Catheter change interval Urinary Catheter Care

Policies and Procedures on Infection Control Ministry of Health Malaysia 47 The need for dressing or wound care depends on the type of wound, which includes incision wound, abrasions, bedsores, ulcers, wound at site of drains and others. The attending physician may require different wound technique for each type of wound. However, the choice of wound dressing should be large enough to cover and protect the wound site and tissue around it. It should allow circulation of air to the skin, secured to prevent slippage and is comfortable for the patient.

4.3.1 General principles of wound care 1.

Hand hygiene Proper hand hygiene before and after attending to a wound is mandatory. Sterile gloves should be worn after performing hand hygiene before starting the procedure.

2. Technique

• Practice a ‘non-touch’ technique. All instruments used during wound dressing must be sterile or autoclaved. • Use sterile water as a cleaning liquid unless some other solution is recommended by doctor. • Cover the entire wound and do not exposed the wound to prevent bacterial contamination. Use non adhesive gauze that promotes wound healing. • Used gloves and soiled dressing must be properly disposed off into the clinical waste plastic bag.

3. Environment

• Maintain a clean environment to minimize dust. High dusting or vacuum cleaning should finish an hour before dressing round begins. • Infected wound must be detected early. To prevent spread, precautions such as cohorting the patient may be required. • Wound care in the ward should begin with the uninfected wound first, then followed by the infected or dirty ones.

4.3 Wound Care

Policies and Procedures on Infection Control Ministry of Health Malaysia 48

4.4.1 Introduction

Enteral Feeding is nutrition provided through the gastrointestinal tract, which includes feeding given via tube and oral. Enteral Feeding preparation and formulation is very complex and should be individualized according to patient’s disease conditions and needs. Contaminated formulas may cause gastrointestinal complications such as diarrhea and vomiting. Colonization of feeding tubes may cause tube occlusion and degradation while colonization of the stomach as been associated with nosocomial infections. Therefore, minimizing potential microbial contamination is crucial to ensure patient achieve optimal nutrition and prevent serious infection and complications related to enteral feeding. This will promote faster recovery rate, shorten hospital stay and reduce overall cost. The risk of contamination occurs during preparation, administration, and storage of the formula and the design of feeding system used. Powder or liquid concentrates prepared on-site poses high infection risk and commercially prepared feeds are known to have lower infectious complications. Bacterial contamination of enteral feeds most commonly arises from exogenous sources.

4.4.2 Routes Of Feeding

1. Oral 2. Tube Feeding a. Nasogastric - short term feeding for 4 to 6 weeks b. Enterostomy postpyloric - Long term feeding for 6 weeks c. GastrostomyDuodenostomyJejunostomyPercutaneous endoscopic gastrostomy Percutaneous endoscopic jejunostomy - Long term feeding

4.4.3 Causes Of Microbial Contamination And Preventive Measures

Personnel Causes of Contamination Preventive Measures 1. Health care worker with active diarrhea should not handle enteral formula until they have been cleared. 2. Open skin lesions should be covered to prevent potential contamination with bacteria.

4.4 Enteral Feeding