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HEEPF ICEP
INFECTION CONTROL
EDUCATION PROGRAM
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SOURCES OF
CONTAMINATION
Skin
H i
Hair
Nasopharynx
Fomites
Air
Human Error
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Tackling Contamination Sources
Skin normallyy harbors resident organisms
g below its surface that are acquired
q byy direct
contact.. Both types of flora are constantly shed into the environment.
contact environment.
Key points are mentioned here for all personnel entering the operating room.
1. Daily bathing with soap containing an antibacterial agent.
2. Donning for clean OR attire upon each entry into the OR suite. Long sleeves are worn
by unsterile team members.
3. Covering g abrasions or cuts hands and skin. Persons with infected skin lesions should
not be permitted in OR suite.
4. Thorough hand washing before initial every into restricted are of OR suite.
5. Impeccable hand washing after every direct contact with patients or items in contact
with ppatient’s blood,, bodyy fluids,, or excretions.
6. Wearing of gloves when handling blood, excreta, drainage, and secretions or items
contaminated with body substances, including tissue specimens. Hands are washed
after removing gloves.
NOTE hand washing cannot be overemphasized. This is vigorous rubbing of all surface of
well--lathered, soapy hands, followed by rinsing under a stream of water.
well
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Tackling Contamination Sources
H i should
Hair h ld bbe shampooed
h d ffrequently.
l C Caps or h
hoods
d
are worn to completely cover hair, including beards.
N
Nasopharynx
h M k are worn to cover nose and
Masks d
mouth. They should be changed after caring for each
patient Persons with respiratory infection should not
patient.
be permitted in OR suite. Coughing and sneezing
explode droplets into the environment
environment. Taking should
be kept to minimum.
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Tackling Contamination Sources
F it Inanimate
Fomites I i t objects
bj t collect
ll t dust,
d t lint,
li t droplets
d l t andd particles
ti l from
f the
th
air. Surfaces of furniture, equipment, and floors may be contaminated by
spills or contact with organic debris.
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Environmental Services/Housekeeping
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Tackling Contamination Sources
C
Controll off Ai
Airborne
b C
Contamination
i i
Air currents and movement in the OR should be
k at a minimum
kept i i to prevent airborne
ib contamination.
i i
Viable microorganisms from the air settle on
h i
horizontall surfaces.
f P
Proper cleaning
l i off these
h surfaces
f
helps control this contamination.
Th ventilation
The il i system andd efforts
ff to minimize
i i i air
i
turbulence and contaminants also are important factors.
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Universal Precautions
Transmission of infection requires a source, a method, and a susceptible host.
host.
Everyy p
patient is considered a source when blood and bodyy fluids containing
g blood
will be encountered , as in invasive diagnostic or therapeutic procedures.
procedures.
Universal precautions imply treating all human blood and other bodily fluids as
though they were
infected with blood-
blood-borne pathogens.
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Blood--borne Pathogen Standard
Blood
Requirements
Employers must have a written Exposure Control
Program that explains the risks and protective measures
to be followed.
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H to Protect
How P Ourselves?
O l ?
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Universal Blood and Body Fluid Precautions
Note: All skin defects (cuts, abrasions, ulcers, areas of dermatitis, etc,)
should be covered with an occlusive bandage.
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Universal Blood and Body Fluid
Precautions 2
Change gloves between each patient.
Place large
large-
g -bore reusable needles ((e.g.,
g , bone-
bone-marrow needles
and biopsy needles) and other reusable sharps into a puncture-
puncture-
resistant container for transport to the reprocessing area.
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Universal Blood and Body Fluid
Precautions 4
Minimize the need for mouth-
mouth-to-
to-mouth emergency
resuscitation p
procedures. Mouth p pieces,, resuscitation
bags, or other ventilation devices should be used
routinely.
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Handling Precautions
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Aseptic Techniques & their
Applications
Strict
S i aseptic i andd sterile
il techniques
h i are needed
d d at allll
times in places such as the operating room
room..
Sterile techniques prevent transfer of microorganisms
into body tissues.
tissues.
Intact skin and mucous membranes are the body body’ss first
line of defense against infection
infection.. Infraction of their
integrity
g y creates a p portal of entryy for microorganisms
microorganisms.
g .
Therefore, anything in contact with body tissues is
potentially dangerous.
dangerous.
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Aseptic Techniques & their
Applications
D
Depending
di on theirh i iintended
d d purpose and
dbbody
d contact, iitems
are classified as:
1. C
Critical.
c . Items
te s entering
e te g body tissues
t ssues underlying
u de y g skin
s and
a d mucous
ucous
membranes must be sterile, i.e., free of microorganisms, including spores.
They are handled to maintain sterility.
