Q- Post-exposure prophylaxis for HBV, HCV, and HIV:

(after sharp injury)

First aid:

1. encourage bleeding, squeeze the injury, don't suck.

2. wash the skin thoroughly with soap and water. Don't scrub or use
alcohol 70%.
3. irrigate contaminated mucous membranes like mouth, and eyes with
large quantities of tap water.
4. Cover the injury with waterproof dressing and seek medical advice
without delay.

Subsequent action:

1. Consent done from donor for testing for HBV, HCV, and HIV.
2. Take blood from injured lesion (10ml clotted).
3. Send blood to public health lab.
4. Emergency PEP (post-exposure prophylaxis).

HIV  1. Start within 2 hrs using 2 or 3 antiretroviral drugs for 28 days.

2. No vaccine

HCV  1. Follow-up by screening for HCV RNA for 1 month or anti-HCV

AIT for 6 months

2. No vaccine.

HBV  1. Unvaccinated: Hepatitis B immunoglobulin together with

vaccination with hepatitis B vaccine (0,1,6 months IM).

2. Previously vaccinated and known antibody responder: No ttt.

3. Non-vaccinated and non-responder: HBIG + vaccine.

 4. Ab response unknown  test Ab + HBIG + vaccine.

Iodine & Iodophors

Iodophor:

- Iodine
- Iodide
- Triiodide

Mechanism:

1- Rapid penetration of cell wall of microorganism

2- Inactivate cells by forming complexes with amino acids & unsaturated
fatty acids.
3- Impaired protein synthesis (alteration of cell membrane).

Advantages:

1- Bactericidal activity against Gram -ve, +ve, certain spore-forming

bacteria (mycobacteria, fungi, virus).
2- In-vivo: iodophor decreases the number of viable organisms that are
recovered from the hand of personnel.
3- Iodophor exhibits persistent antimicrobial activity after they have been
washed off the skin is unclear.
4- Povidine- lodine has been accepted by FDA-Tfm as Safe, effective
against microorganism in hand wash & HCW hand wash.
 Triclosan

Mechanism: affect cytoplasmic membrane & synthesis of RNA.

Action:

- Against gram +ve bacteria (MRSA)is greater than gram -ve bacteria.
- Activity against mycobacterial and candidal spp.
- Has persistent activity on the skin.

Alcohol

Majority of alcohol-based hand contain:

- Isopropranolol
- Ethanol
- N. propanol

Antimicrobial activity  denaturation of protein.

Alcohol solution  60-95% alcohol is most effective.

Advantages:

- Excellent in vitro germicidal activity against various microorganisms.

- Reduce bacterial count on hand.
- Effective for preoperative cleaning of hand of surgical personnel.
- Easy, suitable, not costly.

Disadvantages:

- Cause drying of skin.

- Not appreciable persistent activity.
- Poor activity against bacterial spores & protozoan.
- Volatile & flammable.
- Not used when the hand is visibly dirty.
 Chlorhexidine

Mechanism: subsequent disruption of cytoplasmic membrane resulting in

precipitation of cellular content.

Advantages:

- Immediate antimicrobial activity.

- Good activity against gram +ve bacteria.
- Activity against enveloped viruses (HSV, HIV, RSV).
- Has substantial residual activity.

Disadvantages:

- Less active against gram -ve bacteria & fungi.

- Less active against non-enveloped viruses.
- Non-sporicidal.
- Frequency of skin irritation is concentration dependent.
- Avoid pouch eye  conjunctivitis, corneal damage.
Q- Define basic concepts of infection prevention & control?

It is a practical evidence-based approach which prevents patients and

health workers from being harmed by available infection as a result of
antimicrobial resistance.

1- Hand hygiene is the most effective overall infection control measure.

2- Recent recommendations include 2 levels of precautions:
a. Standard precautions.
b. Transmission-based precautions.

Standard precautions:

1. Hand hygiene 4. Safe injection practices.

2. Barrier technique 5. Patient care equipment.
3. Respiratory hygiene  cough 6. Cleaning & disinfection.
etiquette. 7. Waste management.

Transmission-based precautions:

- Transmission based precautions should be used when treating patients

who are known or suspected of being infected or colonized é infectious
agents.
- Precautions are applied according to the clinical syndrome & etiologic
agents, based on test results.

