ARABIC CANADIAN MEDICAL CENTER INFECTION CONTROL … CONTROL.pdf · Infection prevention and control practices shall be adhered to in the Organization at all times. 2.1.3. Qualified

ARABIC CANADIAN MEDICAL CENTER INFECTION CONTROL POLICIES AND PROCEDURES

1 Approved by ACMC Medical Director

2. Infection Control Policies.

2.1. Policy.

2.1.1. Infection Control Program imposed by the Organization must adhere with the

applicable law, regulations and standards.

2.1.2. Infection prevention and control practices shall be adhered to in the Organization

at all times.

2.1.3. Qualified staff/s is/are assigned to oversee the Organization all Infection

Prevention and Control activities. The lead staff must have relevant training,

experience, and education regarding infection control.

2.1.4. Infection prevention and control in the Organization shall be effectively and

efficiently supervised, and supported by appropriate and adequate resources.

2.1.5. Vaccination records for Hepatitis B are required for all healthcare workers and

any staff at risk like housekeeping personnel and driver. Anti HBs titer and

vaccination records shall be documented in the personnel file.

2.1.6. Needle stick injury and exposure to blood borne pathogens must be immediately

reported and manage promptly. Post-exposure incident report form for blood

borne pathogen (consent) must be filled up and signed by the expose personnel

or person served if appropriate.

2.1.7. Infection control education shall be provided to all personnel starting from the

orientation phase and in ongoing basis. Person served shall also receive infection

control education and must be documented in the interdisciplinary health

education form.

2.1.8. The Personal Protective Equipment must be available and used correctly when

required.

2.1.9. Hand Hygiene Supplies must be available and accessible to personnel and

person served and must be accessible in prominent person served care areas.

2.1.10. Hand hygiene supplies, to ensure adherence to hand washing, must be available

and accessible at all times and be place in person served care areas. Supplies

include but not limited to alcohol based hand gel, hand washing sinks, soap and

paper towels. Hand washing signage must also be posted in prominent hand

washing areas.

2.1.11. The water source quality of the facility must be regularly test especially in the

dental clinics. The test results shall be documented and file in the infection

control office.

2.1.12. Furniture, fixtures and fittings used in the facility must be decontaminated in

accordance with manufacturer‘s instructions.

DOCUMENT TITLE: INFECTION CONTROL POLICIES

REFERENCE NUMBER: ICD-002

VERSION: 2.0

EFFECTIVE DATE: 01 DEC 2016 REVIEWED: 01 DEC 2017



2.1.13. Medical equipment and devices shall be decontaminated as per manufacturer‘s

instructions. The cleaning and disinfecting agents and methods shall be

appropriate for the type of equipment. All decontaminated equipment shall be tag

dated and signed. Decontaminated equipment shall be stored separately and

must not be mix from used items.

2.1.14. The facility waste management should follow the following important areas:

designation; packaging and transport; storage; disposal; record keeping; and staff

training. Log book for disposed medical waste must be in place for tracking

purposes.

2.1.15. Appropriate personal protective equipment shall be available and use properly for

all personnel with involvement on waste management.

2.1.16. Waste containers shall have cover and foot control and must be cleaned regularly

and be free from dirt or rust.

2.1.17. Storage of medical waste shall be temperature controlled and free from

unauthorized access.

2.1.18. List of approved detergents and disinfectant solutions used in the facility must be

available for reference of housekeeping personnel. A copy shall also be available

in the infection control office.

2.1.19. Housekeeping equipment and cleaning materials must be well identified by

housekeeping staff. Color coding system of cleaning materials and equipment

must be in place and strictly adhered.

2.1.20. For cases of blood spills and body substances cleaning spills kit must be

available. Reports and investigation of spills shall be conducted by the infection

control department.

2.1.21. Pest Control program is one part of infection control management and

procedures must be in place within the facility.

2.1.22. Housekeeping standard procedures must be available for housekeeping

personnel and orientation and training must be provided to them.

Training/education attendance on housekeeping must be documented in the

housekeeping personnel file.

2.2. Appendix.

2.2.1. Infection Control Program Statement.



3. Personnel Vaccination.

3.1. Procedures.

3.1.1. All health care and high-risk personnel will undergo Hepa B antibody titer test

before appointment/placement in any clinical setting. The test will be performed

by the facility affiliated laboratory.

3.1.2. All health care and high-risk personnel who have a low Hepa B anti body titer

result as determined by the Infection Control Officer will be immunized with

Hepatitis B vaccination in order to protect the workers from acquiring infection at

worksite.

3.1.3. The Infection Control Officer in coordination of HRD should ensure that all health

care and high-risk personnel have been screened and test results are received

before their clinical placement is made.

3.1.4. Records of the titer and vaccination of Hepa B shall be placed in the personnel

record.

3.1.5. Regular titer and vaccination of healthcare and high-risk personnel will be

monitored and be determined for retest and booster by the infection control

officer.

3.2. Appendix.

3.2.1. None.

DOCUMENT TITLE: PERSONNEL VACCINATION PROCEDURES


VERSION: 2.0




4. Safety Injection Practices.

4.1. Procedures.

4.1.1. Three Things Every Provider Needs to Know About Injection Safety.

4.1.1.1. Needles and syringes are single use devices. They should not be used for

more than one patient or reused to draw up additional medication.

4.1.1.2. Do not administer medications from a single-dose vial to multiple patients.

4.1.1.3. Limit the use of multi-dose vials and dedicate them to a single patient

whenever possible.

4.1.2. Needle stick and Sharps Injury Prevention.

4.1.2.1. Safe handling of needles and other sharp devices are components of

standard precautions that we implement to prevent health care worker

exposure to blood borne pathogens.

4.1.2.2. Needle stick and other sharps injuries are a serious hazard in any

healthcare setting. Contact with contaminated needles, scalpels, broken

glass, and other sharps may expose healthcare workers to blood that

contains pathogens which pose a grave, potentially lethal risk.

4.1.3. Activities with Potential For Needle stick Injuries. DHCWs can be at risk for

needle stick or sharps injuries when they:

4.1.3.1. Handle needles that must be taken apart or manipulated after use.

4.1.3.2. Dispose of needles attached to tubing.

4.1.3.3. Manipulate the needle in the patient.

4.1.3.4. Recap a needle.

4.1.3.5. Use needles or glass equipment to transfer body fluid between containers.

4.1.3.6. Fail to dispose of used needles in puncture-resistant sharps containers.

4.1.3.7. Lack proper workstations for procedures using sharps.

4.1.3.8. Work quickly.

4.1.3.9. Bump into a needle, a sharp, or another worker while either person is

holding a sharp.

4.1.4. The management.

4.1.4.1. Part of our needle stick and sharps injury prevention is the use of sharps

with engineered safety devices when suitable devices exit.

4.1.4.2. Eliminate the use of needle devices whenever safe and effective

alternatives are available.

4.1.4.3. Provide needle devices with safety features.

4.1.4.4. Provide sharps containers.

4.1.4.5. Investigate all sharps-related injuries.

4.1.4.6. Provide post-exposure medical evaluations.

DOCUMENT TITLE: SAFETY INJECTION PRACTICES


VERSION: 2.0




4.1.5. Staff Should:

4.1.5.1. Avoid using needles whenever safe and effective alternatives are

available.

4.1.5.2. Avoid recapping or bending needles that might be contaminated.

4.1.6. How to Prevent Needle stick and Sharps Injuries.

4.1.6.1. Bring standard-labeled, leak-proof, puncture-resistant sharps containers

to clients‘ homes. Do not assume such containers will be available there.

4.1.6.2. Promptly dispose of used needle devices and sharps, which might be

contaminated, in the containers.

4.1.6.3. Plan for the safe handling and disposal of needle before use.

4.1.6.4. Store sharps containers out of the reach of children, and others not

needing access.

4.1.6.5. Secure used sharps containers during transport to prevent spilling.

4.1.6.6. Follow standard precautions, infection prevention, and general hygiene

practices consistently.

