Page 82 - policy and procedure infection control

Policies and Procedures on Infection Control

5.3.3 Prevention of Postoperative Pneumonia
The following patients are high risk for developing postoperative pneumonia:
i. Age >60 years
ii. History of chronic lung disease or smoking

iii. On steroids for chronic conditions
iv. History of chronic alcohol consumption
v. Impaired sensorium
vi. History of cerebrovascular accident with residual neurologic deficit
vii. General anaesthesia
viii. Upper abdominal or thoracic surgery
ix. Emergency surgery
xi. Obesity

1. Patients at risk should receive pre and postoperative instructions on deep breathing
exercises and incentive spirometry.
2. Encourage all postoperative patients to take deep breaths and ambulate them as
soon as possible postoperatively, unless medically contraindicated.
3. Provide adequate postoperative analgesia to facilitate effective coughing and deep breathing.

5.3.4 Sterilization or disinfection and maintenance of respiratory equipment and devices
1. For sterilization or disinfection of respiratory equipment, refer policy and procedure
of nosocomial infection in general intensive care unit.

2. Do not routinely sterilize or disinfect the internal machinery of mechanical ventilators
3. Do not routinely change the ventilator breathing circuit on the basis of duration of
use. Change the ventilator breathing circuit when visibly soiled.
4. Drain and discard periodically any condensate in the circuit. Take precautions not to
allow the condensate to drain towards the patient.
5. Use sterile water to fill bubble-through humidifiers.
6. Do not routinely change more frequently than every 48 hours an HME that is in use
on a patient. Change when it malfunctions mechanically or becomes visibly soiled.
7. Change the oxygen delivery system (tubing, nasal prongs or mask) that is in use on
one patient when it malfunctions or becomes visibly contaminated or between uses
on different patients.

8. Clean, disinfect, rinse with sterile water and dry nebulizers between treatments on
the same patient. Replace nebulizers with those that have undergone sterilization or
high-level disinfection between uses on different patients.

Ministry of Health Malaysia 71