Menjamin keamanan dan keselamatan di tempat kerjaUpaya dan
Budaya yang patut dicontoh untuk mendukung pencegahan infeksi
This slide triggers a series of questions related to the most
common process of becoming infected while working. When using these
questions, it would be useful, time permitting, to wait for
responses. Responses may or may not be coming, but people will at
least be thinking about them.In the past, the primary focus of
infection prevention (IP) in family planning programs was
preventing serious postoperative infections when providing
contraceptive methods. Although serious postoperative infections
are still a problem in many countries, the emergence of AIDS (and
continuing problems with hepatitis B and the more recently
identified hepatitis C and D) has shifted the focus of IP
dramatically. Attention must now be directed towards minimizing the
risk of transmitting these diseases not only to clients but also to
service providers and staff, including cleaning and housekeeping
personnel. Thus, for today and for the future, the goal of IP for
family planning and reproductive health service programs must be
two-fold: preventing infection and providing protection to clients
and to all levels of healthcare workers.How risky is working in a
healthcare setting? Do you know how many of your friends or
colleagues have been stuck with a needle, or cut during work, or
know of someone who has been injured with another sharp during
surgery? (Most everyone who works with clients or patients
personally knows of at least one person.) Do any of you know how
many of your friends or colleagues have been infected with HIV or
HBV or HCV from work? Maybe one or two or ten? How many of you dont
know? Most people dont want that type of information made public.No
slide or leave slide #6-4 up while asking the following
questions.Do you know what the risk is of contracting HIV after a
needle stick from a HIV+ client? Is the risk high or low?
Now put up slide #6-5.
The risk is 4 per 1000 or .04%. Doesnt sound too bad, or is it?
Remember, if you do become HIV+, you will die. So is that really
risky? Yes, I think so. Leave up slide 6-5 and ask:What is the risk
of contracting Hepatitis B after a needle stick from a HB+
client?Now put up slide #6-6.
The risk is 27-37%. Now this is really risky. Chances are pretty
high that you would become positive after an exposure. This risk is
about 100 times the transmission risk of HIV.
The Centers for Disease Control (CDC) estimated that the number
of chronically HBV-infected people in the United States is 1 to
1.25 million, with an estimated 200,000 to 300,000 new cases
annually. Each year, approximately 10,000 (8,700 documented as
occupationally acquired) healthcare providers acquire hepatitis
(Gershon et al 1995). Of these, between 150 to 250 die of
complications from the disease (Gershon et al 1995; Quebbeman and
Telford 1993).
Yet, why dont healthcare workers use barrier precautions with
each and every client? I dont know, maybe they dont feel or believe
the risk is real. Some areas of healthcare are even more risky than
others. Labor and delivery and the emergency room are two areas
where people are frequently exposed to blood and body fluids. Just
look at healthcare workers glasses or their scrubs or their feet
for splashes or spills of blood or body fluids. The risk is high,
yet some people working in these areas havent even had hepatitis B
vaccine. And this vaccine has been available since 1982.Each year
800,000 needle sticks are reported by healthcare workers in the US
and most researchers feel this number is under reported. These
healthcare workers are at risk. How many of you have been stuck by
a needle at least once while working or had a friend who has been
stuck?Slide 6-8 provides a global view and the following question
attempts to localize the impact of the global trend.
As of the last count there are 33.6 million people in the world
living with HIV/AIDS. Do you know what percentage live in your
country or region or visit your clinics? How many people are HB
carriers in your locality? We dont know, so the best way to
decrease the risk of exposure is to protect ourselves at all times
by using barriers each time we treat a client. The best way to
prevent these infections from occurring is to use IP practices that
will set up a barrier between you and the organisms that cause
these infections.
For these IP practices to be useful, we need to remember
that:
Most infectious agents are transmitted by contact with body
substances (blood, feces, or sputum)
Most infections are communicable for some period of time when
symptoms are absent.
So, consider every person (client or staff) infectious.
Before putting on the next slide, ask the participants to think
about:What can you do to protect yourself when you are working with
client?
Review list.
Easiest to remember is handwashing.
Wash hands
Before and after examining any client (direct contact). After
removing gloves because gloves may have holes in them. After
exposure to blood or any body fluids (secretions and excretions),
even if gloves were worn.Just wash with soap and water for 10 to 15
seconds. Or, if there isnt any water, you can use an
alcohol/glycerin hand rub.
Remember common towels become wet and dirty after they are used
the first time.If water is not available or if you need to wash
your hands frequently, use an alcohol rub. Having an
alcohol/glycerin rub available has helped to increase staff
handwashing compliance in many countries.
Give examples: Rounds, nurses in neonatal intensive care unit,
etc. Use an antiseptic. If an antiseptic is not available, use
plain soap and then apply an alcohol solution and rub until dry two
times. Use running water from tap or bucket. Use a stick or brush
for cleaning the fingernails. Use a soft brush or sponge for
cleaning the skin. Remember, a hard bristled brush can irritate and
cut your skin. Use towels or air dry. (Sterile towels should be
provided in the operating room.)
Do not shave hair at the operative site (if necessary, trim hair
close to skin surface immediately before surgery). Ask the client
about allergic reactions before selecting an antiseptic solution.