4.1.6.7. Participate in the blood borne pathogens training program.

4.1.6.8. Help to select and evaluate devices with safety features.

4.1.6.9. Use devices with safety features provided by the facility.

4.1.6.10. Report any needle stick and other sharps injury immediately to your

supervisor.

4.1.7. If you experience a needle stick or sharps injury or are exposed to the

blood or other body fluid of a client during the course of your work,

immediately follow these steps:

4.1.7.1. Wash needle sticks and cuts with soap and water.

4.1.7.2. Flush splashes to the nose, mouth, or skin with water.

4.1.7.3. Irrigate eyes with clean water, saline, or sterile irrigants.

4.1.7.4. Report the incident to your supervisor.

4.1.7.5. Fill in the OVR and Post-Exposure Incident Report Form for blood borne

pathogen (consent) if appropriate.

4.1.7.6. Immediately seek medical treatment if necessary and follow other

instructions from Infection Control Officer.

4.2. Appendices.

4.2.1. OVR.

4.2.2. Post-Exposure Incident Report Form for Blood Borne Pathogen.

4.2.3. Sharps Injury Log.



5. Personal Protective Equipment.

5.1. Procedures.

5.1.1. When you are selecting PPE, consider three key things:

5.1.1.1. First is the type of anticipated exposure. This is determined by the type

of anticipated exposure, such as touch, splashes or sprays, or large

volumes of blood or body fluids that might penetrate the clothing. PPE

selection, in particular the combination of PPE, also is determined by the

category of isolation precautions a patient is on.

5.1.1.2. Second, and very much linked to the first, is the durability and

appropriateness of the PPE for the task. This will affect, for example,

whether a gown or apron is selected for PPE, or, if a gown is selected,

whether it needs to be fluid resistant, fluid proof, or neither.

5.1.1.3. Third is fit. PPE must fit the individual user and ensure that all PPE are

available in sizes appropriate for the workforce that must be protected.

5.1.2. Key Points about PPE. There are four key points to remember about PPE use:

5.1.2.1. First, don it before you have any contact with the patient, generally before

entering the treatment room.

5.1.2.2. Once you have PPE on, use it carefully to prevent spreading

contamination.

5.1.2.3. When you have completed your tasks, remove the PPE carefully and

discard it in the receptacles provided.

5.1.2.4. Then immediately perform hand hygiene before going on to the next

patient.

5.1.3. Sequence for Donning PPE.

5.1.3.1. The gown should be donned first.

5.1.3.2. The mask or respirator should be put on next and properly adjusted to fit;

remember to fit check the respirator.

5.1.3.3. The goggles or face shield should be donned next.

5.1.3.4. The gloves are donned last.

5.1.3.5. Keep in mind, the combination of PPE used, and therefore the sequence

for donning, will be determined by the precautions that need to be taken.

5.1.4. How to Don a Gown.

5.1.4.1. To don a gown, first select the appropriate type for the task and the right

size for you. The opening of the gown should be in the back; secure the

gown at the neck and waist. If the gown is too small to fully cover your

DOCUMENT TITLE: PERSONAL PROTECTIVE EQUIPMENT


VERSION: 2.0




torso, use two gowns. Put on the first gown with the opening in front and

the second gown over the first with the opening in the back.

5.1.5. How to Don a Mask.

5.1.5.1. Some masks are fastened with ties, others with elastic. If the mask has

ties, place the mask over your mouth, nose and chin. Fit the flexible

nosepiece to the form of your nose bridge; tie the upper set at the back of

your head and the lower set at the base of your neck.

5.1.5.2. If a mask has elastic headbands, separate the two bands hold the mask in

one hand and the bands in the other. Place and hold the mask over your

nose, mouth, and chin, then stretch the bands over your head and secure

them comfortably as shown; one band on the upper back of your head,

the other below the ears at the base of the neck.

5.1.5.3. Adjust the mask to fit. Remember, you don‘t want to be touching it during

use so take the few seconds needed to make sure it is secure on your

head and fits snuggly around your face so there are no gaps.

5.1.6. How to Don a Particulate Respirator.

5.1.6.1. The technique for donning a particulate respirator, such as an N95, N99

or N100, is similar to putting on a pre-formed mask with elastic

headbands. Key differences, however, are 1) the need to first select a

respirator for which you have been fit tested and 2) fit checking the

device, as you have been instructed, before entering an area where there

may be airborne infectious disease. Be sure to follow the manufacturer‘s

instructions for donning the device. In some instances, the manufacturer‘s

instructions may differ slightly from this presentation.

5.1.7. How to Don Eye and Face Protection.

5.1.7.1. If eye protection is needed, either goggles or a face shield should be

worn. Position either device over the face and/or eyes and secure to head

using the attached earpieces or headband. Adjust to fit comfortably.

Goggles should feel snug but not tight.

5.1.8. How to Don Gloves.

5.1.8.1. The last item of PPE to be donned is a pair of gloves. Be sure to select

the type of glove needed for the task in the size that best fits you. Insert

each hand into the appropriate glove and adjust as needed for comfort

and dexterity. If you are wearing an isolation gown, tuck the gown cuffs

securely under each glove. This provides a continuous barrier protection

for your skin.

5.1.9. How to Safely Use PPE.

5.1.9.1. In addition to wearing PPE, you should also use safe work practices.

Avoid contaminating yourself by keeping your hands away from your face

and not touching or adjusting PPE. Also, remove your gloves if they

become torn and perform hand hygiene before putting on a new pair of

gloves. You should also avoid spreading contamination by limiting

surfaces and items touched with contaminated gloves.



5.1.10. How to Safely Remove PPE.

5.1.10.1. To remove PPE safely, you must first be able to identify what sites are

considered ―clean‖ and what are ―contaminated.‖ In general, the outside

front and sleeves of the isolation gown and outside front of the goggles,

mask, respirator and face shield are considered ―contaminated,‖

regardless of whether there is visible soil. Also, the outside of the gloves

is contaminated.

5.1.10.2. The areas that are considered ―clean‖ are the parts that will be touched

when removing PPE. These include inside the gloves; inside and back of

the gown, including the ties; and the ties, elastic, or earpieces of the

mask, goggles and face shield.

5.1.11. Sequence for Removing PPE.

5.1.11.1. The sequence for removing PPE is intended to limit opportunities for self-

contamination. The gloves are considered the most contaminated pieces

of PPE and are therefore removed first. The face shield or goggles are

next because they are more cumbersome and would interfere with

removal of other PPE. The gown is third in the sequence, followed by the

mask or respirator.

5.1.12. Where to Remove PPE.

5.1.12.1. The location for removing PPE will depend on the amount and type of

PPE worn and the category of isolation a patient is on, if applicable. If only

gloves are worn as PPE, it is safe to remove and discard them in the

patient room. When a gown or full PPE is worn, PPE should be removed

at the doorway or in an anteroom. Respirators should always be removed

outside the patient room, after the door is closed. Hand hygiene should be

performed after all PPE is removed.

5.1.13. How to Remove Gloves.

5.1.13.1. Using one gloved hand, grasp the outside of the opposite glove near the

wrist. Pull and peel the glove away from the hand. The glove should now

be turned inside out, with the contaminated side now on the inside. Hold

the removed glove in the opposite gloved hand.

5.1.13.2. Slide one or two fingers of the ungloved hand under the wrist of the

remaining glove. Peel glove off from the inside, creating a bag for both

gloves. Discard in waste container.

5.1.14. Remove Goggles or Face Shield.

5.1.14.1. Using ungloved hands, grasp the ―clean‖ ear or headpieces and lift away

from face. If goggle or face shield are reusable, place them in a

designated receptacle for subsequent reprocessing. Otherwise, discard

them in the waste receptacle.

