Quality consultant

Safe injection

Standard specifications for the WHO on Safe Injection

Safe injection
• Safe injection characterized as follows (WHO):
 A specific place for injection.
 Hand wash.
 One sterile syringe is disposed of immediately after the completion of the injection
process and not reused.
 Injected drugs containers are sterilized and all necessary solvents are also sterile.
 Cleanse the skin injection site.
 Safe disposal of all consequential after the injection process.
Safe injection

• Dangers of the re-use of syringes.

• Re-use of syringes lead to the spread of:
 Hepatitis (B).
 Hepatitis (C).
 The human immunodeficiency virus (HIV).
 And other diseases transmitted via the blood.
Safe injection
Safe injection

• Peripheral venous catheter and IV injection procedures:

 Wash hands !!!, and gloves !!!,
 Wash your hands, and preparing supplies, and delivery of
intravenous device intravenous solution, and the preparation of
hand turnique , and assess the injection site, and scrubbing hands
with antiseptic substance, and wait until the end of the contact
time
 Gloves !!!.
Safe injection

• Peripheral venous catheter and IV injection procedures:

 Do not touch the inserting site of the needle into the skin.
 Change the cannula in each new attempt.
 In the case of entry of the cannula, can take a sample of blood befor
e installing injection device intravenously.
 Put the tape correctly to check the position of entry easily.
 Do not put betadin solution at the injection site.
Safe injection
Safe injection

• Needles recapping: Warning

• Recapping of the needles is the main cause of exposure
to acupuncture in many health facilities.
• Prohibits recapping of syringe .... why .... !!
• Re-capping by using a technique i.e. One hand
(Scope method).
Safe injection
Safe injection
Safe injection
Re-processing of tools & sterilization services.
Sterilization services
Sterilization services

• Cleaning Methods:
 Manual cleaning.
 Washing and cleansing machines.
 Cleaning machines that rely on high frequency ultra-sound wave
Sterilization services

• Cleansing:
 Chemical disinfections used.
 Cleaning is an important step leading up to the disinfection
process.
Sterilization services

• Sterilization:
 Is the level of decontamination that intended to get rid of
all forms of microbial life, including cysts.

• Either:
 Steam Sterilization.
 Dry heat Sterilization
Sterilization services

• Sterilization:
 Time and temperatures needed for heat sterilization

• steam :
 121 C° for 15 minutes Autoclaves
 126 C° for 10 minutes
 134 C° for 3 minutes

• Dry heat
 180 C° for 60 minute Ovens
Sterilization services

• Sterilization:
 Factors affecting the effectiveness of the sterilization

• Burden bio - influenced cleaning before sterilization.

 Heat.
 Time.
 Vapor pressure.
 Chemical used (focus - activated - contact).
Sterilization services

• Sterilization:
 Factors affecting the effectiveness of the sterilization
• The tool properties to be sterilized:
 The surface (rough or smooth - contains pores or not
 reacts with disinfectants or steam).
 The material of construction.
 Figure (cavities).
• Steps sterilization:
 Rinsing.
 Packaging.
Sterilization services
• Sterilization:
 Sterilization indicators
 Colorimetric and chemical sterilization indicators.
 Tapes for the detection of encapsulated bacteria.
 Biological indicators.
Sterilization services
Sterilization services
Sterilization services
Environmental Cleaning & Disinfection

• Hospital environment
 Low-risk areas:
 Waiting and Management rooms.
 Medium-risk areas:
 Wards for patients.
 High-risk areas:
 Special care areas (isolation -Dental -intensive care - prem
ature - dialysis -burns - endoscopy - Operations).
Environmental Cleaning & Disinfection
Environmental Cleaning & Disinfection

• Methods of cleaning up the environment:

 Dry Cleaning.
 Wet cleaning
 Environmental Cleaning & Disinfection

• Hygiene Workers
 Number should be enough.
 Well trained for cleaning.
 Vaccinated to protect them against infection (Hepatitis B).
 Clear instructions must be written for the cleaning.
 Supervision and follow-up on them to make sure the
 integrity of the of cleaning processes.
 PPE for the cleaners
Environmental Cleaning & Disinfection

• Tools and Cleaning Supplies

 Must be clean and dry when stored, and should also be
cleaned and disinfected before reuse.
Environmental Cleaning & Disinfection

• Tools and Cleaning Supplies

 What is:
 Twiner (Fathallah) with long hand.
 Heavy duty gloves.
 Cleaning towel.
 Puckets.
 Liquid soap.
 Disinfectant (chlorine, for example).
Environmental Cleaning & Disinfection
Environmental Cleaning & Disinfection
• Number of cleaning times
 Low-risk areas:
 once a day and when needed.
 risk Medium-areas:
 at least twice a day and when contaminated with
organic matter.
 High-risk areas:
 cleaned at higher rates than
 previously, at the end of the day and when the
 contaminated, and after leaving the patient and
 between each patient and another when
 contaminated with organic matter.
Environmental Cleaning & Disinfection

