Infection Control in CSSD

Your Heart…Our Passion

RUSMAWATI KHOSIM

(INFECTION CONTROL NURSE)

INSTITUT JANTUNG NEGARA

Click to edit Master title styleINSTITUT JANTUNG NEGARA

National Heart Institute

(IPSG 5)



INFECTION CONTROL UNIT

All clinical area

(ward, ICU, CCU, Renal unit)

Out patient and emergency department

Engineering and Facilities

department

Pharmacy LaboratoryNon Invasive

Cardiac Lab and ICL

OT CSSD Kitchen

Mortuary



HEALTH CARE ASSOCIATED INFECTION

Healthcare Associated Infection

Blood stream

Infection

Pneumonia

Urinary Tract

Infection

Surgical Site Infection

http://www.google.com.sg/imgres?imgurl=http://i.ehow.com/images/a05/a9/rb/antibiotics-staph-strep-infections-200X200.jpg&imgrefurl=http://www.ehow.com/about_5580651_antibiotics-staph-strep-infections.html&usg=__xWM7Pn7tcFGh0yQnRxQxLpgTE-k=&h=200&w=200&sz=44&hl=en&start=38&zoom=1&tbnid=57ovAgPBejiwQM:&tbnh=104&tbnw=104&prev=/images?q=types+of+infections&start=20&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1



INFECTION CONTROL

AND

CSSD



CENTRAL STERILE SUPPLY DEPARTMENT

Instrument Processing

Prolong hospital

Stay

Increased Hospital

cost

Cause death

X



CHAIN OF INFECTION

Infectious Agent

Reservoir

Mode

of

escape

Mode of transmission

Portal

of

entry

Susceptible host



CHAIN OF INFECTION

Infectious agent

Prion Parasite Bacteria Virus Fungi

http://www.google.com.sg/imgres?imgurl=http://www3.niaid.nih.gov/NR/rdonlyres/58C1A3DB-3E32-4DB1-8745-12D934001AA5/0/Tvaginalisparasite.jpg&imgrefurl=http://www.nih.gov/news/pr/jan2007/niaid-11.htm&usg=__3g0K43qSDYB18C5iaaFvdP1sYpM=&h=435&w=580&sz=143&hl=en&start=13&zoom=1&tbnid=Qk2CclPxMn2gsM:&tbnh=101&tbnw=134&prev=/images?q=parasite&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.vedicsciences.net/design/bacteria5.jpg&imgrefurl=http://www.vedicsciences.net/articles/dawkins-evolution-challenge.html&usg=__PLhQW_hLutDZ13eNQ9OFhRZaDxw=&h=400&w=400&sz=44&hl=en&start=2&zoom=1&tbnid=KSKqyaolCmEirM:&tbnh=124&tbnw=124&prev=/images?q=bacteria&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://scienceblogs.com/retrospectacle/upload/2007/02/Prion2.gif

http://www.google.com.sg/imgres?imgurl=http://www.uu.edu/studentservices/healthservices/commonillnesses/PE07292_.gif&imgrefurl=http://www.uu.edu/studentservices/healthservices/commonillnesses/common_illnesses.htm&usg=__jmuRt_B-mjRwdOgmBDolElyqr9Y=&h=365&w=424&sz=9&hl=en&start=1&zoom=1&tbnid=LvoNr1ryXlMm9M:&tbnh=108&tbnw=126&prev=/images?q=illness&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://i.livescience.com/images/060104_hiv_virus_02.jpg&imgrefurl=http://www.livescience.com/php/multimedia/imagedisplay/img_display.php?pic=060104_hiv_virus_02.jpg&cap=A+three-dimensional+model+of+the+HIV+virus.+Credit:+3DScience.com&usg=__d9baIrb-LX2_gD-nUj7Z1-y-N1I=&h=400&w=400&sz=41&hl=en&start=7&zoom=1&tbnid=3chL6KcY79vf4M:&tbnh=124&tbnw=124&prev=/images?q=virus&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.independent.co.uk/multimedia/archive/00091/pg-20-fungi-alamy_91555t.jpg&imgrefurl=http://www.independent.co.uk/news/science/fungi-scientists-are-endangered-species-1038862.html&usg=__q0o7zFNemgxn8jAp9ugqlceyOpc=&h=374&w=300&sz=25&hl=en&start=4&zoom=1&tbnid=_busDb6I600FcM:&tbnh=122&tbnw=98&prev=/images?q=fungi&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1



