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Personal Protective Equipment reduces the risk of infection if used correctly and includes the use
of the following:
Mask
Gown (long sleeved)
Protective Eyewear / goggles / visors / face shields
Gloves (non-sterile)
Single use cap
Who should use PPE?
Anyone who enters isolation room / area including:
All health care workers who provide patient care (e.g. Doctors, nurses, radiographers,
physiotherapist, etc.)
All support staff including medical aides and cleaning staff
Family members or visitors
All laboratory workers handling specimens from an infected patient
All sterilizing service workers handling equipment that requires decontamination and has
come from an infected patient
All sterilizing service workers handling equipment that requires decontamination and has
come from an infected patient
Principles for Using PPE
Personal Protective Equipment (PPE) is used to protect health care workers by preventing
potentially infectious microorganisms from:
Contaminating their hands, eyes and clothing; and
Being transmitted to other patients and staff.
PPE reduces, but does not completely eliminate the possibility of infection.
PPE is only effective if used correctly.
The use of PPE does not replace basic hygiene measures such as hand washing – hand
washing is essential to prevent transmission of infection.
Principles for Using the N-95 Respirator Mask
The N-95 respirator mask is used to protect health care workers, other patients, staff or visitors
by preventing potentially infectious microorganisms such as respiratory secretions from:
Contaminating their face including the nose and mouth.
Being inhaled or ingested.
Proper use of N-95 Respirator Mask
DO NOT touch the front of the mask
Wear only one N-95 mask – no need for additional respiratory protection.
REMOVE the N-95 mask before leaving the isolation unit / area.
WHY an N-95 Respirator Mask?
N-95 respirator masks offer a higher level of filtration for respiratory secretions than a surgical
mask.
HOW to use an N-95 Respirator Mask?
Use for single shift unless excess moisture necessitates replacement during each shift.
Label with the wearer’s name.
Dispose of with medical waste.
NB: You must fit the mask securely over both your nose and mouth, so size is important.
RECOMMENDED SEQUENCE
A. Wearing PPEs.
1. Wash hands
2. Wear scrub suit
3. Wear boots or shoe cover
4. Wash hands
5. Wear cap
6. Wear mask
7. Wear the gown
8. Wear the impermeable apron
9. Wear protective eyewear
10. Wash hands and dry them
11. Wash hands and dry them
B. When removing the PPEs…
1. Untie the gown string if tied in front and remove shoe covers.
2. Remove gloves and discard in an appropriate manner.
3. Wash hands.
4. Remove gowns and apron without contaminating clothing underneath.
5. Remove googles, mask, and cap and place in appropriate container.
6. Wash hands up to wrists with soap and water, dry and decontaminate using alcohol base
hand rub.
Key Points
The use of goggles, disposable gowns, gloves, caps and overshoes for all patient contact
is designed to protect both the health care worker and the patient.
It also protects other patients, staff and visitors from potentially infectious
microorganisms.
Wear N-95 respirator mask, goggles, disposable gowns, gloves, cap and overshoes for all
patient contact.
Wash hands using soap (preferably liquid) and water when leaving the anteroom.
Use a 70% alcohol-based hand rub solution after hand washing.
Wash hands when leaving the unit.
REMINDERS
Personal Protective Equipment (PPE) is essential for all contact with infected patients.
Ensure N-95 respirator masks fit properly.
Ensure googles cover the entire eye area.
Have sufficient PPE supplies available.
All visitors must wear full PPE.
Dispose of all PPE in the appropriate container for disposal or cleaning and disinfecting.
APPROPRIATE HANDLING OF WASTES and SOILED LINEN or CONTAMINATED
LAUNDRY
o Handle, transport and process used linen that is soiled with blood, body fluids,
secretions or excretions with care to ensure that there is no leaking of fluid.
1. All needlestick injuries and contact to blood and body fluids among employees must be
reported to the Infection Control Committee.
2. During injuries:
a. The ICP/ICN will advice initial management of the injury.
b. The exposed employee should submit an incident report to the ICC before further
actions are done. The incident report should be noted by the involved personnel
who will serve as witness of the said injury.
3. The ICN will do investigation regarding the incident which includes the following:
a. Vaccination History of the Employee
b. Status of Source Person
If status is unknown, necessary laboratory tests (per ICP’s recommendation)
should be done in consultation with the Attending Physician (if any). The source
person should be informed regarding the incident and the consequent actions.
