PERSONAL PROTECTIVE EQUIPMENT (PPEs)

Personal Protective Equipment reduces the risk of infection if used correctly and includes the use
of the following:

 Mask
 Gown (long sleeved)
 Protective Eyewear / goggles / visors / face shields
 Gloves (non-sterile)
 Single use cap
Who should use PPE?
Anyone who enters isolation room / area including:
 All health care workers who provide patient care (e.g. Doctors, nurses, radiographers,
physiotherapist, etc.)
 All support staff including medical aides and cleaning staff
 Family members or visitors
 All laboratory workers handling specimens from an infected patient
 All sterilizing service workers handling equipment that requires decontamination and has
come from an infected patient
 All sterilizing service workers handling equipment that requires decontamination and has
come from an infected patient
Principles for Using PPE
Personal Protective Equipment (PPE) is used to protect health care workers by preventing
potentially infectious microorganisms from:
 Contaminating their hands, eyes and clothing; and
 Being transmitted to other patients and staff.
 PPE reduces, but does not completely eliminate the possibility of infection.
 PPE is only effective if used correctly.
 The use of PPE does not replace basic hygiene measures such as hand washing – hand
washing is essential to prevent transmission of infection.
Principles for Using the N-95 Respirator Mask
The N-95 respirator mask is used to protect health care workers, other patients, staff or visitors
by preventing potentially infectious microorganisms such as respiratory secretions from:
 Contaminating their face including the nose and mouth.
 Being inhaled or ingested.
Proper use of N-95 Respirator Mask
 DO NOT touch the front of the mask
 Wear only one N-95 mask – no need for additional respiratory protection.
 REMOVE the N-95 mask before leaving the isolation unit / area.
WHY an N-95 Respirator Mask?
N-95 respirator masks offer a higher level of filtration for respiratory secretions than a surgical
mask.
HOW to use an N-95 Respirator Mask?
 Use for single shift unless excess moisture necessitates replacement during each shift.
 Label with the wearer’s name.
 Dispose of with medical waste.
NB: You must fit the mask securely over both your nose and mouth, so size is important.

N-95 Respirator Masks – Fitting Instructions

 Cup the respirator in your hand with the nosepiece at your fingertips allowing the
headbands to hang freely below your hand.
 Position the respirator under your chin with the nosepiece up.
 Pull up the top strap over your head resting it high at the top back of your head. Pull the
bottom strap over your head and position it around the neck below the ears.
 Place the fingertips of both hands at the top of the metal nosepiece. Mold the nosepiece
to the shape of your nose by pushing inward while moving your fingertips down both
sides of the nosepiece. Pinching the nosepiece using one hand may result in less effective
respirator performance.
 The seal of the respirator on the face should be fit checked prior to wearing in the work
area.
 Cover the front of the respirator with both hands, being careful not to disturb the position
of the respirator.
 Positive Fit Test – Exhale sharply. A positive pressure should be felt inside the respirator.
If any leakage is detected, adjust the position of the respirator and/or tension of the
straps. Retest the seal. Repeat the steps until the respirator is sealed properly.
 Negative Fit Test – Inhale deeply. If there is no leakage, the negative pressure will make
the mask cling to your face. A poor seal will result in prompt loss of negative pressure in
the mask due to air entering through gaps in the seal.
When to change your N-95 Respirator Mask?
 If you touch it.
 If it is grossly contaminated.
 But not necessarily between isolated patients
Principles for Using Goggles, Gowns, Gloves, Caps, Overshoes and N95 Respirator
Goggles, gowns, gloves, caps and overshoes are used to protect health care workers by
preventing potentially infectious microorganisms from:
 Contaminating their eyes, clothing, hands, hair and shoes; and
 Being transmitted to other patients and staff.
Goggles
 Assign one pair to each worker at the beginning of a shift.
 You should use goggles to cover all of the eye area.
 Wear goggles in room with infected patients.
 Leave in the container in the anteroom at the end of the shift to be cleaned and
disinfected.
Gowns
 Long-sleeved gowns must be worn when in direct contact with the patient.
 Wear gown at all times in the patient’s room
 Gowns must be removed before leaving the patient’s room or dedicated anteroom.
 Remove used gowns as soon as possible, particularly when grossly contaminated.
 Reusable Gowns, if necessary, gowns may be reused during one shift for the same patient,
e.g. when short of supplies. Discard immediately if visibly contaminated. Hang gown with
outside facing when not in use. Discard at the end of the shift.
Gloves
 Before all patient contact.
 Before all cleaning.
 Before handling soiled linen and waste.
 Remove after contact with patients or lab specimens.
 Do not wear gloves outside of the patient’s room / anteroom.
 Do not re-use gloves.
 Wash hands after removing your gloves.
Plastic Disposable Aprons
 Plastic disposable aprons must be worn whenever there is a likelihood of other PPE such
as gowns becoming wet.
 They are worn to reduce the risk of breakthrough and contamination of clothing worn
underneath the PPE.
 They must be disposed after use.
 Performing patient care activities where soiling or increased moisture is likely.
 Cleaning and disinfecting the patient environment.
 Cleaning and disinfecting medical; other patient care equipment.
 Laundering used linen.
 Cleaning and disinfecting the cleaning equipment.
Caps
 Caps are worn to protect the hair from aerosols that may otherwise lodge on the hair and
be transferred to other parts of the health care worker such as the face or clothing by the
hands or onto inanimate objects.
Overshoes
 Overshoes are worn to protect the health care worker’s shoes and feet from being
splashed by spills such as blood or other body fluids or aerosols.