3 categories:

- Contact precautions
- Droplet precautions
- Airborne precautions
 Q- Organization structural of IPC unit, IC team & IC committee?

IPC  infection prevention and control

*IPC Program Organization Structure*

Hospital Director
General

Deputy Hospital
Director General for
Clinical Affairs

Infection Control
Unit

Infection Control Infection Control

Team Committee

Director of Clinical
IC Consultant
Department

IC Team Member
IC Officer

Director of
Pharmacy
Surgical CSSD Liaison Inpatient
Services Liaison Liaison Director of Medical
Supply
Outpatient Hospital
Financial Director
Liaison Services Liaison
Hospital

Quality Coordinator

Head Nurse
 Sterilization

1- Heat Sterilization:
a. Moist (steam).
b. Dry
2- Low Temperature:
a. Chemical (gas, liquid)
b. Plasma
3- Others:
a. Ionizing radiation
b. Filtration
c. Microwave

(1)Moist Steam Sterilization:

Methods: By saturated steam at high pressure.

Heating water under high pressure chamber (Autoclave) boiling above

100°C saturated steam with same temperature.

Sterilizat require heat at 121°C for 20-30 min or 134°C for 3-6 min.

Types of Autoclaves:

- Downward displacement
- High pre-vacuum autoclave
- Flash Autoclave
- N type: naked instrument (unwrapped)
- S type: specific
- B type: big sterilization
Advantages:

- Steam has good penetrative power

- Absent toxicity
- Low Cost

Disadvantages:

- Some items can’t stand high temp.

- Not suitable for powders, oil.
- Corrosive effect

Packing: ‫ ادوات حفظ‬items

- Disposable paper sheets

- Bags
- Containers

:‫مؤشرات كفائة التعقيم‬

‫ من الل جداول النتائج فالجهاز‬:‫ التعقيم الفيزياني‬-
‫ شرائط ورقيه فاكياس الدوات يتغير لونها عند التعقيم‬:‫ المؤشرات الكيميائية‬-

- Bacteriol test: strip culture at diff site of autoclave for spore sterilization.

(2) Dry Heat Sterilization:

a) Incineration: Dead animal bodies.
b) Red heat: for tip of forceps
c) Hot air sterilization (Hot oven)

Advantages: can be used for powders, absent corrosive, low cost

Disadvantages: slow penetration of heat, prolonged time, damage to some
items (rubber).

(3)Gas (ethylene oxide) Sterilization:

Advantages: ability to sterilize subject can’t stand steam and air.

Disadvantages: long time, high cost, toxicity {High toxic, Inflammable,

Explosive}.

(4)Liquid Sterilization: Glutaraldehyde, peracetic acid, hydrogen peroxide

‫ يجب غسل الدوات بعد تعقيمها‬/ ‫ل تحقق المان او التعقيم‬

(5)Gas Plasma: (with electrons, positive ions)

(6)Ionizing Radiation (disposable items): Gamma or Beta.
(7)Filtration Method: cellulose acetate membrane (sterilize fluid,
medication) serum.
Sources & Risk factors:

HAI may be endogenous or exogenous sources:

[1] Endogenous:

* Infections are caused by opportunistic pathogens of patients own normal

flora due to:

a) Immunocompromised patients.

b) Invasive procedure.

c) Injury.

[2] Exogenous Infections:

* Infections from sources outside the patient’s own body.

a) Presence within a hospital of pathogens which are capable of infecting

individuals with low immunity.

b) Many pathogens possess antibiotic resistance.

c) Hospital pathogens may be in the normal flora of staff.

Cleaning:

- Removal of visible dust and soil, organic material.

- Done with water, soap, detergent or enzymatic products.
- Must precede disinfection and sterilization.

Decontamination: general term to any procedure by which reduces

microorganism to level where items are safe to handle.

Anti-septic: special type of chemical disinfectant (safely applied to skin). Not

for systemic use.

Disinfectant: chemicals used for disinfection (eliminate most not all

organisms). Exclude spore.

Sterilization: complete removal of microbial life (bacteria, fungi, spores).

Disinfectant

Classification:

- High: all bacteria, Mycobacterium tuberculosis, all fungi, all viruses.

- Moderate: all bacteria, Mycobacterium tuberculosis, major fungi,
major viruses.
- Low: all bacteria except Mycobacterium tuberculosis, some fungi, some
viruses.

