Clinical skills for preparation of the patient and clinical environment

Chapter 5 Clinical skills for preparation of the patient and clinical environment



Karen Dunmall



CHAPTER CONTENTS


Introduction 53

Diseases and organisms 54

Cross-infection 55

Imaging equipment cleaning 56

Personal hygiene 58

Aseptic technique 59

Fluoroscopic examination preparation 60

Specialist procedure preparation 62

Record keeping 63


KEY POINTS


image Infection control is essential to ensure that the environment is safe and clean for patients and staff at all times.

image Aseptic techniques are utilised to minimise the risk of contamination during clinical procedures.

image Record keeping is needed to provide a continuation of care for the patients during their stay or treatment within the clinical environment where a number of professionals and individuals are involved at different times.


INTRODUCTION


Great importance must be put on the maintenance of a safe and clean clinical environment for the patients. Within the diagnostic imaging department it should be recognised that all patients have the potential to carry and transmit organisms. It has been shown that nosocomial infections (those occurring in a hospital setting) can be reduced considerably with the introduction of basic hygiene procedures.1 In order to prevent the transfer of infections it is important to be aware of the specific organisms that can cause infection and the mode of transfer so that the cycle of replication can be disrupted.



DISEASES AND ORGANISMS


A disease is a condition causing symptoms of an illness, which occurs when cells or molecules within the body stop functioning properly. For example, a disease can be caused through aging, the effects of chemicals, or arise from gene mutation/alteration.


There are four main groups of pathogenic organism which can cause diseases, some of which are harmless to the host when sited in the correct place; for example there are organisms living in the bowel which cause infection when they enter the urinary or respiratory tracts.



BACTERIA


Bacteria are small unicellular organisms which are much smaller than a typical animal cell. There are many species of bacteria and they may be characterised in a number of ways, such as by shape (e.g. rod-like (bacilli) or spherical (cocci)). Within each species there are many different strains. Some bacteria are susceptible to treatment; however, there is an increase in the number of bacteria becoming resistant to drug treatments due to the overuse of antibiotics.



Examples of bacteria



• Escherichia coli 0157:H7 is one of hundreds of strains of E. coli, which can be found in human and animal gastrointestinal tracts.

• Staphylococcus has more than 20 species, including Staphylococcus aureus and Staphylococcus epidermidis, which can be found in the nose and on the skin of healthy individuals.


VIRUSES


Viruses are not cellular and exist as genetic material (RNA or DNA) enclosed in a protein coat. Unlike bacteria, which replicate by a simple cell-division process, viruses require a cellular organism in which to reproduce. The genetic material invades the cell and hijacks the replication process. Antibiotics are ineffective against viruses; however, there are some antiviral agents (aciclovir) that prevent the virus from functioning normally, thus disrupting reproduction.



Examples of viruses



• Human immunodeficiency virus (HIV)

• Herpes simplex virus


FUNGI


Fungi can be found in soil, air and water and are in fact primitive plants. Some fungi live in and on humans in balance without causing illness; these include Candida and Aspergillus species. Conditions caused by the presence of fungi are called mycoses. It is usually the unbalanced propagation of a fungus that causes the illness. Some antibiotics are fungi that are beneficial in the treatment of bacterial infections, one example being penicillin.



Examples of fungi



• Aspergillus fumigatus can cause aspergillosis, which affects the respiratory system.

• Overgrowth of Candida albicans is known as candidiasis and can be found in the immunocompromised; it is also known as thrush.


PROTOZOA


Protozoa are unicellular microscopic animals. They can live in decaying matter, assisting with decomposition; however, when found in humans protozoa normally cause disease.



Examples of protozoa



• Toxoplasma gondii causes toxoplasmosis in humans.

• Plasmodium is responsible for causing malaria in humans.


CROSS-INFECTION


An infection occurs when other organisms, e.g. bacteria, viruses, fungi or protozoa, enter or come into contact with the body and multiply. The organisms can cause direct damage or prompt an immune response, which causes symptoms to manifest, e.g. fever.