5.1.15. Removing Isolation Gown.

5.1.15.1. Unfasten the gown ties with the ungloved hands. Slip hands underneath

the gown at the neck and shoulder, peel away from the shoulders. Slip the

fingers of one hand under the cuff of the opposite arm. Pull the hand into



the sleeve, grasping the gown from inside. Reach across and push the

sleeve off the opposite arm. Fold the gown towards the inside and fold or

roll into a bundle. (Only the ―clean‖ part of the gown should be visible.)

Discard into waste or linen container, as appropriate.

5.1.16. Removing a Mask.

5.1.16.1. The front of the mask is considered contaminated and should not be

touched. Remove by handling only the ties or elastic bands starting with

the bottom then top tie or band. Lift the mask or respirator away from the

face and discard it into the designated waste receptacle.

5.1.17. Removing a Particulate Respirator.

5.1.17.1. The bottom elastic should be lifted over the headfirst. Then remove the

top elastic. This should be done slowly to prevent the respirator from

―snapping‖ off the face.

5.1.18. Perform hand hygiene.

5.1.18.1. Hand hygiene is the cornerstone of preventing infection transmission. You

should perform hand hygiene immediately after removing PPE. If your

hands become visibly contaminated during PPE removal, wash hands

before continuing to remove PPE. Wash your hands thoroughly with soap

and warm water or, if hands are not visibly contaminated, use an alcohol-

based hand rub.

5.2. Appendix.

5.2.1. None.



6. Hand Hygiene and Hand Washing.

6.1. Procedures.

6.1.1. Indications for Hand Hygiene.

6.1.1.1. Wash hands with soap and water when visibly dirty or visibly soiled with

blood or other body fluids before and after touching the patient.

6.1.1.2. Before handling an invasive device for patient care, regardless of whether

or not gloves are used.

6.1.1.3. After contact with body fluids or excretions, mucous membranes, non-

intact skin (e.g. when taking a pulse or blood pressure and lifting a

patient).

6.1.1.4. If moving from a contaminated body site to another body site during

treatment of the same patient.

6.1.1.5. After contact with inanimate surfaces and objects (including dental

equipment) in the immediate vicinity of the patient.

6.1.1.6. Before donning and after removing sterile or non-sterile gloves.

6.1.1.7. On completion of treatment, before leaving the dental treatment room, to

avoid taking germs from one room to another.

6.1.1.8. Before entering and leaving a dental treatment room.

6.1.1.9. After using a restroom.

6.1.1.10. After each personal bodily function (e.g. blowing nose, coughing,

sneezing, combing hair, scratching).

6.1.1.11. After leaving a contaminated area.

6.1.2. Five moments of Hand Hygiene in Dental Setting.

6.1.2.1. Before touching a patient.

6.1.2.2. Before clean/aseptic procedure.

6.1.2.3. After body fluid exposure risk.

6.1.2.4. After touching a patient.

6.1.2.5. After touching patient surroundings.

6.1.3. Hand Washing Procedures.

6.1.3.1. Duration of hand washing technique with soap and water is 40-60

seconds.

6.1.3.2. Wet hands with water.

6.1.3.3. Apply enough soap to cover all hand surfaces.

6.1.3.4. Rub hands palm to palm.

6.1.3.5. Right palm over left dorsum with interlaced fingers and vice versa.

6.1.3.6. Palm to palm with fingers interlaced.

6.1.3.7. Back of fingers to opposing palms with fingers interlocked.

DOCUMENT TITLE: HAND HYGIENE AND HANDWASHING


VERSION: 2.0




6.1.3.8. Rotational rubbing of left thumb clasped in right palm and vice versa.

6.1.3.9. Rotational rubbing, backwards and forwards with clasped fingers of right

hand in left palm and vice versa.

6.1.3.10. Rinse hands with water.

6.1.3.11. Dry hands thoroughly with a single use towel.

6.1.3.12. Use towel to turn off faucet.

6.1.3.13. Dispose used towels in general waste bins.

6.1.4. Hand Rub Procedures.

6.1.4.1. Duration of Hand rub Technique with Alcohol-Based Formulation is 20-30

seconds.

6.1.4.2. Apply a palmful of the product in a cupped hand, covering all surfaces.

6.1.4.3. Rub hands palm to palm.

6.1.4.4. Right palm over left dorsum with interlaced fingers and vice versa.

6.1.4.5. Palm to palm with fingers interlaced.

6.1.4.6. Backs of fingers to opposing palms with fingers interlocked.

6.1.4.7. Rotational rubbing of left thumb clasped in right palm and vice versa.

6.1.4.8. Rotational rubbing, backwards and forwards with clasped fingers of right

hand in left palm and vice versa. Once dry, your hands are safe.

6.1.5. Hand Hygiene Supplies.

6.1.5.1. Infection Control Officer will ensure the availability of the following at all

times:

6.1.5.1.1. Hand washing sinks in prominent person served care areas and

washrooms.

6.1.5.1.2. Alcohol based hand gel, soap and paper towels.

6.1.5.1.3. Hand washing supplies must me be stocked in a sufficient quantity

and new orders must be requested once stock volume goes below

the average monthly use.

6.2. Appendix.

6.2.1. None.



7. Dental Unit Waterlines.

7.1. Procedures.

7.1.1. The CDC recommends that dental unit water used in non-surgical procedures

measure less than or equal to 500 colony forming units of heterotrophic bacteria

per milliliter (≤500 CFU/mL) of water, the standard set for drinking water by the

Environmental Protection Agency (EPA).

7.1.2. Biofilm—a coating of microorganisms—can develop in dental unit waterlines (the

tubes connecting instrumentation such as high-speed handpieces, air/water

syringes and ultrasonic scalers with a water supply). To deliver water of optimal

microbiologic quality, dental unit waterlines must be maintained regularly.

7.1.3. Several methods for improving dental unit water quality, includes:

7.1.3.1. Filtration;

7.1.3.2. Chemical treatments;

7.1.3.3. Anti-retraction valves;

7.1.3.4. Use of water sources separate from the public water system (NOTE: An

independent water source also will help offices avoid interruptions in

dental care when community ―boil water‖ notices are issued by local

health authorities).

7.1.4. The CDC recommends that any devices that enter a patient‘s mouth (e.g.

handpieces, ultrasonic scalers, or air/water syringes) should be connected to the

waterline and flushed for at least 20 seconds between person served.

7.1.5. In addition, warming dental unit water (with the intent of improving person served

comfort) should be avoided because it can augment biofilm formation.

7.1.6. Delivery of Sterile Surgical Irrigation.

7.1.6.1. The CDC recommends use of sterile solutions (e.g., sterile saline or

sterile water) as a coolant or for irrigation during oral surgical procedures.

The CDC defines oral surgical procedures as those that involve the

incision, excision, or reflection of tissue that exposes normally sterile

areas of the oral cavity. These include procedures such as gingivectomy,

extraction of an impacted third molar, soft-tissue biopsy, and bone re-

contouring.

7.1.6.2. Dental units cannot reliably deliver sterile water even when equipped with

independent water reservoirs because the water-bearing pathway cannot

be reliably sterilized. Delivery devices (e.g., sterile bulb syringe or single-

use disposable products) should be used to deliver sterile water.

7.1.7. Cleaning Dental Unit Waterlines.

DOCUMENT TITLE: DENTAL UNIT WATER LINES


VERSION: 2.0




7.1.7.1. Check the dental unit manufacturer for recommendations on how to clean

waterlines, even if using an independent water source. Manufacturers

may suggest options such as filtration or use of chemicals or a

combination of these.

7.1.7.2. Once identified a process that fits the needs and is compatible with the

dental unit (per the manufacturer) establish a schedule for waterline

maintenance as well as an individual designated for this responsibility.

7.1.8. Water Quality Monitoring.

7.1.8.1. The only way to ensure effectiveness of a dental unit waterline cleaning

regimen is to test the water coming out of the unit. Simple and

inexpensive products are available that estimate the number of free-

floating heterotrophic bacteria in dental unit water. A well-designed water

quality indicator should accurately detect a wide concentration range and

type of aerobic mesophilic heterotrophic waterborne bacteria within a

reasonable incubation time at room temperature. In addition to in-office

testing kits, laboratories across the UAE also offer mail-in testing

services.