- Critical: enter tissues.‫الحقنه الكانيول‬

- Semi: contact è mucous membrane (thermometer, endoscope)
- Non-critical: contact è skin ‫جهاز الضغط‬
 1) Chemical Disinfection:

Methods: formalin, alcohol 70%, chlorine, phenol preparation, Hydrogen

peroxide, Glutaraldehyde Cidex

Mode: denature protein, decrease enzyme, destruct cell wall.

* Alcohol 70%: exposure for 5 min to achieve adequate level of disinfection

(disinfect thermometers, stethoscope).

*Chlorine active: decontaminate blood splashes, lab surface.

*Phenol: floor, walls, furniture.

*Hydrogen peroxide: soft contact lenses, open wounds.

*Peracetic acid: High level - Glutaraldehyde high level disinfectant

2) Boiling Water:

At 100°C for 20 min useful in emergencies.

3) Pasteurization (for milk):

Heat at 63°c for 30 min then followed by rapid cooling.

4) Ultraviolet Radiation.
Q- Categories of transmission-based precaution (contact, airborne, droplet):

- Used when routes of transmission not completely interrupted using

standard precaution alone.

A) Contact Precaution:
- E.g. disease transmitted by contact.
o GIT, respiratory, skin, wound infections.
o Enteric infections.
o Para-influenza virus in infants and young children.
- Wear a gown when entering room.
- Wear gloves.
- Wash hands before leaving room.
- Use pt-dedicated or single-use disposable shared equipment or clean
and disinfect shared equipment.

B) Droplet Precaution: -
- The distance droplet travel depends on:
o Velocity.
o Density of resp. secretions.
o Environmental factors: temperature & humidity.
o Ability of pathogen to maintain infectivity over distance.
- Apply to any pt. known or suspected to be infected è epidemiologically
important pathogen transmitted by droplet (pneumonia, meningitis,
pharyngitis, influenza)
- Patient Placement: single pt. room.
- Patient transport: limit movement, mask wear, cough etiquette.
- Mask, other PPE.
- Environmental measures: daily cleaning, disinfection of surfaces.
(3) Airborne Precaution:

- Prevent transmission of infectious organisms that remain suspended

in air and travel great distance.
- E.g.: Chicken Pox, SARS, Corona virus, Avian influenza.

*Patient Placement: -

- Airborne infection isolation room (AIIR).

- Six a'r change per hour.
- Keep AIIR door closed.

* Personnel Restrictions: -

- From entering the rooms of pt known or susceptible to have measles,

chickenpox, …

* Respiratory Protection: -

- Wear fit-tested NIOSH N95.

- Recommended for all health care workers.

* Patient transport: -

- Limit movement. transport of Pt from the room.

- If transport necessary  wear surgical mask, cough etiquette.

* Environmental Measures: -

- Routine cleaning, disinfection of high touch surface.

(1) Define basic concept of Infection prevention & Control?

It is a practical evidence-based approach which prevents patients and

health workers from being harmed by avoidable infection & as a result of
antimicrobial resistance.

(2) Define healthcare associated infections & Risk factors of Infection

transmission?

HAI is an infection that is acquired in a medical setting in the course of

medical treatment.

“Criteria”:

(1) Infections that can be acquired through receiving medical treatment in

healthcare facilities.

(2) Infections occurring more than 48 hours after admission are considered
HAI.

(3) Infection acquired in hospital by a patient who has been admitted for a
reason other than that infection.

(4) Infection occurring in a patient in a hospital or health care facility when

infection was not present at time of admission.
Q- Components of chain of infection?

Chain of Infection:

- Infectious agent
- Susceptible host
- Reservoir
- Portal of exit
- Mode of transmission
- Portal of entry

1) Infectious agent: bacteria, viruses, parasite.

2) Reservoir: people, animals (pets), wild animals, food, soil, water.
3) Portal of exit:
a. Mouth (vomit, saliva)
b. Cuts in skin (blood)
c. During diapering and toileting (stool)
4) Susceptible host: babies, children, elderly, people with weakened
immune system, unimmunized people, and anyone.
5) Portal of entry: mouth, cuts in skin, eyes.
6) Mode of transmission:
a. Contact (hand, eyes, sand)
i. Droplets (speak, sneeze, cough)
ii. Direct
iii. Indirect
b. Airborne
c. Other source of infection e.g. vector
Q- Different types of personal protection equipment (PPE)?

