Asepsis means without micro-organisms.

It is the prevention of microbial contamination during invasive procedures or management of breaches in the skins integrity. Aseptic technique ensures that only uncontaminated objects/fluids make contact with sterile/susceptible sites, minimizing the risks of exposure to pathogenic and potentially pathogenic micro-organisms.

STERILIZATION: Destruction of all microorganisms including viruses, bacteria, their spores and fungi, both pathogenic and non-pathogenic. Should be used for all instruments which come in contact with blood or saliva
DISINFECTION: Destruction of organisms capable of giving rise to infection and rarely spores. Used for surfaces and impressions

CROSS CONTAMINATION: The spread of microorganisms from one source to another.

 CATEGORY

I Routinely exposed to blood, saliva or both Examples: Dentist, Hygienist, Assistant, Infection Control/Sterilization Assistant
II May on occasion be exposed to blood, saliva or both Examples: lab technician

CATEGORY

Every dental office should have an infection control program designed to prevent the transmission of disease from: Patient to dental team Dental team to patient Patient to patient Dental office to community (includes dental teams family) Community to patient

Health care workers must

Consider

blood and saliva from all patients as potentially infectious precautions to protect themselves from exposure

Take

 Universal

Precautions were recommended to protect exposure from blood and other body fluids Standard Precautions are the latest recommendations, although Universal Precautions are still used regarding the OSHA bloodborne pathogens standard.

 Apply

not only to contact with blood but also to all body fluids, secretions and excretions except sweat, Non-intact skin, Mucous membranes. These guidelines were developed as a response to the understanding that other body fluids besides blood are potentially infectious, and that anyone with patient contact could be at risk.

Infectious Agent-any potential pathogen (bacteria, virus, fungi, etc.) Reservoir-where the pathogen lives (a person, on equipment, surfaces, instruments, etc) Portal of exit- how the infectious agent leaves its reservoir and reach a new host. Transmission-direct, indirect, airborne, droplet Portal of entry- how the infectious agent gets into the new host (bloodstream, mucous membrane, etc.) Susceptible host-someone who is not immune

The

goal of an infection control program is to break the chain of infection by consistently practicing protocols which would prevent the infectious agent from moving to one host to another and preventing cross-contamination.

Procedure A. Employees must be familiar with Administrative Policies related to Infection Control.

B.Employees must be familiar with the Standard Precautions and Transmission-based Precautions Policy.

C.Employees must be familiar with the general principles of medical asepsis, which are as follows:

1.Handwashing Handwashing is the single most important means of preventing the spread of infection in the hospital. Hands should be washed before beginning work, after using the bathroom, before and after patient contact, before eating and before leaving work. Using mechanical friction, all areas of the arms, lower than the elbows, should be well lathered and scrubbed. Special attention should be given to the nails and nail beds. Rings and jewelry should be removed from hands and wrists because these articles may shelter large numbers of microorganisms. Thoroughly rinse hands under running water.

2.Dressing Changes Wash hands and don gloves as necessary. Remove dressings using no-touch technique and place them in a disposable bag. The physician will remove the sutures. Place the removed sutures in the disposable bag. If needed, apply a sterile dressing. Never touch the skin around a wound without sterile gloves being worn. Place tightly closed disposable bag in the infectious waste receptacle in soiled utility room. Wash hands. The use of gloves does not negate the importance of handwashing before and after patient care.

3.Intravenous Aseptic technique is mandatory in the preparation and administration of intravenous solutions. The longer the catheter remains in place, the greater the potential of infectious complications.
4.Personal Hygiene All hospital personnel must be hygienic. If any employee is hygienically offensive, it is your responsibility to report the situation to the proper supervisor. 5.Employee Rashes or Skin Lesions Lesions on Body lesion such as boils, abscesses, impetigo, etc., must be reported to the employees supervisor. The employee shall be referred to Occupational Health

6.Patients with Rashes or Skin Lesions The most important intervention for rashes or skin lesions is to call it to the attention of the patients physician and determine its cause promptly. In many cases, prompt recognition of the rash, identification of the cause, and prompt appropriate intervention can prevent transmission to the care provider and others. If a transmissible skin condition is identified, a CONTACT PRECAUTIONS sign shall be placed on the door of the patients room so that ALL personnel can be advised of the protective barriers to be utilized.

