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Nosocomial Infection ----Prevention and control

Nosocomial Infection ----Prevention and control. Wang kefang ( 王克芳 ) wangkf@sdu.edu.cn. 2. Cleaning, Disinfection and Sterilization. 下列物品或情形该怎样处理? 体温计需要消毒吗?该怎样处理? 你发现手上扎了一根小刺,同学找来缝衣针要给你挑出来,这根缝衣针可以直接用吗? 你从商店里买来一件 T 恤衫,你穿之前处理吗? 有个亲戚在你家吃住 2 天,他走后你想消毒一下餐具和被褥,如何做?. Concepts. Cleaning (清洁)

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Nosocomial Infection ----Prevention and control

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  1. Nosocomial Infection----Prevention and control Wang kefang(王克芳) wangkf@sdu.edu.cn

  2. 2 Cleaning, Disinfection and Sterilization 下列物品或情形该怎样处理? • 体温计需要消毒吗?该怎样处理? • 你发现手上扎了一根小刺,同学找来缝衣针要给你挑出来,这根缝衣针可以直接用吗? • 你从商店里买来一件T恤衫,你穿之前处理吗? • 有个亲戚在你家吃住2天,他走后你想消毒一下餐具和被褥,如何做?

  3. Concepts Cleaning(清洁) Disinfection(消毒) Sterilization(灭菌)

  4. Concepts Cleaning • Cleaning is toremove the dirt from item surface by the use of water, detergents and mechanical actions. • Will remove most organisms from a surface. Remove not kill!!!

  5. Concepts Cleaning Disinfection • A process that eliminates/kills almost all pathogens on objects, except of bacterial spores, to decrease the number of them to a harmless level.

  6. Concepts Cleaning Disinfection Sterilization • Aprocess that destroys all forms of microorganisms, including bacterial spores

  7. Decontamination Steps

  8. Levels of disinfection and sterilization Low-level disinfection (LLD) ,Intermediate-level disinfection (ILD),High-level disinfection (HLD)

  9. How to select disinfection and sterilization • Items’ risk to patients • High risk(critical) items • Intermediate risk (semi-critical) items • Low risk (noncritical) items

  10. How to select disinfection and sterilization • Items’ risk to patients • High risk(critical) items • Items that reach the sterile tissues or organs( such as body cavities and the vascular system). • Items: Surgical instruments, syringes • Items should be sterilized before using

  11. How to select disinfection and sterilization • Items’ risk to patients • High risk(critical) items • Intermediate risk (semi-critical) items • Items that do not enter sterile areas of the body but contact with mucous membranes or skin closely. • Items: thermometer, ventilator tube • HLD/ILD, Sterilization is preferred.

  12. How to select disinfection and sterilization • Items’ risk to patients • High risk(critical) items • Intermediate risk (semi-critical) items • Low risk (noncritical) items • Items that contact with intact skin, not mucous membranes • Items: gown, sheet, blood pressure cuff • LLD (in some cases, cleaning is acceptable)

  13. How to select disinfection and sterilization • Items’ risk to patients • Characters of contaminated microorganisms 种类、数量、对消毒因子的敏感性 • 致病性芽胞、真菌孢子—灭菌、高水平消毒 • 致病性细菌、真菌、亲水病毒、支原体、衣原体—中水平以上消毒 • 一般细菌和亲脂病毒—中水平和低水平消毒

  14. How to select disinfection and sterilization • Items’ risk to patients • Characters of contaminated microorganisms • Characters of items • 耐热、耐湿物品和器材,应首选压力蒸汽灭菌法 • 耐高温的玻璃器材、油剂类和干粉类可选用干热灭菌 • 怕热、忌湿和贵重物品,可选择甲醛或环氧乙烷气体 • 金属器械的浸泡灭菌,应选择腐蚀性小的灭菌剂 • 在进行物品表面消毒时,应考虑到表面性质 表面光滑—紫外线;多孔材料—喷雾

  15. Methods of Disinfection and Sterilization Heat Microwave Ionizing radiation Radiation Mechanical removing microorganisms burning、toasting Dry heat: Moist heat: Boiling Steam Disinfection Low Temperature Steam Disinfection High-Pressure Steam Sterilization • Physical Methods • Chemical Methods: Sunshine Ultraviolet light ozone Immersion; Rubbing; Nebulization; Fumigation

  16. Physical Methods High-Pressure Steam Sterilization • the most common and effective method • Advantages: • Highly effective; • Rapid heating and rapid penetration of items; • Nontoxic; • Inexpensive; • 用途: • 常用于: 耐高温、耐高压、耐潮湿物品的灭菌 • ----金属、玻璃、橡胶、搪瓷、敷料等 • 不能用于凡士林等油剂、滑石粉等粉剂的灭菌 Sterilization

