Hygiene

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Hygiene

• Infection Control

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destroy the cycle

• Micro-organisms
• Cycle of infection
• The bodys defence
• Infectious disease
• Preventing disease transmission
• Surgical asepsis

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Micro-organisms

• Infection
• Infectious disease
• Pathogens
• Bacteria
• Viruses
• Fungi
• Protozoa

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Bacteria

• Microscopic
• Single celled
• Procaryotic
• Identified and classified by
• Morphology
• Biochemistry
• Genetic constitution

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Viruses

• Microscopic
• Simple design
• Not procaryotic or eucaryotic
• Unable to live outside living cell
• Identified and classified by
• Chemical nature of nucleic acid
• Size
• Symmetry
• Virion

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Fungi

• Can be macroscopic or microscopic
• Much larger than bacteria
• Eucaryotic
• Have nucleus and membrane-bound organelles
• Dimorphic
• Identified and classified by
• Type and method of sexual reproduction
• Disease caused by fungi
• Superficial infection
• Cutaneous infection
• Subcutaneous infection
• Systemic infection

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Protozoa

• Can be macroscopic or microscopic
• Unicellular organisms
• Neither plant nor animal
• eucaryotic
• Able to ingest food particles
• Identified and classified by
• According to their motility
• Amoeboid locomotion
• Long flagella
• Cilia
• sporozoans
• Disease caused by protozoa
• Can form cysts
• Resistant to chemical and physical change
• Trichomonas vaginalis
• Plasmodium vivax

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Cycle of infection

• Infectious organisms
• Reservoir of infection
• Susceptible hosts
• Transmission of disease

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Infectious organisms

• Micro-organisms
• Some live on our body as normal flora
• Candida albicans

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Reservoir of infection

• Or source, where infection can live and thrive
• Environment must provide
• Moisture
• Nutrients
• Temperature
• People can be reservoirs carriers without
  knowledge
• Food, water, damp place

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Susceptible hosts

• Nosocomial
• Patient with impaired health
• Open wounds
• Health staff with fatigue, stress or low grade
  infection

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Transmission of disease

• Four main routes of transmission
• Direct contact
• Indirect/fomite
• Vector
• Airborne contamination

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The bodys defence

• Natural resistance
• Normal flora
• active immunity the body produces its own
  antibodies to defend against certain antigen
• passive immunity the person is given the
  antibodies required to defend against the
  antigen. Passive immunity is only for a short
  period of about one month because the borrowed
  antibodies are destroyed by the body

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• The Immune System - Bacteria, viruses, and any
  other thing that may cause disease are called
  pathogens.  The micro-organisms exist almost
  everywhere in the environment, which means that
  you are exposed to these pathogens every day.
   Thankfully, humans have several defences against
  these various pathogens.  The defences keep your
  body's environment healthy most of the time.
• First-Line Defences - The body's first line of
  defence against pathogens uses mostly physical
  and chemical barriers such as sweat, skin, tears,
  mucus, stomach acid, and so on.  Our skin and
  other membranes which line the body passages are
  fairly effective in keeping most pathogens out of
  the body.  Mucus can trap pathogens, which are
  then washed away or destroyed by chemicals.
   Tears, sweat, and saliva have certain chemicals
  which can kill different pathogens.
• Second-Line Defences - If a pathogen is able to
  get past the body's first line of defence, and an
  infection starts, the body can rely on it's
  second line of defence.  This will result in what
  is called an inflammatory response.  This is a
  reaction that causes redness, heat, swelling, and
  pain in the area of infection.   Redness and heat
  are due to capillary dilation resulting in
  increased blood flow.  Swelling is caused by the
  passage of plasma from the blood stream and into
  the damaged tissue.  The pain is mainly due to
  the tissue destruction, and to a lesser extent,
  the swelling.
• Third-Line Defences - Sometimes the second line
  of defence is still not enough and the pathogen
  is then heading for the body's last line of
  defence, the immune system.  The immune system
  will recognize, attack, destroy, and remembers
  each foreign substance and pathogen that enters
  the body.  It does this by making specialized
  cells and antibodies that makes the pathogens
  useless.  Unlike the first line and second line
  defence the immune system determines between
  kinds of pathogens. For each type of pathogen,
  the immune system produces cells that are
  specific for that particular pathogen. 

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Infectious disease

• Emerging diseases
• HIV and AIDS
• Hepatitis
• tuberculosis

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Preventing disease transmission

• Historical perspective
• Standard precautions
• Medical asepsis
• Isolation technique
• Precautions for compromised patients

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Surgical asepsis

• Sterilisation
• Sterile fields
• Skin prep for sterile procedures
• Surgical scrub
• Sterile gowning and gloving
• Removing and applying dressings

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Create a Barrier
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Protect yourselves!