7.Skin Punctures/Blood and Body Fluid Exposure If you break skin from a sharp object or sustain a blood or body fluid splash to the eyes, nose, or mouth or to open areas of your skin, you are required to report the incident to your supervisor for referral to Occupational Health Services. An Incident Report is to be completed. 8.Equipment Handling Equipment used for patient care is contaminated after use whether visible soiled or not. Reusable equipment must be cleaned and disinfected before being used for another patient. Hands must be washed immediately after use of equipment for patient care. 9.Sterilized Articles Articles which have been sterilized must be carefully protected from contamination. Initial and put an expiration date on all packs and containers of sterile articles. If articles are not used within the specified period of time or if the packs become wet or damaged, the articles must be sterilized again. Consider all opened, wet or damaged packs as contaminated.

10.Work Area Sanitation Work areas must be free from refuse, especially around refuse disposal units. Refuse in high risk areas Surgical Suites, Laboratory, Dietary, Emergency Room, Isolation Rooms and Central Sterile Processing should be removed at least twice during the day shift.

11.Needle Syringe Disposal Used needles and syringes are potential health hazards and should be treated with respect. Contaminated needles and syringes must be discarded uncapped and unbroken into a needle and other sharps disposal boxes. Needle disposal boxes, when full, will be removed by Building Services.

1) Wipe down all operating room fixtures, furnishings and equipment with a clean, sterilized cloth and a hospital approved antibacterial, germicidal cleaning agent prior to use each morning. 2) Clean the room between each operation. Begin by bagging and removing all cloth items such as surgical drapes and hospital linens. Gather all gowns, shoe covers, masks, gloves and other disposable items and remove them from the operating area, then properly dispose them.

3) Wash, sterilize and replace any items used during the surgical procedure, such as scalpels, forceps and clamps. Also, clean any large pieces of equipment that may have be physically handled by the surgical team, such as trays and light fixtures, with an antibacterial germicidal cleaning agent. 4) Clean the floor using a shop vac or wet/dry vacuum, paying particular attention to the area where the surgical team works. Remove any furniture from the operating room and run a dust mop over the floor to collect any loose debris before vacuuming. Then pour a hospital-approved disinfectant solution on the floor and allow it to stand for approximately 10 to 15 minutes.

5) Scrub the floor with an abrasive pad or stiff-bristled scrub brush to loosen any dried-on or clinging materials and then suck up the dirty water with the wet/dry vacuum. 6) Cover the floor in clean water to rinse away any remaining disinfectant. Soak up rinse water with a clean mop head and allow the floor to dry. 7) Return furniture to the room once the floor is completely dry. 8) Apply an antibactarial germicidal solution to the following items at the end of each day: any equipment that is mounted on the walls or ceiling, low hanging light fixtures, sinks, all operating room furniture including the undersides and the wheels and any waste containers, buckets or scales, sterilizing as many of these items as possible .

Suction equipment and spittoon

Disposable suction tips . clean using warm water and non foaming disinfectant . Filters changed according to manufacturers instructions . Tubing and lines disinfected according to chair and spittoon instructions.

Fan (mechanical) and conditioning

Avoids use of fans in clinical areas as difficult to clean effectively . if use is consider essential , then routinely change filters and clean air conditioning units .

Dental chair Dental chair switches Furniture and fittings

Covering should be intact . Clean regularly with warm water and detergent . Blood / body splashes should be cleaned immediately with dilute hypochlorite solution And whiped with a manufacturer recommended surface disinfectant .

Cover with cling film , change between patients , end of session disinfect with surface disinfectant .

