prevention of hospital infection
TRANSCRIPT
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Prevention of Hospital Infection
Exogenous infection
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Hospital Infection
• Surgical wards
• Operation Theaters
• Surgical Instruments
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Surgical wards
• Should be well ventilated and cleaned • The floor should be scrub washed once a
week• Preop. Pts should not be mixed with
postop. Pts.• Severely infected cases should be
isolated • Immuno suppressed pts also isolated
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Operation Theaters• Adjacent to ICU• Height – 3M. Floor area 10 sqM.• Anaesthetic room -10 Sqm.• Minimise bacterial contamination The concept Site – away from the wards of
zones : a) outer zone – reception area. b) clean zone – between the reception and OR. C) asceptic zone – OR . D) dirty zone – disposal area and space for cleaning of instruments
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Air flow of OR
•Filtered air – directed vertically or horizontally
• Ideal – laminar flow•Restrict entry of
nonessential personnel & their movements
•Temperature – 20 - 22°C
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Other Measures
• Wearing of disposable nonwoven fabric• Masks• Head & beard cover• Preparation of the surgical team• Preparation of the patient Preoperative hospitalisation
minimised Skin infection treated Hair removal Skin preparation, Drapes
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Disinfection
The process that reduces the no. of viable microorganisms, but does not affect the spores
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Disinfection
Three levels of disinfection 1. Low: reduces the overall no. of
vegetative microorganisms. Does not destroy TB bacilli or bacterial spores .Application – environmental surfaces
2. Intermediate : kills TB bacilli, most viruses,and some fungi but only some spores. Application – horizontal surfaces,floors
3. High: kills most forms of microbial life including TB bacilli but not some spores. Application – flexible endoscopes
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Disinfection
• Heat disinfection 1) Pasteurization 2) Boiling 3) Low temperature steam
disinfection
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Chemical disinfection
• Chemical disinfectants are used to reduce the pathogenic microbes of inanimate objects, which are heavily contaminated.
• Alcohols, aldehydes, halogens, phenolics and quaternary ammonium compounds
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Chemical disinfectants
• Alcohol – isopropyl alcohol & ethyl alcohol – kills most vegetative bacteria in less than 30 seconds , relatively inactive against spores and fungi. 70% alcohol is usually used.
• Aldehydes – glutaraldehyde & formaldehyde – good activity against spores, bacteria, virus and fungi . 2% glutaraldehyde rapidly inactivates HIV and hepatitis B after exposure for 10 minutes.
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Chemical disinfection
• Diguanides – e.g. chlorhexidine – good activity against gm + ve organisms , moderate activity against gm- ve organisms, poor activity > TB bacilli, spores , fungi & viruses . Used as an antiseptic for skin & mucous memb.
• Halogens e.g. hypochlorites and chlorine – active against bacteria including spores ,fungi, hepatitis B & HIV virus
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Chemical disinfection• Iodophores -1% available Iodine
mixed with alcohol excellent skin preparation
• Phenolics – e.g phenol &chlorxylenol surface cleaning – Hexachlorophene – preparation of surgeon's hands
• Quaternary ammonium compounds – good detergent properties – savlon when mixed with chlorhexidine
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Sterilization
• Complete removal of all microbes including spores
• Methods : Heat method – dry or moist
Ionization radiation
Ethylene oxide gas
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Heat Methods
• Dry heat – Hot air ovens which have controlled cycles, such as 160°C for 1 hour – suitable for killing bacteria on materials which are not penetrable by steam e.g. glassware, powder such as talc, oils & petroleum jelly.
• Moist heat – Steam under pressure – simplest is domestic pressure
• High pressure vacuum autoclaves• Low temp. steam(73°C) & formaldehyde –
suitable for heat sensitive materials and equipment with plastic component
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Ionising Radiation
• Gamma rays – lethal, noncharged, ultrashort, wavelength rays with great penetrating power from a radioactive isotope such asCobalt-60 e.g.Disposable syringes, sutures and rubber gloves
• The radiation dose 2.5 mrad – kills bacteria by ionising their DNA.
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EthyleneOxide
• It should be used with suitable humidity at the correct temp. for sufficient time
• CO2 is mixed with ethylene oxide to reduce Highly toxic inflammable gas – kills all types of microbes including spores.
• the risk of explosion• It diffuses well through items such
as plastic materials, swabs and paper.