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Microbiology Skill Lab
Dalia Mohamed Moemen Assistant Lecturer of Medical
Microbiology & Immunology
Department
Infection Control and Hospital
Safety Skills
• hand hygiene
• personal protective equipments
• handling of sharps
• waste disposal
Definition
• Infection control refers to policies and
procedures used to minimize the risk
of spreading infections, especially in
hospitals and health care facilities.
HAND HYGIENE
MDICU
Introduction
• Hand Hygiene: a general term that
applies to either hand washing,
antiseptic hand wash, antiseptic hand
rub, or surgical hand antisepsis.
Hand-borne Microorganisms
• Presence – bacterial counts on hands range from 104 to 106 CFU/cm2.
– Resident microorganisms: attached to deeper layers of the skin and are more resistant to removal;
– less likely to be associated with HAIs.
– Transient microorganisms: colonize
the superficial layers of skin and
amenable to removable; acquired by
direct contact with patients or
contaminated environment surfaces;
frequently associated with HAIs.
Pittet D et al. Evidence-based model for hand transmission during
patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.
Pittet D et al. Evidence-based model for hand transmission during
patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.
MDICU
Pittet D et al. Evidence-based model for hand transmission during
patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.
MDICU
Pittet D et al. Evidence-based model for hand transmission during
patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.
MDICU
Pittet D et al. Evidence-based model for hand transmission during
patient care and the role of improved practices. Lancet Infectious Diseases, 2006, 6:641–652.
MDICU
Types of Hand Hygiene
Agents Influence on
hand flora Main purpose Technique
Plain non-
antimicrobial
soap
Partly removes
transient flora
Cleansing after
patient contact &
contamination
Routine Hand
wash
Chlorhexidin
Hexa-chloraphen
Iodine;Iodophoo-
meta-xylenol
-Alcohol-based
waterless
antiseptic
Kills transient
and reduces
resident flora
Hand antisepsis
prior to invasive
procedures, or to
remove pathogens
(e.g., antimicrobial
resistant strains).
Antiseptic Hand
wash or
alcohol-based
handrub
Agents Influence on
hand flora Main purpose Technique
-Chlorhexidine
Hexachloraphene ,
Iodine;Iodophors; Para-
chloro-meta-xylenol
(PCMX
-Alcohol-
based.waterless
antiseptic.
-after washing hands by
soap and water.
Kills transient
flora and
reduces
resident flora
Preoperative antisepsis Surgical Hand
anti-sepsis
MDICU
Sax H, et al. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene J Hosp Infect 2007; 67(1): 9–21
MDICU
Hand Hygiene Technique
.
1 2
4 5 6
3
Effective Handwashing Technique
Hand Washing video.flv
Hand Hygiene Technique with Alcohol-
Based Formulation
Surgical Hand Preparation
• If hands are visibly soiled, wash hands with a plain soap before surgical hand preparation
• Surgical hand antisepsis should be performed using either an antimicrobial soap or an alcohol-based hand rub, preferably with sustained activity, before donning sterile gloves
• When performing surgical hand
antisepsis using an antimicrobial soap,
scrub hands and forearms for the
length of time recommended by the
manufacturer, 2 to 5 min.
MDICU
Surgical scrub video
Drying Hands
A variety of methods are used for drying hands:
• Paper towels are the best method to dry hands.
• Cloth towels could be used if appropriately recycled.
• Warm air dryers shorten the time for hands to dry, however, they can only be used by one person at a time and are noisy and have the evidence of infection.
• Hand-drying materials should be placed near the sink in an area that will not become contaminated by splashing.
Hand drying video
PPE Use in Healthcare Settings:
Improve personnel safety in the
healthcare environment through
appropriate use of PPE.
