Storage and preparation rooms
6.7.1 Introduction
With cessation of life, there is neither the reticulo-endothelial system nor the blood brain barrier presence to restrict the translocation of microorganisms within the dead human remains. Therefore, these microorganisms and bacteria pose serious threat to forensic pathology personnel working in mortuary. The post mortem room is a source of potential hazards and risk, not only to pathologist and anatomical pathology technician, but also to visitors to the mortuary and those handling the body after necropsy. Post mortem staffs have legal responsibilities to be aware of and to minimize these changes. Safety and infection control policy in mortuary is an issue not only relevant to the team performing the autopsy, but also has direct implications regarding the protection of environment. For the purpose of infection control, the mortuary complex may be seen operationally as comprising of; 1 Clean areas – reception areas, offices, consultation and viewing room. 2 Transitional areas – vehicle bay, areas of body freezers, specimen preparation room and changing room. 3 Dirty areas – post mortem rooms. The principal biological risks faced by mortuary workers are the infection caused by Mycobacterium tuberculosis, the blood borne hepatitides, HIV and agents responsible for Transmissable Spongiform Encephalopathy TSE such as variant Creutzfeldt Jacob Disease vCJD. All of these pathogens retain their infectivity after death. The presence of such pathogen may not become known until the gross examination. Risks of health during post mortem examinations are primarily related to airborne and blood borne infection routes. Autopsy transmitted infections may occur via several routes such as: - Percutaneous injury leading to direct cutaneous inoculation - Contact with droplets via preexisting breaks in skin and mucosal surfaces eyes, mouth and nose - Aerosol exposure - Ingestion In mortuary setting there are ten areas to be covered in order to achieve the safety level as explained below.6.7.2 Collection of body from ward
In performing the duty to collect body from ward, medical attendants are at risk of in contact with infectious material. The following precautions must be taken: 1. When handling bodies never smoke, eat, chew, drink or take any other actions that will bring hands into contact with the mouth, eyes or nose.6.7 Mortuary
Policies and Procedures on Infection Control Ministry of Health Malaysia 119 2. Make sure that any open wounds, particularly on the hands, are covered with waterproof dressing. 3. Gloves and apron must be worn due to possibility of either hands or clothing being contaminated with blood or body fluids. 4. When there is serious risk of infection, bodies will normally be enclosed in a leak- proof body bag which under no circumstances should be opened before reaching the mortuary and instruction given by the pathologistmedical officer performing the autopsy. 5. Do not touch any spillage of body fluid outside the body bag until proper decontamination done in the mortuary setting. 6. Any special clothing put on work in the mortuary must be removed before leaving and hands must be thoroughly washed with proper hand washing technique after handling the body.6.7.3 Receiving body from outside BID cases
1. The precaution measures taken in collecting and handling body from wards must be exercised in receiving BID cases.6.7.4 Body storage
1. All bodies must be identified and correctly labeled. Any that cannot be properly identified, and particularly those for which there is no satisfactory medical record, must be labeled and treated as ‘danger of infection’ cases unless additional information becomes available. 2. All bodies labeled as ‘danger of infection’ should be totally enclosed in a leak-proof bag. 3. Bodies are stored temporarily before post mortem examination or when examination not required in cases where cause of death has been given by clinician and therefore not medico-legal cases in a body freezer with temperature maintained at 4 o C.6.7.5 Post mortem procedure
The post mortem procedures are divided into: • routine case autopsy • high risk case autopsy All tools must be kept sharp, clean and ready to use.1. Routine case autopsy
• Protective Personal Equipment PPE such as , sleeved surgical shirt and trousers, surgical gown, disposable waterproof apron, double gloves, cap, mask and water proof boot must be worn. • Examination techniques must ensure that liquid dispersion and splashing is minimized and that all instruments likely to cause puncture wounds and cuts are handled properly.Parts
» Bacaan Penuh ( bersaiz 5.5 MB)
» Roles of Hospital Infection and Antibiotic Control Committee
» Infection Control Doctor ICD
» Chairman of HIACC Bacaan Penuh ( bersaiz 5.5 MB)
» HOSPITAL INFECTION AND ANTIBIOTIC CONTROL COMMITTEE
» Frequency of meetings Circulation of minutes
» Emergency meetings and outbreak control
» Duties and responsibilities of the infection Control Nurse
» HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE
» Types of Surveillance Bacaan Penuh ( bersaiz 5.5 MB)
» Data Collection Tabulation of Data
» Analysis and interpretation of data
» Preparation and dissemination of reports
» ISOLATION PRECAUTION Standard Precautions
» Respiratory hygienecough etiquette: Instruct symptomatic persons and health
» Signs, BHT, Isolation traytrolley
» Visitor Policy for Infection Control
» Dishes, Glasses, Cups, Eating Utensils and Medications
» Transportation of patients Transmission-based
» Hand Hygiene Bacaan Penuh ( bersaiz 5.5 MB)
» Natural ventilation Personal Protective Equipment PPE
» Use of mechanical ventilation
» Minimizing bacteria at entry points
» Maintaining sterility of instruments disposable items during a procedure
» Catheter change interval Urinary Catheter Care
» General principles of wound care 1.