7.1.8.2. Some dental unit manufacturers provide a schedule for monitoring their

equipment. Check with the manufacturer to see if they have a

recommended schedule.

7.2. Appendix.

7.2.1. None.

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/DUWLTestServices2017June23.pdf?la=en

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/DUWLTestServices2017June23.pdf?la=en



8. Cleaning and Disinfection.

8.1. Procedures.

8.1.1. Decontamination of Environmental Surfaces.

8.1.1.1. Person served care areas, common waiting areas, and other areas where

person served may have potentially contaminated surfaces or objects that

are frequently touched by staff and person served (doorknobs, sinks,

toilets, other surfaces and items in close proximity to patients) should be

cleaned routinely with HAAD registered disinfectants, following the

manufacturer‘s instructions for amount, dilution, and contact time.

8.1.1.2. Most disinfectants are not effective in the presence of dirt and organic

matter, therefore cleaning must occur first before disinfection. Wet a cloth

with the disinfectant, wipe away dirt and organic material, then with a

clean cloth apply the disinfectant to the item and allow to air dry for the

time specified by the product manufacturer.

8.1.1.3. Some pathogens such as norovirus and Clostridium difficile are not

inactivated by commercial disinfectants routinely used in local health

settings. In situations where contamination with these pathogens is

suspected, a bleach solution (1:10) is recommended for disinfecting

contaminated surfaces and items.

8.1.1.4. Some person served care items may be damaged or destroyed by certain

disinfectants. Consult with the manufacturer of the items before applying

disinfectants.

8.1.2. Decontamination of Medical Equipment and Devices.

8.1.2.1. The following risk categories may be helpful, to aid staff in the choice of

decontamination method to be used:

8.1.2.1.1. High Risk Items- come into close contact with a break in the skin or

mucous membranes or are introduced into a normally sterile body

area. E.g. surgical instruments, needles, urinary and other catheters.

Sterilization is required for this group.

8.1.2.1.2. Intermediate Risk Items- come into close contact with mucous

membrane or are items contaminated with particularly virulent or

readily transmissible organisms. E.g. Items of respiratory equipment

including laryngoscope blades, endotracheal and tracheostomy

tubes, oropharyngeal and nasal airways. Disinfection is required for

this group.

DOCUMENT TITLE: CLEANING AND DISINFECTION


VERSION: 2.0

EFFECTIVE DATE: 01 SEP 2017 REVIEWED: 01 DEC 2017



8.1.2.1.3. Low Risk Items- only come into contact with normal intact skin. E.g.

stethoscopes or washing bowls. Cleaning and drying is usually

adequate for this group.

8.1.3. Techniques of Disinfection and Sterilization.

8.1.3.1. Before equipment is to be disinfected or sterilized, it should be thoroughly

cleaned to remove any visible dirt or secretions.

8.1.3.2. This involves washing with water and detergent (soap).

8.1.3.3. Protective clothing (an apron, gloves and a facemask) should be worn.

8.1.4. Disinfection.

8.1.4.1. Disinfection is best achieved by moist heat such as boiling in water

(100°C for 10 minutes at sea level) which kills all organisms except for a

few bacterial spores.

8.1.4.2. Temperature at which water boils decreases with altitude and a longer

boiling time will be required. e.g. at 4000m above sea level where boiling

occurs at 86°C a minimum of 20 minutes is required for disinfections.

8.1.4.3. It is important to note that boiling equipment items in water will not

achieve sterilization.

8.1.4.4. Disinfection can also be achieved by using chemicals which however may

themselves be toxic when allowed contact with skin or are inhaled.

8.1.4.5. They can also be corrosive and flammable so that protective clothing

(gloves, apron and a facemask) should be worn.

8.1.5. Chemical Disinfectants.

8.1.5.1. Chemical disinfectants may be supplied ready to use or may need

accurate dilution to provide an appropriate solution.

8.1.5.2. Disinfectants can decay and lose activity.

8.1.5.3. Decay is more rapid at high temperatures and can be accelerated by the

presence of impurities.

8.1.5.4. All disinfectants take time to work.

8.1.6. Range of Activity of Disinfectants.

8.1.6.1. Gram positive bacteria- e.g. Staphylococci, are more sensitive than gram

negative bacteria e.g. Pseudomonas. Mycobacteria and spores are

relatively resistant. Enveloped viruses e.g. HIV are killed by most

disinfectants but non-enveloped viruses like Coxsackie tend to be more

resistant.

8.1.6.2. Spores- fungal spores are easily killed by disinfectants. Other bacterial

spores e.g. Clostridia are resistant to most disinfectants in common use.

Tubercle bacteria are more resistant to chemical disinfectants than other

bacteria. They can be killed by exposure to 2% alkaline Glutaraldehyde

solution (Cidex) for 60 minutes.

8.1.6.3. Viruses- Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV)

are inactivated by Cidex in 1 - 2 minutes. To ensure adequate penetration,

soiled items should be placed in a 2% glutaraldehyde solution for 30

minutes. Exposure to 70% alcohol solution for 10 minutes is also effective.



Viruses causing Rabies, Lassa fever and other haemorrhagic fevers are

also killed by Cidex.

8.1.7. Steam sterilization.

8.1.7.1. Steam sterilization uses pressurized steam at 121-132 C (250-270 F) for

30 or 40 minutes.

8.1.7.2. This type of heat kills all microbial cells including spores, which are

normally heat resistant.

8.1.7.3. In order to accomplish the same effect with dry heat in an oven, the

temperature needs to be increased to 160-170 C (320-338 F) for periods

of 2 to 4 hours.

8.1.8. Liquid Chemicals Used as Disinfectants.

8.1.8.1. Liquid disinfectants are preferably used for solid surfaces and equipment.

8.1.8.2. They vary greatly in their efficiency, depending on the chemical

constituents and the agents involved.

8.1.9. Variables to Remember when Disinfecting:

8.1.9.1. Nature of Surface being Disinfected- porous or smooth. The more

porous and rough the surface, the longer a disinfectant will need to be

effective.

8.1.9.2. Number of Microorganism Present- higher concentrations require a

longer application time and/or higher concentration of disinfectant.

8.1.9.3. Resistance of Microorganisms- microbial agents can be classified

according to increasing resistance to disinfectants and heat.

8.1.9.4. Presence of Organic Material- the proteins in organic materials such as

blood, bodily fluids, and tissue can prevent or slow the activity of certain

disinfectants.

8.1.9.5. Duration of Exposure and Temperature- increased exposure time

increases the effectiveness of disinfectants. Low temperatures may slow

down the activity requiring more exposure time.

8.1.10. Chemical Disinfectant Solutions:

8.1.10.1. Phenol and Phenol Derivatives.

8.1.10.1.1. Concentrations 5% to 10 %.

8.1.10.1.2. Unpleasant odor.

8.1.10.1.3. Toxic.

8.1.10.1.4. Used for disinfection of walls, floors, bench tops.

8.1.10.1.5. They effectively kill bacteria including Mycobacterium tuberculosis,

fungi and lipid-containing viruses.

8.1.10.1.6. They are not active against spores.

8.1.10.2. Halogens (Chlorine and Iodine).

8.1.10.2.1. Sodium hypochlorite is the most common.

8.1.10.2.2. Common household bleach (5% available chlorine) can be diluted

1/10 to 1/100 with water.

8.1.10.2.3. Always use personal protective equipment.



8.1.10.2.4. At high concentrations and extended contact time, considered cold

sterilants.

8.1.10.2.5. Iodine has similar properties to chlorine.

8.1.10.2.6. They are most often used as antiseptics and in surgical soaps and

are relatively nontoxic to humans.

8.1.10.3. Alcohols.

8.1.10.3.1. Ethyl or isopropyl alcohol in concentration of 70% to 90% is good

general-use disinfectants.

8.1.10.3.2. They evaporate fast and therefore have limited exposure time.

8.1.10.3.3. They are less active against non-lipid viruses and ineffective against

bacterial spores.

