedback and
corrective actions as needed to maintain consistent and effective disinfection.
9.
Documentation
and Communication: Keep accurate records of ongoing disinfection activities,
including dates, areas disinfected, and staff responsible. Establish effective
communication channels to relay information and updates regarding ongoing
disinfection practices to staff, patients, and visitors.
10.
Stay
Informed: Stay updated with the latest guidelines, recommendations, and best
practices related to disinfection and infection control. Regularly review and
revise the disinfection plan based on emerging evidence or changing
circumstances.
5.7
Hygiene requirements for nursing staff
Hygiene requirements
for nursing staff are essential to prevent the spread of infections and
maintain a clean and safe healthcare environment. Here are some key hygiene
requirements for nursing staff:
1.
Hand
Hygiene: Nursing staff should practice proper hand hygiene by washing hands
with soap and water for at least 20 seconds or using an alcohol-based hand
sanitizer when soap and water are not readily available. Hand hygiene should be
performed before and after patient contact, after touching surfaces or equipment,
and after removing gloves.
2.
Personal
Protective Equipment (PPE): Nursing staff should use appropriate PPE based on
the level of risk and specific procedures being performed. This may include
gloves, masks, goggles or face shields, and gowns. PPE should be properly worn,
removed, and disposed of according to recommended protocols.
3.
Uniform
and Attire: Nursing staff should follow facility guidelines regarding uniform
and attire. Clean and professional attire should be worn, with consideration
given to minimizing the risk of contamination and maintaining a professional
appearance. Uniforms should be changed regularly and laundered
appropriately.
4.
Respiratory
Hygiene/Cough Etiquette: Nursing staff should follow respiratory hygiene and
cough etiquette by covering their mouth and nose with a tissue or their elbow
when coughing or sneezing. Used tissues should be disposed of immediately and
hands should be cleaned afterward.
5.
Hair
and Nail Care: Hair should be kept neat and away from the face to prevent
contamination. Nails should be trimmed short, clean, and free from artificial
nails or nail polish, as they can harbor microorganisms.
6.
Jewelry
and Accessories: Jewelry should be kept to a minimum, and excessive accessories
should be avoided, as they can harbor microorganisms and interfere with hand
hygiene and wearing gloves.
7.
Environmental
Hygiene: Nursing staff should maintain cleanliness in their immediate work
areas, ensuring that surfaces, equipment, and shared patient care items are
regularly cleaned and disinfected according to facility protocols.
8.
Safe
Handling of Contaminated Items: Nursing staff should handle and dispose of
contaminated items, such as used gloves, dressings, or sharps, safely and in
accordance with infection control guidelines and waste management protocols.
9.
Respiratory
Infections: Nursing staff should adhere to facility policies and guidelines for
preventing the transmission of respiratory infections, including appropriate
use of respiratory protection, isolation precautions, and respiratory surveillance.
10.
Immunizations:
Nursing staff should comply with facility requirements for immunizations,
including vaccinations against vaccine-preventable diseases such as influenza,
hepatitis B, and others.
Regular training,
education, and ongoing reinforcement of these hygiene requirements are crucial
to ensure compliance among nursing staff. Facilities should provide adequate
resources, such as hand hygiene stations, PPE, and educational materials, to
support proper hygiene practices. Additionally, adherence to facility-specific
policies and procedures regarding hygiene and infection prevention is essential
to maintain a safe healthcare environment.
a) General protective measures
General protective
measures are essential for preventing the spread of infections and maintaining
personal and public health. Here are some key protective measures that can be
followed:
1.
Hand
Hygiene: Regularly wash hands with soap and water for at least 20 seconds or
use an alcohol-based hand sanitizer when soap and water are not available.
Clean hands before and after eating, after using the restroom, after coughing
or sneezing, and after being in public places.
2.
Respiratory
Etiquette: Cover your mouth and nose with a tissue or your elbow when coughing
or sneezing. Dispose of used tissues immediately and wash hands afterward.
Avoid touching your face, especially your eyes, nose, and mouth.
3.
Face
Masks: Wear a mask, especially in crowded or public settings where maintaining
physical distance may be challenging. Follow local guidelines regarding mask
usage, such as wearing masks indoors, on public transportation, or in
healthcare facilities.
4.
Physical
Distancing: Maintain a safe distance (at least 1 meter or 3 feet) from others,
particularly in crowded areas. Avoid close contact, such as shaking hands or
hugging, with people who are sick or exhibiting symptoms.
5.
Vaccination:
Stay up to date with recommended vaccinations, including seasonal flu vaccines
and other vaccines as per healthcare provider recommendations. Vaccinations can
help protect against certain diseases and reduce their severity if contracted.