» Spatial separation of catheterized patients Technique
» Environment Urinary Catheter Care
» Wound Care Bacaan Penuh ( bersaiz 5.5 MB)
» Procedure for insertion of catheter
» A dedicated lumen used for PN line should be identified and not be used for
» Nursing considerations for PN
» Storage Replacement of PN tubing and filters
» General Principles. Replacement of PN tubing and filters
» Specific practices transport, storage, transfusion, dispose
» Blood and Blood Products Transfusion
» Hand hygiene Urinary Tract Infection
» Catheter Insertion Urinary Tract Infection
» Closed Sterile Drainage Urinary Tract Infection
» Irrigation Urinary Tract Infection
» Specimen Collection Urinary Tract Infection
» Urinary Flow Urinary Tract Infection
» Meatal Care Urinary Tract Infection
» Catheter Change Interval Urinary Tract Infection
» Critical items - instruments or objects that enter directly into the vascular
» Semi-critical items - instruments or objects that come into contact with
» Developed a good surveillance system to study the incident of SSI.
» Nosocomial Respiratory Infection Bacaan Penuh ( bersaiz 5.5 MB)
» Introduction INFECTION CONTROL IN SPECIFIC HEALTHCARE SETTING
» Personal Protective Equipment Personnel .1
» Neonatal Intensive Care Unit
» Outer zone: This zone should contain:
» Laminar Flow Ventilation Ultra Clean Ventilation
» Wall Mounted Air Conditioners:
» Protective Clothing for Use in the Operating Theatre
» Surgical Hand Scrubbing Refer to hand hygiene section
» Gowning Free-standing Air Conditioners:
» Gloving Free-standing Air Conditioners:
» Draping Free-standing Air Conditioners:
» Establishing a Sterile Field
» Dispensing of the Sterile Supplies
» Maintaining the Sterile Field
» Waste and Linen Post operative
» Cleaning of the Operation theatre
» Intra operative Initial cleaning at the beginning of the day
» Concurrent cleaning between cases
» Haemodialysis unit water supply and air conditioning
» Staff health Terminal cleaning end of the day
» Hand hygiene Terminal cleaning end of the day
» Nephrology and Hemodialysis Unit
» Instrument processing area in the dental clinic
» Instrument cleaning refer to CSSD chapter
» Cleaning and Disinfection of Treatment Room 1.
» Dental Radiology Asepsis Components permanently attached to dental unit waterlines
» Dental Laboratory Materials and Equipment
» Storage and preparation rooms
» Movement of instruments Safety
» Collection of body from ward
» Routine case autopsy Mortuary
» Specimen handling Procedure for post-mortem examination of known or suspected CJD
» Clinical waste Procedure for post-mortem examination of known or suspected CJD
» Visitors Procedure for post-mortem examination of known or suspected CJD
» Quality control Procedure for post-mortem examination of known or suspected CJD
» Care Givers For Patient In The Burn Unit 1.
» Visitors Full time Care givers
» Culturing and Surveillance Full time Care givers
» Antibiotic Policy Full time Care givers
» Haematology and Oncology Unit
» Laboratory Bacaan Penuh ( bersaiz 5.5 MB)
» Introduction Bacaan Penuh ( bersaiz 5.5 MB)
» Personel protective equipment PPE
» Screening for HCW TUBERCULOSIS
» Infection control in specific area .1
» HOSPITAL OUTBREAK MANAGEMENT Steps in Outbreak Investigation and Management
» Introduction Introduction Bacaan Penuh ( bersaiz 5.5 MB)
» Policy Statement Training Bacaan Penuh ( bersaiz 5.5 MB)
» Arrangements Bacaan Penuh ( bersaiz 5.5 MB)
» Infection Control During Construction and Renovation
» Operation Theatre Commissioning Bacaan Penuh ( bersaiz 5.5 MB)
» Administrative monitoring Mechanical Monitoring
» Distribution of sterile items
» Establish a system Bacaan Penuh ( bersaiz 5.5 MB)
» Monitoring antimicrobial use using aggregated data on Defined Daily
» Each hospital shall send report on DDD every 6 months to National Infection
» However, individual local data shall be reported according to discipline
» It is recommended to have a national benchmark data specifically for Intensive
» It is also beneficial if each state have their own benchmark data from their
» A report of local monitoring data for hospital compared with national
» The aggregate benchmark data included numeric presentation of pooled
» Correlation between antimicrobial use and resistance rate
» Costquantity of empiric antimicrobial administered in a specified period.
» Antimicrobial management programstrategies Antimicrobial policy
» Multi-Resistant Organism 13. Bacaan Penuh ( bersaiz 5.5 MB)
» Methicillin Resistant Staphylococcus Aureus
» Vancomycin Resistant Enterococci Bacaan Penuh ( bersaiz 5.5 MB)
» HIV Bacaan Penuh ( bersaiz 5.5 MB)
» Dengue Bacaan Penuh ( bersaiz 5.5 MB)
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