Wash first with soap and water, if visibly soiled. Washing can be
done before entering the operating room--or, if necessary, just
prior to applying the antiseptic. Apply antiseptic starting from
the operative site and working outward in a circular motion for
several inches.
It is not necessary to prep the external genital area if it
appears clean.
If genital area is heavily soiled, it is better to have the
client wash her genital area thoroughly with soap and water before
starting the procedure.
Wear protective goggles, face masks, aprons and rubber boots or
closed shoes: In any situation where splashes and spills of any
body fluids are likely.
How can the healthcare worker be protected?
By wearing closed shoes.Wear gloves:
When performing a procedure in the clinic or operating room
When handling soiled instruments, gloves and other items
When disposing of contaminated waste items (cotton, gauze or
dressings)
Using protective barriers also includes having healthcare
workers...
Handle needles and sharps properly by: using a safe zone for
passing sharps, using a needle driver or holder--not your fingers,
not blind suturing and by using blunt needles when available and...
knowing that even saying pass or sharps when passing sharps during
surgery can prevent accidental sticks.Dont forget to prevent
accidents by always removing blades with another instrument--not
your fingers.Because needle stick accidents continue to be a
problem, immediately after using a needle and syringe, place it
into a puncture-proof container for disposal, or decontaminate it
by flushing three times with a disinfectant (bleach is cheap) and
then deposit it into a puncture-proof container. Do not recap a
needle before disposal, or if it is necessary, recap it using the
one-hand technique. (Show how to recap using the one-hand
technique.) DecontaminationThoroughly wash and
rinseSterilizationHigh-Level DisinfectionAutoclaveDry HeatPreferred
MethodsAcceptableMethodsChemicalStorageDecontamination
Principles
Inactivates HBV and HIV
Makes items safer to handle for the staff cleaning themCleaning
Principles
Removes organic material that: Can protect microorganisms
against sterilization and HLD Can inactivate disinfectants
Must be done for sterilization and HLD to be effective
Method of mechanically reducing the number of endospores
Sterilization Principles
Destroys all microorganisms including endospores Used for
instruments, gloves, and other items that come in direct contact
with blood stream or tissue under the skin
Sterilization Practices
Steam sterilization using an autoclave: 121 degrees C (250
degrees F); 106 kPa (15 lb/in2) pressure: 20 minutes for unwrapped
items, 30 minutes for wrapped items Allow all items to dry before
removing Dry-heat using an oven with a fan: 170 degrees C (340
degrees F) for 1 hour, or 160 degrees C (320 degrees F) for 2 hours
Chemical sterilization using a chemical sterilantExample:Soak items
in glutaraldehyde for 8 to 10 hours or formaldehyde for 24 hours
Rinse with sterile waterHLD Principles Destroys all microorganisms
including HBV and HIV; does not reliably kill all bacterial
endospores Only acceptable alternative when sterilization equipment
is not available
Source: Favero 1985; McIntosh et al 1994.HLD Practices (boiling)
Boil instruments and other items for 20 minutes (sufficient up to
5,500 meters/18,000 ft.). Always boil for 20 minutes in pot with
lid. Start timing when water begins to boil. Do not add anything to
pot after timing begins. Air dry before use or storage.Boiling
instruments for 20 minutes will kill all microorganisms except
bacterial endospores. In fact, most microorganisms will be
inactivated if heated to 80 degrees C for 10 minutes. The boiling
point of water is 1.1 degree C lower for each 1,000 feet in
altitude; even at altitudes up to 5,500 meters (18,000 ft) the
temperature will be adequate for HLD. Note: The highest temperature
that boiling water will reach is 100 degrees C (212 degrees F) at
sea level. HLD Practices (steaming)
Steam instruments, gloves and other items for 20 minutes. Be
sure there is enough water in bottom pan for entire steam cycle.
Bring water to rolling boil. Start timing when steam begins to come
from under lid. Do not add anything to pan after timing starts. Air
dry and store in covered steamer pans.
Waste Disposal Principles
Prevents spread of infection to clinic personnel who handle
waste Prevents spread of infection to local community Protects
those who handle wastes from accidental injury
Waste Disposal Practices
Wearing utility gloves, place contaminated items (gauze or
cotton) in leak-proof container (with a lid) or plastic bag.
Dispose by incineration or burial.
To prevent scenes like this one, bury or burn your clinic
waste.Summary: Infection prevention is everyones responsibility
We know we can reduce the risk of acquiring an infection while
working in healthcare by using barriers and using PPE to make our
job a less risky business.The purpose of this interactive
presentation (slides 6-46 to 6-66) is not only to introduce the
concept of infection prevention (IP) as a self-protective act but
also to capture the participants interest/attention. These goals
are accomplished by asking the following questions, one of which
plays on the phrase risky business.
Are you aware that working in healthcare is risky business? How
risky is it? Every day, we as healthcare providers put ourselves at
risk of acquiring an infectious disease when we take care of
clients, or their familiesor you.
Or, if the person speaking is not a healthcare worker, the
speaker can say every day healthcare workers put themselves at risk
when they take care of clients....