PPE  specialized clothing or equipment worn by employee for protection

against infectious material.

1- Gloves:
a. Protect hand & act as barrier.
b. Prevent gross contamination of hand.
c. Reduce the organism from hands of personnel transmitted to pt.
during invasive or other pt. care.
d. Protect skin against hazardous substances or chemicals.

* Types of gloves: -

a. Surgical sterile gloves

b. Clean disposable non-sterile gloves
c. Utility, heavy-duty gloves

2- Gown or Aprons:

Factors influence selection of gown as PPE:

a. Purpose of use: -
 Isolation gowns  the preferred PPE for clothing.
 Cover the torso, fit-comfortable over body, and long
sleeves of wrist.
b. Material:
 Natural or man-made.
 Reusable or disposable.
 Resistance to fluid penetration.
c. Patient risk:
 Clean  generally used for isolation.
  Sterile  only necessary for performing invasive procedure
(inserting central line).
3- Face Protection:

- Masks & respirator  protect mouth, nose  protect respiratory tract.

- Eye protection (goggles)  protect eyes.

- Face shields  protect face, mouth, eyes, nose.

4- Protective footwear:

- Over shoes worn over ordinary shoes not recommended.

- Closed foot wears replacing ordinary shoes not needed with the exception
of some special areas such as OR.

- Fluid resistant footwear like boots recommended to prevent HCP skin

exposure to blood, other body fluids.

5- Head Caps: Disposable caps.

Q- Importance of PPE?

1- It prepares you for any health & safety risks. Gives you extra
protection even if in an accident or against the elements.
2- Prevent the spread of germs in hospital. Can protect HCW from
infection.
3- Protect skin, mucous membrane of HCWs from exposure to blood and
body fluids.
4- Prevent contamination of clothing, reduce the spread of organism
from pt. or fomites to other pt or environment.
Q- Method of H.H?

1- Plain Soap
2- Alcohol
3- Chloroxylenol
4- Chlorhexidine
5- Iodine, Iodophors
6- Quaternary ammonium compounds
7- Triclosan

A) Plain (Non-antimicrobial) Soap:

- Detergent-based products contain esterified fatty acid & sodium or
potassium hydroxide.
- Bar soap, tissue, leaflet, liquid preparation.
- Removal of dirt, soil, various organic substance form hand.
- Remove loosely adherent transient flora.
- Minimal antimicrobial activity.
- S/E:
o Paradoxical increase in bacterial count on skin.
o Skin irritation, dryness.
B) Alcohols:
- Isopropanol, ethanol or combination.
- Alcohol solution contains 60-95% alcohol  most effective.
- Antimicrobial activity  ability to denature proteins.
- Advantages:
o Germicidal activity in vitro.
o Reduce count of bacteria on hands.
- Preoperative cleaning.
- Easy, available, not costly.
Disadvantages:

- Poor activity against bacterial spores.

- Dryness of skin.
- Transient stinging sensation.
- No appreciable persistent (residual) activity.

Q- Indications for H. H:

1- Hand wash é soap & H2O when it is soiled & visibly dirty or after
using toilet.
2- Exposure to potential spore-forming pathogen is strongly proven
including outbreak of [Link].
3- Use alcohol-based hand rub for routine hand antiseptic if hands aren't
visibly soiled.
4- Perform hand hygiene before & after touching pt.:
a. Before handling an invasive device for pt. care.
b. After contact with body fluids & solution, dressing wound.
c. If moving from contaminated body site to another site of same
pt.
d. After contact with innominate surface & objects in vicinity of pt.
e. After removing sterile & non-sterile gloves.
5- Before preparing medication & food, H.H should be applied using
alcohol-based hand rub.
6- Soap & alcohol-based hand rub shouldn’t be concomitantly used.
Protective Footwear:

*Fluid resistance footwear like boots is recommended to protect HCP from

blood & other body fluids in situations where spills of blood & body fluids
accumulate around pt. table.

*Overshoes worn over ordinary shoes not acceptable.

Head Cap:

*Disposable caps should be worn by HCP to contain hair during certain

procedures as operating theater.
Q- Types of H.H?