RECOMMENDED SEQUENCE

A. Wearing PPEs.
1. Wash hands
2. Wear scrub suit
3. Wear boots or shoe cover
4. Wash hands
5. Wear cap
6. Wear mask
7. Wear the gown
8. Wear the impermeable apron
9. Wear protective eyewear
10. Wash hands and dry them
11. Wash hands and dry them
B. When removing the PPEs…
1. Untie the gown string if tied in front and remove shoe covers.
2. Remove gloves and discard in an appropriate manner.
3. Wash hands.
4. Remove gowns and apron without contaminating clothing underneath.
5. Remove googles, mask, and cap and place in appropriate container.
6. Wash hands up to wrists with soap and water, dry and decontaminate using alcohol base
hand rub.
Key Points
 The use of goggles, disposable gowns, gloves, caps and overshoes for all patient contact
is designed to protect both the health care worker and the patient.
 It also protects other patients, staff and visitors from potentially infectious
microorganisms.
 Wear N-95 respirator mask, goggles, disposable gowns, gloves, cap and overshoes for all
patient contact.
  Wash hands using soap (preferably liquid) and water when leaving the anteroom.
 Use a 70% alcohol-based hand rub solution after hand washing.
 Wash hands when leaving the unit.
REMINDERS

Personal Protective Equipment (PPE) is essential for all contact with infected patients.
 Ensure N-95 respirator masks fit properly.
 Ensure googles cover the entire eye area.
 Have sufficient PPE supplies available.
 All visitors must wear full PPE.
 Dispose of all PPE in the appropriate container for disposal or cleaning and disinfecting.
 APPROPRIATE HANDLING OF WASTES and SOILED LINEN or CONTAMINATED
LAUNDRY

o Handle, transport and process used linen that is soiled with blood, body fluids,
secretions or excretions with care to ensure that there is no leaking of fluid.

o Ensure that wastes are properly disposed.

o Waste Disposal Procedure: Discard/throw the following:

GREEN PLASTIC – BIODEGRADABLE or NABUBULOK
Example: leftover foods, fruits, fishbone, bones, etc.

YELLOW PLASTIC – INFECTIOUS and PATHOLOGICAL WASTE

Example: used gloves, used test strips, cotton balls soaked with blood, diapers, etc.

BLACK PLASTIC – NON-INFECTIOUS

Example: dry cartons, papers, plastics, etc.

Prevention of needle stick/sharp injuries & safe sharps disposal

o Sharps must be appropriately disinfected and/or destroyed.

o DO NOT recap, bend or break, hand manipulate used needles.

o If capping cannot be avoided, use a one-hand Scoop technique ONLY.

 NEEDLESTICK INJURY REPORTING AND MANAGEMENT GUIDELINES

1. All needlestick injuries and contact to blood and body fluids among employees must be
reported to the Infection Control Committee.

2. During injuries:
a. The ICP/ICN will advice initial management of the injury.
b. The exposed employee should submit an incident report to the ICC before further
actions are done. The incident report should be noted by the involved personnel
who will serve as witness of the said injury.

3. The ICN will do investigation regarding the incident which includes the following:
a. Vaccination History of the Employee
b. Status of Source Person
If status is unknown, necessary laboratory tests (per ICP’s recommendation)
should be done in consultation with the Attending Physician (if any). The source
person should be informed regarding the incident and the consequent actions.

4. Needlestick Injury Report Form should be filled out by the ICN and the ICP. The incident
report written by the exposed person should be attached
 The Report Form specifies the immunization required to be administered to the
exposed person and the laboratory test/s required before immunization.