Should be in good repair and all coverings intact .damp dust with warm water and detergent . If know contamination , wash with diluted hypochlorite solution . Choose furniture upholstered with wipeable fabrics.

 HANDWASHING USE

OF GLOVES,MASKS,EYE PROTECTION AND GOWNS. CUBICLE PREPARATION TAKING MEDICAL HISTORY

 USE

OF PROTECTIVE ATTIRE AND BARRIER TECHNIQUES TO PREVENT SKIN AND MUCOUS MEMBRANE EXPOSURE TO DISEASE PRODUCING ORGANISMS.
CLEANING ,DECONTAMINATION AND STERILIZATION OF EUIPMENT ,INSTRUMENTS AN ENVIRONMENT .

EFFECTIVE

 HANDLING

OF SHARP INSTRUMENTS AND

NEEDLES. DENTAL RADIOLOGY ORTHODONTIC APPLIANCES ,PROSTHESIS AND PROSTHODONTIC MATERIALS INJURY PREVENTION

METHODS OF STERILIZATION
Dental offices use different methods to sterilize and disinfect their instruments or tools that they use to treat patients. This keeps disease and viruses from spreading and protects your health so you don't get an infection. Once dental instruments are sterilized, they can't be touched until they're ready to use to keep them sterile.

sterilization techniques-aseptic technique which usually requires the use of sterile instruments and supplies. Many supplies such as gloves, surgical blades, and suture materials are commercially available in sterile packs. It is frequently necessary to sterilize items such as surgical instruments, drapes, gowns, and instrumentation The preferred methods of sterilization are high pressure steam/temperature (in autoclaves) for items that can withstand high temperature, and ethylene oxide gas for items that cannot withstand high temperature. However, cold chemical sterilants may be used effectively for many items

STERILIZATION BY AUTOCLAVING
An autoclave is a device used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 C for around 1520 minutes depending on the size of the load and the contents. Uses of autoclaving-Liquid sterilization with various cooling options Pipette and Glass sterilization Instrument sterilization (wrapped or unwrapped) Biohazard and Waste sterilization Agar preparation

STERILIZATION BY HOT AIR OVEN Hot air sterilization using an oven is the most common method of sterilization as temperatures can be elevated to high levels and a wide variety of devices and instruments can be sterilized safely and effectively. Items that are often sterilized by dry heat, hot air sterilization include glassware and stainless steel equipment

OTHERS METHODS OF STERILIZING INSTRUMENTS

If manual cleaning is not performed immediately, instruments should be placed into a container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner to prevent drying of patient material and make manual cleaning easier and less time consuming. CDC also recommends using long-handled brushes to keep the hand as far away as possible from sharp instruments Debris can be removed from an instrument either by scrubbing the instrument manually with a surfactant or detergent and water or by using automated equipment (e.g., ultrasonic cleaner, washerdisinfector) and chemical agents. After cleaning, instruments should be rinsed with water to remove chemical or detergent residue. Splashing should be minimized during rinsing and cleaning the use of automated equipment can increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids. Thus, using automated equipment can be more efficient and safer than manually cleaning contaminated instruments.

 Wear

gloves during all radiographic, procedures. Disinfect and cover x-ray machine, working surfaces, chair, and apron. Sterilize nondisposable instruments Use barrier-protected film (sensor) or disposable container. Prevent contamination of processing equipments.

 The

practitioner should always wear gloves while handling film, making radiographs, or associated materials like cotton rolls, filmholding instruments etc. After the patient is seated the dentist should wash his hands and wear gloves in presence of the patient. Dental assistants should wear eyewear is contamination with body fluid is expected.

 To

prevent cross contamination disinfect all surfaces and use barriers to isolate equipments from direct contact. The dental chair & head rest should be covered with a plastic bag. The x-ray tube head,PID and yoke should be covered with disinfectant with a barrier to stop any dripping After the patient exposure the barriers should be removed ,contaminated working surface and lead apron sprayed with disinfectant.

