1、PLUS 1112Infection prevention and control in office-based health care and allied servicesLegal NoticeThis document is provided by the Canadian Standards Association (CSA) as a convenience only. The opinions in this document are the opinions of the author(s) and not the opinions of CSA. Disclaimer an
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11、he terms and conditions contained in this Legal Notice, you may not use this document. Use of this document constitutes your acceptance of the terms and conditions of this Legal Notice.Published in March 2004 by Canadian Standards AssociationA not-for-profit private sector organization5060 Spectrum
12、Way, Suite 100, Mississauga, Ontario, Canada L4W 5N61-800-463-6727 416-747-4044Visit our Online Store at www.csa.caPLUS 1112Infection prevention and control in office-based health care and allied servicesbyPauline Fallis R.N., B. Admin (HS), C.I.C.CSA Special PublicationISBN 1-55397-607-XTechnical E
13、ditor: Jeffrey Kraegel Canadian Standards Association 2004All rights reserved. No part of this publication may be reproduced in any form whatsoever without the prior permission of the publisher.PLUS 1112March 2004 Canadian Standards Association iiiContentsPreface ixOne Ethical responsibilities 11Ove
14、rview12 General responsibilities 13 Responsibilities to your patients/clients 14 Responsibilities to your co-workers and other health care providers 1Two Micro-organisms and infection 21Overview22 Positive aspects of micro-organisms 23 Harmful aspects of micro-organisms 23.1 How micro-organisms caus
15、e infections or disease 23.2 Spread of infection 34 Chain of infection 44.1 The infectious agent 44.2 Reservoir 54.3 Portal of exit 64.4 Mode of transmission 64.5 Portal of entry 74.6 Susceptible host 75 Immunity 85.1 Resisting infection 85.2 Specific defence mechanisms 85.3 Non-specific defence mec
16、hanisms 95.4 External factors affecting immunity 96 Signs and symptoms of an infection 9Three Infection prevention and control 101 What is infection prevention and control? 102 The institutional experience 10Four Infection prevention and control precautions 111Overview112 Handwashing 112.1 Importanc
17、e of handwashing 112.2 Recommended handwashing technique 112.3 Hand sanitizing 113Gloves123.1 When to use gloves 123.2 Guidelines for using gloves 124 Protective eyewear 125Masks125.1 When to use a mask 125.2 How to use a mask 13PLUS 1112iv Canadian Standards Association March 2004Infection preventi
18、on and controlin office-based health care allied services6 Aprons and gowns 137 Handling specimens 138Sharps13Five Planning for infection prevention and control 141Overview142 Primary considerations 143 Procedures 14Six Patient-care area preparation 161Overview162 Handling patients/clients 163 Care
19、and cleaning of the physical facilities 174 Sample cleaning schedule 17Seven Reprocessing reusable medical devices and equipment 191Overview192 Determining reprocessing requirements 193 Essential reprocessing elements 20Eight Cleaning 211Overview212 The cleaning process 212.1 Sorting 212.2 Soaking 2
20、12.3 Washing 212.4 Rinsing 232.5 Drying 232.6 Inspecting 232.7 Lubricating 243 Cleaning problematic devices and materials 243.1 Instructions and guidelines 243.2 Crevices 243.3 Lumens 243.4 Powered instruments 243.5 Materials 253.5.1 Aluminum 253.5.2 Glassware 253.5.3 Rubber goods 253.5.4 Stainless
21、steel 253.5.5 Textiles 254 Mechanical cleaning 254.1 Types of washers 254.2 Mechanical washers 264.3 Ultrasonic washers 26PLUS 1112March 2004 Canadian Standards Association vContentsNine Disinfection 281Overview282 Liquid chemical disinfectants 283 Pasteurization 344 Ultraviolet (UV) radiation 34Ten
22、 Packaging for sterilization 351Overview352 Essential criteria 352.1 Micro-organism barrier 352.2 Durability 352.3 Ease of use 352.4 Seal of integrity 352.5 Residue-free 362.6 Flexible and memory-free 362.7 Hole-free 362.8 Inert 362.9 Economy and availability 362.10 Suitability 363 Packaging materia