4. Needlestick Injury Report Form should be filled out by the ICN and the ICP. The incident
report written by the exposed person should be attached
The Report Form specifies the immunization required to be administered to the
exposed person and the laboratory test/s required before immunization.
5. The tests and immunizations will be administered as soon as they are available.
Laboratory results should be kept on file by the ICN. The exposed person will be
provided with photo copies.
Tetanus Toxoid Immunizations should be given at 0, 1 and 6 months depending on
the number of doses required.
Hepa B vaccinations should be at the expose person’s own expense.
WORK RESTRICTIONS FOR PERSONNEL WITH INFECTIOUS DISEASES
Dry Heat 171ºC for 1hr; 160ºC for 2 hrs.; 121ºC for
16 hrs.
Gas
Ethylene oxide 450-500 mg/L at 55-60ºC
Liquid
Glutaraldehyde Variable
Hydrogen peroxide 6-30%
Formaldehyde 6-8%
Chlorine dioxide Variable
Peracetic acid Variable
Disinfection
Heat
Moist heat (includes hot water 75-100ºC High
pasteurization)
Liquid
Glutaraldehyde Variable High to intermediate
Hydrogen Peroxide 3-6% High to intermediate
Formaldehyde 1-8% Hight to low
Chlorine dioxide Variable High
Peracetic acid Variable High
Chlorine compounds 500-5,000 mg of free or available Intermediate
chlorine/ liter
Alcohol (ethyl, isopropyl) 70% Intermediate
Phenolic compounds 0.5-3% Intermediate to low
Iodophor compounds 30-50mg of free iodine/liter; up to 10,000 Intermediate to low
mg of available iodine/liter
Quarternary ammonium compounds 0.1-0.2% Low
Antisepsis
Alcohol (ethyl, isopropyl)
Iodophors 70%
1-2 mg of free iodine/L; 1-2% available
iodine
Chlorhexidine 0.75-4.0%
Hexachlorophene 1-3%
Parachlorometaxylenol 0.5-4.0%
Methods of Assuring Adequate Processing and Safe Use of Medical Devices
Purchased as sterile Intravenous fluids; irrigation 1. Store in clean, safe area. Notify BFAD, local and
fluids; normal saline; trays & 2. Inspect package for national departments if
sets integrity before use. intrinsic contamination is
suspected.
3. Use before expiration date
if one is given.
4. Culture only if clinical
circumstances suggest
infection related to use of
the item.
Semicritical
Should be free of vegetative Respiratory therapy and 1. Sterilize or follow protocol Bacterial spores may survive
bacteria. Maybe subjected to equipment & instruments that for high-level disinfection. after high level disinfection,
high-level disinfection rather will touch mucous membranes 2. Bag & store in safe, clean but these usually are not
than sterilization process. area. pathogenic. Microbiologic
3. Conduct quality control sampling can verify that a
monitoring after any high-level disinfection process
important changes in the has resulted in destruction of
disinfection process. vegetative bacteria; however,
this sampling is not routinely
recommended.
Noncritical
Usually contaminated with Bedpans, crutches, rails, EKG 1. Follow a protocol for Gram-negative water bacteria
some bacteria leads cleaning or if necessary a can grow rapidly in water and
low-level disinfection dialysis fluids and can place
process. dialysis patients at risk of
pyrogenic reactions or
Water-produced or treated Water used for hemodialysis 1. Assay water & dialysis septicemia. These water
fluids fluids monthly. sources & pathways should be
2. Water should not have disinfected routinely.
more than 200 bacteria/ml
& dialysis fluids not more
than 2000 bacteria/ml.
STERILIZATION, DISINFECTION AND ANTISEPSIS IN THE HOSPITAL
DEFINITION OF TERMS:
1. Sterilization: use of a physical or chemical procedure to destroy all microbial life, including
large numbers of highly resistant bacterial endospores. This pertains to microorganisms
that may exist on inanimate objects. Moist heat by steam autoclaving, ethylene oxide gas,
and dry heat are the major sterilizing agents used.
