EngenderHealth http://www.engenderhealth __________________________________ USER'S 
GUIDE TO THE INFECTION PREVENTION ASSESSMENT SURVEY The Infection Prevention Assessment 
Survey provides the recognized "standards," or ideals, for the various infection 
prevention practices described in this training course. By using this survey, 
you can compare the infection prevention practices at a health care facility with 
the standards to determine whether or not each standard is being met. This Users' 
Guide to the Infection Prevention Assessment Survey provides a brief explanation 
of and rationale for each standard and provides more detailed information about 
how to get the most out of using the survey. Note: In order to assess whether 
or not a standard is being achieved, it is best to observe the practices as they 
are being conducted. However, if direct observation is not possible, routine performance 
of various practices may be determined by talking with service providers and ancillary 
staff and touring the facility. HANDWASHING Handwashing significantly reduces 
the number of potentially infectious microorganisms on the hands of service providers 
and reduces client sickness (morbidity) and death (mortality) caused by infections 
spread in the health care facility. 1. Hands should be washed when indicated. 
Hands should be washed in all of the following situations: * Immediately after 
arriving at work and before leaving work at the end of the day * Before and after 
examining each client * After touching any instrument or object that might be 
contaminated with blood or other body fluid, or after touching mucus membranes 
(e.g., eyes, nose, mouth) * Before putting on gloves for clinical procedures * 
After removing gloves * After using the toilet or latrine Check "YES" if hands 
are washed during these situations. 2. Hands should be washed with soap and running 
water. Water and mechanical friction (scrubbing or rubbing) alone are not adequate 
for cleaning hands. Soap must be used in conjunction with water and rubbing to 
remove transient organisms and soil. Running water does not have to come from 
a tap mounted on a sink; running water can come from a bucket with a tap or a 
pitcher. If water is not available, an alcohol handrub may be substituted for 
handwashing with soap and water. Check "YES" if hands are washed with soap and 
running water. If running water is not available and an alcohol handrub is used, 
check "NO" and record this in the Comments column. 3. Hands should be dried with 
a clean towel or allowed to air-dry. If towels are used, they should be either 
disposable or for personal use only. More than one person should not use the same 
towel, because towels quickly become contaminated with microorganisms from the 
users' hands and easily be passed from one user to another. Check "YES" if hands 
are dried with a clean towel or allowed to air-dry. 4. Plans should be made and 
supplies should be available for times when running water is not available. Even 
if water from a tap is normally available at a facility, there may be times when 
water from a tap is not available. Therefore, plans should be in place for these 
times and all of the necessary supplies should be available to obtain water from 
an alternate source. Check "YES" if plans have been made and supplies are available 
for times when water is not available from a tap. USE OF GLOVES Gloves provide 
a barrier against potentially infectious microorganisms in blood, other body fluids, 
and medical waste and protect against hazardous chemical waste. There are three 
types of gloves used in health care settings: surgical, single-use examination, 
and utility gloves. 5. Gloves should be worn whenever contact with blood or other 
body fluids is anticipated. Sterile or high-level disinfected surgical gloves 
are preferred for procedures in which there will be contact with the bloodstream 
or tissues under the skin (e.g., surgical procedures, insertion of Norplant implants, 
pelvic examinations of women in labor). Single-use examination gloves are indicated 
for all procedures in which there will be contact with intact mucus membranes 
(e.g., IUD insertion, manual vacuum aspiration, pelvic examination) or for situations 
in which the provider may be exposed to a client's blood or other body fluids 
(e.g., drawing blood, working in the laboratory). Check "YES" if sterile or HLD 
surgical gloves and examination gloves are used as indicated. 6. Utility gloves 
should be worn when handling contaminated instruments and other items, handling 
medical or hazardous chemical waste and linen, performing housekeeping activities, 
and cleaning contaminated surfaces. Staff who may not have direct client contact 
are at risk of infections if their work exposes them to potentially contaminated 
instruments or other items or blood or other body fluids. Wearing utility gloves 
when handling any potentially contaminated materials and when cleaning instruments 
or other items reduces the risk of infections. Check "YES" if staff wear utility 
gloves as indicated. ANTISEPTICS AND DISINFECTANTS Antiseptics are chemical agents 
that are used on the skin and mucous membranes to remove or kill microorganisms. 
