HYGIENE AND PREVENTIVE MEDICINE

CORE COMPETENCIES

 Define and describe the main objectives of the

public health
 Define and describe the different levels of the
prevention
 Describe the main characteristics of the
healthcare delivery system
 Describe and identify the effects of major
environmental agents on human health and
safety
 Define and describe epidemiological and
preventive aspects of the main infectious
diseases
 Define and describe the healthcare associated
infections
 THE PURPOSE OF INFECTION
CONTROL PROGRAMS
• to treat every patient and instrument as
capable of transmitting infectious disease
• to protect patients and HCWs from infection
• to reduce the numbers of pathogenic
microorganisms to levels where patients’
normal defence mechanisms can
prevent infection
• to break the cycle of infection
and eliminate cross–contamination
Decontamination: removes pathogenic
microorganisms from objects so they are safe to
handle, use, or discard
Sanitization: process that reduces microbial
population on object to a safe level
Cleaning: removes of visible contamination (e.g.,
organic and inorganic material) from objects and
surfaces. It is normally accomplished manually or
mechanically using water with detergents or
enzymatic products. It is a prerequisite for
effective disinfection or sterilization.
Disinfection: a process that eliminates many or all
pathogenic microorganisms, except bacterial
spores, on inanimate objects
Sterilization: a process that destroys or eliminates
all forms of microbial life and is carried out in
health-care facilities by physical or chemical
methods
Asepsis: methods which prevent contamination of
wounds and other sites, by ensuring that only
sterile object and fluids come into contact with
them
Antisepsis: application of an agent to living tissue
for the purpose of preventing infection
Cross-contamination: passing of microorganisms or
other harmful substances indirectly from one
patient to another through improper or unsterile
equipment, procedures or products
 LEVEL OF DISINFECTION
High: destruction or inhibition growth of
pathogenic microorganisms on inanimate objects.
Reduces the risk of microbial contamination but
does not provide the same level of assurance as
sterilization because all spores are not killed
(glutaraldehyde 2%, hydrogen peroxide 6-10%)
Intermediate: destruction of all vegetative
bacteria including T.B., but may exclude viruses &
fungi and have little or no sporicidal activity
(iodophors 2.5%, fenols)
Low: destroy most vegetative bacteria fungi &
viruses, not include spores & resistant bacteria
(quaternary ammonium compounds)
 SPAULDING CLASSIFICATION
DIVIDED HOSPITAL INSTRUMENTS INTO
GENERAL CATEGORIES BASED ON THE
RISK OF INFECTION INVOLVED IN THEIR
USE
Critical Items: enter sterile tissues, the
vascular system or equipment through which
blood flows (surgical instruments, cardiac and
urinary catheters, implants, needles, etc.)
• risk for infection: high
• treatment: sterilization

Items must be properly and safely pre-cleaned

and sterilised before use
 SPAULDING CLASSIFICATION
Semi-critical items: contact mucous membranes
or non-intact skin but do not penetrate soft tissue
or body surfaces (respiratory therapy and
anaesthesia equipment, endoscopes, cystoscope,
etc.)

• risk for infection: intermediate-high

• treatment: sterilization-high level disinfection
Meticulous physical cleaning followed by
appropriate high-level disinfection
 SPAULDING CLASSIFICATION
Noncritical items: those that come in direct
contact with the patients intact skin but not
mucous membranes (face mask, blood
pressure cuffs, stethoscopes, etc.)

• risk for infection: low

• treatment: low level disinfection-detersion

Clean and disinfect using a low to

intermediate level disinfectant
FACTORS THAT LIMIT THE ACTION
OF DISINFECTANTS
FACTORS RELATING TO THE DISINFECTANT
• concentration
• stability
• PH

FACTORS RELATING TO THE MICROBIAL

POPULATION
• microbial species and stage of the life cycle
• quantity of microbial population
• age of microbial cells
• variations of bacterial resistance
FACTORS THAT LIMIT THE ACTION
OF DISINFECTANTS
Factors relating the material to be disinfected
• prior or concomitant cleaning of the substrate
• compatibility
• completeness of contact
• contact time
• operating temperature
• presence of organic substances