Share the objectives with the participants.
Read objectives.
Slides 6-48 and 6-49 are related. Before putting on slide 6-48 ,
ask and wait for response to the following question: Do you know
what is the most common or frequent risk healthcare workers
encounter while working? Put up slide #6-48. Coming in direct
contact with blood and other body fluids is the most frequent risk
we encounter when we take care of clients....Put up slide # 6-49.
Or clean up after an operation, or an examination or procedure.
This presentation will discuss ways that barrier precautions can be
used to prevent the spread of disease or infection from blood and
other body fluids to the healthcare worker. (...or, I am going to
talk about how to use barriers to prevent the spread of diseases or
infections we encounter in blood and other body fluids while
working.)
Healthcare workers come in contact with many biological hazards
while they work. Exposure or contact with these organisms can make
you sick. (This refers to the organisms listed on the slide.)
Viruses are the organisms we really want to prevent the healthcare
worker from contacting, because HIV, for example, can kill you. In
the past, we tried to prevent our clients from acquiring an
infection from their visits to the clinic or hospital. Now we need
to teach healthcare workers how to protect themselves (thats US) as
well. Because we dont know by looking at someone whether or not
s/he is infected with one of these viruses, and because most of the
time we cant test and wait for the results before treating, we need
to protect ourselves at all times with every client.This slide
triggers a series of questions related to the most common process
of becoming infected while working. When using these questions, it
would be useful, time permitting, to wait for responses. Responses
may or may not be coming, but people will at least be thinking
about them.How risky is working in a healthcare setting? Do you
know how many of your friends or colleagues have been stuck with a
needle, or cut during work, or know of someone who has been injured
with another sharp during surgery? (Most everyone who works with
clients or patients personally knows of at least one person.) Do
any of you know how many of your friends or colleagues have been
infected with HIV or HBV or HCV from work? Maybe one or two or ten?
How many of you dont know? Most people dont want that type of
information made public.No slide or leave slide #6-51 up while
asking the following questions.Do you know what the risk is of
contracting HIV after a needle stick from a HIV+ client? Is the
risk high or low?Before you answer that, I want to ask you some
questions about what you think the risk is of dying from some other
activities. (You can list the number of people responding
positively to the questions on a whiteboard or a flip chart so they
can see real numbers and not forget as you continue the
presentation.) If you were outside during a lightning storm, how
many of you would be afraid of being hit by lightning and dying?
Dont we all run for cover or quickly get out of the water when we
are swimming if we hear thunder or see lightening? How many of you
get nervous in an airplane when there is air turbulence and the
plane starts to bounce around? Dont we immediately put on or
tighten our seat belts? How many of you are afraid of dying from a
plane crash? ...or from a car crash? We make our kids use seat
belts and now we even buy cars with air bags, right? We do this
because we are trying to reduce the risk of dying if we are in an
accident. How many of you sky dive or bungee jump for fun? No one?
How many of you dont because you are afraid of dying if you did?
Most of you. Me too.Before putting on the next slide, ask the
participants to think about:
What can you do to protect yourself when you are working with
clients?
Slides 6-57 through 6-63 discuss barrier precautions.
You can use personal protective equipment. Use gloves when you
are going to touch anything wet or moist. There are different types
of gloves for different jobs: thick utility gloves for cleaning,
latex or vinyl gloves to be used for surgery or examinations. There
are masks, goggles or face shields to protect you from splashes.
Gowns and aprons will protect you from large spills, during a
delivery, for example. Do sandals protect your feet? No they dont,
but isnt it amazing how many people take off their shoes and put on
sandals to go into the operating room. Your feet need protection
from both sharps and splashes; so use closed shoes. (Note: All of
the equipment pictured can be purchased or made locally from
materials that are locally available. For example, the face shield
can be made with elastic band, foam and a piece of clear plastic.
Plastic can be purchased in a bookstore, or a used x-ray can be
used.)Sometimes people forget they can be proactive and reduce
their risk of acquiring a disease by doing something about it
outside of work. So remind them of immunizations.
Many immunizations are available to healthcare workers as well
as the public. Immunizations can protect you from acquiring a
number of diseases but you have to go get it. Which immunization
should every healthcare worker be offered and get? Hepatitis B.How
else can we make our workplace safer?
Administrative support. Administration needs to make IP a part
of the healthcare worker performance evaluation. Administration
also needs to make sure the necessary supplies are available.
Positive feedback from supervisors on individual behavior
possibly with verbal praise or other awards will help healthcare
workers change their behavior.
Who do you think is responsible for providing the healthcare
worker with Personal Protective Equipment (PPE)? Obviously
administrationbut if they cant or wont, each person individually is
responsible for his or her own safety. The next life you save may
be your own.If the chiefs or senior staff (nurses and doctors)
actively use PPE and actively support IP practices, then other
healthcare workers will feel that it is the correct way to work and
will actively copy them. If healthcare workers see the chief of
surgery, for example, wash her/his hands, then they will also wash
their hands all the timenot just when someone is looking.
What is the most important thing you can do to keep your
workplace safer for everyone?
Each one of us can follow and support IP practices while we are
working.
