Page 79 - policy and procedure infection control

Policies and Procedures on Infection Control

5.2.4.3 Microbiologic sampling
1. Do not perform routine environment sampling of the OR. Perform
microbiologic sampling of OR environment surfaces or air only as part of an
epidemiologic investigation, or when there is gross violation of the OR sterility,
or when there is an increased in SSIs.

5.2.4.4 Sterilization and disinfection of surgical and other medical instruments
1. Critical items - instruments or objects that enter directly into the vascular
system or sterile areas of the body. These items should be sterilized
according to the recommended approved sterilization methods; such as
steam under pressure, dry heat, ethylene oxide, or other approved methods.
Flash sterilization should only be used for emergency situation with the
conditions that the instruments must be already manually cleaned,
decontaminated, and properly arranged in the container before sterilization.
Implantables should not be flash sterilized.
2. Semi-critical items - instruments or objects that come into contact with
mucous membranes or skin that is not intact (bronchoscopes and
gastroscopes), such items generally require high-level disinfection that kills
all microorganisms except bacterial spores. The approved disinfectants are
glutaraldehyde 2%, and orthophthaidehyde (OPA) which is a newer agent
approved by FDA. In order to achieve high-level disinfection, make sure that
the internal and external surfaces and channels should come into contact
with the disinfecting agent for a minimum of 20 minutes.
3. Non-critical items - instruments or objects that come in contact with intact
skin (e.g., blood pressure cuffs). They generally require only washing or scrubbing
with a detergent and warm water or disinfection agents such 70% alcohol.
4. Reuse of single-use medical devices is not encouraged although the implied
cost is a major concern.
5.2.4.5 Surgical attire and drapes
1. The mask must fully covers the mouth and nose when entering the OR if an
operation is about to begin or already under way, or when sterile instruments
are exposed. The mask must be wear throughout the operation.
2. Wear a cap or hood to fully cover hair on the head and face when entering
the OR.
3. Wear sterile gloves if a scrubbed surgical team member. Put on gloves after
donning a sterile gown.
4. Use surgical gowns and drapes that are effective barriers when wet.
5. Change scrub suits whenever it is soiled, contaminated, and/or penetrated
by blood or other potentially infectious materials.
6. Double gloving for any invasive surgical procedures.
7. Special surgical gown/attire e.g., space suit in arthroplasty surgery, because
of the potential prolonged serious morbidity/mortality post-op complication
if SSI set in.

68 Ministry of Health Malaysia