8.1.10.3.4. Concentrations above 90% are less effective. (eg methanol, ethanol

& isopropanolol) have good activity against bacteria & viruses.

8.1.10.3.5. They should only be used after all the visible surface dirt has been

removed from the area to be disinfected.

8.1.10.4. Aldehydes.

8.1.10.4.1. Formalin: Formalin is 37% solution of formaldehyde in water.

8.1.10.4.2. Dilution of formalin to 5% results in an effective disinfectant.

8.1.10.4.3. Formaldehyde is a human carcinogen and creates respiratory

problems at low levels of concentration.

8.1.10.5. Glutaraldehyde.

8.1.10.5.1. Chemically related to formaldehyde, is more effective against all

types of bacteria, fungi, and viruses.

8.1.10.5.2. Vapors of glutaraldehydes are irritating to the eyes, nasal passages

and upper respiratory tract.

8.1.10.6. Quaternary Ammonium Compounds (Quats).

8.1.10.6.1. Detergents with strong surface activity.

8.1.10.6.2. They are active against Gram-positive bacteria.

8.1.10.6.3. They are less active against Gram-negative bacteria .

8.1.10.6.4. Quats are relatively nontoxic and can be used for decontamination of

food equipment and for general cleaning.

8.1.10.7. Formaldehyde

8.1.10.7.1. Formaldehyde is irritant to the eyes, respiratory tract and skin.

8.1.10.7.2. It can also be absorbed by some materials and subsequently slowly

released with potentially hazardous results.

8.1.10.7.3. Hot air sterilization takes a long time and items must be able to

withstand temperatures of at least 160°C for periods of 2 hours or

more.

8.1.10.8. Radiation.

8.1.10.8.1. Gamma and X-ray are two principal types of ionizing radiation used

in sterilization.

8.1.10.8.2. Their application is mainly centered on the sterilization of

prepackaged medical devices.



8.1.10.8.3. Ultraviolet (UV) radiation is a practical method for inactivating

viruses, mycoplasma, bacteria and fungi.

8.1.10.8.4. UV radiation is successfully used in the destruction of airborne

microorganisms.

8.1.10.8.5. UV light sterilizing capabilities are limited on surfaces because of its

lack of penetrating power.

8.1.11. Decontamination of Dental Supplies and Materials.

8.1.11.1. Blood and saliva should be thoroughly and carefully cleaned from Dental

supplies and materials that have been used in the mouth (e.g., impression

materials, bite registration), especially before polishing and grinding intra-

oral devices.

8.1.11.2. Materials, impressions, and intra-oral appliances should be cleaned and

disinfected before being handled, adjusted, or sent to a dental laboratory.

8.1.11.3. These items should also be cleaned and disinfected when returned from

the dental laboratory and before placement in the patient's mouth

8.1.11.4. Because of the ever-increasing variety of dental materials used intra-

orally, DHCWs are advised to consult with manufacturers as to the

stability of specific materials relative to disinfection procedures.

8.1.11.5. Users of dental devices are responsible for the decontamination of the

equipment in accordance with this procedure.

8.1.11.6. Any equipment that has been decontaminated must be labeled as such.

8.1.11.7. When a medical device is to be returned to medical device office or to

affiliated maintenance agencies, e.g. for maintenance or repair (or to any

other location) the user must ensure that it has been properly cleaned and

decontaminated prior to return, and labeled as such.

8.1.11.8. It is an offence to send contaminated equipment through the external mail

or transport system.

8.1.12. Indications for High-Level Disinfection or Sterilization of instruments.

8.1.12.1. Surgical and other instruments that normally penetrate soft tissue and/or

bone (e.g., forceps, scalpels, bone chisels, scalers, and surgical burs)

should be sterilized after each use.

8.1.12.2. Instruments that are not intended to penetrate oral soft tissues or bone

(e.g., amalgam condensers, plastic instruments, and burs) but that may

come into contact with oral tissues should also be sterilized after each

use, if possible; however, if sterilization is not feasible, the latter

instruments should receive high-level disinfection.

8.1.13. Methods for High-Level Disinfection or Sterilization.

8.1.13.1. Before high-level disinfection or sterilization, instruments should be

cleaned to remove debris. Cleaning may be accomplished by a thorough

scrubbing with soap and water or a detergent, or by using a mechanical

device (e.g., an ultrasonic cleaner).

8.1.13.2. Persons involved in cleaning and decontaminating instruments should

wear heavy-duty rubber gloves to prevent hand injuries.



8.1.13.3. Metal and heat-stable dental instruments should be routinely sterilized

between uses by dry heat. The adequacy of sterilization cycles should be

verified by the periodic use of spore-testing devices. (e.g., weekly for most

dental practices). Heat- and steam-sensitive chemical indicators may be

used on the outside of each pack to assure it has been exposed to a

sterilizing cycle.

8.1.13.4. Heat-sensitive instruments may require up to 10 hours' exposure in a

liquid chemical agent registered by the HAAD as a disinfectant/sterilant;

rinsing with sterile water should follow this.

8.1.13.5. High-level disinfection may be accomplished by immersion in either

boiling water for at least 10 minutes or an HAAD-registered

disinfectant/sterilant chemical for the exposure time recommended by the

chemical's manufacturer.

8.1.14. Use and Care of Ultrasonic Scalers, Handpieces, and Dental units.

8.1.14.1. Routine sterilization of handpieces between patients is

desirable; however, not all handpieces can be sterilized.

8.1.14.2. The present physical configurations of most handpieces do not readily

lend them to high-level disinfection of both external and internal surfaces;

therefore, when using handpieces that cannot be sterilized, the following

cleaning and disinfection procedures should be completed between each

patient:

8.1.14.2.1. After use, the handpiece should be flushed, then thoroughly scrubbed

with a detergent and water to remove adherent material.

8.1.14.2.2. It should then be thoroughly wiped with absorbent material saturated

with a chemical germicide that is registered with the HAAD as a

"hospital disinfectant" and is mycobactericidal at use-dilution.

8.1.14.2.3. The disinfecting solution should remain in contact with the handpiece

for a time specified by the disinfectant's manufacturer.

8.1.14.2.4. Ultrasonic scalers and air/water syringes should be treated in a

similar manner between patients.

8.1.14.2.5. Following disinfection, any chemical residue should be removed by

rinsing with sterile water.

8.1.14.3. Because water retraction valves within the dental units may aspirate

infective materials back into the handpiece and water line, check valves

should be installed to reduce the risk of transfer of infective material.

8.1.14.4. While the magnitude of this risk is not known, it is prudent for water-

cooled handpieces to be run and to discharge water into a sink or

container for 20-30 seconds after completing care on each patient.

8.1.14.5. This is intended to physically flush out patient material that may have

been aspirated into the handpiece or water line.

8.1.14.6. Additionally, there is some evidence that overnight bacterial accumulation

can be significantly reduced by allowing water-cooled handpieces to run



and to discharge water into a sink or container for several minutes at the

beginning of the clinic day.

8.1.14.7. Sterile saline or sterile water should be used as a coolant/irrigator when

performing surgical procedures involving the cutting of soft tissue or

bone.

8.1.15. Disposal of Dental Devices.

8.1.15.1. Responsibility for the safe disposal of dental devices rests with the

Medical Devices Officer.

8.1.15.2. Dental and Medical equipment may be considered for disposal as a result

of its natural obsolescence, failure to meet current treatment standards,

uneconomic or poor serviceability etc. Decontamination should be carried

out prior to final disposal.

8.1.15.3. The medical devices office must be informed of ALL disposals of dental

and medical equipment or device to ensure the inventory is kept up to

date.

8.1.15.4. The medical device office will issue: ―Decontamination Certificate‟ –

Department to fill in and attach to equipment, ―Remove for Disposal‖ tag –

to be attached to equipment based on advice received from maintenance

contractors and / or other specialist advisors.