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
“Specialized clothing or equipment worn
by an employee for protection against
infectious materials” (OSHA)
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from
airborne infectious agents
• Goggles – protect eyes
• Face shields – protect face, mouth, nose,
and eyes PPE Use in Healthcare Settings
Do’s and Don’ts of Glove Use
• Work from “clean to dirty”
• Limit opportunities for “touch
contamination” - protect yourself,
others, and the environment
– Don’t touch your face or adjust PPE with
contaminated gloves
– Don’t touch environmental surfaces except
as necessary during patient care
PPE Use in Healthcare Settings
Do’s and Don’ts of Glove Use
(cont’d)
• Change gloves
– During use if torn and when heavily soiled
(even during use on the same patient)
– After use on each patient
• Discard in appropriate receptacle
– Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Face Protection
• Face shields – protect face, nose, mouth,
and eyes
– Should cover forehead, extend below chin
and wrap around side of face
PPE Use in Healthcare Settings
PPE Use in Healthcare
Settings:
How to Safely Don, Use, and
Remove PPE
Sequence* for Donning PPE
• Mask or respirator
• Goggles or face shield
• Gown
• Gloves
*Combination of PPE will affect sequence –
be practical
PPE Use in Healthcare Settings
How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
• Position goggles over
eyes and secure to the
head using the ear pieces
or headband
• Position face shield over
face and secure on brow
with headband
• Adjust to fit comfortably PPE Use in Healthcare Settings
How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Don a Gown
PPE Use in Healthcare Settings
PPE Use in Healthcare
Settings:
How to Safely Remove PPE
“Contaminated” and “Clean” Areas of PPE
• Contaminated – outside front • Areas of PPE that have or are likely to have been in contact
with body sites, materials, or environmental surfaces where the
infectious organism may reside
• Clean – inside, outside back, ties on
head and back • Areas of PPE that are not likely to have been in contact with
the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPE
• Gown
• Gloves
• Face shield or goggles
• Mask or respirator
PPE Use in Healthcare Settings
Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
• Discard
PPE Use in Healthcare Settings
How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for
both gloves
• Discard
PPE Use in Healthcare Settings
Remove Goggles or Face Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or
disposal PPE Use in Healthcare Settings
Removing a Mask
• Untie the bottom,
then top, tie
• Remove from face
• Discard
PPE Use in Healthcare Settings
Hand Hygiene
• Perform hand hygiene immediately after
removing PPE. – If hands become visibly contaminated during PPE removal, wash
hands before continuing to remove PPE
• Wash hands with soap and water or use
an alcohol-based hand rub
PPE Use in Healthcare Settings
* Ensure that hand hygiene facilities are available at the point needed,
e.g., sink or alcohol-based hand rub
HANDLING OF SHARPS
HOW DOES EXPOSURE
OCCUR? Needle sticks (most common) - 800,000 needle stick injuries occur each year in the
U.S.
Cuts from other contaminated sharps
(scalpels, broken glass, etc.)
Contaminated blood contact with the
eyes, mucous membranes of the mouth
or nose, or broken (cut or abraded) skin
Needle Stick Injury and Accidental Exposure to Blood
Risks
Accidental exposure to blood caused by needle injuries or injuries
following, cutting, biting or splashing incidents carries the risk of
infection by blood-borne viruses such as the hepatitis B virus (HBV),
hepatitis C virus (HCV) and human immunodeficiency virus (HIV).
HBV risk= 5 - 40%
HCV risk= 3 - 10%
HIV risk = 0.2 - 0.5%
Say NO to Recapping
One hand technique
HANDLING OF SHARPS
Immediately or as
soon as possible
after use,
contaminated sharps
shall be placed in
puncture-resistant,
leak proof and
labeled or color-
coded containers
until properly
reprocessed.
Clinical Waste – Sharps Containers
Sharps containers:
• Must be located as close as is feasible to
where sharps are used.
• Labeled or color-coded.
• Leakproof.
• Puncture resistant.
• Must not be overfilled, ¾ of its volume.
• Able to be closed well before disposal.
• Made of environment friendly material
• should be disposed according to Infectious
Waste Control Act requirements.
CLINICAL WASTE
• Regulated waste must
be placed in closeable,
leakproof containers built
to contain all contents
during handling, storing,
transporting or shipping
and be appropriately
labeled or color-coded.
63
Steps of Medical-
Waste Management
64
Sorting is separating waste by type (e.g., non-
medical waste, infectious waste, pharmaceutical
waste) into color coded bags at the place where
it is generated.
Sorting:
Office of Engineering
Safety
65
Waste sorting should be established
as follows:
Black Bags
•Waste to be disposed with the normal general waste. •Final disposal: Landfill
66
Waste sorting should be established
as follows:
Red bags
•For infectious & pathologic waste
•Final disposal: incineration
67
Infectious waste:
•Dressings (heavily blood stained or
from infected Wounds)
•Any waste item with a soiled infected
body fluid.
•Final disposal: incineration
Yellow bags
Waste sorting should be established
as follows:
Infectious Medical Waste
70
Incineration
Incineration is the best option for solid waste
disposal, high temperature (1300 °C)