Compared barrier nursing care in health and social facilities in the Czech Republic, Slovenia and Turkey

Transcription

1 Compared barrier nursing care in health and social facilities in the Czech Republic, Slovenia and Turkey Theme Disinfection Author: Kader KARAGöL, Melek Yeşim ERİŞMİŞ 1. What disinfectants, in what ways are they applied? Disinfectants According to Their Efficiency : Disinfectants are classified as high, medium and low level disinfectants according to their activities. For decontamination in laboratories, medium-level disinfectants such as chlorinated compounds and alcohol are often used. High Level Disinfection As this disinfection kill all microorganisms except for bacterial sporesin 20 minutes and kill bacteria spores in 6-10 hours it is defined as high level disinfection. DISINFECTANT USE CONCENTRATION Gluteraldehyde %2,0-3,2 Formaldehyde %6,0-8,0 Sodium hypochlorite Hydrogen peroxide %6,0-25, ppm free clorine Ortho-phthalaldehyde -OPA) 0,55% Medium Level Disinfection It is an effective disinfection method to tuberculosis and other microorganisms except bacterial spores in approximately 10 minutes. Medium level disinfectants are eddective on tuberculosis, fungi, vegetative bacteria and viruses. Low Level Disinfection It is a kind of disinfection which can kill most of the bacteria, some fengi species, and in 10 minutes some viruses.it is not effective in bacterial spores and Tbc bacillus.in the laboratory, medium disinfectants are used for surface decontamination, especially chlorinated compounds because they are cheap and effective. 70% ethanol is often used to clean biosafety cabinets and work surfaces. DISINFECTION CONCENTRATION Gluteraldehit 2,0-3,2 % Formaldehit 6,0-8,0 %

2 Sodyum hipoklorit ppm Hidrojen peroksit 6,0-25,0% Orto-fitalaldehit 0,55% 2. Disinfection by means of appliances cleaning and washing appliances, germicide lamps Instrument washer disinfector: It is used for surgical instruments, anesthesia and respiratory hoses, luminaire tools, glassware. For washing, rinsing and disinfection phases, water can be heated to the desired degree. At the end of the process, it can be dried with filtered air. The entire process, including drying, takes place within 1 hour 80 C seconds 90 C seconds Duck-slider washer disinfector; Human waste containers, duck slider washer disinfectors have an open drainage, such as a regular toilet bowl. Thus, a limited number of ducks, slides, vacuum bottles can be drained, cleaned, disinfected and dried, the process is completed in 3-6 minutes 80 C 60 seconds 90 C 6 seconds 3. Physical and chemical disinfection - formaldehyde chamber Disinfection by physical methods a) Disinfection by boiling: 100 C for 3-5 minutes. b) Disinfection by Heat: It is the most commonly used disinfection method. With high heat the proteins of microorganisms become denatured. It gives simple, cheap and fast results. It does not form toxic waste for both employees and nature 70 C 15 minutes, 75 C 10 minutes, 80 C 2 minutes Disinfection with Chemical Methods It is disinfected with chemical substances. In cases where thermal disinfection methods can not be used, it is applied by methods such as pulverization, fumigation etc. after cleaning before disinfection. Disinfectants show effects between 2-30 minutes depending on structures Preparation of antiseptic solutions - Marking of containers for antiseptic solutions Many disinfectants have toxic properties. They damage skin and eyes. While preparing disinfectant solutions, take protective measures to avoid splashing and wear protective gloves and goggles when using concentrated disinfectants. Some products (especially those containing alcohol) should be carefully used, considering that they may catch fire. The most important condition for a disinfectant substance to be effective is the well-known concentration and the duration of action. Many disinfectants present in the concentrate must be adjusted to the appropriate dilution before use. When a disinfectant is used for different purposes, the disinfectant must be diluted at different rates. These dilutions do not take place in the hospital environment, they come ready to use. Instructions for use are on the antiseptic solutions. Antiseptic solutions

