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Proper Use of Mechanical Ventilation and Respiratory Equipment
The use of mechanical ventilation should be used only when absolutely necessary, because these devices can cause high rates of nosocomial infections. Specific policies and procedures are required if these devices are available in the hospital. Suctioning is important, and catheters should be used only once (or reprocessed appropriately). Suction contents should be disposed of properly and soon after collection. All equipment should undergo ethylene oxide sterilization or high-level disinfection before reuse. Other important guidelines include the following—
• Wean from mechanical ventilation as early as possible.
• Use heated humidifiers.
• Ensure proper handling of inhalation medications, nebulizers, and tubing.
The following interventions can help reduce the incidence of nosocomial infections related to surgery and surgical site care—
• Implement comprehensive policies and procedures.
• Minimize preoperative stays in the hospital.
• Avoid shaving patients unless absolutely necessary. In these cases, use hair clippers (or disposable razors when clippers are not available). Clipper heads must be disinfected between uses. If shaving is necessary, shave immediately before surgery and not the night before.
• Use antibiotic prophylaxis only when indicated. The appropriate medicine, dose, and interval must be used following established protocols. Usual prophylaxis involves a single dose of an antimicrobial 1–2 hours before procedure. Prescribing practices in this setting must be monitored to ensure correct use. Inappropriate use will contribute to AMR, adverse drug reactions, prolonged hospitalizations, and significantly higher costs.
• Ensure that dressing carts for surgical site cleaning and dressings do not contain instruments that are submerged between uses, because this practice may cause contamination of disinfectants. Sterile instruments should be provided in individually wrapped sterile packages.
• Use only effective antiseptics and disinfectants. Older disinfectants, such as benzalkonium chloride, should not be kept in stock, because of efficacy problems. As with selecting medicines for a formulary, antiseptics and disinfectants must be selected using an evidenced-based approach.
• Ensure that hand and forearm antisepsis for surgical team members includes perioperative scrub with an appropriate antiseptic scrub.
Education of Hospital Personnel
Educational programs that emphasize appropriate IC techniques and procedures are necessary for controlling nosocomial infections. Educational activities should focus on basic IC functions, including hand hygiene, housekeeping, aseptic technique, procedures for the preparation of IV fluids and medicines, care of ventilated patients, care of patients with indwelling urinary catheters, wound care and use of antiseptic solutions, isolation and universal precautions, effective use of microbiology laboratory services, and appropriate use of antimicrobials.