Requirements towards the microbial population

• efficacy
 IDEAL DISINFECTANT
Safe to handle
Free rinsing

Non-toxic to the
Non corrosive
environment
Rapid action
Cost effective

Easily measured
Inexpensive

Compatible with
Capable of killing the vegetative cleaning materials
form of all pathogenic organisms
 COMMON DISINFECTANTS
• Disinfectant
– Physical
• Ultraviolet radiation
– Chemical
• Alcohols
• Phenols
• Quaternary ammonium compounds
• Glutaraldehyde
• Iodine and iodine compounds
• Chlorine species (free chlorine,
chloramines, chlorine dioxide)
 COMMON STERILIZERS
• Sterilizer

– Moist heat (>121 oC)

– Dry heat (>160 oC)

– Ionizing radiation
 COMMON STERILIZERS

Factors influencing sterilization by HEAT

1. Nature of heat
a. Dry
b. Moist
2.Temperature & time
3. No. of organism present
4.Whether organism has sporing capacity
5. Type of material from which organism is
to be eradicated
 COMMON STERILIZERS

Moist heat
Autoclave
121-132 °C for 15 min or longer => Kill both
the vegetative and spore forms of the
bacteria
Dry heat
Dry oven
160 °C for 2 hrs or 171 °C for 1 hr (B. subtilis)
 TEMPERATURE & TIME
The sterilization is complete if these two factors are
achieved throughout the load

Temperature Time (Min)

140oC 180
150oC 150
160oC 60
170oC 45
180oC 18
190oC 7.5
 GLASS BEADS STERILIZER
•The media used are glass beads, molten metal and salt
•The temperature achieved is of 220oC
•The method employs submersion of small instruments
into the beads and are sterilized in 10 seconds provided
they are clean
•A warm-up time of at least 20 minutes to ensure uniform
temperatures in these sterilizers
 COMMON STERILIZERS
Hydrogen Peroxide Gas Plasma

• Highly reactive/charged particles from

hydrogen peroxide generated under vacuum
• To sterilise heat- and moisture-sensitive
items
– Some plastics, electrical/electronic devices, and
corrosion-susceptible metal alloys
• Not compatible with cellulose (linen,
paper), devices with dead-end lumens, powders
and liquids
• Special wrapping required
 MONITORING STERILIZATION PROCESS
Biological indicator
Spores of non-toxigenic strain of Bacillus
stearothermophylus are used as a
microbiological test for monitoring the
effectiveness of sterilization processes
Autoclave tape – external indicator
indicates that set has been exposed to
process parameters
Chemical indicator – internal indicator
indicates that process parameters have
been met in the interior of the wrapped or
packaged set
Indicators should be checked prior to using any item.
No color change – do not use and return for proper
sterilization.
 HAND HYGIENE

• Hand hygiene
– Performing handwashing, antiseptic handwash, alcohol-
based handrub, surgical hand hygiene/antisepsis
• Handwashing
– Washing hands with plain soap and water
• Antiseptic handwash
– Washing hands with water and soap or other detergents
containing an antiseptic agent
• Alcohol-based handrub
– Rubbing hands with an alcohol-containing preparation
• Surgical hand hygiene/antisepsis
– Handwashing or using an alcohol-based handrub before
operations by surgical personnel
 SPECIFIC INDICATIONS
FOR HAND HYGIENE
• Before:
– Patient contact
– Donning gloves when inserting a CVC
– Inserting urinary catheters, peripheral vascular
catheters, or other invasive devices that do not
require surgery
• After:
– Contact with a patient’s skin
– Contact with body fluids or excretions, non-intact
skin, wound dressings
– Removing gloves
 SOCIAL HAND WASHING
• Recommended following social-type contact
with patients, after covering a cough or sneeze
• A plain liquid soap (3-5 ml) is often used
• Wet hands with water, apply soap, rub hands
together for at least 15 seconds
• Rinse and dry with disposable towel
• Use towel to
turn off faucet
 CLINICAL HAND WASHING
• Is used before clinical procedures on
patients, when a patient is being managed
in isolation, or in outbreak situations
• An anti-microbial soap, containing an
antiseptic agent (5 ml), is used
• Wet hands with water, apply soap, rub
hands together for 2 minutes
• Rinse and dry with disposable towel
• Use towel to turn off faucet
SURGICAL HAND WASHING

• Is required before any invasive or

surgical procedure requiring the use of
sterile gloves
• An antimicrobial skin cleanser, usually
containing chlorhexidine or detergent-
based povidone-iodine, is used