8.1.15.5. Disposed dental and medical device must be bagged and tagged. Bags

and tags are available through Medical Devices Office.

8.1.15.6. Batteries from battery operated dental and medical device must be

removed from the device before putting them both to the sealed

transparent bag.

8.1.15.7. When dental and medical devices are disposed of the inventory will be

adjusted as necessary.

8.2. Appendix.

8.2.1. Decontamination Certificate.



9. Waste Disposal.

9.1. Procedures.

9.1.1. The Center of Waste Management-Abu Dhabi (TADWEER) regulates the

management of medical waste under Local Law No. 17 of 2008.

9.1.2. Anyone handling, storing, or disposing of medical waste is covered under this

section.

9.1.3. Designation.

9.1.3.1. The Infection Control and Occupational Health and Safety Officer will act

as a waste coordinator.

9.1.3.2. The ICOHSO designates housekeeping personnel that are responsible for

medical waste in the facility.

9.1.3.3. ICOHSO schedules the collection of medical waste by coordinating with

contracted medical waste collecting agency.

9.1.3.4. The collection of waste by the contracted agency must be schedule

weekly at the minimum or more often if necessary.

9.1.4. Packaging and Transport.

9.1.4.1. Waste segregation shall take place at source (the point of generation) to

effectively reduce not only the amount of medical waste but also of the

risk of contamination.

9.1.4.2. Because of the simplicity of the medical center setting, the facility

potentially generate two types of waste:

9.1.4.2.1. Medical Waste;

9.1.4.2.2. Hazardous Waste;

9.1.4.2.3. Sharps; and

9.1.4.2.4. General Waste.

9.1.4.3. Sharp items should be disposed of in containers that are puncture

resistant, leak-proof, closable, and labeled with the biohazard symbol or

are yellow in color.

9.1.4.4. Sharps containers should be replaced when filled up to the indicated full

line. Items generated by the facility that should be discarded into sharps

containers include contaminated items that may easily cause cuts or

punctures in the skin (used needles, lancets, broken glass or rigid plastic

vials) and unused needles and lancets that are being discarded. Syringes

or blood collection tube holders attached to needles must also be

discarded still attached to the needles.

DOCUMENT TITLE: WASTE DISPOSAL


VERSION: 2.0




9.1.4.5. Non-sharp disposable items saturated with blood or body fluids (i.e., fluid

can be poured or squeezed from the item or fluid is flaking or dripping

from the item) should be discarded into biohazard bags that are puncture-

resistant, leak-proof, and labeled with a biohazard symbol or yellow in

color. Such items may include used PPE and disposable rags or cloths.

9.1.4.6. Sharp boxes should be situated in a safe and secure place and not

accessible to other person served or visitors in rooms or areas where

boxes do not need to be moved (wall mounted).

9.1.4.7. Sharp boxes must be labeled with date and signature, when assembled,

locked and disposed of. They must be labeled with their source prior to

disposal and expiry date. Sharp boxes must be disposed when ¾ full or

after three months whether or not ¾ full.

9.1.4.8. For solid medical waste, wastes should not be mixed with non-medical

general waste streams such as waste from meals, kitchens, offices and

the like.

9.1.4.9. Medical waste shall be collected into dedicated medical wastes storage

bags before safe disposal. The bags shall be color coded and marked

according its contents for safe handling. Wastes should not be re-bagged,

except under supervision in the event of a bag failure.

9.1.4.10. Solid medical wastes should be discarded into plastic bags or multi-layer

coated paper bags that are capable of containing the waste without

spillage or puncture, especially during transport and handling.

9.1.4.11. Medical waste bag must be labeled with date and signature, when

assembled. They must be labeled with their source prior to disposal.

Medical waste must be disposed when ¾ full.

9.1.4.12. Bags for medical wastes while in use must be held firmly in a dedicated

bag-holder drum or bin. The drum shall be of rigid but smooth material

and able to hold a bag of waste in its place. The bags and any container

for storage of medical wastes should be marked properly with the

biohazard symbol and the words Medical Waste in Arabic and English.

Waste containers should be covered and foot control and be free with dirt

or rust.

9.1.4.13. For Hazardous chemical waste, hazardous chemical containers are

maintained in good condition and kept closed at all times, except when

adding, removing, or bulking chemical waste. If a container is damaged, it

will be replaced, repaired, or over packed.

9.1.4.14. Hazardous chemical waste containers are compatible with their contents;

they are made of, or lined with, a composition material that is compatible

with the chemical waste so as not to cause a reaction and maintain

integrity of the container.

9.1.4.15. If the chemical waste is characterized as a hazardous waste, personnel

responsible shall label the container with the words ―hazardous waste‖.



Prior to treatment or disposal. Personnel responsible shall also label the

shipping container with all applicable hazardous waste codes.

9.1.4.16. Hazardous chemical waste container must be labeled with date and

signature, when assembled. They must be labeled with their source prior

to disposal. Hazardous chemical waste container must be disposed when

¾ full.

9.1.4.17. The Organization contracted with TADWEER to collect and transport

waste.

9.1.4.18. The Organization is required to maintain a log of waste that is transported

from us, regardless of the amount or how it is transported.

9.1.4.19. The log must contain the following information: date of disposal, location

to which waste is transported, name of person transporting the waste, and

the amount and type of waste transported (e.g., three sharps containers

or five biohazard bags). Care must be taken to contain the waste during

transport, keep waste separate from clean items in the transport vehicle,

and to clean and disinfect areas of the vehicle containing infectious waste

before hauling clean items and materials.

9.1.5. Storage.

9.1.5.1. Bagged medical waste when labeled should not be stored in any areas

except to the dedicated collection point.

9.1.5.2. The facility medical waste collection point is an area of adequate size

related to the volume of production and frequency of collection.

9.1.5.3. The storage area for the waste awaiting collection is secured and

lockable.

9.1.5.4. Access to this storage room is limited to those responsible for handling,

transporting or disposing of the waste.

9.1.5.5. The storage area is temperature-controlled not exceeding to 15 degrees

to delay growth of bacteria while pending for collection of waste collecting

agency.

9.1.5.6. Appropriate PPEs for waste management will be provided in all waste

collection and storage areas to protect personnel from any risk associate

with the medical and hazard waste.

9.1.5.7. Basic cleaning tools are readily available including among others,

disinfectant, granular chlorine compound for blood spillage

9.1.5.8. Wall-mounted hand sanitizer is ready available outside the medical waste

storage room for hand hygiene purposes every after access of the waste

room.

9.1.6. Disposal.

9.1.6.1. The facility through the coordination of ICOHSO shall be responsible for

coordination of proper handling and transport of medical waste to the

place of disposal.

9.1.6.2. The facility holds a contract TADWEER for waste transport and disposal.



9.1.6.3. The ICOHSO communicates to the waste transporter service provider for

the collection and disposal of medical waste weekly or more often if

necessary.

9.1.7. Record Keeping.

9.1.7.1. The ICOHSO secures and maintain records of the waste disposal

manifest sent by TADWEER.

9.1.7.2. The ICOHSO ensure that its contract with TADWEER is current and not

expired.

9.1.8. Staff Training.

9.1.8.1. The OHSIC ensures waste management training is conducted to all health

care providers and any personnel involve in the process of medical waste

management.

9.2. Appendix.

9.2.1. Medical Waste Collection Log Book.



10. Personnel Education.

10.1. Procedures.

10.1.1. Orientation programs.

10.1.1.1. All Medical, Non-Medical and housekeeping will receive a comprehensive

orientation, which will explain rules, regulations, practices and procedures

for Infection Control.

10.1.2. Components of training in infection prevention and control.

10.1.2.1. Orientation and Training session comply with the Organization mandatory

orientation program for infection control that include but are not restricted

to:

10.1.2.1.1. Infection Control Practices;

10.1.2.1.2. Hand hygiene;

10.1.2.1.3. Correct use of Personal Protective Equipment (PPE);

10.1.2.1.4. Management of needle stick injuries;

10.1.2.1.5. How to seek advice and reporting of communicable disease and other

infection control issues;

10.1.2.1.6. Hazardous and Waste management; and

10.1.2.1.7. Use & storage for antiseptics & disinfectants solution is according to

manufactures instructions.

