SANITATION by keralaguest


                                 LECTURE NOTES

     1. Provide an environment that is as close to germ-free as possible.
     2. Protect patients and hospital personnel from airborne pathogen, contact pathogens
        and bloodborne pathogens.
     3. Prevent any introduction of microorganisms to patients or staff by adhering to strict
        standards of medical asepsis in the surgical OR and for the surgical items including
        instruments, equipment and supplies.
             a. Reduce bioburden created by surgical intervention
             b. Reduce possibility of surgical patient cross-contamination
             c. Prevent nosocomial infections in subsequent surgical patients
     4. Maintain infection free surgical wounds by containing contamination via tissue
        handling or wound closure through surgical asepsis.

      1. Aseptic technique – containment of microbial contamination on animate (living)
         surfaces via mechanical and/or chemical means
             a. Sanitization – a means of reducing microbes
             b. Antisepsis – infection prevention through the inhibition of microbial growth.
                  Because antiseptics are using on animate objects they must be weaker than
                  disinfectants which are used on inanimate objects.
      2. Sterile Technique – Prevention of microbial contamination on inanimate surfaces via
         mechanical, chemical, thermal or nuclear means. Selecting a sterilization method and
         agent depends on multiple variables such as cost and nature of the item
         (submersible/nonsubmersible, heat-sensitive/non-heat sensitive).
             a. Disinfection – the process of destroying all microorganisms, except spore
                  bearing ones.
             b. Sterilization – the process of destroying all microorganisms including
                  viruses, fungi and fungal spores and all forms of bacteria and their spore by
                  using sterilant or sporicidal agents.

     1. LEVEL 1 – High level asepsis for critical items; required for any items introduced to
        internal body areas or areas with high risk of infection if contaminated with
        microorganisms, including bacterial spores.

       2. LEVEL 2 – Intermediate asepsis for semi-critical items; used for those items that
          contact mucous membranes or broken skin.

       3. LEVEL 3 – low level or non-critical items; used for those items that contact intact
          skin only.

     1. Decontamination or cleaning phase – Level 3 process for removing initial gross
        contaminants such as blood and debris from surgical instruments; for non-critical
        items, this is the only phase required before restocking
                a. Pre-rinse or soaking – initial immersion in a soak basin to loosen gross
                   contaminants from instruments in a prepared detergent or distilled water
                b. Washing – a function performed away from the OR in processing room prior
                   to reaching decontamination room
                         i. Manual wash – initial cleaning by personnel using immersion in a
                            cleaning solution
                        ii. Mechanical wash – initial cleaning by machine using some version
                            of washer – washer, washer disinfector, washer sterilizer
                c. Lubrication – any instrument with moving parts must be lubricated following
                   cleaning, but not with mineral oil, silicone or machine oil, which leaves
                   residues that resist sterilization. To “milk” an instrument immerse in an
                   approved lubricant for 30 – 45 seconds, then dip and drip dry in a draining
                   tray. Rinse off excess solution.

2. Preparation, assembly and packaging phase: This is a Level 3 process used to assemble
instruments and supplies into penetrable packaging prior to terminal sterilization or disinfection.
        1. Inspection of instruments
                 a. Damage
                 b. Stiffness
                 c. Not too tight or too loose, proper alignment
                 d. Properly sharp or dull, depending on design
        2. Assembly – Distribution of instruments into instrument sets or procedure trays for
             packaging and placement in sterilizer racks
        3. Packaging – Selection of appropriate container
                 a. Rigid containers – metal/plastic hard case surrounding an internal, removable
                     wire basket
                 b. Wrapped instrument trays – Open, perforated trays with towels or foam in
                     the bottom to protect/absorb
                 c. Pre-packaged instrument sets – Double wrapped package, used for
                     specialized instruments or instruments that require disassembly – all parts
3. Terminal phase – Final cleaning phase used for all critical items
                 a. Disinfection – Level 2 process used for semi-critical items that do not have a
                     direct impact on patient safety
                 b. Sterilization – Level 1 process used for critical items that are introduced
                 directly into the blood stream or directly contact internal areas of the body
                 c. Aeration – Some methods of sterilization require a period to elapse between
                 end of the sterilization cycle and actual usage that involves air-drying tools
4. Storage phase – Controlled environment with limited access where surgical supplies are kept;
acceptable shelf-life in this environment depends on the procedure

     1. Intra-operative or concurrent decontamination
            a. Follow standard precautions when handling contaminated instruments
            b. Keep all instruments used during surgical procedure free of gross soil by
                wiping with a moistened sponge
     2. Postoperative decontamination pre-rinse
            a. Follow the four steps of instrument decontamination: pre-rinsing, washing,
                rinsing and sterilizing according to the manufacturer’s recommendation
      b. Disassemble instruments with removable parts to expose all surfaces for
      c. Open all hinged instruments to expose box locks and serrations
      d. Begin initial instrument decontamination immediately after completion of
          surgical procedures
      e. Open and disassemble all ratcheted instruments before leaving the operating
          room, then place in a basin of sterile water and enzymatic detergent
      f. Flatten or straighten malleable instruments such as retractors and probes
      g. Flush cold distilled water through hollow instruments to prevent drying of
          organic debris
      h. Place reusable sharps, such as skin hooks, in a separate container to prevent
          injury to instrument room personnel.
      i. Transport all instruments to the processing room for decontamination.
3. Decontamination Washing
      a. Use automated cleaning for initial decontamination
      b. Wear protective attire if manual cleaning
      c. Use distilled water for cleaning.
      d. Remove excessive bioburden from instruments by placing in washer
          sterilizer or manually hand washing each item
      e. Place instruments with crevices, serrations, box locks and ratchets in
          ultrasonic cleaner after completion of washer-sterilizer cycle
      f. Use an enzymatic soak solution on delicate items
      g. Do not soak instruments for prolonged time
      h. Use detergent with a neutral pH, never > 8.
      i. Do not use abrasive agents such as wire brushes and steel wool.
4. Decontamination rinsing

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