Patient Safety: Handwashing, Sterilization, and Isolation Flashcards
healthcare-associated infections are the ______________leading cause of death in the US behind heart disease, cancer, and strokes.
4th
75% of all hospitals have been cited for serious ____________________________.
cleanliness and sanitation violations
why should we care about healthcare-associated infections (HAI’s)?
they are a major threat to patient safety
Central line-associated bloodstream infections (CLABSI)
ICUs, NICUs, and wards
Catheter-associated urinary tract infections (CAUTI)
ICUs and wards
C. difficile infections
all inpatient locations in the facility, with the exception of the NICU and well-baby locations
surgical site infections
colorectal, hysterectomy
MRSA bloodstream infections
all inpatient locations in the facility
approximate sources of hospital-onset infections:
-patient’s endogenous flora, 40-60%
-cross-infection via hands of personnel, 20-40%
-antibiotic-driven changes in flora, 20-25%
-other, 20%
what are the steps to properly wash hands?
- wet hands with clean water, turn off tap, apply soap
- rub hands together with soap, lather back of hand, between fingers and under nails
- scrub for at least 20 seconds
- rinse your hands
- dry your hands
if you don’t have access to soap and water, use
-hospital-grade foam
-hand sanitizer with > 60% ethanol content
when is alcohol-based sanitizer the preferred method for cleaning hands in a healthcare setting?
when they are not visibly dirty
what should be used to clean your hands from spores or certain viruses like C. diff or Norovirus?
soap and water
when should hand hygiene be performed for all employees?
-upon entry of patient room or care area even when not touching the patient
-before applying gloves and after removing gloves
-before and after patient contact
sterilization
-complete destruction of all forms of life
-includes bacteria, spores, fungi, and viruses
-no such thing as partially sterile
disinfection
-use of agent to lower the number of growing microorganisms
-does not provide sterility (some may survive)
disinfectant
-agent which lowers the count of viable organisms
-usually applied to inanimate objects
antiseptic
-an agent which lowers the count of viable microorganisms
-usually applied to patients
-penetrate soft tissue or contact bone, enter into or contact the vascular system or other normally sterile tissue
-greatest risk of transmitting infection
-must be heat sterilized or disposable
-ex. surgical instruments
critical items
-contact mucous membranes or non-intact skin
-lower risk of transmission
-should be heat sterilized or high-level disinfected
-ex. mouth mirrors, amalgam condensers, reusable impression trays
semicritical items
-contact intact skin
-barrier protect or clean and disinfect
-ex. blood pressure cuff
noncritical items
agents which inhibit the growth of microorganisms; upon removal of the agent, growth may resume
bacteriostatic
agents which kill microorganisms; upon removal of agent, growth cannot resume
bactericidal
the irreversible inability of a microorganism to reproduce
microbial death
what is the level of microbial resistance to germicidal chemicals from most resistant to least resistant?
- bacterial spores (bacillus & clostridium)
- mycobacteria (mycobacterium tuberculosis)
- non-enveloped viruses (poliovirus & coxsackievirus)
- fungi (aspergillus & candida)
- vegetative bacteria (pseudomonas aeruginosa, staphylococcus aureus, and E. coli)
- enveloped viruses (herpes, HIV)
what are the factors that affect potency of chemical agents
-number and location of microorganisms
-innate resistance of microorganisms
-presence of extraneous materials
-concentration of the agent
-time
-temp, pH
what chemical agents target membrane function?
-quaternary ammonium compounds
-detergents
-phenols
-organic solvents
-alcohols
what chemical agents can denature proteins?
-acids and alkalis
-phenols
-acetone and other organic solvents
-alcohols
what chemical agents destroy or modify the functional groups of proteins?
-heavy metals
-oxidizing agents
-dyes
-alkylating agents
how does hand sanitizer serve as a chemical agent?
alcohols make cytoplasmic membranes more permeable which allows leakage of cell contents, and denaturation of proteins
what are some high activity disinfectants and what are they active against?
-formaldehyde
-glutaraldehyde
-gaseous ethylene oxide
bacterial spores, mycobacteria, nonenveloped viruses, vegetative bacteria, enveloped viruses
what are some intermediate activity disinfectants and what are they active against?
-phenols
-chlorine
-iodophores
-alcohols
-mycobacteria, vegetative bacteria, enveloped viruses
what are some low activity disinfectants and what are they active against?
-detergents
-quaternary ammonium compounds
-mercurials
-vegetative bacteria
what are the properties of an ideal disinfectant?