10.1.2.2. All new staffs, medical and non-medical and housekeeping are required

to attend the orientation program in infection prevention and control.

10.1.2.3. All staffs, medical and non-medical and housekeeping are required to

attend annual updates in infection prevention and control teaching

sessions provided by the Infection Control Officer.

10.1.2.4. Feedbacks from the educational content provided from the orientation

and training session are expected to be submitted by the staffs as part of

the program appraisal and improvement.

10.1.2.5. Medical staff specific updates are provided for according to the

requirements needed by the department but does not count as an annual

updates.

10.1.2.6. Any additional training or support will be offered on request, either

formally or informally.

10.1.3. Monitoring compliance.

10.1.3.1. Compliance with this policy will be demonstrated by the attendance

records kept in the Quality Department.

DOCUMENT TITLE: PERSONNEL EDUCATION


VERSION: 2.0




10.1.3.2. Feedback and appraisal for infection prevention and control component is

part of every clinical appraisal for the infection and Control program in the

Organization.

10.1.3.3. Records are kept as part of the Organizations overall appraisal

documentation.

10.1.4. Training needs analysis.

10.1.4.1. Analysis from the training provided to all medical, non-medicals and

housekeeping is done for the improvement of infection control program.

10.2. Appendix.

10.2.1. None.



11. Housekeeping Equipment and Materials.

11.1. Procedures.

11.1.1. Housekeeping equipment used in the facility for cleaning and disinfecting will be

provided to ensure its availability at all times.

11.1.2. Housekeeping personnel will be trained in proper identification and use of

housekeeping equipment and materials.

11.1.3. Color coding system will be used to prevent transfer and spread of infection. The

color coding should be as the following:

11.1.3.1. Green: kitchen areas and person served food service at ward level.

11.1.3.2. Red: toilets, bathrooms, washrooms, basins, bathroom floors.

11.1.3.3. Blue: General areas including offices hallway, and all public areas.

11.1.4. The color coded chart will be displayed in the housekeeping unit and dirty utility

room.

11.1.5. For the list of approved disinfectant solutions used in the facility kindly refer to

Disinfection and Cleaning Policy.

11.2. Appendix.

11.2.1. Housekeeping Color Coding Chart.

DOCUMENT TITLE: HOUSEKEEPING EQUIPMENT AND MATERIALS


VERSION: 2.0




12. Blood, Body Substance and Chemical Spill.

12.1. Procedures.

12.1.1. The Spill Response Team will consist of the Occupational Safety /Infection

Control Officer the Patient Safety Officer and Facility Maintenance Manager, the

Cleaning Supervisor and cleaner who are prepared to serve.

12.1.2. When a biological spill occurs, the following factors must be considered before

attempting a clean-up response:

12.1.2.1. Pathogenicity of the material;

12.1.2.2. Mode of transmission for the pathogenic;

12.1.2.3. Location of spill (within or outside of containment?);

12.1.2.4. Form of the material spilled (solid, aerosol, liquid?); and

12.1.2.5. Quantity of material spilled.

12.1.3. These factors will dictate the best course of response to the spill.

12.1.4. Blood and Body Fluid Spillage.

12.1.4.1. Small spots of blood or small spills.

12.1.4.1.1. Gloves and eye protection should be worn.

12.1.4.1.2. Contamination should be wiped up with paper towels soaked in

freshly prepared hypochlorite solution (Milton or chlorine releasing

tablets) containing 10,000 ppm (1%) available chlorine.

12.1.4.1.3. If broken glass is present, first treat the spillage with hypochlorite,

and then carefully remove the pieces of glass with disposable

forceps or scoop to sharps bin, before wiping up as above.

12.1.4.1.4. Towels and gloves should be disposed of in a yellow clinical waste

bag for incineration (or an autoclave bag if in a laboratory).

12.1.4.1.5. Hands must be washed following clearing up.

12.1.4.2. Larger spills other than urine (unless bloodstained).

12.1.4.2.1. Staff, patients and visitors must be kept away from the spillage and if

possible a warning sign shown, while preparation is made to handle

the spill as outlined below.

12.1.4.2.2. Gloves, eye protection and a disposable apron should be worn. If the

spillage is extensive, disposable plastic overshoes or rubber boots

may be necessary.

12.1.4.2.3. Liquid spills should be covered with dichloroisocyanurate (chlorine

releasing) granules and left for at least two minutes before clearing

up with paper towels, absorbent mats or incontinence pads. A

specialized spillage mop with detachable absorbent pads (see

DOCUMENT TITLE: BLOOD, BODY SUBSTANCE AND CHEMICAL SPILL


VERSION: 2.0




under Chemical Spillage- Dealing with the spillage) is a convenient

way of absorbing the spillage after disinfection.

12.1.4.2.4. Alternatively, the spill may be covered with paper towels, absorbent

mats or incontinence pads and gently flooded with hypochlorite

solution (Milton or chlorine releasing tablets) containing 10,000 ppm

(1%) available chlorine (again this should be left for at least two

minutes before attempting to clear up).

12.1.4.2.5. If broken glass is present, first decontaminate the spillage as above,

and then carefully remove the pieces of glass with disposable

forceps or scoop to a sharps bin, before wiping up.

12.1.4.2.6. Paper towels, gloves, disposable overshoes and any contaminated

clothing should be placed in a yellow clinical waste bag for

incineration (or an autoclave bag if a laboratory) and hands washed

(reusable PPE may need to be decontaminated with dilute

disinfectant).

12.1.4.2.7. Finally, the area should be washed with water and detergent and

allowed to dry.

12.1.4.2.8. Hypochlorite solutions (eg household bleach) may be replaced by

solutions of dichloroisocyanurate prepared from tablets according to

the manufacturer's instructions. Note: metals can be damaged by

hypochlorite, and they should not be exposed to it for lengthy

periods.

12.1.4.2.9. NB: Spilt blood should not be allowed to dry as potential aerosol

production is greater from dried blood.

12.1.4.2.10. A normal mop and bucket should not be used for blood spillages.

12.1.4.2.11. Note that urine may promote the release of free chlorine from the

treated area when hypochlorite or other chlorine-containing

compounds are applied. Ventilation of the area may be necessary.

12.1.4.3. Immediate action when spillage occurs:

12.1.4.3.1. The member of staff first on the scene must immediately alert other

staff, and tell patients or visitors to keep a safe distance away.

12.1.4.3.2. Make decision to evacuate the area affected- using fire alarm to call

fire brigade or Control the spillage.

12.1.4.3.2.1. If the Chemical is unknown or the staff are unable to deal safely

with it. Set off the fire alarm immediately.

12.1.4.3.2.2. If the nature of the spillage or uncontrolled release is unknown, or if

the staff present is not trained in the use of PPE and suitable

spillage kits, the fire alarm must be set off immediately. The person

who raises the alarm should await the arrival of the Fire Team and

the Fire Brigade and provide details of the spillage. Staff working on

the floor directly below should also be informed where possible.

12.1.4.3.2.3. If the Chemical is known and the staff trained and equipped to deal

with the spillage locally only if it is safe to do so.



12.1.4.3.2.4. A spillage may only be dealt with locally if the nature of the spillage

is known and by staff who are trained in the use of the required

PPE and chemical spillage kits.

12.1.4.3.2.5. If there is any doubt about the hazard involved or ability to deal with

the size of the spillage, the fire alarm should be raised and details

given of the location and nature of the spillage to the fire team on

their arrival.

12.1.4.3.2.6. If the spillage has occurred in a biological or radiation hazard area

the Safety Officer and Fire Brigade must be informed and any

further risks assessed.

12.1.4.4. If the decision is to control the spillage- carefully assess the

situation.