• wearing gloves and protective clothing
• wearing goggles
• used needles and other sharp instruments are
  thrown away into containers that cannot be
  punctured
• blood and other specimens are labelled clearly
  and put into another container for carrying
• materials soiled with blood or body fluids are
  put into leak-proof bags and labelled as
  biohazards
• washing hands before and after all patient
  contact
• washing all parts of your body that were exposed
  to blood or body fluids
• using a hospital regulated cleaning agent.

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Hand Washing

• First line of defence and easiest for you!

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Gloves

• When direct contact is anticipated
• Suctioning
• Handling soiled items
• Performing invasive procedures
• Selection
• General
• Medical examination
• Surgical
• Sterile

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• Changing and discarding of gloves
• As soon as they are torn or punctured
• After contact
• Performing separate procedures on same patient
• Use of gloves does not eliminate the need for
  hand washing or cleaning, even after removal of
  gloves hands should be washed

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Masks, face shields, gowns and protective eye
wear.

• Fluid repellent mask or face shield.
• Fitted according to manufacturers instructions
• Single use only

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Masks, face shields, gowns and protective eye
wear.

• Protective gowning
• Create a protective barrier
• Fluid resistant gown
• Remove contaminated gown
• Protective eyewear
• Whilst performing procedure (with likelihood of
  splash)
• Worn and fitted in accordance with manufacturers
  instructions
• Single use, reusable (cleaned in accordance with
  manufacturers instructions)

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Sharps management

• Safe handling
• Passing sharps
• Removal of scalpel blades from handles
• Removing needles
• Bending needles

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• Sharps should never be forced into sharps
  container!
• Sharps containers
• Comply with Aust/NZ standards (AS/NZS 42611994,
  reusable containers for the collection of sharp
  items used in human and animal medical
  applications)
• Be puncture resistant, water proof, leak proof
• Wide enough opening
• Labelled clearly Biohazard
• Never be overfilled
• Securely sealed

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Clinical waste

• Clinical waste includes
• Should be segregated
• Bag must be strong enough
• Do not overfill bags
• Bags should be tied or sealed
• Bags should be yellow with biohazard printed on
  them

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Instruments and equipment

• Adhere to Aust standard AS 41871998. Cleaning,
  Disinfecting and sterilising reusable medical and
  surgical instruments and equipment, and
  maintenance of associated environments in health
  care facilities.

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• Cleaning
• Disinfecting
• Sterilisation

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Cleaning

• Any instrument or equipment coming into contact
  with intact skin must be cleaned before use
• Any instrument or equipment that is required to
  be sterilised must be cleaned.
• The process of cleaning
• Water
• Physical or mechanical action
• Cleaning agent

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Disinfecting

• Instruments and equipment should be cleaned
• This is not a sterilisation process
• Manufacturers instructions must be adhered to
• Thermal vs chemical
• Items should not be stored in disinfectants.
• Items must be used immediately

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Thermal
Chemical
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Sterilisation

• Any equipment used to enter, or that is capable
  of entering tissue, that would be sterile under
  normal circumstances.
• Method of sterilisation must be compatible with
  type of instrument or equipment.
• Must comply with Aust standard AS 41871998.
  Cleaning, Disinfecting and sterilising reusable
  medical and surgical instruments and equipment,
  and maintenance of associated environments in
  health care facilities .
• All instruments and equipment must be cleaned
  prior to sterilisation.

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Sterilisation

• Sterilised / wrapped. (unless for immediate use).
• Microwave ovens, pressure cookers, dishwashers or
  domestic ovens, are NOT suitable for
  sterilisation.
• Sterilisation should be achieved by
• Steam under pressure sterilisation
• Dry heat sterilisation
• Low temperature hydrogen peroxide plasma
  sterilisation
• Low temperature peracetic acid
• Ethylene oxide
• Flash sterilisation

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Sterilisation

• Categorisation of instruments and equipment
• Storage
• Shelf life and rotation
• documentation

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Blood and bodily fluid spills

• Protective apparel
• Confine and contain
• Cover
• Treat as clinical waste
• Clean spill site

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Environmental cleaning

• Dust, soil and microbes on surfaces potential
  source of nosocomial infection.
• Neutral detergent
• Work surfaces cleaned regularly
• Gloves, and other protective apparel

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Outbreak management

• May be described as epidemic
• Case definition
• Case confirmation
• Establish background rate of nosocomial infection
• Decide if there is an outbreak
• Formulate hypothesis
• Test hypothesis
• Environmental investigation
• Infection control measures
• Communicate findings

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MRSA, VRE, VMRSA

• Methicillin resistant staphylococcus aureus
• Hand wash
• Gloving
• Masking
• Gowning
• Vancomycin resistant enterococci
• Hand wash
• Gloving
• Masking
• Gowning
• Vancomycin resistant staphylococcus aureus

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OHS

• http//www.workcover.nsw.gov.au/FAQs/OHSResponsibi
  lities/RiskManagement/default.htm