• Urinals
 Large number of dangerous germs, but a low risk.
 PPE and then washing thoroughly after patient’s use
and disinfectant is used in average level.
 Patient washes his hands after use.
 Used for one patient during the stay.
 Cleaning well after the departure of the patient and clea
nsing high-level disinfects.
Environmental Cleaning & Disinfection

• Bathrooms
 Cleanse the average level (may come in
 contact with non-intact skin)
 Example chlorine (1000 p/m)
Environmental Cleaning & Disinfection

• Environmental Disinfectants
 Chlorine.
 Phenol.
 Alcohol.
 Ammonia compounds.
Environmental Cleaning & Disinfection

• Hypochlorites / chlorine
 Concentration measured by the number of molecules per
million of chlorine in the solution .
 Can eliminate bacteria, viruses, fungi, and some cysts .
 Organic materials lead to the inhibition of its activity.
 Caustic, irritant .
 Theoretically suitable for most purposes different
 Cleansing
 Should be used with cautious.
Environmental Cleaning & Disinfection

• Hypochlorites / chlorine
 Different concentrations of hypochlorite:

 Advisable to use chlorine concentration of

 1000 p/m for ordinary disinfection.

 5000 p/m for any splashes or body fluids .

Environmental Cleaning & Disinfection
• Hypochlorites / chlorine

• Example:
 Preparation of chlorine solution concentration 1000 p/m of
active chlorine 5% :
 5/100
 ( -------------------------- ) - 1
 1000/1000000
 Any size and one active chlorine (5%) per 49 volume of
 water (10 cm active chlorine per 490 cm of water) .
Environmental Cleaning & Disinfection
Environmental Cleaning & Disinfection
Environmental Cleaning & Disinfection
 Anti-septic Techniques

• It is a general term intended to how to perform

safe medical practices for both the patient and
the service provider within the health facility .!!
• It varies according to medical intervention.
• It includes cleaning methods - cleansing
• methods - sterilization methods.
 Anti-septic Techniques

• Importance
 Reduce the high rates of the disease resulting from the
spread of infection within the health facility.
 Reduce the mortality rate resulting from complications
caused by the infection within the health facilities.
 Limit the spread of infection among health
 service providers (Occupational Health).
 Reduce the costs of health care services.
 Anti-septic Techniques

Clean storage areas:

 Clean areas separated from dirty areas.
 Sterile or re-processed supplies must be separated
away from used and polluted supplies.
 Must be a few traffic areas.
 Anti-septic Techniques
• Clean work areas:
 Sedentary and are available by way of washing hands.
 Only a small stock of supplies that needed for use.
 Personal tools must be away from hospital tools.
 Workers not allowed to eat or drink in work areas.
 Storage clean tools such as linens and cottons, gauze, towels,
covered.
 Anti-septic Techniques

• Surfaces
 It is usually done at the beginning of the day.
 Hand washing to get rid of all visible dirt on your hands,
then drying hands.
 Surfaces cleaning to get rid of visible dirt using soap and
water, and surfaces can be dried by using a towel.
 Surfaces are disinfected by using hypochlorite 1000 part
per million then left to dry providing appropriate contact time.
 Anti-septic Techniques
• Patient:
 Clean or sterile gloves may be used according to risk
assessment.
 Cleaning, washing hands (mostly healthy). Cleanse the skin
before doing an surgical site or injection.
 "Do not touch" entry positions, needles or dangerous parts
of the sterile tools.
 Dealing with catheters must be limited.
 Experienced workers can perform intramuscular injections
without touching the injection site, and then they will not be
in need to wear gloves, specially if the patient covers position
after the injection.
 Anti-septic Techniques

• Uses of sterile techniques:

 Mixing intravenous fluids.
 Central venous catheterization (CVP) and
 central catheters change.
 Some laboratory procedures.
 Tracheal intubation.
 Surgeries.
 Anti-septic Techniques
• Urinary catheters
 Urinary catheters are more reasons for the spread of nosocomial
infections in the world, where the ratio ranging from 35-100%.
 Good practices delay the infection.
 If a good technique is applied to prevent contamination during in
stallation of the catheter, the infection occurred may be
endogenous, from the patient himself.
 Anti-septic Techniques
• Urinary catheters
 Urine bag emptying
 Routine hand washing.
 Wearing latex gloves.
 Empties from the bottom of the bag through
 the discharge tap, using a special patient’s pot.
 Routine hand washing.
 Washing and disinfection of the pot used.
 Anti-septic Techniques
• Urinary catheters
 Daily care of urinary catheter:
 The area is cleaned with soap and water when needed.
 Use of betadine liquid or ointment has no benefits.
 Urinary catheters system must be preserved as a closed
circle like intravenous system for its safety.
 Prohibiting session at any moment and separating the cath
eter to take a sample.
 Anti-septic Techniques
• Urinary catheters