12.1.4.4.1. Inform others that you intend to deal with the spill. Two trained

members of staff should act as a response team. Someone should

watch from a safe distance, preferably through an observation

window.

12.1.4.4.2. Eliminate ignition sources, such as naked flames.

12.1.4.4.3. If a large spill, contact Municipality to deal with spill.

12.1.4.4.4. Arrange to isolate electrical supply – Do not use switches in the

immediate area as spark from the switch may ignite spill.

12.1.4.4.5. Ventilate area and close doors. Open windows (where possible).

Do not cross the spill or move further into the room to close doors.

If safe, ask others to close doors from adjacent rooms.

12.1.4.4.6. Isolate spill. Consider sealing off the area and displaying warning

signs on the doors.

12.1.4.4.7. If there is a possibility the chemical could seep to the floor below,

the occupants must be warned and evacuated.

12.1.4.4.8. Assemble equipment required and make preparations to deal with

the spill in an adjacent but safe room.

12.1.4.5. Personal Protective Equipment (PPE) to be used, listed below:

12.1.4.5.1. Respirator (use half mask, suitable for the fumes*)

12.1.4.5.2. Gloves (Do not use latex gloves), gloves with wide chemical

resistance such as nitrile should be used. However, neoprene,

PVC or butyl gloves give greater protection than nitrile against

certain chemicals; for example some concentrated acids.

12.1.4.5.3. Eye protection.

12.1.4.5.4. Chemical resistant apron or gown

12.1.4.5.5. * NB If vapors penetrate the respirator and the chemical smell

becomes apparent, the wearer should leave the area and call the

fire brigade.

12.1.4.6. Note special attention to the following chemicals:



12.1.4.6.1. Formaldehyde. Never attempt to deal with large spillages of

formaldehyde. Evacuate the room and sound fire alarm to call fire

brigade.

12.1.4.7. Safe waste disposal after spillage.

12.1.4.7.1. All chemical waste must be disposed of in accordance with the

hazardous waste management procedures.

12.1.4.7.2. When the spillage has been contained and it is considered safe to

return to the area, proceed with the clean-up procedure below:

12.1.4.7.3. Wearing PPE, place the waste in a suitable container with a tight

fitting lid or a suitable sealable plastic bag (which can be later

placed in a container with a lid).

12.1.4.7.4. Clearly label and identify the chemical waste. If the waste is volatile

or fuming, the waste container must be placed open in a fume

cupboard (not a recirculating model) to allow complete evaporation

to take place before sealing.

12.1.4.7.5. The floor and contaminated surfaces should then be washed with

fresh soapy water.

12.1.4.7.6. On leaving the area all PPE must be removed carefully and either

disposed of or washed.

12.1.4.7.7. Care must be taken not to take off the respirator and eye protection

until the contaminated gloves are first removed.

12.1.4.7.8. The Safety Officer is responsible for ensuring that the correct

procedures for the disposal of chemical waste are followed in

accordance with the Hazardous Waste Management Policy.

12.1.4.8. Reporting of spillage incidents and further action.

12.1.4.8.1. Following a biological or chemical spillage the Manager or

Department Safety Officer should complete an incident form and

append any additional relevant details. Certain high risk spillages

need to be reported to OSHAD.

12.1.4.9. Exposure to micro-organisms, chemicals or chemical fumes.

12.1.4.9.1. If exposure to potentially hazardous micro-organisms or a chemical

has occurred, those involved should report to the Occupational

Safety and Health.

12.2. Appendix.

12.2.1. None.



13. Pest Control.

13.1. Procedures.

13.1.1. Pest Control is a highly controlled activity in the U.A.E. since it will be using

highly toxic chemicals in order to control pests, rodents and all crawling insects.

Pest control should be undertaken by licensed companies only.

13.1.2. What are the official rules? Who regulates?

13.1.2.1. The rules are similar across the Emirates. These are governed by the

Federal Law 41 for 1992, the Ministerial Decree No.13 for 2012 and the

Cabinet Decision No. 27 for 2012. At the national level, the Ministry of

Environment and Water regulates what chemicals can be used in what

ways. Those rules are implemented at the emirate level by municipalities,

waste management authorities and economic departments. In brief, pest

control companies have to be licensed, their workers have to be certified

and trained, and their chemicals approved for use. These requirements

are checked annually.

13.1.3. Chemical used by official companies..

13.1.3.1. There is very wide range of chemicals that are approved for pest control.

In fact, this list changes, as new products become available. Examples

include imidacloprid, a gel bait for cockroaches; bromadiolone, a block

bait for rodents; and d-Phenothrin, a micro-emulsion concentrate for flies

and mosquitoes.

13.1.4. How long do you use pesticides when employing a company endorsed by

the authorities?

13.1.4.1. It varies, depending on the treatment used and area covered. The actual

treatment usually takes just 15-30 minutes; the bulk of the time involves

inspections and preparations (about an hour or so). It is not usually

necessary to vacate the premise, but keeping people away from treated

areas is recommended for about four hours in most cases.

13.1.5. How often should one get pest control done?

13.1.5.1. It is not necessary to call in pest control if the facility doesn‘t have any

pests. However, some companies suggest a half-yearly ‗treatment‘, while

others suggest a quarterly inspection. If there are pests, the treatment is

usually carried out as an initial visit plus one or two follow-ups in a month

or two.

13.1.6. What precautions should you take when getting pest control done?

DOCUMENT TITLE: PEST CONTROL


VERSION: 2.0




13.1.6.1. Inform neighbors nearby so that they can keep their doors and windows

closed to prevent the entry of pesticide vapors into their areas. Always

keep people away from treated areas and from applied pesticides.

13.1.7. Notice to neighbors – is this a must?

13.1.7.1. According to the Centre of Waste Management in Abu Dhabi, pest control

companies are mandated to display a notice informing tenants that pest

control activities are underway in the building.

13.1.8. What are the signs of pesticide poisoning?

13.1.8.1. The symptoms can and do vary from case to case, but common signs

include dizziness, nausea, vomiting, headache, fatigue, numbness and

convulsions.

13.1.9. What should you do if you develop symptoms of pesticide poisoning?

13.1.9.1. Seek medical help immediately.

13.1.9.2. Leave the treated zone to a well-ventilated area or open space outdoor.

13.1.9.3. Remove any affected clothing.

13.1.9.4. Wash affected parts with water.

13.1.9.5. If the pesticide has been ingested, vomiting can be induced by drinking

warm water with salt in some cases.

13.1.10. 13 ways to prevent pest infestations.

13.1.10.1. Ants love leftovers, so store food in airtight containers like Tupperware or

jars with rubber seals on the lids.

13.1.10.2. Keep a tight lid on your trash can at all times and move the trash to an

outside dumpster as soon as possible.

13.1.10.3. Inspect y office for cracks or holes in walls, foundation, and vents. If find

any, fill or seal them as soon as possible to prevent termites, roaches,

and other pests.

13.1.10.4. Inspect dried food packages (when possible) for worms, beetles, moths,

and other pests before buy them.

13.1.10.5. Landscaping that comes in contact with office give pests an easier way

indoors, so keep trees and bushes away from the building.

13.1.10.6. Fix any leaking pipes, faucets, appliances, etc. Standing water can

attract many different types of pests.

13.1.10.7. Clean counter tops, tables, and floors on a regular basis to prevent

crumbs or food buildup.

13.1.10.8. If don‘t have screens on windows or storm doors, install some. Let fresh

air in without worrying about pests.

13.1.10.9. Beetles and termites love wood, so eliminate any scrap wood inside or

outside office.

13.1.10.10. Keep office clutter-free. Pests love hiding out in dark areas, so the more

clutter has, the more they have to choose from.

13.1.10.11. Use pest control products like zappers, sprays, sticky paper, and more

to prevent the problem from getting bigger.

13.1.10.12. Vacuum office frequently to eliminate pests and/or pest eggs.



13.1.10.13. Resist using wood mulch for your landscaping. Instead, try gravel or

rock.

13.2. Appendix.

13.2.1. None.

Documents

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