Transcript Infection Control in the Surgical Center

Infection Control in the
Surgical Center
Linda Verchick, MS
Epidemiology Supervisor
Clark County Health District
Outpatient Surgery Outbreaks
Mycobacterium sp.
Mycobacterium sp. (non-TB) associated
with outpatient/cosmetic surgery clinics.
– 2003 M. chelonae from multi-dose container
of methylene blue used to mark muscle
– 2001 mycobacterial keratitis associated with a
contaminated medical device
Key Recommendations of CDC
and HICPAC
Ventilation and water system performance
Multidisciplinary risk assessment team
Use of dust control procedures during construction,
repair, renovation or demolition
Environmental surface cleaning and disinfection
strategies geared towards antimicrobial resistant
organisms
Note: There are actually 12 Key recommendations listed in
“Guidelines for Environmental Infection Control in
Health-Care Facilities”
Regulate the Operating Room
Environment
Ventilation = positive pressure.
– Variable air systems (positive
pressure only)
– Air introduced at the ceiling and
exhausted near the floor
Humidity <68%
Temperature control
Regulate the Operating Room
Environment
Minimize personnel
traffic during
operations
Cleaning and Disinfecting
Environmental Surfaces
– Medical equipment surfaces
knobs, handles on equipment
such as x-ray machines,
instrument carts
– Housekeeping surfaces
floors, walls, chairs, and
tabletops
Cleaning and Disinfecting
Medical Equipment
– Manufacturer’s recommendation for
sterilization
Recommended chemical germicides
Water-resistant properties
Required decontamination after servicing
Non-critical medical equipment (see intermediate
level disinfection)
Cleaning and Disinfecting
Housekeeping Surfaces
 Frequent hand contact “high touch surfaces
Doorknobs, bedrails, light switches, wall areas
around the toilet, edges of privacy curtain
Clean/disinfect more frequently
 Minimal hand contact
Hard surface floors and window sills
– Clean on a regular basis, when soiled, and
when patient is discharged from facility
Walls, blinds and window curtains
– Clean when visibly soiled
Cleaning
A form of decontamination by removing organic
matter, salts, and visible soils
– Physical action of scrubbing with detergents or
surfactants and rinsing with water
– Necessary step prior to sterilization or disinfection
Cleaning Strategy
Minimize contamination of cleaning
solutions and tools
Change cleaning solutions
frequently
– Replace soiled cloths and mop heads
with each cleaning solution change
– Launder cloths and mop heads after
use and allow to dry before re-use or
use disposable cloths and mop heads
Use manufacturers recommended
concentration
Cleaning Carpeting and Cloth
Furniture
Vacuum carpeting and cloth furniture on a
regular basis
Maintain vacuum to minimize dust
dispersal by using HEPA filters
Maintain wet cleaning equipment in good
repair and allow to dry between uses
Note: Avoid use of carpeting and cloth
furnishings in areas where spills are
likely to occur
Disinfection
“The process that eliminates many or all
pathogenic micro-organisms on inanimate
objects with the exception of bacterial spores”
Spaulding’s* three levels of disinfection:
High-level
Intermediate-level
Low-level
*for
treatment of devices and surfaces that do not require
sterility for safe use
High-level Disinfection
Includes powerful sporocidal chemicals (glutaraldehyde,
peracteic acid and hydrogen peroxide)
Inactivates all vegetative bacteria, mycobacteria (TB),
viruses, fungi, some bacterial spores, enveloped and
non enveloped viruses
Utilize for items that come into contact with intact
mucous membranes and are heat sensitive
– semi-critical medical instruments (s/a flexible fiber optic
endoscopes)
– thermometers
– vaginal speculums
– sigmoidoscopes
Intermediate-level Disinfection
Includes Chlorine-containing compounds,
alcohols (small surfaces), some phenolics, and
some iodophors
Inactivates a highly resistant organisms and
exhibits some sporcidal activity
Utilize for non-critical medical equipment s/a
stethoscopes, blood pressure cuffs, dialysis
machines, equipment knobs and controls.
Low-level Disinfection
Includes quaternary ammonium compounds, some
phenolics, and some iodophors
Inactivates vegetative bacteria, fungi, and some lipid
enveloped medium size viruses
Utilize for items that come in contact with intact skin such
as examining table top, baby weigh scale, blood
pressure cuff
Monitor employee
compliance to
hand hygiene
recommendations
Special Pathogen Concern
Recent studies indicate that MRSA and VRE are most
likely transmitted either:
– Patient to patient contact
– Via health-care workers hands
– Hand transfer from contaminated environmental
surfaces and patient care equipment
Note: Use standard cleaning and disinfection protocols
to control environmental contamination with
antibiotic-resistant, gram-positive cocci
Hand Hygiene
Avoid artificial nails and keep natural nails < ¼ in
For visibly soiled hands use soap and water
Use alcohol-based handrubs
– Before and after each patient
– Before and after glove use
Improved hand hygiene adherence has:
– Terminated outbreaks in health care facilities
– ↓ transmission of AR organisms
– ↓ overall infection rates
References
“Guidelines for Environmental Infection Control in Health-Care
Facilities. Recommendations of CDC and Healthcare Infection
Control Practices Advisory Committee (HICPAC)”
http://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdf
“Cleaning, Disinfecting and Sterilizing Office Instruments. CPSA
Guideline”
http://www.cpsa.ab.ca/publicationsresources/attachments_policie
s/Cleaning,%20Disinfecting%20&%20Sterilizing%20Office%20In
struments.pdf
Centers for Disease Control and Prevention
www.cdc.gov