5. The tests and immunizations will be administered as soon as they are available.
 Laboratory results should be kept on file by the ICN. The exposed person will be
provided with photo copies.
 Tetanus Toxoid Immunizations should be given at 0, 1 and 6 months depending on
the number of doses required.
 Hepa B vaccinations should be at the expose person’s own expense.
 WORK RESTRICTIONS FOR PERSONNEL WITH INFECTIOUS DISEASES

Disease/Problem Disease/Problem Disease/Problem

PC Remove from Direct Patient Contact PC Remove from Direct Patient Contact PC Remove from Direct Patient Contact
WR Partial Work Restriction WR Partial Work Restriction WR Partial Work Restriction
For Duration For Duration For Duration
Conjunctivitis, infectious Hepatitis A Measles, active
PC Remove PC Remove PC Remove
WR No Partial Work Restriction WR WR
For Discharge cessation For 7 days after Rx start improvement For Rash + 7 days
Cytomegalovirus infections Hepatitis B (acute or chronic antigenemia) Measles, Post exposure
PC Do not Remove PC Do not Remove PC Remove
WR No WR Gloves for procedures which involve WR
trauma to tissues or con tact with mucous For Exposure + 5 days until
membranes or non-intact skin + 21 days
If symptomatic: rash + 7 days
For Until antigenemia resolves
Diarrhea, acute Hepatitis C Mumps, active
PC Remove PC Do not remove PC Remove
WR WR Same as acute HBV WR
For symptoms resolution and For Period of infectivity has not been For Parotitis + 9 days
Salmonella excluded determined
Diarrhea, convalescent Herpes simplex, genital Mumps, post exposure
PC Do not remove PC Do not remove PC Remove
WR WR None WR
For Stools negative on 2 cultures, For Exposure + 12 days until + 26 days
2 or more days apart If symptomatic: Parotitis
+9 days
Enteroviral infections Herpes simplex, Hands: Herpetic whitlow Pertussis, active
PC Do not remove PC Remove from Patient Contact PC Remove
WR Should not take care of infants and WR Maybe gloves prevent transmission WR
newborns For resolutions of lesions For Cough + 21 days
For symptoms resolution
Group A Streptococcal disease Herpes simplex, orofacial
PC Remove PC No
WR WR No high-risk patients (neonates, severe
For 24 hours after adequate Rx start malnutrition, burns, immunosuppressed)
For resolution of lesions
Disease/Problem Disease/Problem
PC Remove from Direct Patient Contact PC Remove from Direct Patient Contact
WR Partial Work Restriction WR Partial Work Restriction
For Duration For Duration
Pertussis, post exposure Upper respiratory infections
PC Remove PC Remove
WR WR Personnel with upper respiratory infections
For Effective Rx +7 days Should not take care of high risk patients
If symptomatic: cough + 7 days For symptoms resolution
Rubella, active Varicella, active
PC Remove PC Remove
WR WR
For Rash + 5 days For All lesions dry and crust
Rubella, susceptible, post exposure Varicella, post exposure, susceptible
PC Remove PC Remove
WR WR
For Exposure + 7 days until + 21 days For Exposure + 10 until + 21 days or if
If symptomatic: Rash + 5 days Symptomatic- all lesions dry and crust
Scabies Zoster (shingles)
PC Remove PC Partial
WR WR Appropriate barrier desirable; personnel
For for 24 hours after start of effective Should not take care of high risk patients
therapy For All lesions dry and crust
Staphylococcus aureus (skin lesions) (impetigo) Tuberculosis, pulmonary active
PC Remove PC Remove
WR WR
For until lesions have resolved For Until sputum negative
 STERILIZATION / DISINFECTION OF SPECIFIC EQUIPMENT