 Always

use film-holding instruments that are heat sterilized and kept in bags for storage. The same sterilization bag should be used to transport the contaminated instruments back.

 Film

should be dispensed only by staff members with clean hands and gloves. Film packets are packed in plastic envelope to prevent contamination with saliva and blood and immersed in a disinfectant after the films have been exposed in the patients mouth.

 The

operators gloves and should remove his gloves and take container to the darkroom. Two towels should be placed on the darkroom working surface. The container of contaminated films should be placed on one of these towels. After the films are open the operator gathers the contaminated contents and discards them along with the contaminated gloves

Design and Disinfection of Operation Theatre

1. Only people absolutely needed for an assigned work should be present. 2. People present in theatre should make minimal movements and curtail unnecessary movements in and out of theatres, which will greatly reduce bacterial count. 3. Air borne contamination is usually affected by type of surgery, quality of air which in fact depends on rate of air exchange. All the persons including the least cadre of employers are partners in infection control and should be aware to comply with infection control regulations 4 Prompt disposal of Theatre waste out of the theatre is of top priority. Any spillage of Body fluids including Blood on the floors is highly hazardous and prompts the rapid multiplication of Nosocomial pathogens in particular Pseudomonas spp

SURVEILLANCE OF OPERATION THEATRE

Role of Microbiological Surveillance

The environments in the operation theatre are dynamic and subject to continuous change. Good infrastructures do not mean a safe environment as human make a greater difference in making the environment unsafe.
AIR IS THE IMPORTANT SOURCE OF INFECTION

Bacterial counts in operation theatres are influenced by the number of individuals present, ventilation and air flow, the results should be interpreted taking the above facts into consideration.

STERILISATION AND DISINFECTION OF OPERATION THEATRES AND CRITICAL CARE AREAS

GENERAL INSTRUCTIONS

1. Keep the floor dry when in use. 2. Use only vacuum cleaners (booming to be forbidden as it will dispense the infected material all around and on the equipments. 3. Chemical disinfection of an operation room floor is probably unnecessary. The bacteria carrying particles already on the floor are unlikely to reach an open wound in sufficient numbers to cause an infection Cleaning alone followed by drying will considerably reduce bacterial population. 4. Wall and Ceilings- Wall and ceiling are rarely contaminated. The numbers of bacteria do not appear to increase even if walls are not cleaned. Frequent cleaning is not necessary and has little influence on bacterial counts. Routine disinfection is therefore unnecessary, but only cleaned when dirty.

FUMIGATION.
1. Seal close all the outlets like doors/windows. 2. Put off the fans, A/C, any electrical/electronic device. 3. Formaldehyde gas is generated by adding 150grams of KMno4 (Potassium permanganate) to 300ml of formalin (40%) for every 1000cubic feet of space.

4. PROCEDURE.
a. Take three one litre capacity heat resistant vessels. Divide the calculated quantity of formalin and KMno4 approximately into three equal parts and dispense formalin into each vessel. Place the vessels at equal distance in the centre of the operation theatre. Add KMno4 into each vessel now and immediately leave the room. b. Other method of producing formaldehyde gas is to place the calculated quantity of formalin (no KMno4 is needed) in a single large vessel in the centre and heating done electrically for 45mins, then put off the heater from the switch situated outside the OT room. c. The OT room should be kept closed for 36 to 48hrs.

d. NEUTRALIZATION OF TOXIC FORMALDEHYDE GAS. 250ml of 10% liquid Ammonia per litre of formalin used, is placed in a container in the centre of the room for 3hrs. This will neutralize the toxic formaldehyde gas produced. Operation theatre room should be well ventilated before the entry of any personnel.

e. Fumigation ideally should be performed every week; desirably on Saturday evening so that it can be reopened on Monday morning (after 36hrs). Switch over to monthly fumigation procedure can be done in favorable circumstances under supervision.
f. Fumigating employee must be provided with personal protective equipments like (cap, masks, foot cover, protective goggles, etc).