Examples include alcohol, chlorhexidine gluconate (e.g., Hibitane, Savlon), hexachlorophene 
(e.g, pHisoHex), iodine, iodophors (e.g, Betadine), and para-chloro-meta-xylenol 
(PCMX; e.g., Dettol). Disinfectants are chemical agents that are used on inanimate 
objects, such as instruments and surfaces, to kill microorganisms. Examples include 
chlorine and glutaraldehyde. 7. Antiseptics should be used only on the skin and 
mucous membranes. Antiseptics are indicated for: * Surgical handscrub * Skin, 
cervical, and vaginal preparation before a clinical procedure * Handwashing in 
high-risk situations, such as before invasive procedures or contact with clients 
at high risk of infections Antiseptics should never be used on instruments or 
other items, surfaces, or reusable gloves. In addition, instruments and other 
items should never be left soaking in an antiseptic solution. Check "YES" if antiseptics 
are used only on the skin and mucous membranes as indicated. Note: Record the 
name(s) of the antiseptic(s) used in the Comments column. 8. Disinfectants should 
be used only for processing instruments and other items for reuse and for housekeeping 
activities. Disinfectants are indicated for: * Processing instruments and other 
items (high-level disinfectants) * Cleaning surfaces (low-level disinfectants) 
Disinfectants are not to be used on the skin or mucous membranes. In addition, 
instruments and other items should not be left soaking indefinitely or stored 
in disinfectant solutions. Check "YES" if disinfectants are used on inanimate 
objects as indicated. Note: Record the name(s) of the disinfectant(s) used in 
the Comments column. 9. Antiseptics and disinfectants should be handled in a manner 
that reduces the risk of contamination. Antiseptic and disinfectant solutions 
can easily become contaminated; microorganisms can survive and grow in them. Care 
must be taken to avoid contamination of antiseptics and disinfectants by following 
these guidelines: * Solutions should be poured into smaller containers for use 
during service delivery. * The amount of antiseptic needed for one client should 
be poured into a small bowl or gallipot before starting the procedure, and any 
remaining solution should be discarded at the end of the procedure. * Solutions 
should be poured without touching the rim or the solution itself with hands, cotton, 
or gauze * Gauze, cotton wool, and cotton balls should not be stored in any solution, 
since gauze and cotton provide a good medium for microorganisms to grow. * Containers 
should be stored in a cool, dark area. Check "YES" if antiseptics and disinfectants 
are handled as indicated. ASEPTIC TECHNIQUE Aseptic technique refers to practices 
that help reduce the risk of postprocedure infections in clients by reducing the 
likelihood that, during clinical procedures, microorganisms will enter areas of 
the body where they can cause disease. 10. A surgical handscrub should be performed 
before all surgical procedures. A surgical handscrub should be performed to prevent 
the rapid growth of microorganisms inside surgical gloves for a period of time 
and reduce the risk of infections to clients if gloves develop holes, tears, or 
nicks during the procedure. A surgical handscrub should be performed as follows: 
* Remove all jewelry. * Clean fingernails with a stick or brush. * Wash hands 
with an antiseptic soap for 3-5 minutes. Beginning at the fingertips, wash between 
the fingers and move toward the elbow. * Rinse each arm separately, fingertips 
first, holding hands above the level of the elbows. * Dry hands with a sterile 
towel or allow to air-dry. * Hold hands above the level of the waist at all times. 
If an antiseptic soap is not available or staff are allergic to the available 
antiseptic, staff should scrub as described above with plain soap and water and 
then apply 3-5 mL of alcohol or an alcohol handrub solution and rub hands together 
until they are dry. Ideally, surgical handscrub should be performed between each 
procedure. However, to prevent skin irritation from too-frequent handscrubbing 
in high-volume settings, the surgical team can use 3-5 mL of an alcohol handrub 
solution between clients, rubbing the hands together until they are dry. Staff 
should scrub every hour or after every four clients (whichever comes first). Check 
"YES" if a surgical handscrub is performed as indicated before all surgical procedures. 
11. Sterile or high-level disinfected surgical gloves should be put on and removed 
in ways that do not contaminate the gloves or allow the wearer to touch the contaminated 
outside part of the gloves. Sterile or high-level disinfected surgical gloves 
should not be contaminated while they are being putting on. When removing contaminated 
gloves, the wearer should not touch the outside of the glove, which is contaminated. 