6.
Clean
and Disinfect Surfaces: Clean and disinfect frequently touched surfaces and
objects regularly. Use appropriate disinfectants and follow instructions for
effective disinfection. Pay attention to surfaces such as doorknobs, light
switches, phones, keyboards, and countertops.
7.
Ventilation:
Ensure proper ventilation in indoor spaces. Open windows, use fans, or employ
air ventilation systems to improve air circulation and reduce the concentration
of airborne particles.
8.
Stay
Home When Sick: If you're feeling unwell, especially with symptoms such as
fever, cough, or difficulty breathing, stay home, and avoid close contact with
others. Follow local health guidelines for self-isolation and seek medical
advice if necessary.
9.
Healthy
Hygiene Practices: Maintain a healthy lifestyle by eating a balanced diet,
staying physically active, getting enough sleep, and managing stress. A
healthy immune system can better defend against infections.
10.
Stay
Informed: Stay updated with reliable information from reputable sources such as
the World Health Organization (WHO) or local health authorities. Follow
their guidance on preventive measures and recommended actions.
5.7.1
Individual and clothing hygiene
Individual hygiene
and clothing hygiene play a significant role in maintaining personal
cleanliness and preventing the spread of infections. Here are some key
considerations for individual and clothing hygiene:
Individual Hygiene:
1.
Hand
Hygiene: Wash your hands frequently with soap and water for at least 20
seconds, especially before handling food, after using the restroom, after
coughing or sneezing, and after being in public places. Alternatively, use an
alcohol-based hand sanitizer when soap and water are not readily available.
2.
Bathing
and Showering: Take regular showers or baths to keep your body clean. Use mild
soap and warm water to cleanse your body, paying attention to areas such as
underarms, groin, and feet. Dry yourself thoroughly after bathing.
3.
Oral
Hygiene: Brush your teeth at least twice a day using fluoride toothpaste and a
soft-bristled toothbrush. Clean between your teeth with dental floss or
interdental cleaners. Additionally, use mouthwash or rinse as recommended by
your dentist.
4.
Respiratory
Hygiene: Cover your mouth and nose with a tissue or your elbow when coughing or
sneezing. Dispose of used tissues immediately and wash your hands afterward.
Avoid touching your face, especially your eyes, nose, and mouth.
5.
Nail
Care: Keep your nails clean and trimmed. Regularly clean under your nails using
a nail brush. Avoid biting your nails or picking at the skin around your nails
to prevent the entry of germs.
Clothing Hygiene:
1.
Regular
Laundering: Regularly wash your clothes, including undergarments and socks, to
remove dirt, sweat, and potential pathogens. Follow the care instructions on
clothing labels regarding washing temperatures and drying methods.
2.
Separation
of Dirty and Clean Clothing: Separate dirty and soiled clothing from clean
clothing to prevent cross-contamination. Use designated laundry bags or hampers
for dirty laundry and ensure they are properly sealed to contain any potential
contaminants.
3.
Washing
Bedding and Linens: Wash bed sheets, pillowcases, towels, and other linens
regularly to maintain cleanliness. Use hot water and appropriate detergent to
ensure effective cleaning.
4.
Personal
Protective Equipment (PPE): If required, use appropriate PPE such as gloves,
masks, or gowns based on the situation or specific activities. Follow
guidelines and recommendations for the proper use, handling, and disposal of
PPE.
5.
Footwear
Hygiene: Keep your shoes clean and dry. Regularly clean the soles and inner
linings of your shoes, especially if you have been in environments that may be
contaminated. Consider having separate indoor and outdoor shoes to minimize the
tracking of dirt and germs.
6.
Personal
Grooming: Maintain good personal grooming habits, including regular hair
washing, shaving, and beard trimming (if applicable). Keep hairstyles neat and
tied back if necessary, especially in food preparation areas or healthcare
settings.
5.7.2
Hand disinfection
Hand disinfection,
also known as hand sanitizing, is a crucial practice for reducing the
transmission of pathogens and maintaining hand hygiene. Here are some important
points to consider for effective hand disinfection:
1.
Hand
Sanitizer Selection: Choose an alcohol-based hand sanitizer that contains at
least 60% alcohol (usually ethanol or isopropyl alcohol). The alcohol
concentration is important for effective disinfection. Read the label to ensure
it meets the recommended alcohol content.
2.
Apply
the Right Amount: Dispense a sufficient amount of hand sanitizer onto the palm
of your hand. Follow the manufacturer's instructions for the recommended
volume, typically about a dime-sized amount.
3.
Rub
Hands Together: Rub your hands together, covering all surfaces, including the
back of your hands, between fingers, fingertips, and under nails. Ensure that
the sanitizer reaches all areas of your hands and fingers.