Bedpans and urinals

 Wash thoroughly with warm water using a brush and detergent to remove all visible
signs of organic contamination. Dry.
Blood Pressure Cuff
 Wash with soap and water
Humidifiers
 Empty daily
 Refill with sterile water
 Disinfect when contaminated. Wash and leave in a solution of 1 % hypochlorite for 30
minutes then wash thoroughly and dry.
 Routine heat disinfection after each patient use
 If humidification is required for a prolonged time, the humidifier should be cleaned
thoroughly, dried, filled daily with sterile water.
Incubators
 Clean thoroughly with warm soapy water to remove contaminants.
 Dry and wipe over with 70% isopropyl alcohol
Masks, Oxygen delivery face masks
 If reused, wash thoroughly
 Dry and wipe over with 70% isopropyl alcohol. This will remove mucus.
Mattresses and Pillows
 Soggy (wet) mattresses must be changed.
 Clean with warm water and detergent.
Stethoscopes
 Wipe with alcohol after each use.
Stretcher
 Wash with detergent
Suction and Drainage Bottles
 Non-disposable bottles must be changed every 24 hours or sooner if full.
 Must be rinsed and sent to the CSSD for autoclaving or wash thoroughly and dry.
 Recyclable connector tubing should be cleaned thoroughly and sterilized. The system
must be closed and risk to staff from body fluids should be minimal.
 Do not leave fluids standing in suction bottles.
Thermometers
 Use individual thermometers for each patient.
 Wash in warm water and detergent and dry.
 Wipe over with a swab or cotton wool ball soaked in 70% isopropyl alcohol or soak in
alcohol for 10 min.
 Use plastic shield.
Wheelchairs
 Wash with detergent.
 Use of Disinfectants
Final
Disinfectant Concentration** Effective on: Ineffective on: Comments
Phenolics: e.g. Bacteria, most viruses, Spores, polio, Relatively insensitive to
LysolTM* TB Coxsackie
1/20 HIV Viruses High protein
concentrations
Corrosive
Chlorine Bleaches: e.g. Bacteria, some spores, Prepare once a week.
Chlorox TM* 1:10 viruses, TB t, HIV Some spores It takes 20 minutes to
disinfect.
Corrosive.
A surface disinfectant.
Iodophors: e.g. 1:100 Bacteria, most viruses, Spores Iodine is insoluble so
TB it’s
WescodyneTM* not good in solutions
Corrosive
Alcohols: e.g. ethanol, 70% Bacteria, most viruses Spores, TB At 100% alcohols are a
isopropanol preservative!!
Flammable.
* The use of brand names does not imply a recommendation.
** Concentration of named brands.
t Use 1/5 dilution
 Methods of Sterilization or Disinfection; Activity Levels of Selected Liquid Germicides

Method Concentration or Level Disinfectant Activity

Sterilization
Heat
Moist Heat (steam under pressure) 250ºF(121ºC) or 271ºF(132ºC)

Dry Heat 171ºC for 1hr; 160ºC for 2 hrs.; 121ºC for
16 hrs.

Gas
Ethylene oxide 450-500 mg/L at 55-60ºC

Liquid
Glutaraldehyde Variable
Hydrogen peroxide 6-30%
Formaldehyde 6-8%
Chlorine dioxide Variable
Peracetic acid Variable
Disinfection
Heat
Moist heat (includes hot water 75-100ºC High
pasteurization)

Liquid
Glutaraldehyde Variable High to intermediate
Hydrogen Peroxide 3-6% High to intermediate
Formaldehyde 1-8% Hight to low
Chlorine dioxide Variable High
Peracetic acid Variable High
 Chlorine compounds 500-5,000 mg of free or available Intermediate
chlorine/ liter
Alcohol (ethyl, isopropyl) 70% Intermediate
Phenolic compounds 0.5-3% Intermediate to low
Iodophor compounds 30-50mg of free iodine/liter; up to 10,000 Intermediate to low
mg of available iodine/liter
Quarternary ammonium compounds 0.1-0.2% Low
Antisepsis
Alcohol (ethyl, isopropyl)
Iodophors 70%
1-2 mg of free iodine/L; 1-2% available
iodine
Chlorhexidine 0.75-4.0%
Hexachlorophene 1-3%
Parachlorometaxylenol 0.5-4.0%
 Methods of Assuring Adequate Processing and Safe Use of Medical Devices
Object & Classification
PATIENT -CARE OBJECTS
Critical
Sterilized in the hospital
Purchased as sterile
Example
Surgical instruments and
devices; trays & sets
Intravenous fluids; irrigation
fluids; normal saline; trays &
sets
Method
1. Thoroughly clean objects
and wrap or package for
sterilization.
2. Follow manufacturer’s
instructions for use of each
sterilizer or use
recommended protocol.
3. Monitor time-temperature
charts.
4. Use commercial spore
preparations to monitor
sterilizers.
5. Inspect package for
integrity & for exposure of
sterility indicator before
use.
6. Use before maximum safe
storage time has expired if
applicable
1. Store in clean, safe area.
2. Inspect package for
integrity before use.
Comment
Sterilization processes are
designed to have a wide
margin of safety. If spores are
not killed, the sterilizer should
be checked for proper use &
function; if spore test remain
positive, discontinue use of
the sterilizer until properly
serviced. Maximum safe
storage time of items
processed in the hospital
varies according to type of
package or wrapping material
used; follow manufacturer’s
instructions for use and
storage times.
Notify BFAD, local and
national departments if
intrinsic contamination is
suspected.