3 and containers are supplied by companies where our hospitals are contracted. No antiseptic solution is also prepared in the hospital environment. 6. Antiseptic rules in wards Anticeptic rules for wards -Hands should be washed frequently and especially before and after the operations to be carried out or done. -Medical equipment and sheets must be transported untouched. -You should not put your bedding and other equipment on the ground. -The sheets should not be shaken and dust removal should be avoided. - Patients should not be faced while coughing, sneezing and breathing. -The tools must be kept away from the body while washing, brushing or dusting. -Cleaning should be done from the least dirty area to the very dirty area. -Dirty or used tools must be placed directly in the appropriate containers. -Body wastes and wet instruments contaminated with fluids should be thrown into the dirty car after being placed in plastic bags. - Dirty water, such as bath water, gargle water, should be piped directly to the side of the bathtub without splashing to the uniform. - Instruments suspected of being contaminated with parasites should be sterilized. - Personal cleaning and care must be taken to prevent the spread of microorganisms. -Small rings or wristbands should not be worn because it will be a settlement place for microorganisms. 7. Tools for dilution of disinfection Points to Consider in Preparing, Diluting and Using Stock / Pure Disinfectants Many disinfectants have toxic properties. They damage skin and eyes. While preparing disinfectant solutions, take protective measures to avoid splashing and wear protective gloves and goggles when using concentrated disinfectants. Some products (especially those containing alcohol) should be carefully used, considering that they may catch fire. The most important condition for a disinfectant substance to be effective is the well-known concentration and the duration of action. Many disinfectants present in the concentrate must be adjusted to the appropriate dilution before use. When a disinfectant is used for different purposes, the disinfectant must be diluted at different rates. Therefore, the manufacturer's instructions must be followed. The staff must be strictly in compliance with the instructions and be trained in disinfectant preparation. Disinfectant should be measured before putting it into the water. To add by just looking at it or using the lid as measure is an erroneous application Hard water should not be used for dilution. Dilutions should be set in glass or plastic cups, not in metal cups The disinfectant solution must be protected from sunlight. To avoid contact with air, keep mouth shold be tightly closed. The caps of solution containers should not be cork because microorganisms grow rapidly in cork caps. Before the disinfectants are reconstituted, the container they are to be stored in must be cleaned, dried and if possible sterilized Dilution should not be added on top of it. It has to be prepared every time.

4 The date on which the dilution is prepared should be written and should not be waited for a long time. If a diluted disinfectant solution is left on for a long time, a suitable environment for pathogenic microorganisms can be created and the efficiency is reduced. To prevent this, the solutions should be diluted to a daily consumption. To ensure maximum disinfection, the appropriate solution must be applied in the period and in the manner recommended by the manufacturer. In most cases, a minute contact period is required for a disinfectant to be effective. Medical instruments should be completely in contact with the solution during the recommended period. There is no reason to keep the appliance for longer than it is given in the disinfectant; On the contrary, long contact time can cause irreversible damage to the tools. No other contaminating device should be added to the solution during disinfection. If the material to be disinfected is wet, it must be thrown into solution after disinfection, in order not to reduce the density of the disinfectant. After washing and rinsing, there should be no visible dirt, detergent and any chemical residue on the medical equipment. 8. Stowing of antiseptic solutions in wards Sterile storage area The sterile storage area must be located in a separate, enclosed and entry restricted area adjacent to the sterilization area, preferably having a single function of sterilization and storage of clean materials.. The section where the sterile materials will be delivered to the user must be separate. The ventilation system should be designed to allow air to flow out of the sterile storage area with positive pressure. The material shelves should be at least 30 cm above the floor, the distance between the attic and the top shelf after putting materials should be at least 50 cm and should be 5 cm far from the wall for the air circulation. Shelves should be fixed. Fire taps for fire safety must be accessible. Storage (eg open wire shelves, open unibody shelf) should be grouped according to the packaging materials and systems used, the types of packaged devices and the transport methods used in the health facility. 9. Disinfection of devices with optical systems higher stage of disinfection Disinfection of Devices with Optical Systems Endoscope Arthroscope Laparoscope Cystoscope These should be sterilized. If there is no possibility of sterilization, They are waited 2 hours in 2% gluteraldehyde and rinsed with sterile distilled water. Cystoscope is kept in 2% gluteraldehyde for 20 minutes, rinsed with sterile distilled water.

5 10. Disinfection of tools made of different materials surgical instruments, plastic tools, glass tools, underlying bowls, urinary bottles Disinfection of tools made of different materials MATERIAL NAME APPLICATION METHOD Drugs Goblet If used for one patient, it should be wiped with 70% alcohol and stored dry. - Commonly used medication glasses; after use should be washed with detergent, rinsed and stored dry Aspiration device Oxygen tube cap, humidifer Humidifiers Nebulizers - The reservoir is emptied after each use. The joints, glass parts are disinfected with tool disinfectant, cleaned and stored dry. The aspirator tip is changed after each patient. It must be disposable and sterile. - It must be disinfected twice a week if used constantly. - It should be cleaned with the disinfectant. - It must be kept dry as long as it is not used. - Even ifthe water in the water reservoir is not exhausted, it should be replaced with sterile distilled waterin every 24 hours - Sterile distilled water in the humidifier should be changed when passing from one patient to another - It is preferred that it is disposable. - It should be cleaned every 8-24 hours. -After sterilization, it must be sterilized in the autoclave and disinfected if it can not be autoclaved. - Sterile distilled water should be put in the reservior. - Should be stored dry when not in use. Laryngoscope, bone -After treatment, it is left in hypochlorite or 2% gluteraldehyde for 10 minutes and rinsed with sterile distilled water. It is stored dry. Stethoscope Surgical vessels, surgical supplies Dressing materials, dressing trolleys Slider duck - It must be used by only one person. - After use, the diaphragm should be wiped off with 70% alcohol. - Must be sterilized in autoclave. - Dressings must be sterile. -The dressing trolleys should be cleaned with detergent at the end of the day and wiped with a paper towel -When not used, after use, it is washed with water with gloves and keptin hypochlorite solution. It should be kept dry.