Treatment of special infected instruments in sterile supply center

Definition of special infections

The supply center is responsible for the cleaning, disinfection, sterilization and supply of medical devices, and is a key department in hospital infection prevention and control. The handling of special infection devices is of utmost importance, because they involve highly pathogenic pathogens, which may cause serious consequences if not handled properly.

Special infections refer to tetanus, prions, gas gangrene, anthrax, and other sudden infectious diseases of unknown causes. They have a low incidence, rapid changes in the condition, and a high mortality rate, so early clinical diagnosis is difficult, and emergency surgery is an effective measure to avoid worsening of the condition. However, special infections are highly contagious, and because there are not many cases, medical staff in clinical practice are often prone to cross-infection and other adverse events due to lack of practical experience.

Core Principles for Handling Special Infected Devices

1 "Disinfection first, then cleaning"

The biggest difference between the treatment of special infected instruments and ordinary instruments is that pathogens must be inactivated first to prevent the spread of pathogens during the cleaning process, and then subsequent cleaning and sterilization operations are carried out.

2 "Double bag sealing, obvious marking"

All contaminated instruments must be double-packed, and the type of infection must be clearly marked on the packaging to avoid cross-infection during transportation and handling.

3 "Strict protection, on-site treatment"

Preliminary disinfection and sealing are carried out at the point where the infected instrument is produced to reduce the risk of transmission during its movement within the hospital. At the same time, staff must take strict personal protection measures.

In addition, use special cleaning, disinfection and sterilization equipment or run special procedures to handle special infected equipment to ensure the disinfection and sterilization effect.

Management of prion infection

What is prions

Prinions are protein infectious factors that lack nucleic acids, unlike pathogenic microorganisms such as bacteria, viruses, fungi and parasites. They can self-proliferate without nucleic acid replication.

Disinfection methods

Purpose: To prevent contamination of the surrounding environment and other reusable instruments, instruments and articles, achieve sterilization effects, and prevent cross-infection.

Patients infected with prions or suspected of being infected with prions should use disposable diagnostic and treatment instruments, instruments and articles, which should be sealed and incinerated in double layers after use.

Reusable moderately and highly dangerous items contaminated by highly dangerous tissues (such as the patient's brain, dura mater, pituitary gland, eyes, spinal cord, etc.) can be disinfected and sterilized by one of the following methods, and the strictness of sterilization is gradually increased.

1) Soak in 1 mol/L sodium hydroxide solution for 60 minutes, clean, disinfect and sterilize according to WS 310.2 method, and the pressure steam sterilization conditions are 134℃～138℃, 18 minutes, or 132℃, 30 minutes, or 121℃, 60 minutes.

2) Use a cleaning and disinfection machine (preferably a cleaning agent with prionicide activity) to remove visible contaminants, then clean and sterilize according to the general sterilization procedure.

3) Soak in 1 mol/L sodium hydroxide solution for 60 minutes to remove visible contaminants, then clean and sterilize according to the general procedure.

For low-risk items and general object surfaces contaminated by highly dangerous tissues, after cleaning with a detergent, wipe or soak with 10000mg/L chlorine-containing disinfectant or 1mol/L sodium hydroxide solution for at least 15 minutes according to the material to ensure that the contaminated surface is in contact with the disinfectant.

Environmental surfaces contaminated by highly dangerous tissues of prion patients or patients suspected of being infected with prions should be cleaned with detergent and disinfected with 10000mg/L chlorine-containing disinfectant for at least 15 minutes. It is advisable to cover the operating table with disposable plastic film and incinerate it after the operation is completed.

For medium and highly dangerous items contaminated by low-risk tissues, the transmission risk is unknown and should be handled in accordance with the above measures. Low-risk items, general object surfaces and environmental surfaces contaminated by low-risk tissues should be treated with conventional disinfection methods.

Diagnostic and therapeutic instruments that come into contact with highly infectious tissues cannot be cleaned or can only be sterilized at low temperatures and should be treated as special medical waste.

Diagnostic and therapeutic instruments and endoscopes that do not come into contact with highly infectious tissues of patients can be cleaned, disinfected and sterilized according to conventional procedures, and endoscopes that do not come into contact with the central nervous system should be handled according to the technical specifications for endoscope cleaning and disinfection.

The biggest difference between the treatment of special infection instruments and ordinary instruments is that pathogens must be inactivated first to prevent the spread of pathogens during the cleaning process, and then subsequent cleaning and sterilization operations can be performed.

Precautions

During the treatment process, special attention should be paid to classification and treatment.

Classification principle 1: whether it has come into contact with the patient's highly infectious tissues, such as brain tissue, eyes or central nervous system. Those that have come into contact should be treated specially; those that have not come into contact can be treated according to the normal process.

Classification principle 2: whether it can be cleaned or sterilized by high-temperature and high-pressure steam. Diagnostic and therapeutic instruments that have come into contact with highly infectious tissues that cannot be cleaned or sterilized by steam should be disposed of as special medical waste even if they are not disposable instruments. In addition, the following matters should also be noted:

1) Patients suspected or confirmed of prion infection should use disposable diagnostic and therapeutic instruments, instruments and items, which should be double-sealed and incinerated after use.

2) Diagnostic and therapeutic instruments that come into contact with patients' highly infectious tissues (such as the central nervous system, eyes and other tissues) should be handled immediately after use to prevent drying.

3) Cleaners and disinfectants used should be changed every day.

4) After each treatment, the equipment should be disinfected and cleaned immediately, personal items should be replaced, and hands should be washed and disinfected.

5) Rapid sterilization procedures should not be used.