3. LEVELS OF DISINFECTION:
a. High-level disinfection: minimum treatment recommendation for the
reprocessing of semi-critical instruments or devices. Includes glutaraldehyde,
chlorine dioxide, hydrogen peroxide, and peracetic-acid based formulations.
b. Intermediate-level disinfection: not capable of inactivating bacterial spores, but
inactive M. tuberculosis var bobis, fungi, lipid and most non-lipid medium-size and
small viruses. Examples are: alcohol (70-90% ethanol or isopropanol), chlorine
compounds (free chlorine, i.e. hypochlorous acids derived from sodium or calcium
hypochlorite, gaseous chlorine or chlorine dioxide (500 mg/liter) and certain
phenolic or iodophor preparations.
c. Low-level disinfection: kill rapidly vegetative forms of bacteria and most fungi as
well as medium-size or lipid containing viruses. Examples are quarternary
ammonium compounds and certain iodophors and phenolic compounds.
4. Decontamination: a process or treatment that renders a medical device, instrument, or
environmental surface safe to handle. Use of decontamination or treatment does not
necessarily ensure that the item is safe for patient reuse.
5. Antisepsis: An antiseptic is a germicide that is used on skin or living tissue for the purpose
of inhibiting or destroying microorganisms.
1. Critical instruments or devices: instruments or objects that are introduced directly into
the bloodstream or into other normally sterile areas of the body. Examples are: surgical
instruments, cardiac catheters, implants, pertinent component of the heart-lung
oxygenator, and the blood compartment of a hemodialyzer. Critical items should be
sterilized. If sterilization is not feasible, they should be at a minimum receive a high-level
disinfection.
2. Semi-critical instruments or devices: these are items that make contact with mucous
membranes during use but do not ordinarily penetrate the blood barrier or enter other
normally sterile areas of the body. Examples are flexible and rigid fiberoptic endoscopes,
endotracheal tubes, laryngoscopes, vaginal specula, anesthesia breathing circuits, dental
equipment like amalgam condensers and ophthalmic devices like direct contact
tonometers. Meticulous physical cleaning followed by an appropriate high-level
disinfection is required.
3. Noncritical instruments or devices: do not ordinarily touch the patient or touch only
intact skin. These include instruments such as electrocardiogram electrodes, physical
measurement devices, blood pressure cuffs and stethoscopes, crutches, and bedboards.
Washing with detergent and water is sufficient or use of low level disinfectants either
alone or in addition to the cleansing.
RECOMMENDATIONS:
1. CLEANING:
All objects to be disinfected or sterilized should first be thoroughly cleaned to
remove all organic matter (blood and tissue) and other residue.
3. METHODS OF STERILIZATION:
Whenever sterilization is indicated, steam sterilizer should be used unless the
object to be sterilized will be damaged by heat, pressure, or moisture or is
otherwise inappropriate for steam sterilization. In this case, another acceptable
method of sterilization should be used.
Flash sterilization (270ºF or 132 ºC for 3 minutes in a gravity displacement steam
sterilizer) is not recommended for implantable items.
6. CHEMICAL INDICATORS:
Chemical indicators that will show a package has been through a sterilization cycle
should be visible on the outside of each package sterilized.
I. SETTING UP/INSERTING IV
1. Wash hands before starting an Intravenous line or before handling any IV equipment.
2. Always wear gloves when doing any venipuncture.
3. Identify the site for venipuncture. Choose appropriate vein, location, size, and condition.
4. Open administration set aseptically.
5. Use an approved antiseptic to clean the proposed IV site in circular motion. Allow 30
seconds to dry.
6. If necessary, cut or clip the hairs of the venipuncture site. Do not shave.
7. Never re-use a catheter or needle.
8. Anchor needle firmly in place. Apply dressing (sterile 2x2 gauze or transparent dressing)
to the venipuncture site. Do not cover the venipuncture site directly with a plaster or a
micropore, unless sterile.
9. Check for infiltration.
10. Discard sharps and other waste materials properly.
11. Wash hands after the procedure.
II. CHANGING AN IV INFUSION
1. Assess IV site for redness, swelling, pain, etc.
2. Check date of insertion, re-site if 48-72 hours has lapsed.
3. Wash hands before and after the procedure.
4. Discard all waste materials properly.
III. DISCONTINUING AN IV INFUSION
1. Wash hands before and after the procedure.
2. Remove plaster gently.
3. Remove needle or catheter then immediately apply pressure over the venipuncture site
using a clean cotton ball.
