Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
Healthcare Consideration/Evidence Based Practice On November 9, 2023, the New England Journal of Medicine published results of a study on nursing homes that used chlorhexidine for all routine bathing and showering as well as administration of nasal povidone–iodine twice daily for the first five days after admission and then twice daily for five days every other week. Data were obtained from 28 nursing homes with a total of 28,956 residents. The bathing routine, designed to decolonize the skin and nasal passages, resulted in significant reductions of infection-related hospitalization and all-cause hospitalization compared with nursing homes that did not implement the strategy. Chlorhexidine (4% chlorhexidine rinse-off antiseptic wash for showering and 2% chlorhexidine no-rinse cloths for bed bathing) was used for bathing on admission and then for all routine bathing and showering. This decolonization strategy reduced the prevalence of multidrug-resistant organisms (MDRO) such as methicillin-resistant Staphylococcus aureus (MRSA). Chlorhexidine comes in multiple commercial formulations, such as liquid and impregnated cloths, that provide options for economy, ease of use, or both, depending on the needs and resources of facilities and individual residents. Source: [23]
ELEMENT V Creation and maintenance of a safe environment for patient care in all healthcare settings through application of infection control principles and practices for cleaning, disinfection, and sterilization [1]. See Element V Glossary. Content Outline Due to the length of the outline for this element, it will be abbreviated and can be viewed at NYSDOH [1]. I. Universal Principles A. Instruments, medical devices, and equipment should be managed and reprocessed according to recommended/appropriate methods regardless of a patient’s diagnosis except for cases of suspected prion disease. 1. Special procedures are required for handling brain, spinal, or nerve tissue from patients with known or suspected prion disease (e.g., Creutzfeldt-Jakob disease [CJD]). Consultation with infection control experts prior to perform- ing procedures on such patients is warranted. B. Industry guidelines as well as equipment and chemi- cal manufacturer recommendations should be used to develop and update reprocessing policies and procedures. C. Written instructions should be available for each instrument, medical device, and equipment repro- cessed. II. Potential for Contamination is Dependent Upon Several Factors A. Type of instrument, medical device, equipment, or environmental surface: 1. Potential for external contamination (e.g., pres- ence of hinges, crevices).
2. Potential for internal contamination (e.g., pres- ence of lumens). 3. Physical composition, design, or configuration of the instrument, medical device, equipment, or environmental surface. B. Frequency of hand contact with instrument, medical device, equipment, or environmental surface. C. Potential for contamination with body substances or environmental sources of microorganisms. D. Level of contamination. Type and number of micro- organisms and potential for cross- contamination. III. Steps of Reprocessing A. Pre-cleaning: 1. Removes soil, debris, lubricants from internal and external surfaces. 2. To be done as soon as possible after use. B. Cleaning
1. Manual (e.g., scrubbing with brushes). 2. Mechanical (e.g., automated washers).
3. Appropriate use and reprocessing of cleaning equipment (e.g., do not reuse disposable cleaning equipment). 4. Frequency of solution changes. C. Disinfection – requires sufficient contact time with chemical solution. D. Sterilization – requires sufficient exposure time to heat, chemicals, or gases. IV. Choice/Level of Reprocessing Sequence A. Based on intended use: 1. Critical instruments and medical devices require sterilization, which is the use of a physical or chemical procedure to destroy all microbial life, including highly resistant bacterial endospores. An item that enters sterile tissue or the vascular system must be sterile prior to contact with tis- sue.
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