23、ls 363.1 Types of packaging materials 363.2 Reusable materials 373.3 Single-use materials Paper, plastic, and combinations 374 Wrapping techniques 374.1 General wrapping techniques 374.2 Textile wrapping techniques 384.3 Wrapping with paper/plastic pouches 414.4 Guidelines for using paper/plastic po
24、uches 414.5 Single-use material 415 Rigid sterilization containers 416 Labelling 42Eleven Sterilization 431Overview432 Sterilization indicators 432.1 Types of sterilization indicators 432.2 Interpreting and acting on indicator results 443 Guidelines for sterilization 453.1 General guidelines for ste
25、rilization 453.2 Guidelines for testing sterilization equipment 453.2.1 New equipment 453.2.2 Routine testing 454 Steam sterilization 464.1 Using steam sterilization 464.2 Conditions for steam sterilization 464.3 Common causes of steam sterilization failure 464.4 Types of steam sterilizers 474.4.1 T
26、able-top sterilizers 474.4.2 Table-top sterilizers with a cassette chamber 494.4.3 Table-top sterilizers with a basket 49PLUS 1112vi Canadian Standards Association March 2004Infection prevention and controlin office-based health care allied services4.5 Loading the sterilizer 514.6 Unloading the ster
27、ilizer 514.7 Monitoring steam sterilization 524.8 Using BIs with steam sterilizers 524.9 Cleaning steam sterilizers 524.10 Maintaining steam sterilizers 535 Dry heat sterilization 535.1 How dry heat sterilization works 535.2 Advantages of dry heat sterilization 535.3 Disadvantages of dry heat steril
28、ization 545.4 Common causes of dry heat sterilization failure 545.5 Preparing items for dry heat sterilization 545.6 Loading dry heat sterilizers 545.7 Monitoring dry heat sterilization 555.7.1 Using BIs with dry heat sterilization 555.7.2 Using CIs with dry heat sterilization 555.8 Cleaning dry hea
29、t sterilizers 555.9 Maintaining dry heat sterilizers 556 Chemical vapour sterilization 566.1 When to use chemical vapour sterilization 566.2 Monitoring chemical vapour sterilization 566.3 Maintaining chemical vapour sterilizers 567 Liquid chemical sterilization 577.1 Using liquid chemicals for steri
30、lization 577.2 2 % alkaline glutaraldehyde 577.3 Peroxyacetic acid 577.4 Sodium hypochlorite 588 Sterilization record keeping 58Twelve Reuse of single-use medical devices (SUD) 60Thirteen Storage of sterile supplies 611Overview612 Basic principles of storing sterile supplies 613 Adapting the basic p
31、rinciples 614 Storing sterile supplies 624.1 Shelf life 624.2 Ensuring that sterile packages remain sterile 624.3 Guidelines for handling sterile medical supplies 624.4 Dust covers 62Fourteen Medical waste management 631Overview632 Medical waste regulations 633 General precautions 644 Medical waste
32、procedures 644.1 Segregating waste 644.2 Using garbage bags, closures, and containers 654.3 Handling waste 664.4 Maintaining reusable waste containers, carts, and storage areas 664.5 Locating and maintaining long-term storage areas 66PLUS 1112March 2004 Canadian Standards Association viiContents4.6
33、Handling spills 664.7 Handling blood and body fluid spills 665 Biomedical human and animal anatomical waste 675.1 Definition 675.2 Human anatomical waste 675.3 Animal anatomical waste 676 Contaminated sharps 676.1 Definition 676.2 Handling of contaminated sharps 676.3 Disposal of contaminated sharps
34、 687Chemical waste687.1 Definition 687.2 Handling of chemical waste 687.3 Disposal of chemical waste 688Pharmaceutical waste688.1 Definition 688.2 Reducing pharmaceutical waste 688.3 Handling and disposal of cytotoxic pharmaceutical waste 688.3.1 Cytotoxic pharmaceutical waste 688.3.2 Cleaning up a
35、cytotoxic spill 698.4 Handling and disposal of non-cytotoxic pharmaceuticals 708.5 Disposal of narcotics and controlled drugs 709 Radioactive waste 7010 Pressurized container waste 7110.1 Definition 7110.2 Handling of pressurized container waste 7110.3 Disposal of pressurized container waste 7111 Ge
36、neral waste 7111.1 Definition 7111.2 Handling of general waste 7111.3 Disposal of general waste 71Fifteen Occupational health 721 Guidelines for an effective occupational health program 722 Diseases that require work restrictions 72Sixteen Procedures forparticulardisciplines 731 Chiropody/podiatry 7
