sources of infection and disinfection and sterilization in home care and hospice settings module e
TRANSCRIPT
SOURCES OF INFECTION AND DISINFECTION AND STERILIZATION IN HOME CARE AND
HOSPICE SETTINGS
Module E
OBJECTIVES
• Disease transmission in the home• Environmental Contamination in the home• Role of the environment in infections• Properties of an ideal disinfectant• Use antimicrobials in the home
FACTORS FOR DISEASE TRANSMISSION
DiseaseAgent
Host
Transmission
SOURCES OF INFECTION
• Human • Patients
• Healthcare Personnel
• Visitors/household members
• Environmental• Common Vehicles• Vectorborne
HOST FACTORS
• Age• Mobility• Incontinence• Dysphagia• Chronic diseases• Loss of functional status• Medications• Indwelling devices
Contact (MRSA)
Direct
Indirect
Droplet (Flu)
Airborne (TB)
Combination (shingles, SARS)
Modes of Transmission
PATHOGENS OF CONCERN IN THE HOME
• Bacterial (Streptococcus, Salmonella, Staphylococcus)
• Viral (Influenza, Rhinovirus, Herpes, Adenovirus)• Mycobacterial (M. tuberculosis)• Fungal (Trichophyton)• Helminths (Enterobius)• Mycoplasma (M. pneumoniae)
VIRUS TRANSMISSION IN THE HOME
• Virus discharge (Rhinovirus 103, Norovirus 107)• Virus contamination of surface/objects (hands)• Virus survival on inanimate (Hepatitis B, Adeno-50
d, Rhino-hr)• Virus survival on hands• Virus transfer between vehicles (hands)
SOURCES OF MICROBIAL CONTAMINATION IN THE HOME
• Contamination of wet/moist areas• Sinks• Drains• Toilets• Food preparation areas
• Contamination of dry areas• Floors, carpets• Curtains• Furniture
BACTERIAL CONTAMINATION
• Staphyloccocus sp. 100%
• Micrococcus 100%
• Bacillus subtilis 56.5%
• Enterobacter cloacae 52.2%
• Bacillus sp. 39.1%
• Enterobacter sp. 26.1%
• Klebsiella pneumoniae 23.9%
• E. coli 19.6%
• Bacillus lichenformis 17.4%
• Klebsiella sp. 15.2%
• Pseudomonas aeruginosa 15.2%
Spiers JP, et al. Intern J Environmen Health Research 1995;5:109-122
RISK OF INFECTION
SURFACES RISK OF INFECTIONHigh Food, toilets, pets,
infected people Neonates, elderly, immunocompromised
Moderate Sinks, drains, baths, cleaning utensils
Mild host defense abnormalities (diabetes), ill persons
Low Floors, walls, furniture, linens, clothing
Healthy subjects
MITIGATING THE RISK
FREQUENCY OF DISINFECTION
• Surfaces should be disinfected routinely (e.g., daily, weekly, etc.), and when visibly soiled
• Frequency of disinfection could be based on frequency of use of the surface and the level of soil present on the surface.
• Frequency may need to vary based on host susceptibility and environmental site
DISINFECTION OF PATIENT CARE EQUIPMENT AND DEVICES
A RATIONAL APPROACH TO DISINFECTION AND STERILIZATION
EH Spaulding believed how an object will be disinfected depends on the object’s intended use.
CRITICAL - objects which enter normally sterile tissue or the vascular system or through which blood flows should be sterile.
SEMICRITICAL - objects that touch mucous membranes or skin that is not intact require a disinfection process (high-level disinfection) that kills all but high numbers of bacterial spores.
NONCRITICAL - objects that touch only intact skin require low-level disinfection.
NON-CRITICAL OBJECTS
Classification: Noncritical objects will not come in contact with mucous membranes or skin that is not intact.
Object: Can be expected to be contaminated with some microorganisms.