II. Cleaning and Mopping in Operation Theatre.

Large bacterial load (about 85-95%) can be reduced just by following regular/proper cleaning and mopping procedures.
Before starting in the morning (everyday)

1. Clean using vacuum cleaner (using broom increases bacterial counts in air which is highly undesirable).
2. After 10min of cleaning, Mopping should be done using plain water with 10grams of bleaching powder per litre and then using 2-5% phenol (carbolic acid 20ml-50ml per litre of water) or a good quality disinfectant like Lysol can be used as per the manufacturers instructions. 4. Lower concentration of phenol acts as a perfume rather than a disinfectant. 5. Clean the Operation Theatre table, instruments coming in intimate contact with patient and door handles with 70% Alcohol solution. 6. After mopping, mops must be kept dry by exposure to sunlight. Continuous use of mops with out intermittent drying leads to contamination more than disinfection.

Between two procedures in the same session. 1. Clean the Operation Theatre table and instruments coming in intimate contact with patient with 70% Alcohol solution. 2. Discard waste immediately into respective plastic bags. After concluding in the evening (everyday) 1. Wait for at least 30min after all the OT Personnel are out of the room.

2. Mopping is to be done using 2% phenol solution. 3. Bathrooms and toilets should be disinfected with bleaching powder (10 grams per litre).
III. MICROBIOLOGICAL MONITORING OFOPERATION THEATRE. Swabbing and culture for bacterial and fungal organisms should be requested for once in every three months and/or whenever an outbreak is suspected, whenever there is some renovation work done in the OT complex.

Purpose:
The purpose of this waste management policy is to outline safe and efficient practices for the segregation, store and disposal of biomedical and general waste generated by the hospital

1. 2. 3.

Classification of the waste generated :

80% is non-hazardous waste . 15% is infectious waste . 5% is non-infectious but hazardous waste . Infectious waste includes all kinds of waste that may transmit viral, bacterial or parasitic diseases to human beings. Pathological waste include human tissues, organs and body parts and body fluids that are removed during surgery or autopsy or other medical procedures and specimens of body fluids and their containers

o
1.

Biomedical Waste :
Identifying waste: Classified into two categories: Infectious

2.

Non-infectious
Both infectious and non-infectious waste may either be biodegradable, or non-biodegradable.

Biodegradable Waste: That which is capable of being decomposed and broken down by biological agents, like bacteria.
Non-biodegradable Waste: That which cannot be broken down by biological agents. Example: Plastics.

Segregation of Biomedical Wastes

Category No. 1 Human Anatomical Waste (human tissues, organs, body parts) Category No. 2 Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses) Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures)

Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps)

Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines Category No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood) Category No. 7 Solid Waste (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.) Category No. 8 Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities) Category No. 9 Incineration Ash Ash from incineration of any bio-medical waste) Category No. 10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc.)

Colour Coding & The Type of Container and Method for Disposal of Biomedical Waste
Type of Container Plastic Bag Waste Catagory Cat. 1, 2, 3 & 6. Cat. 3, 6, 7 Treatment Options Incineration/ Deep Burial

Colour Coding Yellow

Red

Disinfected container/ Plastic bag Plastic Bag / puncture proof containers Plastic Bag

Autoclaving/Microwaving/ Chemical Treatment

Blue/ White Translucent Black

Cat. 4,7

Autoclaving/Microwaving/ Chemical Treatment & Destruction/Shredding Disposal in secured landfill

Cat. 5, 9, 10

CONDITIONS FOR WASTE DISPOSAL

There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection. Mutilation/shredding must be such so as to prevent unauthorised reuse.

PRESENTED BY :
Surbhi Singhal - 61 Virendra Sinhasane - 62 Priyanka Suryawanshi - 63 Shruti Tupe - 64 Garima Tyagi - 65 Sweta Varia - 66 Smruti Venkatraman - 67 Meghna Verma - 68 Sahil Wathodkar - 69