Check "YES" if staff follow the procedures for putting on and removing surgical 
gloves. 12. Shaving the surgical site should not be performed routinely and should 
be performed only when absolutely necessary. Shaving can create nicks and breaks 
in the skin, which can lead to increased risk of postprocedure infections. Research 
has shown a reduction in the number of postoperative surgical-site infections 
when shaving is not performed. Clipping hair with scissors is acceptable if hair 
interferes with the procedure. Shaving the surgical site should be performed only 
when absolutely necessary. Check "YES" if shaving is not performed routinely, 
hair is clipped with scissors if it interferes with the procedure, and shaving 
is performed only when absolutely necessary. 13. The surgical/procedure site should 
be prepared properly using an appropriate antiseptic solution. The surgical/procedure 
site should be cleaned with soap and water and then cleaned with an antiseptic 
solution just before the procedure. If an iodophor (e.g., Betadine) is used, the 
antiseptic should be left on for 1-2 minutes before wiping off the excess solution. 
The site should be wiped using a circular motion, beginning in the cneter of the 
site and moving out. Check "YES" if the surgical site is prepared as indicated. 
14. A sterile field should be established and maintained during all surgical/clinical 
procedures. A sterile field is maintained by: * Placing only sterile items for 
use within the sterile field * Opening, dispensing, or transferring sterile items 
without contaminating them * Considering items located below the level of the 
draped client to be unsterile * Not allowing sterile personnel to reach across 
unsterile areas or to touch unsterile items * Recognizing and maintaining the 
service provider's sterile area (when gowned, this extends from the chest to the 
level of the sterile field; sleeves are sterile from 5 cm above the elbow to the 
cuff * Recognizing that the edges of a package containing a sterile item are considered 
unsterile * Recognizing that a sterile barrier that has been penetrated (wet, 
cut, or torn) is considered contaminated * Being conscious of where your body 
is at all times and moving within or around the sterile field in a way that maintains 
sterility * Not placing sterile items near open windows or doors Once the sterile 
field is established, it should be maintained until the procedure is finished. 
If a "break" (contamination) occurs, it must be corrected before the procedure 
continues. Check "YES" if the sterile field is maintained as indicated. 15. Traffic 
and activities should be controlled and appropriate attire should be worn in surgical/procedure 
areas. Minimizing traffic in surgical/procedure areas reduces the amount of dirt, 
dust, and insects in the area. Only necessary staff should be allowed in these 
areas during procedures. Changing into attire designated for use in the surgical 
area further reduces the introduction of microorganisms into the area. Proper 
surgical attire includes caps, masks, gowns, protective eyewear, and sturdy footwear. 
Staff (including cleaning staff) should wear caps, masks, and sturdy footwear 
at all times in the surgical area. Masks should cover the nose and mouth. Caps 
should cover all hair. Street shoes should be clean and covered, or staff should 
change to shoes or boots that are worn only in the surgical area. Check "YES" 
if these conditions are met. USE AND DISPOSAL OF NEEDLES AND OTHER SHARPS Injury 
from hypodermic needlesticks or other sharp objects is the number-one cause of 
occupational exposure to bloodborne pathogens. Therefore, all sharps must be handled 
and disposed of properly. 16. Hypodermic needles should not be routinely recapped 
and should never be bent or broken before disposal. Needles should not be removed 
from syringes before disposal. Needles and other sharps should be handled as little 
as possible after use. If recapping is absolutely necessary, the one-handed technique 
should be used, as follows: * Place the cap on a flat surface, then remove your 
hand. * With one hand, hold the syringe and use the needle to "scoop-up" the cap. 
