Hygiene, handwashing and hospital design Flashcards
Why is regular handwashing needed?
Remove bacteria and reduce level of residual bacteria
When do you need to wash your hands?
Before aseptic procedures
Before and after touching patients and their surroundings
How should you wash your hands properly?
Antimicrobial soap or alcohol based sanitiser
Use WHO handwashing protocol
What are the general requirements for hand hygeine?
Bare below elbows
Short clean and bare nails
Cover cuts in water proof dressing
Describe the stages of the WHO handwashing procedure
Wet hands and apply soap Palm to palm Palm over back of hand with interlocked fingers (both sides) Palm to palm with fingers interlocked Hands clasped around each other with fingers interlocked Rotational thumb rubbing Clean fingers on palms Rinse hands and dry
Why is infection control important?
Prevent HAI
Keep staff and patients safe
Maintain public health
How to clean kennels appropriately
Remove bedding and wash at 60 degrees
Remove organic material then remove any traces with detergent
Use disinfectant correctly
Wipe top to bottom
Define disinfectant
Killing or removal of microorganisms
Define antiseptic
Similar to disinfection but on living tissue
Define detergent
Solution with cleaning activity to remove organic matter
Define sterilisation
Removal of all microorganisms including spores
Define asepsis
Complete removal of all microorganisms including spores resulting in complete sterile state
How do bacteria exist in the environment?
Spores- dormant
Vegetative- living and replicating
What is the effect of viruses lipid envelope when trying to disinfect?
More easily removed as disinfectant removes lipid layer making it vulnerable
What are features of the ideal disinfectant?
Broad spectrum Non-irritant and non-toxic Easy to use Stable and not easily inactivated Cost effective Rapid action Remains on surface for contact time Not deactivated easily
What needs to be considered when choosing disinfectant?
Whats it being used on
Amount of organic matter involved
Contact time
Dilution
How do alcohol disinfectants work, what are they used for and what is an example?
Cause cell membrane damage Fast acting but no residual activity Broad spectrum effect except against enveloped viruses and spores Hand disinfection and patient prep Surgical spirit
How do aldehyde disinfectants work, why aren’t they used and what is an example?
Denatures proteins, broad spectrum
Toxic and possible carcinogenic
Formaldyhyde
How do biguanide disinfectants work, what are they used for and what is an example?
Alters cell membrane permeability but inactivated by organic matter, good residual action.
Effective against bacteria, some fungi but not spores
Used for patient prep or surgical scrub
Chlorhexidine
How do halogen disinfectants work, what are they used for and what is an example?
Destroys proteins in cells
Broad spectrum
Cleaning surfaces and skin
Bleach
How do QAC disinfectants work, what are they used for and what is an exmaple?
Inactivate enzymes and denature proteins Some residual activity Broad spectrum but not against unenveloped viruses or spores Surface disinfection Anigene
How to phenol disinfectants work, what are they used for and what is an example?
Denature proteins and disrupt cell membranes
Broad spectrum but not against unenveloped viruses or spores
Surface disinfection
Dettol
What is meant by a hospital acquired infection?
Infections acquired by patients during hospitalisation of acquired up to 30 days father discharge
What are common HAI?
UTIs
Pneumonia
Blood stream infections
Diarrhoea
What are some of the consequences of hospital acquired infections?
Client dissatisfaction
Longer hospitalisation
Higher morbidity
Multidrug resistance
What are common routes of infection of HAI?
Urinary catheters Surgery IV catheters or blood taking Implants Feeding tubes Contamination between patients
What are risk factors for HAIs?
Elderly Young Immunocompromised Invasive devices Endocrine disease
How are UTIs acquired in hospitals?
Urinary catheters main cause from repeated placement or poor hygiene
What are the signs of UTI?
Pyrexia
Colour or smell change in urine
How to correctly insert urinary catheter to prevent UTI?
Wash hands and wear sterile gloves
Clean and clip area
Used closed system collection bag
Avoid repeated placement and remove as soon as possible
What is the main cause of blood stream infections?
IV catheter use especially central lines when placed/maintained with poor hygeine
How to prevent bloodstream infections from catheterising?
Wash hands
Clean and clip area
Use sterile equipment
Remove catheter as soon as possible and avoid repeated placement
How to prevent infectious diarrhoea?
Wash hands and clean accommodation thoroughly between patients
Regularly deep clean facilities
Limit transport in and out of ward when there is an outbreak
What equipment is the main cause of pneumonia in patients?
ET tubes, circuits so need cleaning properly or disposing if cant clean
What is the most common type of pneumonia and how is it prevented?