Hand Hygiene: general term that applies to:

- Hand Washing
- Antiseptic Hand Washing
- Antiseptic Hand Rub
- Surgical Hand Antiseptic

1- Hand Washing: washing hand é plain soap and water (detergent does
not contain antimicrobial agents).
2- Antiseptic Hand Washing: washing hand é water, soap or other
detergents containing antiseptic agent.
3- Antiseptic Hand Rub: applying antiseptic hand rub product to all
surfaces of hand to reduce number of microorganisms present.
4- Surgical Hand Antiseptic: antiseptic hand wash or antiseptic hand rub
performed pre-operatively by surgical person to eliminate transient
and reduce resident hand flora.
a. Transient hand flora  Colonize superficial layer of skin,
removed by routine hand wash.
b. Resident hand flora  Attached to deep layer of skin, more
resistant to removal.
Importance of PPE?

1- It prepares you for any health & safety risks. Gives you extra
protection even of an accident or against the elements.
2- Prevent the spread of germs in hospital. Can protect HCW from
infection.

Different Types?

1- Gloves:
o Protect hand & act as barrier to prevent gross contamination of
hand.
o Reduce the likelihood that organisms can transmit from
personnel to pt. during invasive or other pt. care.
o Reduce the likelihood that the hand of personnel contaminated
with organisms from a pt. can be transmitted to another pt.
o Protect skin from hablard Sub. "chemical”.

Types of Gloves:

1- Surgical Sterile gloves

2- Clean disposable nonsterile gloves
3- Utility & heavy-duty gloves

Gown: generally preferred PPE for clothing.

- If contamination of area can be anticipated  gown should be used.

Face Mask/Respirator:

- Protect facial skin & mm of HCP from splatter & reduce risk of
infection with blood-borne pathogens.
- Also needed during activities that may expose to chemical splashes or
mechanical trauma.
Hand hygiene with Soap & water:(40-60 seconds).

1. wet hands with water.

2. Apply enough Soap to cover all hand surfaces

3. .Rub hands palm to palm.

4. Right palm over left dorsum with Interlaced fingers &vice-versa

5. palm to palm with fingers interlaced

6. Back of fingers opposite palms.

7. Rotational rubbing of the thumb of put palm & vice-versa

8. Rotational rubbing of Backwards to forwards of fingers to palm & vice-versa

9. Rinse hands with water.

10. Dry hands thoroughly with single use towel

11. Use towel to turn off Faucet.

12. Your hands are now safe.

Hand Hygiene :

1. wash hands with Soap and water when visibly dirty or soiled with body fluids

2. wash hands when exposure to a spore -forming pathogen.

3. Use an alcohol based hand rub as preferred means for routine Hand antiseptic.

4. Before and after touching the patient

5. Before handling invasive device for a patient care

6. after contact Body fluid, excretion, mucous membrane

7. . If moving from Contaminated body site to another in the same patient it

8. after removing of sterile or non sterile gloves.

9. Before handling medication or preparing food

Hand hygiene : A general term that applies to Either. (Hand washy, Antiseptic
hand-wash, Antiseptic Hand Rub, Surgical hand antisepsis)
Methods:

A-Hand hygiene Technique with Alcohol Based Formulations. (20-30) seconds:

1-apply a palm ful of the product in cupped hard all surface

2- Rub hand palm to palm

3- flight palm over left dorsum & Interfaced digits & vice versa

4-palm to palm with fingers interlaced

5-Back of the fingers to opposing palms

6-Rotational rubbing of left thumb in Right palm & vice-versa.

7- Rotation rubbing Backwards and forwards with clamped Fingers

8- once dry, your hands are safe

Types of hand hygiene:

1-Hand washing: washing hand with plain soap &water(detergent not containing
antimicrobial agent)

2-Antiseptic hand washing: washing hand with water, soap or other detergents
containing antiseptic agent

3-Antiseptic hand rub:Applying antiseptic hand rub to all surfaces of hand to

reduce number of microorganisms present

4-Surgical hand antisepsis: Antiseptic hand wash or antiseptic hand rub

performed preoperative by surgical person to eliminate transient( colonize
superficial layer of skin ,removed by routine hand wash) and reduce transient
hand flora (attach to dead layer of skin& more resistant to removal)