Semicritical
Should be free of vegetative
bacteria. Maybe subjected to
high-level disinfection rather
than sterilization process.
Noncritical
Usually contaminated with
some bacteria
Water-produced or treated
Respiratory therapy and
equipment & instruments that
will touch mucous membranes
Bedpans, crutches, rails, EKG
leads
Water used for hemodialysis
fluids
3. Use before expiration date
if one is given.
4. Culture only if clinical
circumstances suggest
infection related to use of
the item.
1. Sterilize or follow protocol
for high-level disinfection.
2. Bag & store in safe, clean
area.
3. Conduct quality control
monitoring after any
important changes in the
disinfection process.
1. Follow a protocol for
cleaning or if necessary a
low-level disinfection
process.
1. Assay water & dialysis
fluids monthly.
2. Water should not have
more than 200 bacteria/ml
& dialysis fluids not more
than 2000 bacteria/ml.
Bacterial spores may survive
after high level disinfection,
but these usually are not
pathogenic. Microbiologic
sampling can verify that a
high-level disinfection process
has resulted in destruction of
vegetative bacteria; however,
this sampling is not routinely
recommended.
Gram-negative water bacteria
can grow rapidly in water and
dialysis fluids and can place
dialysis patients at risk of
pyrogenic reactions or
septicemia. These water
sources & pathways should be
disinfected routinely.
 STERILIZATION, DISINFECTION AND ANTISEPSIS IN THE HOSPITAL

The effective use of antiseptics, disinfectants and sterilization procedures is important in

preventing nosocomial infections. The choice of agents and procedures to be used for hospital
environmental disinfection, sanitization and antisepsis depends on a variety of factors, and no
single agent or procedure is adequate for all purposes. Factors to be considered in selection of
procedures include the degree of microbial killing required, the nature of the item or surface to
be treated and the cost and ease of using the available agents.

DEFINITION OF TERMS:

1. Sterilization: use of a physical or chemical procedure to destroy all microbial life, including
large numbers of highly resistant bacterial endospores. This pertains to microorganisms
that may exist on inanimate objects. Moist heat by steam autoclaving, ethylene oxide gas,
and dry heat are the major sterilizing agents used.

2. Disinfection: eliminates virtually all recognized pathogenic microorganisms but not

necessarily all microbial forms (e.g. bacterial endospores) on inanimate objects. The
effectiveness of a disinfection procedure is controlled significantly by a number of factors,
each of which may have a pronounced effect on the end result. Among these are the
nature and number of contaminating microorganisms (esp. the presence of bacterial
endospores), the amount of organic matter (soil, feces, blood, etc.) present, the type and
configuration of the medical and surgical materials to be disinfected, the type and
concentration of chemical germicide used, and the time and temperature of exposure.
Chemical disinfection lacks sporicidal power.

3. LEVELS OF DISINFECTION:
a. High-level disinfection: minimum treatment recommendation for the
reprocessing of semi-critical instruments or devices. Includes glutaraldehyde,
chlorine dioxide, hydrogen peroxide, and peracetic-acid based formulations.
b. Intermediate-level disinfection: not capable of inactivating bacterial spores, but
inactive M. tuberculosis var bobis, fungi, lipid and most non-lipid medium-size and
small viruses. Examples are: alcohol (70-90% ethanol or isopropanol), chlorine
compounds (free chlorine, i.e. hypochlorous acids derived from sodium or calcium
hypochlorite, gaseous chlorine or chlorine dioxide (500 mg/liter) and certain
phenolic or iodophor preparations.
c. Low-level disinfection: kill rapidly vegetative forms of bacteria and most fungi as
well as medium-size or lipid containing viruses. Examples are quarternary
ammonium compounds and certain iodophors and phenolic compounds.
4. Decontamination: a process or treatment that renders a medical device, instrument, or
environmental surface safe to handle. Use of decontamination or treatment does not
necessarily ensure that the item is safe for patient reuse.
 5. Antisepsis: An antiseptic is a germicide that is used on skin or living tissue for the purpose
of inhibiting or destroying microorganisms.

3 GENERAL CATEGORIES OF PATIENT CARE EQUIPMENT:

1. Critical instruments or devices: instruments or objects that are introduced directly into
the bloodstream or into other normally sterile areas of the body. Examples are: surgical
instruments, cardiac catheters, implants, pertinent component of the heart-lung
oxygenator, and the blood compartment of a hemodialyzer. Critical items should be
sterilized. If sterilization is not feasible, they should be at a minimum receive a high-level
disinfection.

2. Semi-critical instruments or devices: these are items that make contact with mucous
membranes during use but do not ordinarily penetrate the blood barrier or enter other
normally sterile areas of the body. Examples are flexible and rigid fiberoptic endoscopes,
endotracheal tubes, laryngoscopes, vaginal specula, anesthesia breathing circuits, dental
equipment like amalgam condensers and ophthalmic devices like direct contact
tonometers. Meticulous physical cleaning followed by an appropriate high-level
disinfection is required.