4.
Duration
of Rubbing: Continue rubbing your hands together for at least 20 seconds or
until the hand sanitizer has completely dried. This ensures enough time for the
alcohol to effectively kill the pathogens on your hands.
5.
Don't
Rinse or Dry: Do not rinse or wipe off the hand sanitizer before it has dried
naturally. The alcohol needs time to evaporate and complete the disinfection
process.
6.
Avoid
Touching Surfaces: While waiting for the hand sanitizer to dry, avoid touching
any surfaces or objects to prevent recontamination.
7.
Frequency
of Use: Use hand sanitizer when soap and water are not readily available, but
handwashing is necessary. It is particularly useful in situations such as when
you are outside, in public places, or when caring for patients in healthcare
settings.
8.
When
to Use Soap and Water: Remember that hand sanitizer is not a substitute for
proper handwashing with soap and water, especially when your hands are visibly
dirty or contaminated with bodily fluids. Use soap and water for those
instances.
9.
Proper
Storage: Store hand sanitizer in a cool, dry place, away from direct sunlight
or high temperatures. Follow any specific storage instructions
provided by the manufacturer.
10.
Hand
Moisturization: If frequent hand sanitizing causes dryness or irritation, use a
moisturizer to keep your hands hydrated. Choose a moisturizer that is
compatible with frequent use and quickly absorbed.
Hand disinfection
with alcohol-based hand sanitizers is an effective method for reducing the
number of microorganisms on your hands when soap and water are not available.
However, it is important to note that handwashing with soap and water remains
the preferred method for hand hygiene, especially in certain situations.
5.7.3
Donning sterile gloves
Donning sterile
gloves is an important procedure to maintain a sterile environment and prevent
contamination during certain medical or surgical procedures. Here's a
step-by-step guide on how to don sterile gloves:
1.
Prepare
the Work Area: Ensure you have a clean and well-lit work area. Remove any
unnecessary items or clutter from the surface to maintain a sterile field.
2.
Perform
Hand Hygiene: Wash your hands thoroughly with soap and water, following proper
handwashing techniques, for at least 20 seconds. Dry your hands using a clean
towel or air dryer.
3.
Select
the Correct Glove Size: Choose a pair of sterile gloves that fit your hand size
properly. Improperly sized gloves can affect dexterity and comfort, and may
compromise the integrity of the gloves.
4.
Open
the Packaging: Carefully open the sterile glove packaging, being cautious not
to touch the inside of the packaging or the gloves themselves. Ensure that the
gloves do not come into contact with any non-sterile surfaces.
5.
Glove
Orientation: Identify the cuff of each glove. The cuff is the end of the glove
that will be worn around the wrist. Keep in mind that the outer surface of the
glove is considered contaminated, while the inner surface is considered
sterile.
6.
Don
the First Glove: a. Hold the cuff of the first glove with your dominant hand,
using the opposite hand to stabilize the glove. b. Gently slide your dominant
hand into the glove, ensuring that your fingers and thumb are properly aligned
with the glove's fingers and thumb. c. Slowly pull the glove over your hand and
wrist, being careful not to touch any non-sterile surfaces or the outside of
the glove.
7.
Don
the Second Glove: a. Keep your gloved hand elevated and away from your body to
prevent contamination. b. Insert your non-dominant hand into the second glove,
using the already gloved hand to stabilize it. c. Carefully slide your
non-dominant hand into the second glove, ensuring proper alignment of fingers
and thumb. d. Pull the glove over your hand and wrist, avoiding contact with
non-sterile surfaces or the outside of the glove.
8.
Adjust
the Gloves: Once both gloves are on, adjust them to ensure a proper fit and
full coverage. Smooth out any wrinkles or folds in the gloves, ensuring that
they cover the wrists adequately.
9.
Perform
a Glove Integrity Check: Inspect the gloves for any signs of damage, such as
tears or punctures. If you notice any compromise in glove integrity, remove the
gloves and don a new pair following the same procedure.
The specific steps
and techniques may differ depending on the facility's protocols and the type of
sterile gloves being used. It is important to follow the guidelines provided by
your healthcare facility and receive proper training in donning sterile gloves
to ensure patient safety and infection control.
5.8
Environmental protection in the hospital
Environmental
protection in hospitals is crucial to minimize the facility's impact on the
environment and promote sustainability. Here are some key considerations for
environmental protection in the hospital:
1.
Waste
Management: Implement proper waste management practices to reduce, segregate,
and dispose of waste effectively. Establish recycling programs for paper,
plastic, glass, and other recyclable materials. Separate hazardous or
biomedical waste and ensure their safe disposal according to local regulations.