 Urine sample collection

 Session of the circle at any moment or separating the
catheter to take a sample must be prohibited.
 Sample is not taken from the bag.
 Healthy hands washing.
 Cleansing the catheter above the connection with urine bag by
alcohol and close the catheter by sterile clamp.
 Sample is withdrawn from the catheter using a sterile syringe.
 Anti-septic Techniques
• Wound Care

 Surgical site infection (SSI) may occur during or after surgery by

contaminated hands or contaminated dressing.
 Preferably no interference in surgical sites unless when necessary,
such as the presence of signs of infection and contamination and
when change of bandages is needed.
 Anti-septic Techniques
• Wound Care
 Sources of infection
 Incorrect hair removal.
 Un-proper surgical procedures - tissue injury.
 Dressing of the wounds incorrectly.
 Exposure of the wound to air for a long time.
 Contamination of wound (moisture and blood).
 Contaminated bandages with blood
 Anti-septic Techniques
• Venous Catheter

 Injection is not used intravenously, unless necessary, as in the

following cases:
 No other way for the drug.
 In emergency procedures - life-saving. IV injection site
infection 5-25% , blood stream infection: 7-10%.
 Anti-septic Techniques

 Peripheral IV catheter:
 The introduction site of the needle into the skin must not be
touched.
 The cannula must be changed in each new attempt.
 After entry of the cannula, a sample of blood can be taken
before the connection of the injection device.
 Fixation of the cannula using right technique to ease checking
the site of entry
 Anti-septic Techniques
• Peripheral IV catheter:
• Intravenous infusion device must not be disconnected
from the cannula (closed circle).
• It is better to use the Y-shaped tube and drugs can be
injected through the free part instead of des-connecti
on the cannula and the device.
• Blood samples should not be taken after the fluid inj
ection.
 Anti-septic Techniques
• IV Catheter Care
 Avoidance of catheter moving to a lesser extent.
 Monitoring of the patient to identify the occurrence of
blood stream infection, and examination of the input
site to identify the signs of inflammation.
 Catheter must be removed if there are any signs of
inflammation in the input site, or a blood stream
infection occurrence is suspicious.
 Antiseptics and ointments are avoided on the skin at
the input site as they have no benefit .
Anti-septic Techniques
 Anti-septic Techniques
• Venous Catheter
 Changing IV catheter & infusion set
 Normal fluids and drugs every 72 hours.
 Nutrition via IV route every 24 hours.
 Blood transfer or its components, very soon after use.
 In doubt of the presence of an epidemic infection related
intravenous infusion every 24 hours.
 Cannula is changed: if installed outside the hospital, in an
emergency, or after 72 hours, or in the case of the appearance
of redness and swelling marks.
 Anti-septic Techniques

• Central vein catheters

 Dextrose or nutritive fluids must not be giving through the CVP
devices.
 The device should not be moved as much as possible.
 Cleansing of input site before using it every time.
 Use of sterile needle and syringe every each use.
 Using single-use containers that discarded after use.
• Changing IV catheter & infusion set
 Normal fluids and drugs every 72 hours.
 Nutrition via IV route every 24 hours.
 Blood transfer or its components, very soon after use.
 In doubt of the presence of an epidemic infection related in
travenous infusion every 24 hours.
 Cannula is changed: if installed outside the hospital, in an e
mergency, or after 72 hours, or in the case of the appearan
ce of redness and swelling marks.
• Central vein catheters
 Dextrose or nutritive fluids must not be giving through
the CVP devices.
 The device should not be moved as much as possible.
 Cleansing of input site before using it every time.
 Use of sterile needle and syringe every each use.
 Using single-use containers that discarded after use.
• Preparation and mixing of IV fluids
 All fluids and medicines which are given by IV route must
be prepared in a clean, dry place dedicated to this purpose
with the use of a good ventilation system.
 Containers of IV fluids must be checked to detect the pres
ence of damage or signs of contamination.
 Containers of intravenous fluids must be opened with
a sterile tool.
 Previously opened ampoules have a high risk !!!
• Sharp Instruments

 Handling with used sharp instruments should be restricted.

 Safe disposal of harp instruments immediately after use in the
dedicated containers.
• Multi-dose vials

 Multi-dose medical vials may lead to many cases of infection

outbreaks.
 Preservatives not be able to eliminate the germs when their
presence in large numbers.
 Needle for air entering is completely prohibited.
 Use a new syringe each time to withdraw the amount of drug