3. Noncritical instruments or devices: do not ordinarily touch the patient or touch only
intact skin. These include instruments such as electrocardiogram electrodes, physical
measurement devices, blood pressure cuffs and stethoscopes, crutches, and bedboards.
Washing with detergent and water is sufficient or use of low level disinfectants either
alone or in addition to the cleansing.

RECOMMENDATIONS:
1. CLEANING:
 All objects to be disinfected or sterilized should first be thoroughly cleaned to
remove all organic matter (blood and tissue) and other residue.

2. INDICATIONS FOR STERILIZATION AND HIGH-LEVEL DISINFECTION:

 Critical medical devices or patient-care equipment that enter normally sterile
tissue or the vascular system through which blood flows should be subjected to a
sterilization procedure before each use.
 Laparoscopes, arthroscopes, and other scopes that enter normally sterile tissue
should be subjected to a sterilization procedure before each use; if this is not
feasible, they should at least receive a high-level disinfection.
  Equipment that touches mucus membranes, e.g. endoscopes, endotracheal tubes,
anesthesia breathing circuits, and respiratory therapy equipment should receive
high level disinfection.

3. METHODS OF STERILIZATION:
 Whenever sterilization is indicated, steam sterilizer should be used unless the
object to be sterilized will be damaged by heat, pressure, or moisture or is
otherwise inappropriate for steam sterilization. In this case, another acceptable
method of sterilization should be used.
 Flash sterilization (270ºF or 132 ºC for 3 minutes in a gravity displacement steam
sterilizer) is not recommended for implantable items.

4. BIOLOGICAL MONITORING OF STERILIZERS:

 All sterilizers should be monitored at least once a week with commercial
preparation of spores intended specifically for that type of sterilizer (i.e. Bacillus
stearothermophilus for steam sterilizers and Bacillus subtilis for ethylene oxide
and dry heat sterilizers).
 Every load that contains implantable objects should be monitored. These
implantable objects should not be used until the spore test is found to be negative
at 48 hrs.
 If spores are not killed in routine spore tests, the sterilizer should immediately be
checked for proper use and function and the spore test repeated. Objects other
than implantable objects, do not need to be recalled because of a single positive
spore test unless the sterilizer or the sterilization procedure is defective.
 If spore test remains positive, use of the sterilizer should be discontinued until it
is serviced.

5. USE AND PREVENTIVE MAINTENANCE:

 Manufacturers’ instructions should be followed for use and maintenance of
sterilizers.

6. CHEMICAL INDICATORS:
 Chemical indicators that will show a package has been through a sterilization cycle
should be visible on the outside of each package sterilized.

7. USE OF STERILE ITEMS:

 An item should not be used if its sterility is questionable; i.e. its package is
punctured, torn or wet.

8. REPROCESSING SINGLE-USE OR DISPOSABLE ITEMS:

 Items or devices that cannot be cleaned or sterilized or disinfected without
altering their physical integrity and function should not be reprocessed.
 Reprocessing procedures that result in residual toxicity or compromise the overall
safety or effectiveness of the items or devices should be avoided.
 INFECTION CONTROL POLICIES ON INTRAVENOUS PRACTICE

Observe principles of strict asepsis during the intravenous practice:

I. SETTING UP/INSERTING IV
1. Wash hands before starting an Intravenous line or before handling any IV equipment.
2. Always wear gloves when doing any venipuncture.
3. Identify the site for venipuncture. Choose appropriate vein, location, size, and condition.
4. Open administration set aseptically.
5. Use an approved antiseptic to clean the proposed IV site in circular motion. Allow 30
seconds to dry.
6. If necessary, cut or clip the hairs of the venipuncture site. Do not shave.
7. Never re-use a catheter or needle.
8. Anchor needle firmly in place. Apply dressing (sterile 2x2 gauze or transparent dressing)
to the venipuncture site. Do not cover the venipuncture site directly with a plaster or a
micropore, unless sterile.
9. Check for infiltration.
10. Discard sharps and other waste materials properly.
11. Wash hands after the procedure.
II. CHANGING AN IV INFUSION
1. Assess IV site for redness, swelling, pain, etc.
2. Check date of insertion, re-site if 48-72 hours has lapsed.
3. Wash hands before and after the procedure.
4. Discard all waste materials properly.
III. DISCONTINUING AN IV INFUSION
1. Wash hands before and after the procedure.
2. Remove plaster gently.
3. Remove needle or catheter then immediately apply pressure over the venipuncture site
using a clean cotton ball.
4. Discard all waste materials properly.
IV. BLOOD TRANSFUSION
1. Warm blood at room temperature by wrapping the blood bag with a towel.
2. Assess patient’s condition. Countercheck the compatible blood to be transfused against
the x-matching sheet.
3. Wash hands before and after the procedure.
4. Observe patient on an on-going basis for any untoward signs and symptoms.
5. Discard blood bag and BT set properly.
V. ADMINISTERING IV DRUGS
1. Wash hands before and after the procedure.
2. Use gloves especially for chemotherapeutic drugs.
3. Check IV site for any signs of swelling, redness, phlebitis, etc. before giving the drug.
4. Check skin test results of drug for IV push, drug-drug, drug-IV fluid incompatibility.
5. Disinfect the Y-injection port of the IV set with a cotton swab with alcohol piercing.
6. Discard sharps and other wastes properly.
 GUIDELINES FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS

Catheter Use
a. Insert urinary catheters only when necessary.
b. Leave in place the catheter for as long as necessary.
Handwashing
a. Perform handwashing immediately before and after any manipulation of the catheter
site or apparatus.
Catheter Insertion
a. Use aseptic technique and sterile equipment.
b. Use gloves, drape, sponges, an appropriate antiseptic solution for periurethral cleaning,
and a single-use packet of lubricant jelly.
c. Use a small catheter as possible, consistent with good drainage to minimize urethral
trauma.
d. Properly secure indwelling catheters after insertion to prevent movement and urethral
traction
Closed Sterile Drainage
a. Maintain a sterile, continuously closed drainage system.
b. Do not disconnect catheter and drainage tube unless the catheter must be irrigated.
c. If breaks in aseptic technique, disconnection or leakage occur, the collecting system
should be replaced using aseptic technique after disinfecting the catheter-tubing
junction.
Irrigation
a. Use aseptic technique in performing irrigation.
b. Avoid irrigation unless obstruction is anticipated (e.g. as might occur with bleeding after
prostatic or bladder surgery). Use a closed continuous irrigation to prevent obstruction.
Use an intermittent method of irrigation to relieve obstruction due to clots, mucus, or
other causes. Do not perform continuous irrigation of the bladder with antimicrobials.
c. Disinfect the catheter-tubing junction before disconnection.
d. Use a large-volume sterile syringe and sterile irrigant then discard after use.
e. If the catheter becomes obstructed and can be kept open only by frequent irrigation,
the catheter should be changed if it is likely that the catheter itself is contributing to the
obstruction (e.g. formation of concretions)
Specimen Collection
a. If small volumes of fresh urine are needed for examination, clean the distal end of the
catheter, or preferably the sampling port (if present), with disinfectant. Aspirate the
urine with a sterile needle and syringe.
 b. If larger volumes of urine are needed for special analyses, obtain sample aseptically
from the drainage bag.
Urinary Flow
a. Maintain an unobstructed urine flow unless necessary for specimen collection and other
medical purposes.
b. To achieve free flow of urine
 Keep the catheter and collecting tube from kinking
 Empty the collecting bag regularly using a separate container for each patient.
Avoid contact of the draining spigot and the nonsterile collecting container.
 Irrigate poorly functioning or obstructed catheters or replace if necessary.
 Always keep collecting bags below the level of the bladder.
Meatal Care
a. Clean meatus twice a day with povidone-iodine solution or daily cleansing of soap and
water.
Catheter Change Interval
a. Indwelling catheters should not be changed at arbitrary fixed intervals.
Spatial Separation of Catheterized Patients
a. Infected and uninfected patients with indwelling catheters should not share the same
room or adjacent beds.
 HANDLING OF CHEMOTHERAPEUTIC DRUGS

