Question

What are the standard precautions and infection control steps that are necessary before and after use of an exam/treatment room?

Answer 1

Standard Precautions define all the steps that should be taken to prevent spread of infection from person to person or from contaminated environmental surfaces/healthcare items, when there is an anticipated contact with:

• Blood,body fluids,secretions ,excretions,non-intact skin, such as an open wound,mucous membranes, such as the mouth cavity.

Standard Precautions are designed to reduce the risk of transmission of bloodborne pathogens and pathogens from moist body substances. They are applied to all patients regardless of their diagnosis or presumed infection status. The application of Standard Precautions during patient care is determined by the nature of contact/interaction with the patient and the extent of anticipated blood, body fluid exposure which includes:

I. Hand Hygiene

II. Personal Protective Equipment (PPE)

III. RespiratoryHygiene/CoughEtiquette

IV. Patient Triage and Placement

A high index of suspicion is needed for identifying potentially infectious individuals. Specific triage policies such as provision of visual alert to remind patient to inform staff for fever or respiratory symptoms should be developed for early detection and isolation, so as to minimize transmitting communicable diseases to other patients and HCWs in treat room setting. During patient triage, the following should be observed:

 HCWs should assess patients for conditions that require additional precautions (i.e. transmission-based precautions) and prioritize those who may require urgent consultation and isolation.

 Patients with high suspicion of infectious risk should be accommodated and registered in designated area to minimize cross infection.

 Provide a surgical mask for patients identified with respiratory symptoms.

 Minimize the stay of infectious patients in outpatient clinics, arrange consultation soon within their arrival time and facilitate early departure from clinics.

V. Patient Care Equipment

Decontamination of reusable patient care instruments is necessary to prevent transmission of organisms between patients. Disinfection is used to eliminate many or all pathogenic microorganisms, except bacterial spores, on inanimate objects. Sterilisation is used to destroy or eliminates all forms of microbial life. Standard Precautions should be applied when handling used instrumentsreatment room should establish policies and procedures for containing, transporting, and handling equipment that may be contaminated with blood or body fluids.

 Manufacturer’s instructions for reprocessing any reusable medical equipment in the facility (including point-of-care devices such as blood glucose meters) should be readily available and used to establish clear and appropriate policies and procedures.

 Before disinfection and sterilisation, thorough cleaning is essential because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes.

(A) Cleaning:Cleaning is the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces and normally is accomplished manually or mechanically using water with detergents or enzymatic products. It is an essential and important step before processing to disinfection and sterilisation.

 Instrument should be rinsed off gently under running water; or soaked in a solution of lukewarm water (not more than 45 °C ) or any presoaking solutions including enzymatic, disinfectants, or detergents (in accordance with the instructions from device manufacturers) to prevent coagulation of proteinaceous substances and remove gross soil. Appropriate PPE should be worn when cleaning instruments to minimize occupational exposure. Care should be taken not to produce splashes.

(B) Disinfection and Sterilisation Methods

Instruments should be categorized according to the risks they pose for patients.

 Critical items confer a high risk for infection if they are contaminated with any microorganisms. Objects that enter sterile body areas or the vascular system must be sterile because any microbial contamination could transmit disease.

 Semi-critical items are devices that come into contact with mucous membranes or non-intact skin, which require high-level disinfection*. These medical devices should be free from all microorganisms; however, small number of bacterial spores is permissible. Cleaning followed by high-level disinfection should eliminate enough pathogens to prevent transmission.

 Non-critical items are those come into contact with intact skin. Intact skin acts as an effective barrier to most microorganisms; therefore the sterility of items coming in contact with intact skin is not critical. These items can be divided into noncritical patient care items and noncritical environmental surfaces. Low-level disinfection is generally sufficient.