Description #
Outline the ways that infection can spread in a healthcare setting; and examine the important role that reprocessing plays in preventing the transmission of infection from one patient to another.
Routine practices in reprocessing that control the spread of infection such as; hand hygiene, protective equipment, dress codes in various patient procedure areas, transport of soiled devices, and cross contamination prevention.
Learning Objectives #
- Define Infection
- Describe the most common method of transmission of infection
- Outline common routine practices in reprocessing that control the spread of infection
- Describe appropriate Personal Protective Equipment for reprocessing medical devices
- Identify Restricted and Semi-restricted areas in your health care setting
- Define Cross contamination
- Describe the attributes of Protein
- Define the role that reprocessing plays in Infection Control
Infection control practices #
Infection can be defined as: The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.
Infection Control in healthcare facilities is primarily focused on how we can control microorganisms and prevent them from invading a body and multiplying in enough numbers to cause infection. To understand these control measures we need to understand a little of how microorganisms can move from one body to another.This movement is commonly called Transmission of Infection.
- Indirect Contact – is the spread of pathogens by touching an inanimate object that has been contaminated by an infected source and then touching another item or person. Inanimate objects such as patient care equipment, telephone handles, keyboards and door knobs are objects that can transmit pathogens. This is the most common method of transmission.
- Direct Contact – a person to person transmission of pathogens through touch, kissing, sexual contact, and other contact with body fluids contaminated by pathogens.
- Droplets – are large water droplets carrying pathogens released by an infected person though coughing, sneezing or speaking. A huge quantity of the infectious agent may be released all at once, but droplets are heavy in the air and tend to settle on surrounding surfaces within a metre and dry up. Droplets are usually coupled with contact as a means of transmission
- Airborne – occurs when respiratory droplets evaporate, leaving behind minute droplets which can suspend in the air, move through a ventilation system and can be breathed in when a person enters the immediate area. Airborne is usually coupled with contact as a mode of transmission
CSA Z314.0 Chain of Infection
Routine Practices that break the Chain of Infection
Routine infection Control Practices teach us to assume that all soiled or contaminated items may contain harmful microorganisms and that we must protect ourselves from direct contact with them. As well we must stop these microorganisms in the decontamination area and not allow them to travel into the clean areas of the facility. Routine Practices involve the use of: Hand Hygiene, PPE, correct disposal and handling of soil and sharps, careful reprocessing practices, and facility Dress Codes
Hand Hygiene
Because Indirect Contact is the most common method of infection transmission, careful and consistent hand cleaning is the most effective way to stop that transmission. We should clean our hands:
- before entering or leaving our work area
- after removing gloves
- after sneezing, coughing, using the toilet
- before and after work breaks
- after touching the floor or other dirty areas
- before handling clean, disinfected or sterile items
Link to BC HH online unit here
Personal Protective Equipment (PPE)
While everyone knows that PPE should be worn not everyone seems to understand how important it is. PPE is a vital part of infection control. Wearing it is also an important Employee Health and Safety measure. Work Safe BC regulations require that PPE be provided for staff, and be worn.
What does proper PPE look like?
A water-proof gown that has long sleeves
If liquid is able to seep through a gown onto your uniform then you are susceptible to contamination on your uniform and your skin. The chemicals we use in reprocessing can be harmful to your skin. If your uniform or skin is wet after removing PPE you need to change your uniform and wash. If you enter the clean area of your department with wet or contaminated uniform or skin you will transfer the contamination to clean or sterile items
If your arms are not covered by long sleeves then they will be contaminated with microorganisms and chemicals.
Gloves
Gloves must be worn whenever you are handling contaminated items. Chemical resistant gloves (Nitrile) should be worn when using enzymatic detergents.
Face mask and face shield
The chemicals we use in reprocessing can be very dangerous as can the microorganisms in blood and tissue. Using a surgical face mask can help keep chemical fumes away from our mouth and nose. Goggles are important for protecting our eyes. A full face shield will protect our eyes and mouth from splashing or spraying.
We must be very aware of what contamination we bring with us when we move through a facility. Correct use of PPE is vital to preventing the transmission of contamination and infection. When PPE is properly worn and then properly removed in the decontamination area we can keep all the germs and dirt contained in that area. Never enter a clean or sterile area if you are wearing PPE from decontamination.
Routine Practices also state that we must dispose of gross soil and disposable sharps at point of use.
This means that blood and bodily fluids must be carefully disposed of and not transported though a facility, because they pose a risk to us and to our ability to keep patients safe from infection.
Sharps injuries are a risk for us as well. Using Routine Practices help us handle Some recommend guidelines are:
- Dispose of sharps at point of use. If this is not possible then:
- Ensure that there are proper sharps disposal containers in the Decontamination area.
- Do not try to bend, break, recap, or unnecessarily handle any sharps.
- Do not try to stuff a sharp into an overfilled disposal container. This is when injuries often occur.