6) Equipment that has not been treated in the correct way should be recalled and re-treated according to regulations;

7) Strictly abide by the principles of disinfection and isolation, prevent the spread of contamination and take protective measures. And inform relevant personnel, train them, provide personal protection, disinfect the treatment equipment, and clean and disinfect their personal equipment afterwards.

Treatment of gas gangrene infection

What is gas gangrene

Also known as clostridial necrosis, it is a large area of muscle necrosis caused by Clostridium perfringens and other bacteria. It is an anaerobic infection that develops rapidly and has a poor prognosis.

Disinfection method

Purpose: To prevent contamination of the surrounding environment and other reusable instruments, appliances, and items, to achieve sterilization effect, and to prevent cross infection.

Disinfection of wounds: Use 3% hydrogen peroxide solution for flushing, and the skin around the wound can be wiped and disinfected with iodine tincture.

Disinfection of diagnostic and treatment equipment: Disinfection should be done first, then cleaned, and then sterilized. Disinfection can be done by soaking and disinfecting with chlorine-containing disinfectants 1000mg/L~2000mg/L for 30min~45min. When there are obvious contaminants, chlorine-containing disinfectants 5000mg/L~10000mg/L should be used for soaking and disinfection for ≥60min, and then cleaned and sterilized according to regulations.

Disinfection of object surfaces: In the operating room (room) or dressing room, the surface of objects should be disinfected in time between each infected patient, using 0.5% peracetic acid or 500mg/L chlorine-containing disinfectant to wipe.

Disinfection of environmental surfaces: When there is obvious contamination on the surface of the operating room (room), dressing room, and ward environment, disinfect at any time, using 0.5% peracetic acid or 1000mg/L chlorine-containing disinfectant to wipe.

Terminal disinfection: Terminal disinfection should be performed after the operation is completed, the patient is discharged, transferred to another hospital, or dies. Terminal disinfection can be performed by fumigation with 3% hydrogen peroxide or peracetic acid, 3% hydrogen peroxide according to 20ml/m³ aerosol spray, peracetic acid according to 1g/m³ heating fumigation, humidity 70%~90%, closed for 24h; 5% peracetic acid solution according to 2.5ml/m³ aerosol spray, humidity 20%~40%.

Precautions

Precautions for prion contamination.

Treatment of pathogens of sudden infectious diseases of unknown cause

Sudden infectious diseases of unknown causes

Including public health emergencies and hospital infection outbreaks, and infectious diseases with a tendency to spread, such as Ebola virus. The national health administrative department organizes an investigation, and the cause of the infectious disease is still unknown.

Disinfection method

The treatment of diagnostic and treatment instruments, instruments and items contaminated by pathogens of sudden infectious diseases of unknown causes should comply with the regulations and requirements issued by the state at that time. When there are no requirements, the disinfection principles are:

When the transmission route is unknown, determine the disinfection scope and items according to multiple transmission routes.

Determine the disinfection dose according to the most resistant microorganism in the microbial category to which the pathogen belongs (it can be determined according to the dose that kills all spores).

Medical staff should take good occupational protection.

CSSD Disposal Process

1) CSSD receives a call from a patient with a special infection (such as prions, gas gangrene) about the use of instruments, and records the name and quantity of the instrument package used.

2) CSSD personnel wear protective equipment in accordance with standard prevention, and special personnel and vehicles are used to recover.

3) The instrument package is transported in a closed manner on a dedicated route and monitored throughout the process to ensure that the transportation process is safe and controllable and prevent the spread of pathogens.

4) Process after the instrument arrives at the decontamination area:

Soaking and disinfection:

Prions: Soak in 1mol/L sodium hydroxide solution for 60 minutes; Gas gangrene: Soak the recovered reusable contaminated instruments, utensils or items in 1000mg/L~2000mg/L of chlorine-containing or bromine-containing disinfectants for 30 minutes~45 minutes. When there are obvious contaminants, soak in 5000mg/L~10000mg/L of chlorine-containing disinfectants for at least 60 minutes. Sudden pathogens of unknown cause: According to the highest national standards, ensure "safety and accuracy".

Cleaning and disinfection device:

Cleaning procedures: pre-cleaning, enzyme cleaning (45℃), first bleaching, second bleaching, thermal disinfection (90-92℃/oiling), drying. Monitor the temperature, time or A0 value (≥3000) and other parameters of disinfection and make records, and keep them for inspection.

Final disinfection of the area: After the process is completed, wipe and disinfect the area with 10000mg/L chlorine-containing disinfectant or soak the utensils.

Emergency Plan after Occupational Exposure

Purpose

Master the post-processing procedures for occupational exposure, take protective measures, and effectively reduce the hazards caused by occupational exposure.

Process

After occupational exposure occurs, immediately wash the contaminated skin with soap solution and running tap water, and rinse the mucous membrane with saline; if there is a wound, gently squeeze the wound side to squeeze out as much blood as possible, and rinse with soapy water and running water. Local squeezing of the wound is prohibited.

After the wound of the injured part is rinsed, disinfectant such as 75% ethanol or 0.5% iodine tincture should be used to disinfect and bandage the wound. The exposed mucous membrane should be repeatedly rinsed with saline.

After occupational exposure occurs, report to the hospital infection management department in time, and draw blood samples from patients and exposed personnel for examination. And evaluate and determine the level of exposure and the viral load level of the exposure source.

Register the time, location, process, exposure method, specific part of exposure, degree of injury, type of exposure source, HIV infection, treatment method, treatment process, whether preventive medication is implemented, time of first medication, drug toxicity and side effects, medication compliance, etc.

Implement preventive medication according to the level of exposure and the viral load level of the exposure source.