  17. Physical Methods High-Pressure Steam Sterilization Sterilization parameters Sterilization

  18. Notes: • Clean and dry items • Package size:下排气式30 ×30 × 25cm;预真空式 30 ×30 × 50cm • Arrange all packages in a way that allows the steam to circulate freely. • Timing until the autoclave reaches the required temperature and pressure. • Follow the instruction for operating the autoclave. • Packs should NOT be pick out of the autoclave until dry. • Label accurately with contents, date of processing and expiration and store in storage cabinet. • Monitor the effectiveness of sterilization Sterilization

  19. Monitoring the Effectiveness Mechanical indicators Chemical indicators Biological indicators Indicatiors

  20. Mechanical Indicators • These indicators, which are part of the autoclave or dry-heat oven itself, record and allow you to observe time, temperature, and/or pressure readings during the sterilization cycle. Indicators

  21. Chemical Indicators • Each pack must have external chemical indicators. • Indicator strips will change color when temperature, time, and pressure has been achieved. Indicators

  22. Biological Indicators • 非致病性嗜热脂肪肝菌芽孢. • If the bacterial spores have been killed after sterilization, you can assume that all microorganisms have been killed as well. • Advantages: • It directly measures the effectiveness of sterilization. • Disadvantages: • This indicator is not immediate. Bacterial culture results are needed before sterilization effectiveness can be determined. Indicators

  23. Physical Methods Toasting Sterilization (Hot Air Oven) • 用途: • 适用于在高温下不变形、不损坏、不蒸发的物品:glass, metal instruments, oil, ointments and powders • 不适用于纤维织物、塑料制品等的灭菌。 • 灭菌参数: • 160 ºC, 2 hours; • 170 ºC, 1 hour; • 180 ºC, 0.5 hour. Sterilization

  24. Notes: • Clean and dry all items to be sterilized. • Package size:10cm×10cm×20cm. • Organic items:temperature no more than 170℃ Sterilization

  25. Other Physical Methods • Disinfection by Boiling • Ultraviolet Light Radiation • Microwave Disinfection High Level Disinfection

  26. Boiling For items which are resistant to moisture and high temperature, such as mental, glass, rubber. • Notes: • Clean • Open all hinged instruments and other items. Catheter should be filled with water. Make sure that all items are completely submerged because water must touch all surfaces. • Once the water is in a rolling boil, start timing for 5-15 minute. From this point on do not add or remove any water or items. High Level Disinfection

  27. Notes: • A 1-2% solution of sodium bicarbonate(碳酸氢钠) rises the boiled temperature to 105℃ and helps to prevent corrosion of the instruments. • The boiling point of water is affected by air pressure. Generally, every 300 meters is added, disinfection time should be prolonged for 2 minutes. • Never leave boiled items in water that has stopped boiling; they can become contaminated as the water cools. High Level Disinfection

  28. Ultraviolet (UV) Light Radiation The best anti-bacterial effect: 250-270nm. • Air disinfection • A 30W UV light for every 10 m2 • The effective distance:≤ 2 meters • The radiation time: 30-60 min. • Object surface disinfection • The effective distance: 25-60 cm • The radiation time: 20-30min. • Fluid disinfection • The fluid depth : ≤ 2 cm High Level Disinfection

  29. Notes: • Keep UV light clean: alcohol cotton twice a week. • Effective condition: • Temperature: 20-40 ºC Humidity: 40-60% • Record radiation time after the UV light has been on for 5-7 minutes. • When turned off, the light should be cooled off for 3-4 minutes before being turned on again • Regularly check the output of the UV light • Intensity≤ 70µW/cm2 , change the light. • Time ≥ 1000 hours, change the light. • Keep people off the room; cover eyes and skin if people couldn’t leave. High Level Disinfection

  30. Microwave disinfection Uses: food, tableware, medication and some heat-tolerant non-metal instruments. • Notes: • Microwave is harmful to health, so avoid long term contact in small dose or large dose. • Microwave can not penetrate metal, do not put objects in metal container. • Water is a strong microwave absorbing medium, so wet wrapped item or put a glass of water in the microwave oven can enhance disinfection efficacy. High Level Disinfection

  31. Methods of Disinfection and Sterilization Heat Microwave Ionizing radiation Irradiation Mechanical removing microorganisms Dry heat:burning、toasting Moist heat: Boiling Steam Disinfection Low Temperature Steam Disinfection High-Pressure Steam Sterilization • Physical Methods • Chemical Methods:Immersion; Rubbing; Nebulization; Fumigation Sunshine Ultraviolet light ozone

  32. Chemical Methods Sterilant • A chemical agent that can destroys all forms of microorganisms to achieve sterilization. Disinfectant • A chemical agent that destroys most pathogens but may not kill bacterial spores.

  33. Disinfectant/Sterilant 消毒灭菌水平、用法及浓度、注意事项 • Glutaraldehyde(戊二醛) • Chlorine disinfectant(含氯消毒剂) • Alcohol(乙醇) • Iodophor(碘伏) • Iodine tincture(碘酊) Textbook p73 表4-4

  34. Levels of disinfection and sterilization

  35. Principles for Chemical Sterilization/Disinfection • Before deciding to use a chemical method, consider whether a more appropriate physical method is available. • Select appropriate disinfectant and method according to the characteristics of items and microorganisms • Pay attention to the effective concentration of disinfectant and contact time • Make sure the solution is still effective when you use a previously prepared solution or a new solution. • Put it in a sterile container with a lid and mark the container with the preparation date and expiration date. • Do not put gauze, cotton in disinfectant.