* When the cap covers the needle completely, use the other hand to secure the 
cap on the needle hub, being careful to handle the cap at the bottom only, near 
the hub. Check "YES" if hypodermic needles are not routinely recapped and are 
never bent or broken before disposal. Also check "YES" if the one-hand technique 
is used when recapping is necessary. 17. Sharps should be disposed of in puncture-resistant 
containers. A puncture-resistant sharps container can be made out of a heavy cardboard 
box, an empty plastic jug, or a metal container. Check "YES" if sharps are disposed 
of in puncture-resistant containers. 18. Sharps containers should be available 
wherever sharps are used. Containers should be disposed of when they are three-quarters 
full. Sharps containers should be available in injection rooms, treatment rooms, 
operating theaters, labor and delivery rooms, and laboratories. They should never 
be filled to capacity because sharps may penetrate the container wall and cause 
injury. Check "YES" if sharps containers are available in all the areas when sharps 
are used and are emptied when they are three-quarters full. 19. Unprotected sharp 
items should not be passed directly from one person to another during surgical/clinical 
procedures. During surgical/clinical procedures, sharps should be placed in and 
picked up from a kidney basin or a designated "safe zone" to minimize the risk 
of injury to clients and providers. Check "YES" if sharps are not passed directly 
from one person to another during surgical/clinical procedures. 20. A new or properly 
processed needle and syringe should be used every time an injection is given or 
medication is withdrawn from a multidose vial. A new or properly processed needle 
and syringe should be used to prevent contaminating the solution in the vial. 
Needles should never be left inserted in the vial cap, because the hole in the 
needle can allow contaminates to get into the solution. Check "YES" if a new or 
properly processed needle and syringe are used as indicated and if needles are 
not left inserted in multidose vials. PROCESSING INSTRUMENTS AND OTHER ITEMS Processing 
reusable instruments and other items used in surgical/clinical procedures involves 
four steps: 1. Decontamination 2. Cleaning 3. Sterilization or high-level disinfection 
(HLD) 4. Storage The order of the steps, as well as the area in which they are 
performed, are important to reduce the number of microorganisms on the instruments 
and other items and minimize the risk of infections. 21. "Clean" and "dirty" activities 
should be performed in separate areas. When only one room is available for processing 
instruments and other items, it should be arranged so that activities and objects 
flow in an organized fashion from receiving used items to storing sterilized or 
high-level disinfected items. "Clean" areas--areas in which sterilization, HLD, 
and storage are performed--should be separated from "dirty" areas--areas in which 
decontamination and cleaning are performed--in order to reduce the risk of contaminating 
sterile or high-level disinfected instruments and other items. Check "YES" if 
clean and dirty activities are performed in separate areas. 22. Instruments and 
other items should be stored dry and should never be left soaking indefinitely 
in solutions. Instruments and other items should be stored dry, since bacteria 
can grow in solutions, even if a disinfectant is added. Instruments and other 
items should never be left soaking indefinitely in any type of solution; if they 
are high-level disinfected, they should soak only for the amount of time specified 
and then be removed from the disinfectant solution, rinsed, and stored dry. Check 
"YES" if all instruments and other items are stored dry and are not left soaking 
indefinitely in solutions. 23. Soiled linen should be handled wearing utility 
gloves in a way that prevents exposure of the skin and mucous membranes to potentially 
contaminated material. When removing soiled linen, it should be gathered so that 
the contaminated area is on the inside. All laundry, whether or not it is visibly 
contaminated, should be handled wearing utility gloves and clothing that covers 
the arms, legs, and feet. Protective eyewear is recommended. Check "YES" if soiled 
linen is handled as indicated. DECONTAMINATION Decontamination kills viruses (such 
as hepatitis B, other hepatitis viruses, and HIV) and many other microorganisms, 
making instruments and other items safer to handle by staff who clean them. 24. 
Instruments and other items should be decontaminated by placing them in a 0.5% 
chlorine solution immediately after use and letting them soak for 10 minutes. 
Immediately after a procedure is over, instruments should be placed in a bucket 
of 0.5% chlorine solution and left soaking for 10 minutes. The bucket should be 
in close proximity to the surgical/clinical area. The chlorine can be in powder 
or liquid form. Note: Record the chlorine product used and the percent of "active" 
chlorine in the Comments column. Check "YES" if instruments and other items are 
decontaminated immediately after use as indicated. CLEANING Cleaning is performed 
before instruments and other items are sterilized or high-level disinfected to 
remove blood, other body fluids, organic material, tissue, and dirt and to ensure 
that sterilization and HLD are effective. 25. Instruments and other items should 
be thoroughly scrubbed using a soft brush and detergent and water and rinsed thoroughly 
with clean water before sterilization or HLD. Detergent is necessary to remove 
protein, oils, or grease. Hand soap should not be used to clean instruments and 
other items, because the fatty acid contained in the soap will react with the 
minerals of hard water, leaving a residue or scum that is difficult to remove. 