1. Personal Protective Equipment

a. Use double nitrite gloves, or gloves designed specifically for chemotherapy when handling
any cytotoxic agents. Be careful not to puncture cut or tear the gloves. Discard after each
use or when contaminated.
b. Wear protective eye goggles and smock gown that can be taken off quickly if
contaminated for maximum safety.
c. Use face shields if necessary to prevent accidental splashes, sprays or aerosols.
d. Wash hands after removing PPEs.
2. Safe Work Practice
a. Conduct all work in a “designated area”.
b. Ensure that all containers are labeled with the name of the material and with the warning
label, such as “Toxic, Special Handling Required”.
c. Use syringes with retractable needles (engineered sharps) and place in a sharps container
after use.
d. Ampules with dry material should be gently tapped down.
3. Patient Identification System
a. An orange chemotherapy/biohazard sticker is placed at the door to identify patients
receiving or have received cytotoxic drugs within the last 48 hours.
b. The sign should be removed 48 hours after the last dose of chemotherapy or following
appropriate cleaning of rooms after the patient is discharged.
c. The staff/attending physician with the primary responsibility for the patient when
chemotherapy is started is responsible for posting the sticker at the start of
chemotherapy, and for removing the sign 48 hours after completion of chemotherapy.
4. Patient Waste Precautions (within 48 hours of administration)
a. Latex or nitrile gloves must be worn when handling or collecting urine, blood, sputum or
fecal material from patients who have received cytotoxic drugs, and while handling the
linen or trash generated from those patients.
b. Linen, which is overtly soiled with discharge from a patient receiving cytotoxic agents
must be placed in clear plastic linen bags or orange bags. An orange
chemotherapy/biohazard sticker shall be affixed to this bag and the bag taped shut.
c. Excreta may be disposed of through a sewer system.
d. Contaminated disposable supplies (i.e. dressings and specimen collectors) must be placed
in clear plastic waste bags or orange bags as described above.
e. Sharps and lass must be placed in sharps chemotherapy disposal container.
5. Disposal
 a. Chemotherapeutic wastes (empty vials, fluid lines, catheters, syringes, needles, gloves,
supernatant or any item that could have residue of the toxic chemical) should be placed
in a puncture-proof container.
b. Lid and sides should be labeled with “Chemotherapy Waste” or “CHEMO”. Contact
medical waste collection sites if available.
6. Spills/Accidental Exposure
a. Report all accidental spills to the ICC. Chemo Spill Report Forms are available and should
be completed following each chemo spill cleanup. Completed report forms should be
returned to ICC.
b. Obtain medical attention for any accidental eye contact, ingestion, or inhalation of the
material.
c. Remove contaminated clothing.
d. For contaminated skin, wash thoroughly with soap and water. Rinse well.
e. For the eyes, use an eye wash continuously for 15 minutes or flushed with water for 15
to 20 minutes at the nearest sink and obtain medical attention.
7. Cleaning-up of Spills
A. Small pills (less than 5 ml in volume)

a. Wipe liquids with absorbent gauze pads; Solids should be wiped with wet
absorbent gauze.
b. Decontaminate area with sodium carbonate solution (1% for trace materials on
surfaces and 10% for large quantities or solutions containing paclitaxel for 30
minutes or methanolic potassium hydroxide (30% 1 KOH and 70% methanol) for 5
minutes.

Caution: KOH is corrosive and eye protection and chemical resistant gloves should
be worn.

c. Dispose contaminated materials as hazardous cytotoxic material.

d. Clean spill areas three times (3x) using a detergent solution followed by clean
water.
e. Any broken glass fragments should be picked up using a small scoop (never the
hands) and placed in a “Chemotherapy Waste” container along with all other
contaminated waste.

B. Large spills (greater than 5 ml in volume)

When a large spill occurs, the area should be isolated and aerosol generation avoided.
a. All personnel responding to a spill should wear disposable gowns, double nitrile
gloves, and respirators for powdered materials and for protection against aerosols.
 b. If the spill is greater than 5 ml in volume, cover the area with absorbent sheets or spill
control pads. If powder is involved, damp cloths or towels should be used.
c. If an extensive amount of material spilled (e.g. entire contents of one vial) inside a
biological safety cabinet or fume hood, then the entire interior surface needs to be
decontaminated.
6. Decontamination
a. One person should be responsible for cleaning/decontaminating the area of the spill.
b. PPE should be used.
c. All contaminated areas should be washed three times (3x) with soap and water.
d. All waste should be enclosed in a large heavy-duty plastic waste bag, labeled, and
disposed of appropriately. All needles and syringes must be placed as a single unit.
7. Occupational Exposure
a. Exposure can occur by ingestion, inhalation or absorption through the skin or mucous
membranes.
b. Pregnant employees and those who are attempting to become pregnant are encouraged
to discuss effects of exposure to cytotoxic drugs to pregnancy.
c. Adherence to safety procedures is strongly encouraged.
 CYTOTOXIC DRUG SPILL REPORT FORM

Complete this form and return it to the Infection Control Committee to document occurrence of
cytotoxic drug spill.

Name of drug spilled: _____________________________________________________

Spill reported by: (name)_____________________________________________________

(designation)________________________________________________

Date of spill: ____________________

Time of spill: ____________________
Location of spill (Room#) ____________________

When did the spill occur?

__________Before drug administration

__________During drug administration
__________After drug administration

Cause of spill:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Approximate volume spilled:

_____Less than 10 cc
_____10 cc
_____20 cc
_____30 cc
_____40 cc
_____More than 50 cc

Who cleaned up the spill?

_____________________________________