Specimen handling Procedure for post-mortem examination of known or suspected CJD

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6.8.1 Introduction

Patients with burn injuries are highly susceptible to infection as a result of altered physical defense mechanism by the injury. Prevention of infection in patients with burn injury has been recognized as in any other patient population. These include strict aseptic technique during dressing changes or other invasive procedures and using isolation room in treating patient with major burn or those infected with multiple drug resistant organism. Strategies for prevention of infection and control are described in these guidelines:

6.8.2 Environmental Control

The major difference separating the patient with burn injury from other patient population is the presence of open wounds. These wounds are susceptible to be colonized or infected by organisms from the patient’s own flora, or from other patient, personnel caring the patient and the environment. Wound drainage cannot be adequately contained in a dry, occlusive dressing especially during the initial period following burn injury or surgery.

6.8.3 Burn unit setting

Standard precautions should be followed when caring for all patients with burn injury. Routine cleaning, disposal of waste and gathering of soiled linen is essential to keep the unit as clean as possible. Minimize contamination in the environment by using laminar flow units whenever possible and proper maintenance of the air conditioning system.

1. Common cubicles

• Common cubicles are used for patient with minor burn Less than 20 TBSA burn • Patient treated in the common cubicles should have a spacial separation to ensure physical separation at least 3 feet from other patients. • Individual sink for hand hygiene or Hand scrub should be provided to prevent cross contamination among patients.

2. Isolation room

Patient with major burn More than 20 TBSA burn or patient infected with multiple drug resistant organisms should be treated in the Isolation room. The concept of barrier techniques should be followed to reduce the environmental contamination present around the patient refer MOH guidelines for contact precaution.

6.8 Burns

Policies and Procedures on Infection Control Ministry of Health Malaysia 126

3. Treatment room

i. Common treatment room

Common treatment room should be used with caution as this will risk contaminating the surrounding environment and dressing materials stored within the vicinity. Change of dressing is best done by the patient’s bedside. ii. Hydrotherapy room Hydrotherapy and its related equipments should be disinfected with high-level disinfection in between patients. It is difficult to disinfect the pipelines, drains or tanks as these aquatic environments will be continuously inoculated by organisms from patients and the caregivers.

4. Plants and flowers

Plants and flowers should not be allowed in the Burn unit as they harbor gram negative organisms such Pseudomonas species and fungi. These organisms may colonize the burn wound and many are intrinsically resistant to multiple antibiotics. 5. Toys Pediatric patient with burns should be restricted to non porous and washable toys only. This should be designated to individual patient use only, and thoroughly disinfect after use or before giving to another patient.

6.8.4 Patient Care Items and Equipments

All equipments and surfaces such as beds, side rails, tables, wheelchairs and trolleys should be adequately decontaminated Refer MOH guidelines for disinfection.

1. Non invasive items

• Non critical items such as blood pressure cuffs, oxygen mask, nasal prongs, tubing, stethoscopes, bedpans, wheelchair, infusion pumps if used on areas without dry, occlusive dressings, may need high-level disinfection. • These items should be restricted to an individual patient treated in the isolation room.

2. Invasive items

• This refers to the care of endotracheal tracheostomy tube,intravascular catheter and continuous bladder catheterization. Intravascular catheter should be placed through unburned skin, preferably at a sufficient distance from the wound to prevent contamination at the insertion site. If insertion of catheters is placed within or near the burn wound, appropriate dressing is required to cover the site of insertion. Prevention of UTI includes removal of the catheter as soon as it is no longer required for monitoring of urine output, maintaining a closed urinary drainage system, and performance of urinary catheter care.