Instruments with multiple parts should be disassembled, and the grooves, teeth, 
and joints of the instruments and other items should be brushed. Check "YES" if 
cleaning is performed as indicated. 26. If gloves are processed, they should be 
checked carefully for holes or tears after cleaning. Gloves can tear and be punctured 
easily; therefore, they should be checked for holes before washing. To check for 
holes, inflate the glove with air and hold it under water; if air bubbles appear, 
the glove has a hole and should be disposed of. Alternatively, fill the glove 
with water; if any leaks out, the glove has a hole and should be disposed of. 
Check "YES" if gloves are checked for holes after cleaning. STERILIZATION Sterilizing 
eliminates all microorganisms (bacteria, viruses, fungi, and parasites), including 
bacterial endospores. It is the recommended method for processing instruments 
and other items that will come in contact with the bloodstream or tissues under 
the skin. Instruments and other items can be sterilized by steam under pressure 
(autoclaving), dry heat, or soaking in chemicals. 27. For steam sterilization, 
instruments and other items should be packed in a way that allow steams to reach 
all surfaces. For steam sterilization to be effective, steam must have direct 
contact with all surfaces of the instruments and other items, as follows: * All 
jointed instruments and other items and those with sliding or multiple parts should 
be opened or disassembled before sterilization. * All instruments and other items 
that are wrapped must be loaded in the autoclave in a way that allows steam to 
contact all surfaces. All packs, drums, and unwrapped items should be arranged 
in the autoclave in a way that allows steam to circulate freely. Gloves should 
not be wrapped into tight balls. Check "YES" if instruments and other items are 
properly prepared and loaded in the autoclave as indicated. 28. Appropriate parameters 
(time, temperature, pressure) for steam sterilization should be followed. Specific 
time, temperature, and pressure requirements are necessary for steam sterilization 
to be effective. While parameters may vary depending on the autoclave, the following 
rules generally apply (the manufacturer's instructions should be followed whenever 
possible): * Time = 30 minutes if wrapped, 20 minutes if unwrapped * Temperature 
= 121°C (250°F) * Pressure = 106kPa (15 lb/in²) Timing should not begin until 
the temperature and pressure requirements are met. Check "YES" if the appropriate 
parameters for steam sterilization are followed as indicated. 29. Appropriate 
parameters (temperature, time) for dry-heat sterilization should be followed. 
Specific time and temperature requirements are necessary for dry-heat sterilization 
to be effective, as follows: 170°C (340°F) - 1 hour 160°C (320°F) - 2 hours 150°C 
(300° F) - 21/2 hours 140°C (285°F) - 3 hours Timing should not begin until the 
temperature requirement has been reached. Check "YES" if the appropriate parameters 
for dry-heat sterilization are followed as indicated. 30. Sterilization equipment 
should be properly monitored and maintained. Autoclaves (steam sterilizers) and 
dry-heat ovens should be properly maintained to ensure that sterilization has 
been achieved. Routine maintenance should become standard procedure, and someone 
should be assigned to be responsible for this task. If repairs are necessary, 
they should be made before the equipment is used again. Biological monitoring 
should be performed weekly (or monthly, if testing weekly is not possible) to 
verify that sterilization is effective. Check "YES" if autoclaves and dry-heat 
ovens are properly maintained and biological monitoring is performed regularly 
as indicated. 31. A properly prepared chemical solution, such as a product containing 
glutaraldehyde, should be used for chemical sterilization. The products that are 
most likely to be available for chemical sterilization are those containing glutaraldehyde 
(e.g., Cidex, Sporicidin). Formaldehyde should not be used. Most glutaraldehyde-containing 
solutions are effective for anywhere from 14-30 days from activation (the manufacturer's 
instructions should always be followed), and the container should be labeled with 
the date the solution was prepared and the date it expires. The solution should 
be discarded if it becomes cloudy. Check "YES" if an appropriate chemical solution 
is prepared and used as indicated 32. For chemical sterilization, instruments 
and other items should be dry, opened or disassembled, and completely submerged 
in the solution. Instruments and other items should be dry before chemical sterilization, 
because water from wet instruments and other items dilutes the chemical solution 
and reduces its effectiveness. For chemical sterilization to be effective, the 
chemicals must have contact with all surfaces. Therefore, all instruments and 
other items, ports, and valves must be opened, disassembled, and completely submerged 
in the solution. Check "YES" if instruments and other items to be chemically sterilized 
are dry, opened or disassembled, and completely submerged in the solution as indicated. 