CHAIN OF INFECTION

Reservoir

Places where the micro organism able to multiply

http://www.google.com.sg/imgres?imgurl=http://images.clipartof.com/small/66778-Royalty-Free-RF-Clipart-Illustration-Of-Two-Green-Microorganisms.jpg&imgrefurl=http://www.clipartof.com/details/clipart/66778.html&usg=__jtIiMQdHwbFca2WbACeNBoYtjO8=&h=450&w=308&sz=76&hl=en&start=24&zoom=1&tbnid=Oc-b6c8e2ai1kM:&tbnh=127&tbnw=87&prev=/images?q=microorganism+graphic&start=20&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.latexsens.com/your own helping hand.jpg&imgrefurl=http://www.latexsens.com/ourhelpinghands.htm&usg=__Fui-KlbolJrAOysAhrmBpwNqFi8=&h=1024&w=1024&sz=54&hl=en&start=14&zoom=1&tbnid=QCfVXqhI_nPCQM:&tbnh=150&tbnw=150&prev=/images?q=hand&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://static-p4.fotolia.com/jpg/00/05/63/33/400_F_5633305_8wQPvzmuy6OGlyKTJhkGFUya6TQAyh8w.jpg&imgrefurl=http://en.fotolia.com/id/5633305&usg=__zOEv49PkRnBqZEMwUwsTYx_AqvE=&h=298&w=400&sz=54&hl=en&start=20&zoom=1&tbnid=RmHFU1KgPsvuWM:&tbnh=92&tbnw=124&prev=/images?q=microorganism+graphic&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1



CHAIN OF INFECTION

Mode of escape/Portal of entry

microorganism leave the reservoir, commonly by

respiratory, genitourinary, skin or mucous

membrane



CHAIN OF INFECTION


Contact/hands Airborne Vector

http://www.google.com.sg/imgres?imgurl=http://www.trondheimanglicans.net/sitebuildercontent/sitebuilderpictures/handshake.jpg&imgrefurl=http://www.trondheimanglicans.net/&usg=__h-3JeO_ihL24q5Jc5ONH4lf1-o0=&h=600&w=846&sz=32&hl=en&start=12&zoom=1&tbnid=C3XnF9O9Am48sM:&tbnh=103&tbnw=145&prev=/images?q=handshake&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.havenhealth.nhs.uk/userfiles/image/wigglypics/coughing.jpg&imgrefurl=http://www.havenhealth.nhs.uk/self-help-for-common-health-problems,37667.htm&usg=__SAMknz3YSQwmp1pfta0UKJoomLE=&h=469&w=486&sz=32&hl=en&start=1&zoom=1&tbnid=W0-STNZlJtA4tM:&tbnh=124&tbnw=129&prev=/images?q=coughing&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.lifelongsharing.com/wp-content/uploads/sneezing.gif&imgrefurl=http://www.lifelongsharing.com/index.php/2009/04/28/i-keep-sneezing-today/&usg=__TS-RPvhW-iOFYX87alAOEB_oZF0=&h=512&w=491&sz=12&hl=en&start=2&zoom=1&tbnid=xQlxRFdlGXD7WM:&tbnh=131&tbnw=126&prev=/images?q=sneezing&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://ykalaska.files.wordpress.com/2006/11/sneeze.jpg&imgrefurl=http://ykalaska.wordpress.com/2006/03/21/why-cover-sneezes/&usg=__Pes6FgJyxooBRUD2GRBrec9wV1c=&h=298&w=456&sz=21&hl=en&start=5&zoom=1&tbnid=6CDX7LJiKfmlVM:&tbnh=84&tbnw=128&prev=/images?q=airborne+disease&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://blog.ecosmart.com/wp-content/mosquito.jpg&imgrefurl=http://blog.ecosmart.com/index.php/2009/08/17/are-you-a-target-for-mosquitoes/&usg=__Ned3Ox7O7R20i9zhPbTCKWunJfo=&h=249&w=335&sz=8&hl=en&start=4&zoom=1&tbnid=D7dXNh8UIo9kGM:&tbnh=88&tbnw=119&prev=/images?q=mosquitoes&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://mypetjawa.mu.nu/archives/fly.jpg&imgrefurl=http://mypetjawa.mu.nu/archives/195005.php&usg=__bIGpgaX8H6a-yu2yopphsR6Txbo=&h=393&w=500&sz=104&hl=en&start=5&zoom=1&tbnid=yfP_GxW-O6oZ_M:&tbnh=102&tbnw=130&prev=/images?q=fly&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://pestcommand.com/wp-content/uploads/2007/12/dust_mite.jpg&imgrefurl=http://pestcommand.com/?p=36&usg=__Okm04R8IqU2qWkurMz39zULUysc=&h=1221&w=909&sz=104&hl=en&start=8&zoom=1&tbnid=I8X1wjLRFNHxBM:&tbnh=150&tbnw=112&prev=/images?q=mites&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1



