KING KHALID HOSPITALINFECTION PREVENTION

ANDCONTROL MANUAL

REHABILITATION / PHYSIOTHERAPY

Dr. Nahla Abdel Kader, MD, PhD.Infection Control Consultant, MOHInfection Control CBAHI Surveyor

Infection Prevention Control DirectorKKH.

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DEFINITION

To provide clear guidelines on appropriate cleaning, disinfection and sterilization of rehabilitation equipment, to prevent transmission of healthcare associated infections.

COMMENTS

1. The rehabilitation patient may have one or more impairments or disabilities at the time of admission that increase the risk of infection.2. Factors such as incontinence, skin breakdown, co-morbidity, immobility, and age are all associated with increased risk of infection in the rehabilitation population.3. References to specific equipment are applicable where these exist. Each facility should refer to the user manual in its rehabilitation department for specific instructions regarding cleaning disinfecting and preventive maintenance of its equipment

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A. Therapeutic Pool:1. Pools are generally designed to be used by many

individuals concurrently and sequentially. They may become contaminated with organic matter (feces, urine, wound drainage) between cleaning. Therefore to reduce contaminant in the pool water certain measures must be taken.

a. Maintain proper level of chlorine/bromine/other disinfectant to the equivalent of 1.5 to 2.0 ppm free chlorine at a pH of 7.5 to 7.8 to control organic load.b. Sample kits for testing should be available in the pool area.c. Ideal water temperature is 30.5o – 34o C [ 87o - 93o F ] ( maximum 35o – 39 o C [ 96o - 102o F ] )

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d. To reduce contamination of pool consider scheduling modifications or activity limitations for patients with:a. Exposed sub-epidermal tissue or blisters.b. Open wounds, skin lesions, skin rashes.c. Bowel or bladder function incontinence.d. Patients with invasive devices i.e., external fixation, tracheostomy, IV lines.e. Patients with infectious or communicable diseases.

2. The pool should be drained every 2 weeks for scrubbing of sides and bottom and then refilled. Accessory equipment should be wiped with an approved hospital disinfectant, i.e., a quaternary ammonium compound, and rinsed between patients and at the end of the working day.

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3. The procedure to follow when pool is grossly contaminated with patients blood or body fluid:a. Wear the appropriate PPE.b. Remove visible debris from the pool.c. Raise the level of chlorine to 10 ppm, or drain pool and scrub sides and bottom.d. Test the level of chlorine and pH hourly until they return to acceptable ranges.e. Resume patient treatment in the pool when chlorine and pH have returned to acceptable ranges. (1.5 to 2.0 ppm)

B. Hydrotherapy Units:1. There are 3 treatment tanks in use on patients with non-intact skin as follows:

a. Rinse thoroughly and wipe dry

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C. Hydrocollators:1. Hot packs: drain unit once per month or if visibly soiled.

Water may be drained through drain valve located at rear bottom of unit.

a. Clean unit with a mild non-abrasive stainless steel cleanser, and rinse thoroughly. Hot packs can be washed with mild soap and water, however, the simplest method of cleaning is to keep them immersed in the hydrocollator at a preset temperature of 160 0 F (71 0 C).

b. Hot packs which leak or become visibly thinner should be replaced. Hot packs have an expected use period of approximately one year.

c. Towels not in direct patient contact for wrapping hot packs should be laundered once per week or when visibly soiled.

d. Towels in direct patient contact for wrapping hot packs are single use only and are laundered between patients.

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2. Cold packs: drain unit once per month, or if visibly soiled, or if there is excessive frost build-up. Water may be drained through drain valve located at rear bottom of unit. Wash down using warm water only.

a. Cold packs may be cleaned with mild soap and water or disinfected with 70% alcohol if soiled with blood or body fluid.

b. Cold packs which are leaking should be repaired or discarded.c. Towels in direct patient contact for wrapping cold packs are

single use only and are laundered between patients.d. Dust and lint in the condenser fins should be cleaned once per

month. The condenser can be reached by removing the rear access panel.

D. Paraffin Wax Treatment Room:1. Wax treatments should only be used on patients with intact

skin. All skin surfaces to be treated should be washed with an antibacterial soap and rinsed prior to placement in the paraffin bath.

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2. The wax bath should be sterilized at the end of each working day by turning the timer switch on for the full 55 minutes. The wax bath temperature should rise to 212 o F (100 o C) and then should return to normal working temperature automatically when the 55 minutes is complete. For visible sediment at the bottom of the tank, the following procedure should be done:

a. Drain paraffin into a container using the hollow drain rings (this filters wax).

b. Disconnect electrical outlet and remove drain ring - the sediment and sludge can then be drained.

c. Clean the bottom of the wax holder and slats with a mild hospital approved detergent and rinse thoroughly.

d. Return clean paraffin to the container. Reconnect electrical outlet.e. This cleaning method usually removes approximately 1 to 3 pounds

of paraffin which should be added to the cleaned bath.f. Process for reusing wax:

i. Allow wax to harden and sediment to filter to bottomii. Cut off sediment

iii. Return clean wax to container for reuse

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E. Gymnasium/Exercise Rooms:1. All equipment and toys should be made of materials which are

easily disinfected. If this is not possible it should have a cover which can be laundered when visibly soiled. i.e., weights.

2. Whenever possible and if the information is available, follow manufacturer’s instructions for cleaning equipment to avoid injury to patient or damage to equipment, or interference with function, i.e., laser, electrotherapy.

3. Equipment which is frayed, cracked, or otherwise damaged, should be replaced or repaired.

4. Non-critical reusable items such as scissors should be wiped with 70% alcohol between patients.

5. Although difficult to control, children should not place toys in their mouths. Toys should be washed with a hospital approved disinfectant, and then rinsed with water.

6. The plinth table should be wiped off with an approved hospital disinfectant, i.e., a quaternary ammonium compound and rinsed between patients if there is visible blood or body fluid. It should also be covered with a sheet which is changed between patients.

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7. Only patients with intact skin should use hand putty. Appropriate hand hygiene techniques should be used prior to using the putty. Putty that is visibly soiled should be discarded.

F. Cleaning of specific equipment:1. Clean equipment daily or if visibly soiled.2. Follow manufacturer’s recommendations.

G. Patients with communicable diseases/epidemiological significant organisms:

1. Seek infection control advice for individual assessment of these patients

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