4. Discard all waste materials properly.
IV. BLOOD TRANSFUSION
1. Warm blood at room temperature by wrapping the blood bag with a towel.
2. Assess patient’s condition. Countercheck the compatible blood to be transfused against
the x-matching sheet.
3. Wash hands before and after the procedure.
4. Observe patient on an on-going basis for any untoward signs and symptoms.
5. Discard blood bag and BT set properly.
V. ADMINISTERING IV DRUGS
1. Wash hands before and after the procedure.
2. Use gloves especially for chemotherapeutic drugs.
3. Check IV site for any signs of swelling, redness, phlebitis, etc. before giving the drug.
4. Check skin test results of drug for IV push, drug-drug, drug-IV fluid incompatibility.
5. Disinfect the Y-injection port of the IV set with a cotton swab with alcohol piercing.
6. Discard sharps and other wastes properly.
GUIDELINES FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
Catheter Use
a. Insert urinary catheters only when necessary.
b. Leave in place the catheter for as long as necessary.
Handwashing
a. Perform handwashing immediately before and after any manipulation of the catheter
site or apparatus.
Catheter Insertion
a. Use aseptic technique and sterile equipment.
b. Use gloves, drape, sponges, an appropriate antiseptic solution for periurethral cleaning,
and a single-use packet of lubricant jelly.
c. Use a small catheter as possible, consistent with good drainage to minimize urethral
trauma.
d. Properly secure indwelling catheters after insertion to prevent movement and urethral
traction
Closed Sterile Drainage
a. Maintain a sterile, continuously closed drainage system.
b. Do not disconnect catheter and drainage tube unless the catheter must be irrigated.
c. If breaks in aseptic technique, disconnection or leakage occur, the collecting system
should be replaced using aseptic technique after disinfecting the catheter-tubing
junction.
Irrigation
a. Use aseptic technique in performing irrigation.
b. Avoid irrigation unless obstruction is anticipated (e.g. as might occur with bleeding after
prostatic or bladder surgery). Use a closed continuous irrigation to prevent obstruction.
Use an intermittent method of irrigation to relieve obstruction due to clots, mucus, or
other causes. Do not perform continuous irrigation of the bladder with antimicrobials.
c. Disinfect the catheter-tubing junction before disconnection.
d. Use a large-volume sterile syringe and sterile irrigant then discard after use.
e. If the catheter becomes obstructed and can be kept open only by frequent irrigation,
the catheter should be changed if it is likely that the catheter itself is contributing to the
obstruction (e.g. formation of concretions)
Specimen Collection
a. If small volumes of fresh urine are needed for examination, clean the distal end of the
catheter, or preferably the sampling port (if present), with disinfectant. Aspirate the
urine with a sterile needle and syringe.
b. If larger volumes of urine are needed for special analyses, obtain sample aseptically
from the drainage bag.
Urinary Flow
a. Maintain an unobstructed urine flow unless necessary for specimen collection and other
medical purposes.
b. To achieve free flow of urine
Keep the catheter and collecting tube from kinking
Empty the collecting bag regularly using a separate container for each patient.
Avoid contact of the draining spigot and the nonsterile collecting container.
Irrigate poorly functioning or obstructed catheters or replace if necessary.
Always keep collecting bags below the level of the bladder.
Meatal Care
a. Clean meatus twice a day with povidone-iodine solution or daily cleansing of soap and
water.
Catheter Change Interval
a. Indwelling catheters should not be changed at arbitrary fixed intervals.
Spatial Separation of Catheterized Patients
a. Infected and uninfected patients with indwelling catheters should not share the same
room or adjacent beds.
HANDLING OF CHEMOTHERAPEUTIC DRUGS
a. Wipe liquids with absorbent gauze pads; Solids should be wiped with wet
absorbent gauze.
b. Decontaminate area with sodium carbonate solution (1% for trace materials on
surfaces and 10% for large quantities or solutions containing paclitaxel for 30
minutes or methanolic potassium hydroxide (30% 1 KOH and 70% methanol) for 5
minutes.
Caution: KOH is corrosive and eye protection and chemical resistant gloves should
be worn.
Complete this form and return it to the Infection Control Committee to document occurrence of
cytotoxic drug spill.
(designation)________________________________________________
Cause of spill:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____Less than 10 cc
_____10 cc
_____20 cc
_____30 cc
_____40 cc
_____More than 50 cc
_____________________________________