IT’S NOT JUST THE INSTRUMENTS: OTHER ELEMENTS OF ... …TASS vs. Endophthalmitis ©ASC Compliance, LLC TASS 12-24 hour onset Painless Hypopyon Limited to anterior segment Occur in

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PAT LAMB RN, MSN

ELETHIA DEAN RN, PHD

IT’S NOT JUST THE INSTRUMENTS:

OTHER ELEMENTS OF YOUR INFECTION

CONTROL PROGRAM

©ASC Compliance, LLC

Nosocom

ial In

fections


• A Nosocomial/Healthcare-Associated

Infection (HAI) is an Infectious Disease

acquired in a healthcare facility (hospital, ASC, clinic, etc.).

• Nobody goes into medicine in order to

prevent Healthcare Associated

Infections.

• Nevertheless, to practice medicine you must be able to prevent Healthcare

Associated Infections.

Administration of Medications

� Eye drops

� Injections

� Oral Medications


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Disposal of Medications

� Expired Medications

� Flushing

� Biohazardous Waste


Universal Precautions


An approach to infection control.

According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. (OSHA)

Standard Precautions


� Standard Precautions are guidelines recommended by the CDC for reducing the risk of transmission of

bloodborne and other pathogens and applied to all patients receiving care regardless of their diagnosis or presumed infection status.

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Standard Precautions


� Standard precautions apply to:

�Blood

�All body fluids, secretions and

excretions EXCEPT sweat

�Nonintact skin

�Mucous membranes

� In 1996 CDC expanded concept of “universal precautions” and

changed the term to “standard precautions.”

OSHA – PROTECTION OF EMPLOYEES

� Employees with potential for exposure to blood and body fluids:

� Must be offered Hepatitis B vaccination – paid by the

employer

� Annual training required for all employees (including but not limited to the following):

� Bloodborne pathogen

� Workplace violence

� Ergonomics


Spread of Infection


� There are three elements that must be present for an infection to spread:

1. A source of pathogens

2. A susceptible host

3. A mode of transmission

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Chain of Infection


� The "Chain of Infection" is a basic component of understanding the prevention and control of

infection that most healthcare workers recall from their early days of training.

Chain of Infection


Infection Control Methods


� Infection control aims to break the chain of events causing the spread of infection

� This can be achieved by:

1. eliminating the source of pathogens

2. decreasing host susceptibility

3. interrupting transmission routes

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Risk Factors: Environmental Cleaning


� Before and after each procedure/patient –including visual inspection

� End of day (terminal)

�At times, during procedure (contain and confine)

�All horizontal surfaces and lights

� EPA registered hospital disinfection

Risk Factors


� Clean high traffic areas

� Clean door handles

� Know “kill” time for disinfectant used

� Know manufacturer’s recommendations for cleaning supplies (some disinfectants may lead to surface break down of some medical devices)

Risk Factors


Cleaning, Disinfection & Sterilization of instruments

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Instrument Disinfection and Sterilization


� Cleaning and decontamination must occur first!!!

� Contained transport to decontamination area

� Up-to-date instructions from device manufacturer as well as manufacturer of cleaning equipment

� Packaging

� Sterilization

� Automated vs. manual cleaning

� Inspection

� NOTE: Any instrument opened in the OR should be decontaminated and reprocessed, even if not used.

Definitions


Sterilization


1. Flash Sterilization

2. Short Cycle Sterilization

3. Long Cycle Sterilization

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Long Cycle Sterilization


� Follow AORN Perioperative Standards and Recommended Practices for type

of sterilizer used

� Follow manufacturer’s guidelines and

requirements for sterilizer

AORN Perioperative Standards and Recommended Practices, 2010 Edition

Flash Sterilization


� Flash sterilization has traditionally referred to a very short sterilization cycle for a very small and unwrapped load.

� One of the major concerns with this process has been that, because the load was unwrapped, the sterility of the device could not be maintained after it was removed from the sterilizer.

� However, as sterilizers have improved their ability to allow for steam penetration, it has become possible to effectively sterilize wrapped or “contained” (e.g., in specialized metal containers, pouches or cassettes) loads in short cycles.