-broad spectrum
-fast-acting
-not affected by physical factors
-non-toxic
-surface compatibility
-residual effect on treated surfaces
-easy to use
-odorless
-economical
sterilant activity against mycobacterium bovis:
-1.5% glutaraldehyde (28-36 minutes)
-2.5% glutaraldehyde (14-18 minutes)
-0.21% OPA (4.8-6.3 minutes)
what are disinfectants you might encounter in the clinic?
-OPA
-Triclosan
-chlorhexidine
-unsaturated chemical vapor
-ethylene oxide
-chlorine dioxide
-hydrogen peroxide gas plasma
ortho-phthalaldehyde (OPA)
-requires no activation
-not known to irritate the eyes or nose
-stable over a wide pH range
-does not require exposure monitoring
-barely perceptible odor
Triclosan
-bacteriostatic activity against gram-negatives and gram-positives
-increasingly found in persona care and consumer products
chlorhexidine
-chlorhexidine gluconate (oral rinse)
-antiseptic with antibacterial and some antiviral activity
-effective agent for the prevention and treatment of oral disease
-absorbs to negatively charged surfaces in the mouth (prolonged antimicrobial activity)
unsaturated chemical vapor
-involves heating a chemical solution, typically alcohol with 0.23% formaldehyde, in a closed pressurized chamber
-131 C, 20 psi, 30 mins
what are the advantages and disadvantages of unsaturated chemical vapor?
-advantages: short cycle time, does not dull cutting edges, rust or corrode
-disadvantages: instruments must be completely dried, may destroy heat-sensitive materials, chemical odor in poorly ventilated areas
what is the temp and cycle time for ethylene oxide?
room temp and 10-16 hours
advantages and disadvantages of ethylene oxide?
-advantages: high capacity for penetration, does not damage heat-labile materials, evaporates without leaving a residue, suitable for materials that cannot be exposed to moisture
-disadvantages: slow, retained in liquids and rubber material for prolonged intervals, causes tissue irritation if not well aerated, requires special spark-shield for explosion potential
chlorine dioxide
-relatively new sterilization agent
-not yet routinely used but may replace ethylene oxide or chemical vapor
-has been used to sterilize entire buildings contaminated with anthrax spores
-will inactivate prions
hydrogen peroxide gas plasma
-h2o2 vapor subjected to electrical field
-widely used for surgical
-relatively free of toxic residuals, compatible with many medical device materials
-used to disinfect hospitals undergoing outbreaks of carbapenem-resistant Klebsiella pneumoniae
-widely used for sterilizing re-usable PPE during covid
what are the physical agents used to disinfect
-heat
-radiation
-filtration
-ultrasound
-freezing
steam autoclave settings
-121 C, 15 psi, 15-20min
-134 C, 30 psi, 4-5 min
advantages and disadvantages of autoclaving
-advantages: short cycle time, good penetration, wide range of materials can be processed without destruction
-disadvantages: corrosion of unprotected carbon steel instruments, dulling of unprotected cutting edges, packages may remain wet at end of cycle, may destroy heat sensitive materials, effectiveness reduced if chamber is overloaded due to reduced steam penetration
dry heat temp and cycle time
-160 C, 2 hours
-170 C, 1 hour
advantages and disadvantages of dry heat
-advantages: effective and safe for sterilization of metal instruments, powders oils; does not dull cutting edges, rust or corrode
-disadvantages: long cycle required for sterilization, poor penetration, may discolor and char fabric, destroys heat-labile items
radiation
-causes single or double strand breaks in nucleic acids and free radicals
-some agents are resistant (spores and prions)
-UV light used as municipal water disinfectant
-gamma rays used in industry
explain the relationship between radiation and water
-cells are mostly water
-radiation on water releases electrons and free radicals that then damage other molecules in the cell
what are the 4 ways that we can monitor sterilization
-concentration test strips
-process indicators
-dosage indicators
-biologic indicators
process indicators
-dye changes according to temperature
-does not inform on the whole process, no guarantee of sterility
-“was the process hot enough?”
dosage indicators
-dye changes according to temp and time of exposure
biologic indicators
-bacillus spores autoclaved then incubated
-dead spores will not germinate, media stays same color
-live spores will germinate, change media to yellow
common factors in the improper use of sterilizers
-chamber overload
-low temp setting
-inadequate exposure time
-failure to preheat sterilizer
-interruption of the cycle
cleaning
-should always be done before disinfection or sterilization
-automated or manual
-minimize exposure potential
-use carrying container to transport contaminated instruments
-wear personal protective equipment
liquid sterilants/disinfectants
-only for heat-sensitive critical and semicritical devices
-highly toxic
-heat-tolerant or disposable alternatives are generally available
in what type of package does a chemical indicator need to be seen or labeled on package
heat treatment