  36. 妇儿医院手术切口分枝杆菌感染暴发(广东深圳,1998)妇儿医院手术切口分枝杆菌感染暴发(广东深圳,1998) • 表现: 1998年4月1日~5月31日共手术292例,4月22日~7月14日发生切口感染166例。 • 调查:20份切口分泌物标本培养出分支杆菌(脓肿亚型)。使用中和未启用的戊二醛半小时不能杀灭金葡菌、1小时不能杀灭分支杆菌,测浓度为0.137%。 • 结论:戊二醛浓度错配导致手术器械分支杆菌污染,从而引起切口感染

  37. Principles for Chemical Sterilization/Disinfection • Before deciding to use a chemical method, consider whether a more appropriate physical method is available. • Select appropriate disinfectant and method according to the characteristics of items and microorganisms • Pay attention to the effective concentration of disinfectant and contact time • Clean, and dry all items to be sterilized /disinfected. • Maintain enough contact time for items with disinfectant solution • Rinse thoroughly with sterile/clean saline to remove the residue that is left on items. This residue is toxic to skin and to tissues.

  38. Common methods • 浸泡法(immersion) • 擦拭法(rubbing) • 喷雾法(nebulization) • 熏蒸法(fumigation)

  39. Immersion • Open all hinged instruments and other items. • Place all items in the solution so that they are completely submerged. • 应用范围 • 耐湿不耐热的器械物品 • 如锐利器械(刀剪)、贵重仪器(导管、胃镜等)、塑料尼龙制品等

  40. Rubbing • 应用范围 • 擦拭被污染物体的表面或皮肤、黏膜 • 选用: • 易溶于水、穿透力强、无显著刺激的消毒剂 • 如用含氯消毒剂擦拭墙壁、地面

  41. Nebulization • 用喷雾器将消毒剂均匀地喷洒于空气或物品表面进行消毒的方法。 • 常用于地面、墙壁、空气等的消毒。

  42. Fumigation • 将消毒剂加热或加入氧化剂,使其产生气体进行消毒的方法。如手术室、换药室、病房的空气消毒。在消毒间或密闭的容器内,也可用熏蒸法对被污染的物品进行消毒灭菌。 • 常用的有甲醛气体和环氧乙烷气体。

  43. Daily Cleaning, Disinfection and Sterilization in Hospital • Hospital environment • Preventive disinfection and disinfection of epidemic focus • Textiles and laundry • Skin and mucous membrane • Equipment, instruments/devices • Waste and sewage

  44. Environmental: Air Disinfection

  45. Environmental: Surface Disinfection • Floor: • If no obvious contamination, Wet cleaning. • If contaminated by pathogenic microorganisms, use chemical disinfectants to mop or spay the floor. • Wall: • Do not need regular disinfection; • if contaminated, use chemical disinfectants to spay or rub the wall. • Object surfaces: • Use clean cloth or cloth with disinfection solution to rub the surfaces • bed, bedside tables, chair, doorknob, windows, door and urinal. • If contaminated, use chemical disinfectant to spay or rub them, or use ultraviolet light.

  46. Preventive Disinfection andDisinfection of Epidemic Focus • Preventive disinfection • Disinfection of epidemic focus • Concurrent disinfection • Terminal disinfection

  47. Textiles and Laundry • The textiles and laundry used by patients are sterilized by ethylene oxide, then washed and prepared for use. • If there is no ethylene oxide sterilization room, use the following methods: • wash and then disinfect patients’ cloth and sheet by high temperature; • use ultraviolet light to disinfect blankets, pillows, bed mattress; • wash and disinfect contagious patients’ and other patients’ textiles and laundry separately; • wash and disinfect health care workers’ and patients’ textiles and laundry separately.

  48. Skin and Mucous Membrane • Skin and mucous membrane provide protective barrier to microorganisms. • choose appropriate antiseptics according to patients’ skin and mucous membrane site, pathogenic microorganisms. • Use 2% iodine tincture to disinfect skin, after dry deiodinize it with 75% alcohol. • Use 0.5%-2% iodophor.

  49. Surveillance • Environmental air, object surfaces and HCW’s hands • Equipment, instruments/devices • Disinfection solution • High pressure sterilization and ultraviolet light • Dishware and eating utensils • Sanitary utensils • Drink water • Textiles and laundry, medical waste • Waste

  50. 教学内容 清洁消毒灭菌概念 消毒灭菌的方法 医院清洁、消毒、灭菌工作 教学目标 解释术语:清洁、消毒、灭菌 掌握常用物理消毒灭菌法的方法和注意事项 掌握常用化学消毒剂的名称、浓度、使用注意事项 2 清洁、消毒、灭菌

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