5. Cleaning using an approved detergent (this solution cannot be reused).6.

Rinsing (tap water is sufficient for this inbetween rinsing stage).7. Disinfection. Using an approved, high level disinfectant.Regarding CJD risk, a disinfectant with protein fixative properties (i.e. aldehyde-basedproducts) should not be used. A non-fixative disinfectant should be selected.8. Rinsing: The level of microbial purity of the water used depends on the further use of theendoscope (bacteriologically controlled water or sterile water).9. Drying: If the endoscope is not stored, this drying stage includes only air-blowing thechannel to remove residual water.Note: New French guidelines regarding variant CreutzfeldtJakob (CJD) risk recommendscleaning and rinsing the endoscope twice before disinfection.2.8. POLICIES & PROCEDURES ON RATIONALANTIMICROBIAL USE:2.8.1. It is the policy of Institution that the Infection Control Committee shall createAntibiotic Restrictions on a semi-annual basis based on the results of theAntibiotic Resistance Pattern (Antibiogram/ Resistogram) from the laboratoryand recommend this restriction policy for implementation in the hospital.PROCEDURES:1. All in-patient Culture & Sensitivity results are to be compiled per month by the laboratorymicrobiologist. Results are then categorized according to the source of the specimen (blood,urine, sputum/ETA, wound, etc) and patient classification (Wards, IMU or Pedia)2. Results of Culture & Sensitivity are manually tabulated by the laboratory microbiologistfollowing the recent CLSI pattern for each specimen.3. Raw data is then finalized and encoded in the Antibiogram.4. Fungal Culture results are also tabulated and categorized according to growth (Candidaspp. / NonCandida spp.).5. Raw data of the Antibiogram are then given to the Infection Control Nurse for collation andcomputation of the Percentage of Resistance (Resistogram).6. Interpretation of the results shall be done by the Chairman of the Infection ControlCommittee. Recommendations shall be forwarded to the Chief of Clinics.7. Implementation & monitoring of approved restrictions shall be done by the Infection ControlNurse.

2.9. POLICIES & PROCEDURES ON DECONTAMINATION, DISINFECTION,STERILIZATION, DISINFECTANT FOR SPECIFIC MEDICAL EQUIPMENT ANDAREA2.9.1. It is the policy of Institution that areas in the hospital shall be properlydecontaminated, disinfected and sterilized to minimize the transmission ofmicroorganisms from equipment and the environmentPROCEDURES:1. Areas are classified into one of four hospital zones (WHO, Prevention of Hospital AcquiredInfection) Zone A: No patient contact. (e.g. administration, library, offices). Normal domestic cleaning Zone B: Care of patients who are not infected, and not highly susceptible. Cleaned by a procedure that does not raise dust (dry sweeping or vacuum cleaners are notrecommended). The use of a detergent solution improves the quality of cleaning. Disinfect any areas with visible contamination with blood or body fluids prior to cleaning. Zone C: Infected patients (Isolation room). Clean with a detergent/ disinfectant solution, with separate cleaning equipment for eachroom. Zone D: Highly-susceptible patients (protective isolation) or High-risk areas: OR, DR, ICU,NICU and Hemodialysis

units. Clean using a detergent/ disinfectant solution and separate cleaning equipment.2. Isolation rooms and other areas that have patients with known transmissible infectiousdiseases shall be cleaned with a detergent/ disinfectant solution at least daily. Once thepatient is discharged, room shall be AIRED for at least 24 hours or up to three days (forAIRBORNE/ DROPLET Transmission Cases).3. Refer to Work Instructions on Housekeeping of specific patient areas.

SPECTRUM OF ACTIVITYACHIEVED OF THE MAIN DISINFECTANTS(WHO, Prevention of Hospital Acquired Infection)Level ofdisinfectionrequiredSpectrum ofactivity ofdisinfectantActive ingredients potentiallycapable of satisfying thesespectra of activityFactors affecting theefficacy of thedisinfectant High SporicidalMycobactericidalVirucidalFungicidalBactericidalPeracetic acid, Chlorine dioxide,Formaldehyde, Glutaraldehyde,Sodium hypochlorite, Stabilizedhydrogen peroxide, Succinaldehyde(succinic aldehyde)Intermediate TuberculocidalVirucidalFungicidalBactericidalPhenol derivatives, Ethyl andisopropyl alcoholsLow Bactericidal Quaternary ammonium, Amphiprotic,Amino acidsConcentrationContact timeTemperaturePresence of organicmatterpHFormulation of thedisinfectant CLEANING AND DISINFECTING STRATEGIES FOR ENVIRONMENTAL SURFACES INPATIENT-CARE AREAS (Excerpts from CDC Guidelines for Environmental InfectionControl in Health-Care Facilities) GUIDELINES:1. Follow manufacturers instructions for cleaning and maintaining noncritical medicalequipment.2. In the absence of a manufacturers cleaning instructions, follow certain procedures: Clean noncritical medical equipment surfaces with a detergent/disinfectant. This may befollowed by an application of an disinfectant (with or without a tuberculocidal claim), inaccordance with germicide label instructions Do not use alcohol to disinfect large environmental surfaces.3. Keep housekeeping surfaces (e.g., floors, walls, tabletops) visibly clean on a regular basisand clean up spills promptly.4. Detergent and water are adequate for cleaning surfaces in nonpatient-care areas (e.g.,administrative offices).5. Clean and disinfect high-touch surfaces (e.g., doorknobs, bed rails, light switches, andsurfaces in and around toilets in patients rooms) on a more frequent schedule than minimal-touch housekeeping surfaces.6. Clean walls, blinds, and window curtains in patient-care areas when they are visibly dusty orsoiled.7. Avoid large-surface cleaning methods that produce mists or aerosols, or disperse dust inpatient-care areas.8. Follow proper procedures for effective uses of mops, cloths, and solutions: Prepare cleaning solutions daily or as needed, and replace with fresh solution frequently. Change the mop head at the beginning of each day or as indicated in the Housekeepingpolicy, or after cleaning up large spills of blood or other body substances. Clean mops and cloths after use and allow drying before reuse.