Flash Sterilization


� Sterilization of unwrapped/uncontained loads should not be routine practice in ASCs but

should be used only for an urgent and unpredicted need for a specific device (e.g., when an instrument is dropped).

� Routine sterilization of unwrapped/uncontained loads continues to be inappropriate and should be cited as a violation

of 42 CFR 416.44(b)(5).

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Short Cycle Sterilization


� Utilization of a short sterilization cycle of a wrapped/contained load may no longer be a concern

so long as the ASC is following ALL manufacturer’s instructions for the devices involved.

Requirements-Instruments


� Obtain manufacturer’s directions for use for all instruments in facility

� Identify sterilization requirements for each instrument

� Sterilization cycle time and temperature should be based on instrument on tray that requires the longest time/highest temperature

Requirements-Instruments


� Identify manufacturer’s recommendations for cleaning and follow recommendations

� Complete log of all instruments flashed and used during surgery

� Be able to identify/verify sterilization cycle, temperature and time for instruments sterilized

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TASS vs. Endophthalmitis


� TASS

� 12-24 hour onset

� Painless

� Hypopyon

� Limited to anterior segment

� Occur in clusters

� Gram stain negative

� Treated by ophthalmologist

with topical steroids every one to two hours

� Endophthalmitis

� Three to seven days onset

� Painful

� Hypopyon

� Anterior and posterior

segments

� Occur individually

� Gram stain could be positive or negative

� Treatment by retina surgeon

with antibiotics and/or

steroids injections

A Word about Hand Hygiene


Terminology


� Hand Hygiene: A general term that applies to either handwashing, antiseptic handwash, antiseptic

hand rub or surgical hand antisepsis.

� Hand Antisepsis: Refers to either antiseptic

handwash or antiseptic hand rub

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Terminology


� Alcohol based-handrub: Alcohol based preparation (usually 60% to

95% ethanol or isopropranolol) for reducing number of viable organisms on the hands

� Handwashing: Washing hands with plain soap (non antimicrobial)

and water

� Source:Centers for Disease Prevention and Control (CDC) Guideline for Hand Hygiene in Health-Care Settings. Morbidity and Mortality Weekly Reports, Oct. 2002

Handwashing Procedure(Soap & Water)


1. Wet hands first with lukewarm water

2. Apply amount of product recommend by the product manufacturer

3. Rub hands together at least 15 seconds, covering all surfaces of hands and fingers

4. Rinse and dry thoroughly with paper towel

5. Use towel to turn off faucet

� Source: Centers for Disease Prevention and Control (CDC) Guideline for Hand Hygiene in Health-Care Settings. Morbidity and Mortality Weekly Reports, Oct. 2002


� Natural nails no more than a quarter-inch long

� No chipped nail polish in restricted area

� No artificial nails in perioperative environment

� No jewelry

� Facility-approved hand lotion only used

� …and don’t forget proper hand hygiene before and after gloving and every patient contact.

Source:AORN Perioperative Standards and Recommended Practices 2010 Edition.

REMEMBER!

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� You should NOT provide direct patient care if you have:

�Cuts

�Abrasions

�Weeping dermatitis

�Fresh tattoos on exposed skin

Source: AORN Perioperative Standards and Recommended Practices 2010 Edition.

CDC Outpatient Infection Control


� As a companion to the infection prevention guide for outpatient settings released in May 2011, the CDC

posted Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care.

� http://www.cdc.gov/HAI/pdfs/guidelines/ambulatory-care-checklist-07-2011.pdf

Standard Universal Precautions

� Consider all blood and body fluids

potentially infectious.

� Use Personal Protective Equipment (PPE) to

prevent exposure.


If it is wet and sticky and not yours,

DO NOT touch it…

without gloves!

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Infection Control in Ophthalmology

Many critical processes and many paths to patient advocacy!


We Welcome Questions!

[email protected]

[email protected]

Phone: 937-478-1878

Documents

IT’S NOT JUST THE INSTRUMENTS: OTHER ELEMENTS OF ... …TASS vs. Endophthalmitis ©ASC Compliance, LLC TASS 12-24 hour onset Painless Hypopyon Limited to anterior segment Occur in