33. Instruments and other items should soak in the chemical solution for the time 
listed in the manufacturer's instructions and be rinsed with sterile water. Instruments 
and other items should soak in a glutaraldehyde-containing solution for 10-12 
hours (the manufacturer's recommendation should be followed, especially if other 
products are used). No instruments or other items should be added to or removed 
from the solution once timing has begun. Instruments and other items should be 
thoroughly rinsed with sterile water. (Boiled water is not sterile water.) Check 
"YES" if instruments and other items are soaked in the chemical solution and rinsed 
with sterile water as indicated. 34. After any method of sterilization, instruments 
and other items should be stored in a way that limits the risk of contamination. 
Regardless of the sterilization process, sterile instruments and other items should 
be stored dry. Wrapped instruments and other items should be stored in a closed 
cabinet, and unwrapped instruments and other items should be stored in a covered, 
sterile container. All sterile instruments and other items should be stored in 
an environment that is free of dust, dirt, and insects. Properly stored wrapped 
instruments and other items are considered sterile as long as they remain intact 
and dry; properly stored unwrapped instruments and other items may be stored for 
1 week. Check "YES" if instruments and other items that have been sterilized are 
stored properly as indicated. HIGH-LEVEL DISINFECTION High-level disinfection 
(HLD) eliminates all microorganisms (including bacteria, viruses, fungi, and parasites), 
but does not reliably kill all bacterial endospores. HLD is suitable for instruments 
and other items that will come in contact with broken skin or intact mucous membranes. 
It is the only acceptable alternative to sterilization when sterilization is not 
possible. Instruments and other items can be high-level disinfected by boiling, 
soaking in chemicals, or steaming. 35. For HLD by boiling, instruments and other 
items should be opened or disassembled, completely submerged in the water, and 
boiled for 20 minutes from the time when the water comes to a rolling boil. Water 
must touch all surfaces for HLD by boiling to be achieved. Therefore, all instruments 
and other items must be disassembled, opened, and completely submerged in the 
water. (The exception to this is cannulae used in manual vacuum aspiration, or 
MVA, which does not need to be submerged in the water if the pot/boiler is kept 
covered.) Timing does not begin until the water is at a rolling boil. No additional 
water, instruments, or other items should be added or removed once timing has 
begun. Instruments and other items are ready to be removed after 20 minutes and 
should be removed while the water is still boiling, using sterile or high-level 
disinfected pickups (lifters, cheatle forceps). Check "YES" if instruments and 
other items are high-level disinfected by boiling as indicated. 36. Appropriate 
and properly prepared disinfectant solutions should be used for chemical HLD. 
Appropriate chemicals for use in HLD include: * Chlorine (0.5%) * Glutaraldehyde-containing 
solutions Solutions must be properly prepared. The products that are most likely 
to be available for chemical sterilization are those containing glutaraldehyde 
(e.g., Cidex, Sporicidin). Formaldehyde should not be used. Most glutaraldehyde 
solutions are effective for anywhere from 14-30 days from activation (the manufacturer's 
instructions should always be followed), and the container should be labeled with 
the date the solution was prepared and the date it expires. The solution should 
be discarded if it becomes cloudy. A new chlorine solution should be prepared 
each day. Note: Record the type of solution(s) used in the Comments column. Check 
"YES" if a chemical solution is properly prepared and used for chemical HLD as 
indicated. 37. For chemical HLD, instruments and other items should be dry, opened 
or disassembled, and completely submerged in the solution. Instruments and other 
items should be dry before chemical HLD, because water from wet instruments and 
other items dilutes the chemical solution and reduces its effectiveness. For chemical 
HLD to be effective, the chemicals must have contact with all surfaces. Therefore, 
all instruments and other items, ports, and valves must be opened, disassembled, 
and completely submerged in the solution. Check "YES" if instruments and other 
items are chemically high-level disinfected are dry, opened or disassembled, and 
completely submerged in the solution as indicated. 38. Instruments and other items 
should soak in the chemical solution for 20 minutes and be rinsed with boiled 
water. Instruments and other items should soak in a chemical solution for 20 minutes. 
