INFECTION PREVENTION & CONTROL, INCLUDING PROCESSING ITEMS FOR REUSE, IN GENERAL PRACTICE Rose Griffiths May 2016 Rose.griffiths1@gmail.com M 0425 736 817 Ref: RACGP Infection Prevention and Control Standards for general practices and other office based and community based practices (5 th Edition)
LEARNING OBJECTIVES
WHY Standards and Guidelines Business Safety
WHAT Governance Surveillance Risk Assessment Leadership
HOW Written Policies and Procedures Education
PARTNERING WITH CONSUMERS A two-way approach that encourages patient participation, is essential to successful infection prevention and control NHMRC (2010) Australian Guidelines for the Prevention and control of Infection in Healthcare. Commonwealth of Australia. (Page 29)
OVERVIEW Infection Prevention Basics Washing items for reuse Steps of Sterilisation Validation
Preventing cross infection STANDARD PRECAUTIONS Used with all patients regardless known or perceived infection status. TRANSMISSION BASED PRECAUTIONS Only used when known or suspected infection present. (triage) Contact precautions Droplet precautions Airborne precautions
Hand Hygiene Occasions for hand hygiene Promote to patients and staff Physical environment Products Liquid soap & water Hand rub
Respiratory hygiene and cough etiquette. Educate patients and staff Posters On hold messages Tissues available Location of bins
Aseptic Technique Risk Assessment Manage the environment Decontaminate Aseptic fields Non touch Prevent cross infection
Environmental cleaning Designated responsibility Written schedule Risk assessment Trained staff )include contractors) TGA approved products Technique avoid redistribution 2 step clean
Waste & Linen General waste Clinical waste Segregate at point of use Bins and sharps containers Linen
Sharps safety Education Safe handling and disposal Reduce the risk
Blood and body fluid exposure
Using Standard Precautions: Blood and body fluid spill Education Spills Kit Instructions
Using Standard Precautions: Handling Infectious Items
ANY QUESTIONS SO FAR?
Washing & Reprocessing Items: 10 Steps
Step 1. Staff Support
DESIGNATED RESPONSIBILITY KEEP UP WITH CHANGES AND NEW STANDARDS DOCUMENTATION & IMPLEMENTATION STAFF IMMUNISATION WORKPLACE POLICIES EDUCATION & COMPETENCY TESTING NEW STAFF ORIENTATION + COMPETENCY TESTING REFRESHER TRAINING EVERY 3 YEARS
Step 2. Environment & workflow
Adapted handbasin
Purpose built facility
Dedicated area, Workflow, Equipment & Consumables
Step 3. Wash items
Manual Cleaning Ask Is this item suitable to reprocess? Correctly diluted detergent PPE Steps Clean Rinse Dry Cover Tidy up
Step 4. Process for intended use
Low level disinfection for non-critical items High level disinfection for semi-critical items Sterile for critical items
Step 5. Package items for sterilisation
Pack contents and barrier system Class 1 indicator on packaging Correct size pouch Fold on the line Label with permanent marker
Step 6. Load the steriliser
Loading the steriliser-dos & Don ts Don t overload Don t exceed validated load Do try to promote steam flow Do follow operating instructions
Step 7. Steriliser parameters & monitoring the cycle
Monitoring the cycle Required Class 1 indicator Plus either Printout OR Data logger May also add Class 4, 5 or 6 indicator for additional assurance
Check the temperature 134 0 C Check the sterilisation time Save original (or scan) for your records
Data Logger Chemical indicator
Step 8. Unloading the steriliser
What you need to record for every load Date & Load number Contents Preparation signature Class 1 indicator Monitoring evidence Condition of the packs Release signature Additional comments
Documentation & tracking
Step 9. Store items for reuse
Storage of sterilised items Clean and dry Container with a lid or drawer Minimum handling Stock rotation Check integrity prior to use
Step 10. Steriliser maintenance
Routine Maintenance & Cleaning (daily/weekly) Servicing- (yearly or as required, validation needed annually or after major service/repair) Failed Cycles Hint: Keep service technicians business card handy
Validation of your Sterilisation Process
Review policies and procedures and make any changes Document validation cycles in the steriliser log. Select a Challenge pack and determine your Challenge load Service Technician Visits Sterilise your challenge load Challenge pack in the coldest spot 2 biological indicators: Repeat this 3 consecutive times Incubate Biological Indicators 6 sterilised Pass (no growth) 1 control Fail (grew culture) Sign off Educate staff Don t exceed the challenge load DOCUMENT
Your Challenge pack & Challenge load Largest pack you sterilise Largest load you are going to want to sterilise Document what you used and how you loaded it so this can be repeated Ensure staff know what went into the load so they do not exceed it in future
Service Technician Routine service & calibration Heat distribution studies Penetration time Time at temperature Calculation of total processing time Parameter settings TPT = Penetration time + Holding Time (3 min)
Practice Staff Review written protocols Determine challenge pack & challenge load Diagram showing the placement of packs & Biological indicators in the steriliser Run 3 validation test loads Document in steriliser log Record the Biological indicator results
QUESTIONS?
REFERENCES RACGP Standards for General Practices (4th Ed.) (Amended May 2013) http://www.racgp.org.au/your-practice/standards/standards4thedition/ NHMRC (2010) Australian Guidelines for the Prevention and control of Infection in Healthcare. Commonwealth of Australia. https://www.nhmrc.gov.au/guidelines-publications/cd33 RACGP Infection prevention and control standards for general practices and other office-based and community-based practices (5 th Edition) 2014 http://www.racgp.org.au/your-practice/standards/infectioncontrol/