Level germicidal action: Kill vegetative bacteria, fungi and
lipid viruses.Examples: Floors, walls, bedside tables, and
furniture, curtainsMethod: Low level disinfection
EXAMPLES OF NON-CRITICAL OBJECTS
• Blood Pressure cuffs• Crutches• Stethoscopes• Dopplers• Apnea monitor• Urinal, bed pans• Pulse oximeter
LOW-LEVEL DISINFECTION OF NON-CRITICIAL OBJECTS
Exposure time > 1 minGermicide Use Concentration
Ethyl or isopropyl alcohol 70-90%Chlorine 100ppm (1:500 dilution)Phenolic UDIodophor UDQuaternary ammonium UDImproved hydrogen peroxide 0.5%, 1.4%____________________________________________________UD=Manufacturer’s recommended use dilution; if prepared on-
site, document correct concentration at some frequency
SEMI-CRITICAL OBJECTS
Classification: Semicritical objects come in contact with mucous membranes or skin that is not intact.
Object: Free of all microorganisms except high numbers of bacterial spores.
Level germicidal action: Kills all microorganisms except high
numbers of bacterial spores.Examples: Respiratory therapy, thermometer,
etc.Method: High-level disinfection
OTHER SEMI-CRITICAL ITEMS
• Humidifiers• CPAP• Nebulizers• Laryngeal mirror• Feeding tubes/Syringes• Thermometers• Tracheostomy tubes• Wound care items
HIGH-LEVEL DISINFECTION OF SEMI-CRITICAL ITEMS
Exposure Time > 8m-45m (US), 20oCGermicide Concentration_____Glutaraldehyde > 2.0%Ortho-phthalaldehyde 0.55%Hydrogen peroxide* 7.5%Hydrogen peroxide and peracetic acid* 1.0%/0.08%Hydrogen peroxide and peracetic acid* 7.5%/0.23%Hypochlorite (free chlorine)* 650-675 ppmAccelerated hydrogen peroxide 2.0%Glut and isopropanol 3.4%/26%Glut and phenol/phenate** 1.21%/1.93%___*May cause cosmetic and functional damage; **efficacy not verified
HIGH-LEVEL DISINFECTION IN HOME CARE
• Items thoroughly cleaned before disinfection and sterilization
• Modifications to routine disinfection may be made in the home setting
• Semicritical item (i.e., tracheostomy tubes)-agents/exposure times • 1:50 dilution (1000 ppm) of 5.25%-6.15% bleach/5
minutes • 70% isopropyl alcohol/5 minutes • 3% hydrogen peroxide/30 minutes
CRITICAL ITEMS
Classification: Critical objects enter normally sterile tissue or vascular system, or through which blood flows.
Object: Sterility.Level germicidal action: Kill all
microorganisms, including bacterial spores.
Examples: Hypodermic syringes, IV medication and tubing, and hemodialysis tubing and solutions
Method: Steam, gas, hydrogen peroxide plasma, ozone, VHP or chemical sterilization.
STORAGE OF STERILE/CLEAN ITEMS
• Items should be stored in a designated, well ventilated area
• Items should be protected from dust, moisture, and temperature and humidity extremes
• Packaged items should be stored so packaging is not compromised
SUMMARY
• Disinfection• Rational approach to disinfection/sterilization• Disinfectants used in home health and hospice• Disinfection practices
• Sterilization• Sterilization practices used in home health and
hospice
REFERENCES
• Rutala WA, Weber DJ. CJD: Recommendations for disinfection and sterilization. Clin Inf Dis 2001;32:1348
• Rutala WA, Weber DJ. New disinfection and sterilization methods. Emerg Inf Dis 2001;7:348
• Rutala WA, Weber DJ. Clinical effectiveness of low-temperature sterilization technologies. Infect Control Hosp Epidemiol 1998;19:798-804.
• Rutala WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313
• Rutala WA and DJ Weber. CDC Guideline for disinfection and sterilization in healthcare facilities, 2008.