No instruments or other items should be added to or removed from the solution 
once timing has begun. Instruments and other items should be thoroughly rinsed 
with boiled water. Check "YES" if instruments and other items are soaked in the 
chemical solution and rinsed with boiled water as indicated. 39. If gloves or 
MVA cannulae are steamed, they should be placed in the steamer so that steam can 
contact all surfaces and steam for 20 minutes. For HLD by steaming to be effective, 
steam must have direct contact with all surfaces of the gloves or MVA cannulae. 
Paired, cuffed gloves or MVA cannulae should be placed in a steamer tray, loosely 
layered in a criss-cross design. Gloves should never be rolled into balls or packed 
tightly in the tray(s). Check "YES" if gloves and MVA cannulae are HLD by steaming 
as indicated. 40. After any method of HLD, instruments and other items should 
be stored in a way that limits the risk of contamination. Regardless of the HLD 
process, high-level disinfected instruments and other items should be stored dry. 
They should be placed in a covered, dry, high-level disinfected container in an 
environment that is free of dust, dirt, and insects. Check "YES" if instruments 
and other items that have been high-level disinfected are stored properly as indicated. 
HOUSEKEEPING Housekeeping is the general cleaning and maintenance of cleanliness 
in a health care facility. In addition to cleanliness, it reduces the number of 
microorganisms in the facility (thus reducing clients' and staff members' risk 
of infections) and provides an appealing work and service-delivery space. 41. 
Non-client-care areas should be kept free of dust, dirt, and organic debris. Client-care 
areas should have an orderly appearance, as follows: * The areas should becleaned 
with a cloth or mop dampened with detergent and water once a week or when visibly 
dirty * Cloths and mops should be damp so the dirt and dust particles are picked 
up, not spread around. * Waste containers should be emptied daily. * Toilets, 
latrines, and sluice rooms should be cleaned daily with a disinfectant cleaning 
solution. Check "YES" if non-client-care areas and toilets, latrines, and sluice 
rooms are cleaned and waste baskets are emptied as indicated. 42. Client-care 
areas should be dusted each morning and cleaned with a disinfectant cleaning solution 
between clients and at the end of each clinic session or day. Client-care areas 
require special attention to cleaning, as follows: * Surfaces should be dusted 
and mopped with water at the beginning of each day, because dust settles overnight. 
Cloths and mops should be damp so that the dirt and dust particles are picked 
up, not spread around. * Between clients, all potentially contaminated surfaces 
should be wiped with a cloth dampened with a disinfectant cleaning solution. * 
At the end of each clinic session or day, all surfaces and floors should be wiped 
or mopped with a cloth or mop soaked in a disinfectant cleaning solution. * Spills 
of any type should be cleaned immediately with a 0.5% chlorine solution. Check 
"YES" if client-care areas are cleaned as indicated. 43. Once a week, the ceilings 
in operating theaters and procedure rooms should be cleaned with a mop dampened 
with a disinfectant cleaning solution. Check "YES" if the ceilings in operating 
theaters and procedure rooms are cleaned each week as indicated. 44. Housekeeping 
equipment (mops, buckets, and cloths) should be decontaminated, cleaned in detergent 
and water, rinsed in clean water, and allowed to dry before reuse. Items used 
for housekeeping need to be cleaned themselves to reduce the chances of spreading 
infections. Contaminated cleaning equipment spreads, rather than reduces, microorganisms 
in the environment. Check "YES" if housekeeping equipment is decontaminated, cleaned, 
rinsed, and dried before reuse as indicated. 45. Fumigation and ultraviolet (UV) 
light should not be used to disinfect operating theaters or other areas of the 
facility. Fumigation and use of ultraviolet (UV) light are ineffective methods 
of reducing the number of microorganisms in health care facilities. In addition, 
formaldehyde and other agents that are commonly used for fumigation are harmful 
to staff. These approaches should not be used to disinfect any room in the facility. 
