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Cleaning Strategies (Housekeeping)
Adequate cleaning of the hospital on a regular schedule is one of the most important aspects of an IC program. The hospital’s cleanliness is the first thing a patient sees when entering the doors. A clean hospital not only is less likely to cause the spread of infectious diseases, but also creates a positive image and inspires confidence in its professional staff. The following recommendations will greatly reduce the risk of nosocomial infection related to sanitary conditions—
• Written policies and procedures that explicitly describe tasks and how they are to be done must be developed for the housekeeping staff.
• Cleaning should include a regular schedule of mopping floors with appropriate disinfectants. Toilets must be cleaned on a regular basis, because they may be a source of contamination within the hospital. Cleaning equipment must also be cleaned after each use to minimize the spread of potentially dangerous microorganisms. Cleaning walls and ceilings is not recommended unless they have become visibly soiled. The use of fogging disinfectants is not recommended.
• Waste disposal should include the burning of contaminated supplies, including needles, syringes, blood-contaminated materials, and so forth. Infective waste should either be incinerated or autoclaved before disposal in a local sanitary landfill.
• Disposable syringes with needles, scalpel blades, and other sharp items capable of causing injuries should be stored in a puncture-resistant container until disposition of the container. To prevent accidental needle stick and possible infection with a serious pathogen, do not to recap, bend, or cut needles, because these actions may cause an accidental puncture.
• Soiled linen should be bagged and isolated from the normal hospital traffic. Cleaning procedures should include washing in hot water (at least 71 °C/160 °F). Clean linen should be transported and stored, so that cross-contamination does not occur.
Careful Use of Intravascular Catheters, Intravenous Fluids, and Medications
Invasive IV devices and medications can be lifesaving when used appropriately. When used inappropriately, they may result in life-threatening nosocomial infections. To maximize prevention of these infections, hospitals should have the following practices and policies—
• Comprehensive policies and procedures that address catheter placement, maintenance of catheters, and preparation of IV fluids and medications. Education programs to train and monitor personnel in this area are necessary.
• IV catheters and especially central venous catheters should be used only when absolutely necessary, because these devices are associated with a high rate of infection, especially when inserted with a cut-down procedure.
• The use of high-quality silicon elastomer or polyurethane catheters is recommended, because they are known to cause fewer infections. Avoid polyvinyl chloride materials, because they are known to increase infection rates.
• Manufacture of IV solutions requires strict Good Manufacturing Practices standards, and these solutions must be purchased from reliable suppliers that are known to have good quality control. Contamination from improperly prepared solutions may be a significant cause of nosocomial infections.
• Medication admixtures to IV solutions should be prepared centrally by qualified pharmacy personnel. If this is not possible, specific policies and procedures should prepared for nurses who should be certified competent before they are allowed to prepare admixtures. Use all lipid and parenteral nutrition solutions promptly.
Proper Use of Urinary Catheters and Urine Drainage Systems
Indwelling urinary catheters should be used only when absolutely necessary to relieve an obstruction of urinary flow or to monitor urine output in critically ill patients. They should be discontinued as soon as possible to decrease the risk of nosocomial infections. These devices are responsible for a high percentage of hospital infections. The following recommendations should be followed—
• Written policies and procedures are required for techniques of insertion, use, and maintenance of catheters.
• Only closed drainage systems should be used. Triple-lumen irrigation catheters should be available for patients undergoing urological surgeries for which frequent irrigation is necessary. Breaks in the system of any kind should discouraged including for irrigation and obtaining urine samples.
• For selected patients, a condom drainage catheter, suprapubic catheterization, and intermittent urethral catherization can be useful alternatives.