CHAIN OF INFECTION

Portal of entry

Digestion Wound Suction Lines

http://www.google.com.sg/imgres?imgurl=http://intensivecare.hsnet.nsw.gov.au/five/images/suction.jpg&imgrefurl=http://intensivecare.hsnet.nsw.gov.au/suction-catheters&usg=__f0RfhO1TkbLXd_qPX_VV9ya6k3U=&h=1760&w=1168&sz=729&hl=en&start=3&zoom=1&tbnid=YHs5Ax4KpwnheM:&tbnh=150&tbnw=100&prev=/images?q=suction&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://theemtspot.com/wp-content/uploads/2009/05/Firefighter-IV.jpg&imgrefurl=http://theemtspot.com/2010/02/04/how-to-set-up-an-iv-line-firefighter-style/&usg=__rAnV5foK0IEovWDMcY36pU35Z8s=&h=1356&w=1620&sz=157&hl=en&start=6&zoom=1&tbnid=YzS9wh30dWq3aM:&tbnh=126&tbnw=150&prev=/images?q=IV+lines&hl=en&sa=N&gbv=2&tbs=isch:1&itbs=1



CHAIN OF INFECTION

Immune suppress patient

Invasive procedure

Non intact skin

Susceptible host



BREAKING THE CHAIN

Leadership

Accountability Evidence based guidelines and

regulation incorporated into

policies and procedures

Continuous Training



Decontamination

OR



Decontamination

Infectious Agent

Reservoir

Mode

of

escape


Portal

of

entry

Susceptible host X

X

X



Packaging



Packaging

Inspection



Packaging

Packing



Packaging

FIFO



Infectious Agent

Reservoir

Mode

of

escape


Portal

of

entry

Susceptible host X

X

Packaging

X



Sterilizer: Daily Maintenance

Autoclave:

Every morning

Before first

load/test



Sterilization: Monitoring



Infectious Agent

Reservoir

Mode

of

escape


Portal

of

entry

Susceptible host X

X

Sterilization

X



CDC reported…..

CDC

Surgical site infections are the

most common adverse event for surgical patients

Disinfection and sterilization- surgical

and medical instruments do not transmit infectious

pathogens to patients



ACCREDITATION

http://www.google.com.sg/imgres?imgurl=http://www.people.iup.edu/rgvp/images-tree care accreditation.jpg&imgrefurl=http://www.people.iup.edu/rgvp/Implications of Writing Center Accreditation.htm&usg=__mOYVhhPkE7_cCzpypUZwLjtDG0M=&h=1432&w=1709&sz=405&hl=en&start=7&zoom=1&tbnid=kjA0Ak59kDd5eM:&tbnh=126&tbnw=150&prev=/images?q=accreditation&hl=en&sa=G&gbv=2&tbs=isch:1&itbs=1

http://www.google.com.sg/imgres?imgurl=http://www.ewashtenaw.org/government/departments/cmhpsm/provider-homepage/Accreditation Council/images/JCAHO&imgrefurl=http://www.ewashtenaw.org/government/departments/cmhpsm/provider-homepage/Accreditation Council/Accrediation&usg=__rAvGjYnZMKJY64zyEs82z2BXwUc=&h=375&w=374&sz=16&hl=en&start=13&zoom=1&tbnid=PE8CDHqUIiRn8M:&tbnh=122&tbnw=122&prev=/images?q=accreditation&hl=en&sa=G&gbv=2&tbs=isch:1&itbs=1



Training Staffing

Standardization

Safety Environment



ACCREDITATION

TrainingOrientation, training and competency of the HCW who

process medical equipment, devices and supplies




ACCREDITATION

StaffingLevels of staffing and supervision of HCW who process

medical equipment, devices and supplies




ACCREDITATION

StandardizationStandardization of the process regardless of whether

it is centralized or decentralized




ACCREDITATION

Safety•Continuous nursing education of the CSSD staff :

•Hand hygiene•Personal Protective Equipment

•Spillage, waste, linen and needle stick




ACCREDITATION

EnvironmentRecording of the temperature and humidity in sterile store t

o ensure the sets are kept at the recommended levelAir sampling report after changing of hepa filter in

sterile store




Our Role

• To ensure the nurses are following the procedure of receiving and returning the dirty sets to CSSD

• Cleaning of used equipment are not allowed to be done in the ward (centralized cleaning in CSSD)

Decontamination

• To ensure the CSSD sets are arranged according to FIFO

• Education on the importance of hand hygiene before handling the sterile sets.

Sterile Store



• Regular audit in the wards on the storage of CSSD sets

• To ensure the sterile CSSD set are kept properly in the ward in a dedicated cupboard

Ward

• Air sampling in CSSD sterile store every time the hepa filter is changed.

• Regular audit on the environmental cleanliness of the CSSD working area by CSSD Infection Control Link Nurse

Environment

Our Role



JCI ACCREDITATIONS



….THANK YOU

Infection Control in CSSD

Documents

Transcript of Infection Control in CSSD