Infections can be:


a Acute – lasting 2–24 days, e.g. a common cold

b Chronic – duration of months, years or lifetime, e.g. hepatitis

c Latent – remaining hidden after the first manifestation, e.g. Varicella zoster (chickenpox).

The cross transfer of a pathogenic organism from one individual to another (cross-infection) can occur in the following ways:


• Direct contact between individuals or indirect contact involving an infected item, e.g. a toilet door handle.

• Transmission through bodily fluids, e.g. blood,urine or saliva.

• Transfer of organisms between the gut and mouth (the faecal–oral route).

• Through the air via droplets/particles containing pathogens, e.g. sneezing.

• By the use of contaminated non-sterile medical equipment.

Therefore, it is essential that the equipment, environment and healthcare professional are subject to varying levels of cleanliness dependent on the clinical requirement (Table 5.1). There arethree main levels of cleanliness that exist with regards to equipment and surfaces: clean, disinfected and sterilised.


Table 5.1 The purpose and contraindications of cleansing agents











































Cleaning agents Purpose in department Contraindications for use
Chlorhexidine gluconate solution 2.5% For cleansing the skin prior to a procedure Not for hard surfaces
Chlorhexidine gluconate 0.015%, cetrimide 0.15% (e.g. Savlon/Tisept/Sterets)
Pre-injection

Skin sterilisation

Bottle tops
 Not for hard surfaces or open wounds
Chlorhexidine gluconate solution 2.5% (e.g Hibiscrub)
Preoperative surgical hand disinfection

Pre/postoperative skin antiseptic
 None
Detergent, sanitiser, blue bleach powder (sodium hypochlorite) For body fluids and spillages Not for skin
Cleansing foam (e.g. Esemtan) Antimicrobial deodorising foam Not for hard surfaces, floors, etc.
Povidone iodine 7.5% (e.g. Videne antiseptic solution) A rapid acting non-irritating aqueous iodine solution For skin only. Not for hard surfaces, floors, etc.
Alcohol impregnated wipes For hard surfaces and skin Not for open wounds
Sodium chloride 0.9% solution For skin and open wounds None
‘Decon’ For neutralising radioactive spills None


CLEAN


Cleaning removes visible contamination (blood, faeces and the majority of microorganisms), normally using detergents. The process is designed to remove dirt and other materials from objects, surfaces or instruments. It can be done in water, with or without the inclusion of detergents. This is the first stage of removing contamination from the environment prior to disinfecting and sterilising.



DISINFECTED


Disinfecting reduces the number of microorganisms to a ‘non-harmful’ level by using chemical or heat treatment of items in contact with mucous membranes or bodily fluids. Spores are not usually destroyed. This process is halfway between cleaning and sterilising and a range of chemicals that inactivate most serious pathogens can be used. Immersing instruments in boiling water can ensure disinfection. In the case of floors, these will be mopped using chemical disinfectants, an example of which is chlorhexidine.



STERILISED


Sterilising removes and destroys all microorganisms, including spores. It is used on items that penetrate the skin or mucous membranes and enter sterile body areas.


The process involves:


• physical cleaning

• heat treatment

• ethylene oxide gas

• liquid, e.g. Cidex OPA.

Where possible, the CSSD (Central Sterile Supplies Department) should be used.



STERILE SUPPLIES PACKAGING


In order for the healthcare professional to know whether a set of instruments is sterile there are indicators on the outer packaging, which must be intact (Fig. 5.1).


image

Figure 5.1 Sterile supplies packaging.


Specialised tape will seal the package. Non heat treated CSSD tape will have diagonal white lines: heat treated and therefore sterile tape will have black diagonal lines. A label will also indicate the date and cycle number of sterilisation (Fig. 5.2).

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Feb 20, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Clinical skills for preparation of the patient and clinical environment

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