37、31.1 General procedures 731.2 Routine procedures 731.3 Surgery and treatment of open lesions (ulcers or draining wounds) 741.4 Recommended supplies and equipment 742 Chiropractic office 742.1 General procedures 742.2 Recommended supplies and equipment 753 Dental practice 753.1 General procedures 753
38、.2 Handling of special equipment and supplies 753.3 Personal protection 763.4 Recommended supplies and equipment 76PLUS 1112viii Canadian Standards Association March 2004Infection prevention and controlin office-based health care allied services4 Electrolysis clinic 774.1 General procedures 774.2 Cl
39、ient safety procedures 774.3 Recommended supplies and equipment 775 Laboratory services 785.1 General procedures 785.2 Recommended supplies and equipment for laboratories 786 Medical practice 796.1 Screening patients for infectious disease 796.2 Examination area 796.3 Specific items used in medical
40、practices 796.4 Recommended supplies and equipment for medical practices 797 Osteopathic practice 817.1 General procedures 818 Physiotherapy practice 818.1 General procedures 818.2 Recommended supplies and equipment 81Glossary 82Bibliography 89Tables1 Signs and symptoms of specific infections 92 Com
41、mon liquid chemical disinfectants 303 Recommended minimum temperatures and times 554 Waste colour-coding/labelling requirements 655 Handling of special medical equipment and supplies 80Figures1 The chain of infection 32 Structure of a virus 43 Types of bacteria 54 Detailed chain of infection 65 Brea
42、king the chain of infection 86 Washing with plain water 227 Washing with a detergent solution 238 How ultrasonic cleaning is accomplished 279 Square wrapping technique 3910 Envelope wrapping technique 4011 Container system showing component parts 4212 Table-top steam sterilizer 4713 Operation of a t
43、able-top sterilizer 4814 Cassette-type steam sterilizer 5015 Table-top pot-style sterilizer 5016 Loading a table-top sterilizer 5117 Chemical sterilizer 5618 The STERIS System 5819 Example of a record sheet 5920 Cytotoxic hazard symbol 70PLUS 1112March 2004 Canadian Standards Association ixPrefaceTh
44、is is the second edition of CSA PLUS 1112, Infection prevention and control in office-based health care and allied services. It is a comprehensive guideline for use in all disciplines of health care or allied services, in particular, in office-based health care. This handbook has been developed to a
45、nswer general questions common to all health care practices and personal services. How do I process an instrument after I have used it on a patient or client? What kind of disinfectant should I use? What kind of sterilizer should I use and do I really need one? How do I dispose of a contaminated art
46、icle? What should I do with needles and other sharps? How do I store soiled instruments safely until they can be cleaned and sterilized? What precautions should I take to prevent the spread of infection? How can I protect my staff and myself without compromising the safety of my patient?This guideli
47、ne complements the CSA Z314 series of National Standards of Canada, which sets out requirements for medical device cleaning, decontamination, and sterilization in health care facilities. This publication is based on those requirements and is intended to help in their application to office-based faci
48、lities. The principles and practices in this guide can also be applied to other offices where infection can be transmitted. These include such personal care services as piercing or tattoo studios, electrolysis services, and hair and nail salons.The importance of infection prevention and control cann
49、ot be overemphasized. The impact of a transmitted infectious disease can be both personally devastating and socially costly. Health care and service providers are responsible for ensuring that the patient or client is not at risk. This handbook will be useful to all those people who are responsible for infection prevention and control in a health care practice or allied service.March 2004The valuable assistance of members of the CSA Technical Committee on Sterilization in the devel