Aspiration, mainly when under GA
Starve patients before anaesthesia, secure airway ASAP and keep head elevated until cuff is inflated
How to prevent superficial or systemic surgical infections?
Adequately prepare skin and personnel, use good theatre practice
Keep wound covered for 24-48 hours and only change when dirty or damaged
What are some ways to prevent HAI?
Initial telephone calls can flag infection
Use SOPs between patients
Correctly dispose bodily fluids and waste
Handwashing
Barrier nursing when appropriate
Infection control team monitors and makes changes
Where should you house those with poor immune status?
In normal wards but reverse barrier nusre
What is mean by reverse barrier nursing?
Nursing those with poor immune systems before those with strong immune systems
Where should you house those with strong immune systems?
Normal ward
Where should you house those with mild infectious disease?
In ward or isolation
When in ward use separate area, PPE and own equipment
Isolate when with immunocompromised patients
Where should you house severely infectious patients?
Isolation with barrier nursing
What are the features of isolation facilities?
At least 5m away from other patients Dedicated nurse Disposable items where possible Patient has own equipment PPE on entrance Use bedding wash bags to avoid handling Use of SOPs Minimise owner visits
What is meant by HAIs being opportunistic?
Take advantage when patient is already compromised
When should you suspect a resistant infection?
Not responding to antibiotics or is at risk
How is resistant infections avoided?
Limit antibiotic use
Hand hygiene
Education of veterinary team
Report incidences to track any issues
What is MRSA?
Methicillin resistant staphylococcus areus
What issues to MRSA cause and how should you treat it?
Issues- unhealing wounds, sepsis
Treating- strict isolation
What are the 5 freedoms that must be provided to patients?
Freedom from pain, injury and disease Freedom from hunger and thirst Freedom from discomfort Freedom from fear and distress Freedom to express normal behaviour
What considerations need to be in place for boarding environments?
Enough space to express normal behaviour
Able to disinfect
Enrichment and company when approptriate
What considerations need to be in place for animals in hospital environments?
Space to express normal behaviour unless needs restricting or being disturbed due to injury or treatment
Be able to sterilise
Enrichment and company when appropriate
What do you need to consider in hospital design regarding different species housing?
Different area for cats, dogs, exotics and isolation
What are the key features of different structural materials?
Concrete- appropriate outdoors, time consuming to clean, cheap, reflects temperature of environment
Tiles- avoid, hard to clean, slippery and cold
Stainless steel- cheap, manufactured to fit, easy to clean, slippery, loud and reflective
Fibreglass- hardwearing, easy to clean, hard to ventilate but good for oxygen therapy
What are the ventilation requirements in hospitals?
Clean air at least 4-8 changes per hour and more in isolation to reduce likelihood of airborne infections
Allows humidity and temperature control
What are the different ways of ventilating?
Active- extractor fans, aircon
Passive- windows and doors
What temperature should the hospital be at and why?
18-22 degrees
Helps mould and damp prevention and keeps everyone comfortable
How can temperature be regulated in hospitals?
Underfloor/central heating Aircon heating systems Radiators Heat lamps, pads Fans
What are the different types of bedding that can be used?
Fleece Blankets Towels Covered foam wedges Newspaper Incontinence pads Bean bags
What are advantages and disadvantages of fleece bedding?
Adv- reusable, absorbent, warm
Dis- expensive, chewable
What are advantages and disadvantages of blankets and towels for bedding?
Adv- reusable, washable, warm
Dis- expensive, non- draining
What are advantages and disadvantages of covered foam wedges for bedding?
Adv- reusable, support for recumbency
Dis- chewable
What are advantages and disadvantages of newspaper bedding?
Adv- some warmth, cheap
Dis- disposable, staples, ink leaking, no padding
What are advantages and disadvantages of incontinence pads?
Adv- some warmth, absorbent
Dis- disposable, no padding, expensive
What are advantages and disadvantages of bean bags for bedding?
Adv- reusable, insulating, comfortable, support
Dis- only cover is washable
What needs considering for patients when putting them in kennels?
Temperament
Disease and injury
How is the best way to approach and house animals when unsure on temperament?
Hands free when possible
Keep lead not slip attached
Keep on flood level
Never keep muzzle on
How to move patients when in pain?
Slide where possible not lift
What needs considering about mobility of patients?
Whether its acute or chronic
Ambulatory/walking or non-ambulatory
How to manage recumbent patients?
Thick bedding
Incontinence sheets
Vet beds to wick away urine
Enough space to lift patients
What do critical hospitalised patients needs?
Constant monitoring
Rapid access to life support
How should infectious patients be hosptalised?
Barrier nursing
Isolation
Housed at bottom
