Enviromental sampling, guideline for enviromental infection control in health care facilities
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Enviromental sampling, guideline for enviromental infection control in health care facilities
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Enviromental sampling, guideline for enviromental infection control in health care facilities
- 2. Hospital Acquired Infection Top 10 Most fatalCouse of Death 1.7 million Patient Acquire InfectionFrom hospitals each years As a result, Almost 6% Die
- 3. In Hospitals 1 out of 20 Patients develops an HAI Nationwide, 2 million people develop an HAI each ear
- 4. Germs Causing Hospital Acquired Infections
- 5. Breakdown of Hospital Acquired Infection Types
- 20. No. Ruang atau Unit Konsentrasi Maksimum Mikroorganisme (CFU/m³ Udara) 1. Operasi 10 2. Bersalin 200 3. Pemulihan/Perawatan 200 – 500 4. Observasi Bayi 200 5. Perawatan Bayi 200 6. Perawatan Premature 200 7. ICU 200 8. Jenazah/Autopsi 200 – 500 9. Penginderaan Medis 200 10. Laboratorium 200 – 500 11. Radiologi 200 – 500 12. Sterilisasi 200 13. Dapur 200 – 500 14. Gawat Darurat 200 15. Administrasi, pertemuan 200 – 500 16. Ruang Luka Bakar 200
- 21. Hazard / Hygiene Indicator Timing / Frequency of Testing Result Interpretation Action References Conventionally ventilated theatres built/ refurbished before 2007: Aerobic Colony Post-maintenance Count /commissionin g; in empty theatre after ventilation system has achieved steady state 35 cfu/m3 0 - < 35 cfu/m3 UNSATISFACTORY SATISFACTORY Take theatre out of use, clean thoroughly and re-test N/A NHS Estates, 1994 During a surgical operation > 180 cfu/m3 (averaged over five-minute period) UNSATISFACTORY Investigate and re-test 0 - < 180 cfu/m3 SATISFACTORY N/A Table 3: Testing requirements and interpretation of results for operating theatre air quality (as determined by active air sampling)
- 22. Hazard / Hygiene Indicator Timing / Frequency of Testing Result Interpretation Action References Conventionally ventilated theatres built/ refurbished after 2007: Aerobic Colony Post-maintenance Count /commissionin g; in empty theatre after ventilation system has achieved steady state 10 cfu/m3 0 - < 10 cfu/m3 UNSATISFACTORY SATISFACTORY* Take theatre out of use, clean thoroughly and re-test *Note broad category of organisms present; there should not be a preponderance of fungi. Departmen t of Health, 2007 During a surgical operation > 180 cfu/m3 (averaged over five-minute period) UNSATISFACTORY Investigate and re-test 0 - < 180 cfu/m3 SATISFACTORY N/A Ultra-clean theatres: Microbiological testing of empty theatre not recommended on commissioning or post maintenance (but may be necessary if work may have affected air supply or distribution)
- 28. Table 5: Testing requirements and interpretation of results for endoscopy final rinse water Hazard / Hygiene Indicator Timing / Frequency of Testing Result Interpretation Action References Aerobic Colony Count Weekly >100 in 100 ml 20 – 100 in 100 ml 0 - <20 in 100 ml 0 in 100 ml UNACCEPTABLE UNSATISFACTORY ACCEPTABLE* SATISFACTORY Take washer /disinfector out of use Investigate cause and put corrective action in place *Acceptable provided that Pseudomonas aeruginosa is not detected N/A NHS Estates, 1995 Willis (2006) Environmental mycobacteria Annually (or more frequently, depending on risk assessment) > 0 in 100 ml 0 in 100 ml UNSATISFACTORY SATISFACTORY Investigate immediately and take repeat sample N/A Pseudomonas aeruginosa Optional – to be determined in discussion with local microbiologist > 0 in 100 ml 0 in 100 ml UNSATISFACTORY SATISFACTORY Investigate immediately and take repeat sample N/A
- 29. Hazard / Hygiene Indicator Timing / Frequency of Testing Result Interpretation Action References Dialysis fluid and post reverse osmosis fluid: Aerobic Colony Count Monthly (or more frequently if necessary) >100 / ml >50 - <100 / ml 0 - <50 / ml UNSATISFACTORY BORDERLINE SATISFACTORY Take out of use until corrective action implemented Investigate cause and put corrective action in place N/A UK Renal Association, 2009 Endotoxin /ml >0.25 EU/ml >0.125 - <0.25 EU / ml <0.25 EU/ml UNSATISFACTORY BORDERLINE SATISFACTORY Take out of use until corrective action implemented Investigate cause and put corrective action in place N/A Table 6: Testing requirements and interpretation of results for renal dialysis fluid
- 30. Hazard / Hygiene Indicator Timing / Frequency of Testing Result Interpretation Action References Ultrapure fluid: Aerobic Colony Count Monthly (or more frequently if necessary) >10 in 100 ml 0 - <10 in 100 ml UNSATISFACTO RY SATISFACTORY Investigate cause and put corrective action in place N/A Endotoxin / ml >0.03 IU/ml <0.03 IU/ml UNSATISFACTORY SATISFACTORY Investigate cause and put corrective action in place N/A Table 6: Testing requirements and interpretation of results for renal dialysis fluid
- 31. Test Required Sample Bottles Coliforms, Escherichia coli, Pseudomonas aeruginosa, Aerobic Colony Counts, environmental mycobacteria 1 x sterile 500 ml plastic bottle containing an appropriate neutraliser to neutralise any residual disinfectant in the water. (The most commonly used neutraliser, which is appropriate for chlorinated or brominated water systems and those using ozone or hydrogen peroxide, is sodium thiosulphate. For mains water and hydrotherapy pools, 18 mg/L sodium thiosulphate should be added. However, for cooling towers, 180 mg/L (i.e. sufficient to neutralise 50 mg chlorine per litre) must be used. If alternative disinfection methods are used, the laboratory should be contacted to obtain the appropriate neutraliser, if one is available.) Legionella (and other pathogenic bacteria such as Salmonella, Campylobacter and E. coli O157, where required) 1 x sterile 1 litre bottle Or 2 x sterile 500 ml plastic bottles (as above) (See note above regarding neutralisers)
- 32. Test Required Sample Bottles Endotoxin Designated “Pyrogen-free” containers Chemical parameters Specific bottles should be requested from laboratory depending on tests required Table 1: Sample bottles required for the collection of water for different microbiological and chemical analyses
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