Check "YES" if fumigation or UV light is not used to disinfect in the facility. 
WASTE DISPOSAL There are three kinds of waste generated at a health care facility: 
general, medical, and hazardous chemical waste. 1. General waste: nonhazardous 
waste that poses no risk of injury or infections, including uncontaminated paper, 
boxes, packaging materials, bottles, plastic containers, and food-related trash. 
2. Medical waste: material generated in the diagnosis, treatment, and/or immunization 
of clients, including: Blood, blood products, and other body fluids, as well as 
materials containing fresh or dried blood or body fluids (e.g., bandages, surgical 
sponges); Organic waste, such as human tissue, body parts, placentas, and products 
of conception; Sharps (used or unused), including hypodermic and suture needles, 
scalpel blades, blood tubes, pipettes, and other glass items that have been in 
contact with potentially infectious materials (e.g., glass slips, coverslips) 
3. Hazardous chemical waste: chemical waste that is potentially toxic or poisonous, 
including cleaning products, some disinfectants, cytotoxic drugs, and radioactive 
compounds. Proper handling and disposal of waste minimizes the spread of infections 
and reduces the risk of accidental injury to staff, clients, visitors, and the 
community. All staff should wear utility gloves and shoes when handling medical 
and hazardous chemical waste. 46. General and medical waste should be separated 
into appropriate containers at the point at which it is generated. Separating 
waste can greatly reduce the amount of waste requiring special handling. Waste 
should be separated at the point at which it is generated by placing it into bins 
marked "general waste" and "medical waste." These containers should be emptied 
frequently. Waste should never be separated at the disposal or transfer site because 
it needlessly exposes the staff to infectious agents. Check "YES" if waste is 
separated at the point at which it is generated as indicated. 47. Solid medical 
waste should be either burned or buried in a pit. Properly burning or burying 
medical waste protects the community from accidental exposure to infectious agents. 
Burning in an incinerator or oil drum is recommended. Open burning is not recommended, 
because it causes scattering of waste, is dangerous, and is unattractive. If medical 
waste is burned in an incinerator, the following criteria should be met: * The 
incinerator is located downwind from the clinic. * The incinerator has sufficient 
air inlets on the side for efficient burning. * The incinerator is placed on hard 
earth or a concrete base. * Only medical waste is burned. If medical waste is 
buried, the following criteria must be met: * The burial site is at least 50 meters 
away from any water source, is located downhill from any wells, is free of standing 
water, is in an area that does not flood, has proper drainage, and is not located 
on land that will be used for agriculture or development. * The pit is 1-2 meters 
wide and 2-5 meters deep. The bottom of the pit is 1.8 meters above the water 
table. * Every time waste is added to the pit , it is covered with a 10-30-cm 
layer of soil. * When the level of waste reaches to within 30-50 cm of the ground 
surface, the pit is filled with dirt, sealed with concrete, and another pit is 
dug. Check "YES" if medical waste is burned or buried as indicated. 48. The community 
should be protected from possible exposure to medical waste. Interim storage sites 
and medical waste-disposal sites should be located in areas that are minimally 
accessible to staff, clients, and visitors. If they are not contained (e.g., in 
an incinerator), they should be protected by a barrier such as a fence or wall 
to keep animals and children out. Check "YES" if the interim storage site and 
medical waste-disposal site are located in isolated areas or are protected by 
a fence or wall as indicated. 49. Liquid medical waste and hazardous chemical 
waste should be poured down a drain or buried in a pit. Liquid medical waste and 
hazardous chemical waste can be hazardous to the environment and should be disposed 
of according to local regulations. If there are no guidelines, pour solutions 
down a utility-sink drain, flushable toilet, or latrine, or bury them in a pit. 
Do not pour solutions directly on the ground or near an outdoor water source. 
Check "YES" if liquid medical waste and hazardous chemical waste are disposed 
of according to local guidelines or as indicated. 50. Medical-waste containers 
should be cleaned with a disinfectant cleaning solution and rinsed with water 
daily, or more often, if visibly contaminated. Staff should always wear heavy 
utility gloves and shoes when cleaning the containers. Check "YES" if medical-waste 
containers are cleaned daily as indicated. __________________________________ 
copyright 2004 EngenderHealth