Non-critical (low-risk) equipment, such as equipment that is not in contact with patients or with intact skin, may be decontaminated with a neutral detergent and water. Equipment must be dried thoroughly after cleaning. Semi-critical/critical (intermediate and high-risk) equipment such as reusable invasive medical devices (scalpels and surgical instruments) and endoscopes require decontamination by disin- fection and sterilisation. These items also must be stored and handled in a manner that prevents breaks in or damage to the outer packaging, which would render the device unsuitable for use until reprocessed.
Sterile packaged items of equipment must be used prior to the expiry date detailed on the packaging.
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Figure 5.6 How to hand-rub. Reprinted with kind permission from WHO, 2009.
Apply a palmful of the product in a cupped hand, covering all surfaces.
Right palm over left dorsum with interlaced fingers and vice versa.
Rotational rubbing of left thumb
clasped in right palm and vice versa. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.
Once dry, your hands are safe.
Palm to palm with fingers interlaced. Backs of fingers to opposing palms with fingers interlocked.
Rub hands palm to palm.
1a 1b 2
3 4 5
6 7 8
Table 5.2 How to choose your PPE
Type of PPE Indications for use Protective effect
Gloves Anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material
Having direct contact with patients who are colonised or infected with pathogens transmitted by the contact route, e.g. multiresistant organisms
Handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces (Siegel et al. 2007) Indicated prior to sterile procedures (WHO 2009)
Protects the healthcare worker
Protects the healthcare worker
Protects the healthcare worker
Protects the patient Aprons and
gowns Anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material
Having direct contact with patients who are colonised or infected with pathogens transmitted by the contact route, e.g. multiresistant organisms
During sterile procedures
Protects the healthcare worker
Protects the healthcare worker
Protects the patient
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Type of PPE Indications for use Protective effect
Face protection
– masks Different types of mask are available: standard surgical masks, masks with a fluid shield and masks that provide greater protection to the wearer, such as FFP2 and FFP3 masks. The choice of mask to be worn is dependent on the task being undertaken. Masks are only effective when fitted and worn appropriately Face protection
masks Placed on healthcare personnel to protect them from contact with infectious material from patients, e.g.
respiratory secretions and sprays of blood or body fluids
Placed on coughing patients to limit the potential dissemination of infectious respiratory secretions from the patient to others (i.e. respiratory hygiene/cough etiquette) (Siegel et al. 2007)
There is insufficient evidence to confirm that wearing of a face mask during surgery reduces the risk of surgical site infection (National Collaborating Centre for Women’s and Children’s Health 2008; Lipp &
Edwards 2010)
Protects the healthcare worker
Protects the healthcare worker
It is unproven whether there is a protective effect for the patient
Goggles and face shields
Respirators
The choice of eye protection to be worn depends on the risk to the healthcare worker. Personal glasses are not considered to be sufficient protection against blood and body fluid exposure, and specifically designed goggles or faces shields must be worn.
Goggles cover the eye area alone, while face shields that extend from chin to crown ensure greater protection. As with masks, a number of types may be required to ensure individual healthcare needs Respirators should not be confused with masks.
Respirators are designed to prevent and reduce the risk of transmission of airborne pathogens from an infected patient to others
Respirators should also be worn when carrying out aerosol-generating procedures, i.e. intubation, suctioning and bronchoscopy, in patients who are deemed as high risk of transmitting airborne infection, e.g. patients known to or suspected of having
multidrug-resistant pulmonary tuberculosis (National Centre for Health and Clinical Excellence 2011) or influenza (Siegel et al. 2007)
Respirators are only effective when worn correctly, and all staff must be educated regarding how to don and remove the equipment. All staff should be ‘fit-tested’
to ensure they understand how to put on and wear the equipment correctly. Examples of respirators are FFP2 and FFP3
Protects the healthcare worker
Protects the healthcare worker
Table 5.2 (Continued)
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Box 5.2 Points to remember when implementing ANTT
•
Always wash the hands effectively•
Always use the no-touch technique•
Take appropriate equipment precautions•
Take steps to protect key parts from contamination at all timesBox 5.3 Definitions (adapted from National Hospital Office 2006)
•
Contamination – the soiling of inanimate objects with potentially infectious substances. In the clini- cal situation, this is most likely to be organic matter, but it can also include inorganic substances such as dust. Such contamination maybe transferred via the inanimate object to a susceptible host•
Decontamination – a process that removes or destroys contamination and therefore prevents microorganisms reaching a susceptible site in sufficient quantities to cause infection•
Cleaning – a process that physically removes contamination but does not necessarily destroy micro- organisms. Cleaning is a prerequisite for equipment decontamination to ensure effective disinfection or sterilisation•
Disinfection – a process that reduces the number of viable microorganisms but which may not inactivate some bacterial spores•
Disinfectant – a chemical agent that is, under defined conditions, capable of disinfection•
Sterilisation – a process that renders an object free from viable microorganisms, including viruses and bacterial sporesTable 5.3 Management of blood and body fluid spillage Ensure spillages are dealt with promptly
Organisations should have standardised spillage kits in designated locations Before all spillages Blood spillage
management Body fluid spillage
management After all spillages Utilise a hazard/
spillage sign to ensure the safety of patients, visitors and staff Don PPE: gloves and an apron and required equipment
Ensure spillages are dealt with promptly Organisations should have standardised spillage kits in designated locations
Cover the spillage with disinfectant solution/granules Use hypochlorite 10,000 ppm. Leave for the recommended contact time, usually 2–5 minutes
Remove spillages using paper towels and place these into a healthcare risk/clinical waste bag
Wipe the area with disinfectant solution, ensuring that all traces of blood are removed
Do not use chlorine- based disinfectants directly on acidic solutions, e.g. urine and vomitus Using paper towels, remove the spillage and place the towels into a healthcare risk waste bag
Once the fluid has been removed, wipe the area with the disinfectant solution, ensuring that all traces of the fluid are removed
Place all waste into a healthcare risk waste bag
Remove gloves and apron
Perform hand hygiene Ensure the area is washed with detergent and water to remove all traces of the disinfectant
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Equipment should be in a good state of repair and non-porous to facilitate decontamination. All equipment should be cleaned according to the manufacturer’s instructions. Equipment must be cleaned by a designated person in a standardised manner after each patient use. Equipment must always be cleaned prior to maintenance and should be tagged with a decontamination certificate specifying this.
The Medicines and healthcare Products Regulatory Agency advises that a device designated as only for single use must not be reused. It should be used only on an individual patient during a single procedure and then discarded. The ‘single use only’ sign (Figure 5.7) is present on the packaging of medical devices and equipment.
A medical device that is intended for single patient use, for example nebuliser tubing, means that the device may be used for more than one episode of use on one patient only. The device may be reprocessed between each use as per the manufacturer’s instructions.
Figure 5.7 ‘Single use only’ sign.
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Visit www.wileyfundamentalseries.com/medicalnursing and read Reflective Questions 5.1 and 5.2 to think more about this topic.