- Never discard sharps into the regular garbage. Protect others, such as housekeeping staff, from accidental injury.
- When sorting through anything, always be on the lookout for sharps. Being aware and observant protects you.
- Use a needle driver or safety container to remove a blade from a scalpel handle. Never use your fingers!
Transport of Devices
Because medical devices are a source of infection/contamination they must be handled carefully in order to avoid spreading contamination to other devices or areas of your department. How a device is transported from a procedure area to the cleaning, or decontamination area, is important.
Transport Containers should be:
- Solid (puncture resistant, rigid)
- Leak-proof (gaskets are good)
- Lidded (lids should remain closed
For safety, and to avoid any confusion, all containers holding or transporting contaminated items, should be labeled “soiled” or “contaminated” and have a biohazard label attached.
After soiled items are removed for reprocessing the container must be disinfected, and should be labeled “clean”
To prolong the life of medical devices and ensure that they can be reprocessed properly, all devices must be cleaned of visible soil immediately after use, in many cases before they are transported to the reprocessing area. If possible, wipe off any visible soil in the procedure room before transport.
Dress Codes: Many areas of a hospital or clinic require that we wear uniforms and head coverings and do not allow any clothing brought from home. This is to prevent contamination by such things as pet hair, soil from outside or from our houses. Uniforms should not be taken home to wash and must be changed daily.
Different Dress Codes will apply in different areas. Most patient procedure areas are divided into Un-restricted, Semi-restricted, and Restricted areas
- Un-restricted – This is the area closest to the outside and may contain offices, patient waiting areas and public access areas. The un-restricted area is divided from other areas by doors. Street clothes are permitted in un-restricted areas.
- Semi–restricted – only approved uniforms are allowed here; no street clothes. Head coverings must be worn by staff and patients.
- Restricted – the operating rooms or procedure rooms, are located here. Face masks as well as uniforms are required. Sterile procedures are carried out here.
Careful reprocessing is vital to infection control
The primary work of reprocessing is to stop the movement of microorganisms that cause infection from one patient to another or from a patient to staff. Reprocessing practices remove soil and microorganisms from medical devices. The most common soil we see is protein from blood, tissue and other body fluids. The major component of microorganisms is also protein. Therefore, we need to understand protein to successfully reprocess any device.
Protein is:
- not soluble in water – this means we need more than just water to break down protein soil, we also need to use detergents.
- coagulated by heat, and drying – this is why we keep water temperatures in our washing sinks “tepid” (not too hot) and we try to keep soil from drying out on instruments by cleaning them as quickly as we can.
- able to trap and protect microorganisms if it becomes coagulated – again we need to clean instruments quickly and carefully to remove all soil
Cross-contamination – another term for Indirect Contact
We have seen in the previous section on Transmission of Infection that the most common way a microorganism gets from one person to another is by Indirect Contact. Cross-Contamination is a form of Indirect Contact in reprocessing. It happens when we touch a soiled (contaminated) item and then touch a clean or even sterile one; or we place soiled items on clean surfaces; or we wear soiled clothes in a clean area, etc.
The soil we encounter in reprocessing, such as blood and tissue, is often visible and easily removed. However, the most important contamination is invisible. Microorganisms cannot be seen so we must learn to anticipate where they might be. The practice of One-way work flow helps prevent cross-contamination of clean items. In one-way work flow systems dirty items are cleaned and placed on a clean counter never back onto a dirty counter. As well, if we handle a dirty item and then handle a clean or sterile one without removing gloves and properly cleaning our hands we will cross-contaminate.
More information on practices in decontamination can be found in another unit in this series – The Basics of Decontamination
Surgical Conscience is an important part of Infection Control. Members of the operating room team are familiar with the concept of a Surgical Conscience and any healthcare staff members who reprocess medical devices should be aware of it too. It is defined by nursing text books as “an awareness of the importance of strictly and consistently applying knowledge to ensure quality in practice” In other words, ensuring that we always follow best practices and use our knowledge to give each patient the same high standard of care. This high standard applies even if we are under pressure to rush, and whether we are alone or there are others watching us. Developing a surgical conscience shows we care about our patients, ourselves and our coworkers, and helps us do the right thing at all times.
Glossary Infection Control #
Hand Hygiene – a general term referring to any action of hand cleaning. Can be accomplished using soap and running water or an alcohol-based hand rub.
Nitrile – synthetic rubber used in gloves to provide protection against chemicals
One-Way Work Flow – the practice of ensuring that reprocessing work flows in one direction from the dirtiest to the cleanest to prevent contamination
Pathogenic – capable of causing disease in humans
PPE – Personal Protective Equipment. Special clothing or equipment worn by staff for protection against hazards.
Protein – essential organic molecules which constitute a large portion of the mass of living organisms. The primary type of soil we deal with in reprocessing
Sharps – refers to any item capable of cutting or piercing the skin.
Soluble – capable of being dissolved in liquid
Tepid – temperature that is only warm, not hot. Often called lukewarm