2. Semicritical. Sterility is less critical for items that come into contact with
intact skin or mucous membranes. These items are surgically clean, i.e.,
mechanically cleaned and disinfected to reduces microorganisms, but
unsterile. Some items are disinfected immediatelyy before use and are
handled to prevent contamination before use. Other items are terminally
sterilized, but sterility is not maintained during use.
3. Noncrtical. Items that will only come in contact with intact skin or
mucous membranes in an area remote from the operative site may be
cleaned, terminally disinfected, and stored unsterile between patient uses.
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Principles
p
Only sterile items are used within sterile field.
field.
G
Gowns are considered
id d sterile
t il only
l ini front
f t from
f
chest to level of sterile field, and the sleeves from
above elbows of cuffs
cuffs..
Tables are sterile only at table level
level..
Persons who are sterile touch only sterile items or
areas;
areas
r ; persons
p r n who h are r not
n t sterile
t ril touch
t h only
nl
unsterile items or areas.
areas.
Unsterile p persons avoid reaching g over a sterile
field;; sterile persons avoid leaning over an unsterile
field
area..
area
Edges of anything
an thing that encloses sterile contents
are considered unsterile.
unsterile.
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Sterile field is created as close as possible to time
of use
Degree of contamination is proportionate to length of
time sterile items are uncovered and exposedp to
environment..
environment
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Sterile areas are
continuously
i l k
kept iin view
i
Inadvertent contamination of
sterile
il areas must be
b readily
dil
visible. To ensure this
principle:
1. Sterile persons face sterile
areas.
2. When sterile packs are open in
a room, or a sterile field set up,
someone must remain i in
i the
h
room to maintain vigilance.
Sterilityy cannot be
b ensured
without direct observation. An
unguarded sterile field should
b considered
be n id r d contaminated.
nt min t d
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Sterile persons keep well within the sterile area
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Sterile persons keep contact
with sterile areas to a
minimum
Th ffollowing
The ll i rules
l are observed:
b d
1. Sterile persons do not lean on
sterile table and on the draped
p
patient.
2. Sitting or leaning against a non
non--
sterile surface is a break in
technique. If the sterile team sits
to operate, they do so without
proximity
i i to non
non--sterile
il areas.
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Unsterile person avoid sterile areas
They maintain an awareness of sterile, unsterile, clean
and contaminated areas and proximity to each.
each They
must be aware of their closeness to the sterile field.
A wide margin
g of safetyy must be maintained when
passing sterile areas by following these rules:
1. Unsterile persons maintain a distance of at least 1 foot ((30
30
cm) from any area of the sterile field.
field
2. Unsterile persons face and observe a sterile area when passing
it to be sure they do not touch it.
3. Unsterile persons never walk between two sterile areas, e.g.,
between sterile instrument tables.
4. Circulating nurse restricts to a minimum all activity near
sterile field.
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Destruction of integrity of microbial barriers
results in contamination
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To ensure sterilityy of packages:
p g
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1. Skin cannot be sterilized.
sterilized. Skin is a potential source of
contamination in every operation
operation.. Inherent body defense usually
can overcome the h relatively
l i l few f organisms
i remaining
i i after
f patient’s
i ’
skin preparation
preparation..
All p
possible means are used to p prevent entrance of microorganisms
g
into wound. Preventive measure include:
a. Transient and resident floras are removed from skin around site
of ppatient and hands and arms of sterile team members byy
mechanical washing and chemical antisepsis.
b. Gowning and gloving of operating team is accomplished
without contamination of sterile exterior of gowns and gloves.
gloves
c. Sterile gloved hands do not directly touch skin and then deeper
tissues. Instruments used in contact with skin are discarded and
not reused.
reused
d. If glove is torn or punctured by needle or instrument, glove is
changed immediately. Needle or instrument is discarded from
sterile
il field.
fi ld
e. Sterile dressing should be applied before drapes are removed to
reduce risk of the incision being touched by contaminated
hands or objects.
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2. Some areas cannot be scrubbed.
scrubbed. When the operative
field includes the mouth, nose, throat, or anus, the
number of organisms present is great.
great.
The following steps may be taken to reduce number of
microorganisms present in these areas and to prevent
scattering
i them:
h
a. Surgeon makes an effort to use a sponge, only one, then
discards it.
it
b. Gastrointestinal tract, especially colon, is contaminated.
Measures are used to p prevent spreading
p g this contamination.
Infected areas are grossly contaminated. The team should
avoid disseminating the contamination by undue
manipulation.
manipulation
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3. Air is contaminated byy dust and droplets.
p
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St ilit iis never ttaken
Sterility k ffor granted.
t d It mustt be
b
maintained and checked.
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Thank you
for your
attention!
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