2.
Energy
Efficiency: Promote energy-efficient practices by using energy-saving lighting
fixtures, optimizing heating, ventilation, and air conditioning (HVAC) systems,
and employing energy management systems. Encourage staff to turn off lights and
equipment when not in use.
3.
Water
Conservation: Implement water conservation measures, such as using low-flow
faucets, toilets, and showers. Promote awareness among staff to reduce water
consumption and promptly fix leaks or water-related issues.
4.
Chemical
Management: Ensure proper management of chemicals used in healthcare
facilities. Implement safe handling, storage, and disposal practices for
hazardous chemicals to prevent environmental contamination.
5.
Sustainable
Procurement: Consider environmental factors when purchasing equipment,
supplies, and materials. Choose environmentally friendly, energy-efficient, and
recyclable products whenever possible. Give preference to suppliers
and manufacturers with sustainable practices.
6.
Green
Building Design: Incorporate sustainable design principles in new construction
or renovation projects. Use eco-friendly building materials, maximize natural
light, and implement energy-efficient systems. Consider green spaces and
outdoor areas for staff and patient well-being.
7.
Pollution
Control: Implement measures to control air and water pollution within the
hospital premises. Regularly maintain HVAC systems and air filters to ensure
optimal air quality. Monitor wastewater and implement proper
treatment processes before discharge.
8.
Transportation
and Mobility: Encourage sustainable transportation options for staff, such as
carpooling, biking, or using public transportation. Provide designated parking
spots for low-emission or electric vehicles. Promote active transportation by
creating safe walking and biking paths.
9.
Education
and Awareness: Raise awareness among staff, patients, and visitors about the
importance of environmental protection. Provide educational materials, training
programs, and campaigns to promote sustainable practices and encourage
participation.
10.
Continuous
Improvement: Regularly assess and evaluate environmental performance in the
hospital. Set goals, track progress, and engage staff in environmental
initiatives. Continuously seek opportunities for improvement and implement
sustainable practices as new technologies and strategies emerge.
By implementing these
environmental protection measures, hospitals can minimize their ecological
footprint, conserve resources, and contribute to a healthier and more
sustainable future.
5.9
Notifiable diseases
Notifiable diseases,
also known as reportable diseases, are infectious diseases that healthcare
providers, laboratories, and public health authorities are legally required to
report to the appropriate public health agencies. Reporting these diseases is essential
for surveillance, monitoring outbreaks, and implementing appropriate public
health interventions. The specific list of notifiable diseases can vary by
country or region, but here are some examples of commonly notifiable diseases:
1.
COVID-19:
The ongoing pandemic caused by the SARS-CoV-2 virus has resulted in COVID-19
being designated as a notifiable disease in many countries. This means that
cases and deaths related to COVID-19 must be reported to public health
authorities.
2.
Influenza:
Influenza, commonly known as the flu, is often notifiable due to its highly
contagious nature and potential for widespread outbreaks.
3.
Tuberculosis
(TB): Tuberculosis is a bacterial infection that primarily affects the lungs.
It is typically notifiable to ensure timely detection, treatment, and
prevention of its spread.
4.
Hepatitis:
Various types of viral hepatitis, including hepatitis A, hepatitis B, and
hepatitis C, may be notifiable. These infections affect the liver and can have
significant public health implications.
5.
Measles:
Measles is a highly contagious viral illness that can cause severe
complications. Prompt reporting and investigation of measles cases help prevent
outbreaks and ensure appropriate vaccination measures.
6.
Sexually
Transmitted Infections (STIs): Several STIs, such as syphilis, gonorrhea, and
chlamydia, are often notifiable to track their prevalence, implement
appropriate treatment and prevention strategies, and monitor antimicrobial
resistance patterns.
7.
Meningitis:
Bacterial meningitis, especially certain strains such as meningococcal
meningitis, is typically notifiable due to its potential for rapid spread and
severe outcomes.
8.
Foodborne
Illnesses: Certain foodborne illnesses caused by pathogens like Salmonella,
Escherichia coli (E. coli), and Listeria are often notifiable to identify and
control outbreaks associated with contaminated food or water sources.
9.
Viral
Hemorrhagic Fevers: Notifiable diseases may also include viral hemorrhagic
fevers, such as Ebola virus disease or Lassa fever, due to their high mortality
rates and potential for outbreaks.
10.
Other
Infectious Diseases: The list of notifiable diseases can vary depending on the
country or region. Other examples may include pertussis (whooping cough),
malaria, Zika virus infection, dengue fever, and certain healthcare-associated
infections like Clostridium difficile infection.
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