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• Wear an apron when entering the room of a patient infected or
colonised with VRE:
If substantial contact with patient or with environmental surfaces in the patient’s room is anticipated.
If the patient is incontinent.
If the patient has had an iliostomy or colostomy, has
diarrhoea,or has a wound drainage not contained by a dressing.
Remove gloves and apron BEFORE leaving the patients room
and immediately wash hands or use alcohol hand gel.
Dedicated thermometers, blood pressure cuffs, stethoscopes, should be kept in the patients room. After discharge they
should be cleaned and disinfected appropriately.
13.3.6.6 Transfer Of Infected Or Colonized Patients
• Patients that are colonised with VRE must not be transferred
without prior knowledge of the receiving hospital or department. •
VRE positive patients may attend other hospital departments such as radiology, with prior arrangement with the receiving department.
13.3.6.7 Waste Disposal
• Dispose of aprons gloves and incontinence wear in clinical waste
bin.
13.3.6.8 Linen
• Soiled linen must be placed in an alginate bag prior to placement
in outerbag. Other linen treat as normal.
13.3.6.9 Cleaning Policy
• Separate equipment must be kept for isolation areas.
• Thorough cleaning of all surfaces including bed rails, call bells,
bedside tables, commodes, bathroom and toilets must be done on at least a daily basis.
• On the advice of the Infection Control Nurse, hypochlorite 1: 1000
maybe recommended after cleaning. •
On discharge of the patient all areassurfaces of the room or ward must be thoroughly cleaned with hypochlorite.
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13.4.1 Introduction
In the health-care setting, the major risks for HIV infection are blood contact due to percutaneous injuries and, to a lesser extent, mucous membrane and skin contact. There are no known
instances of transmission of a bloodborne pathogen by aerosol in a clinical setting. In studies conducted in dental operatories and hemodialysis centers, hepatitis B surface antigen
could not be detected in the air during the treatment of hepatitis B carriers, including during procedures known to generate aerosols. This suggests that detection of HIV in aerosols would
also be uncommon, since the concentration of HIV in blood is generally lower than that of HBV. HIV in an aerosol would not necessarily mean that HIV is readily transmissible by this route.
13.4.2 HIV Related Infection Control Procedures
1. Standard chemical germicides at concentrations much lower than commonly used
in practice can rapidly inactivate HIV. 2.
In general, reusable instruments or devices that enter sterile tissue, including the vascular system of any patient, and devices through which blood flows should be
sterilized before reuse. 3.
Reusable devices or items that contact intact mucous membranes should be sterilized or receive high-level disinfection before reuse.
4. Medical devices that require sterilization or disinfection should be thoroughly cleaned
to reduce bioburden before being exposed to the germicide, and the germicide and device manufacturers’ instructions should be closely followed.
5. Extraordinary attempts to disinfect walls, floors, or other environmental surfaces are
not necessary. However, cleaning and removal of soil should be done routinely. Germicide effective against HIV is a solution of sodium hypochlorite 1 part household
bleach to 99 parts water or 14 cup bleach to 1 gallon of water prepared daily. Bleach, however, is corrosive to metals especially aluminum and should not be
used to decontaminate medical instruments with metallic parts.
6. Chemical germicides that are approved for use as “hospital disinfectants” and that
are tuberculocidalvirucidal when used at recommended dilutions and contact times can be used to decontaminate spills of blood or other body fluids.
7. In patient-care areas, visibly soiled areas should first be cleaned and then chemically
decontaminated. For disinfection, the pre-cleaned areas should be moistened with the appropriate germicide and allowed to air dry.
8. In the laboratory, large spills of cultured or concentrated infectious agents should be
flooded with a liquid germicide before cleaning, then decontaminated with fresh germicidal chemical after organic material has been removed. It is not necessary to
flood spills of blood or other body fluids with germicide before cleaning.
9. Gloves should always be worn during cleaning and decontaminating procedures
10. Aerosols should not be confused with droplets and splashes. CDC recommends barrier precautions face shields, masks, gowns, etc. to prevent contact with droplets and splashes.
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13.5.1 Introduction
Dengue DF and dengue hemorrhagic fever DHF are caused by one of four closely related virus serotypes of the genus Flavivirus, maintained in a cycle that involves humans
and the Aedes mosquito.
Aedes aegypti, a domestic, day-biting mosquito that prefers to feed on humans, is the most common Aedes species. It is highly susceptible to dengue virus, is a daytime
feeder, has an almost imperceptible bite, and is capable of biting several people in a short period for one blood meal.
The mosquito is well adapted to life in urban settings and typically breeds in clean, stagnant water in containers that collect rainwater, such as tyres, tin cans, pots, and buckets.
13.5.2 Patient’s Isolation
Dengue patient need not be nursed in isolation room. However, an air-conditioned or a natural-ventilated room is preferred.
If a natural-ventilated room is used, it is suggested to put mosquito nets to all the windows in the room.
If both facilities are not available, then the patients can be nursed in the general ward. Specific measures to avoid mosquito bites should be considered.
13.5.3 Prevention of vector transmission
1. Source eliminationreduction for Dengue fever
Source elimination or reduction is the method of choice for mosquito control when the mosquito species targeted are concentrated in a small number of discrete habitats.
Among the suggested measures to make sure that there will be no breeding grounds for mosquito in the area are:
• The larval habitats may be destroyed by filling depressions that collect water, by
draining swamps, or by ditching marshy areas to remove standing water. •
Container-breeding mosquitoes need to be identified and removed. •
Water in cans, cups, and rain barrels around hospitals should be covered. •
Chemical insecticides can be applied directly to the larval habitats. Other methods, which are less disruptive to the environment, are usually preferred:
• Oil may be applied to the water surface, suffocating the larvae and pupae. Most
oil in use today are rapidly biodegraded.
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• Biological control agents include toxins from the bacterium Bacillus thuringiensis
var. israelensis Bti. These products can be applied in the same way as chemical insecticides. They are very specific, affecting only mosquitoes, black flies, and
midges.
• Insect growth regulators such as methroprene. Methoprene is specific to
mosquitoes and can be applied in the same way as chemical insecticides. •
Mosquito fish Gambusia affinis are effective in controlling mosquitoes in larger bodies of water.
• Other potential biological control agents, such as fungi e.g., Laegenidium
giganteum or mermithid nematodes e.g., Romanomermis culicivorax, are less efficient for mosquito control and are not widely used.
2. Avoidance from mosquito bite
Specific measures on the avoidance from mosquito bite should be followed. Measures that have been described to avoid mosquito bites are:
•
insect repellents containing N,N-diethyl-3-methylbenzamide DEET, Adult-dose 95 DEET lasts as long as 10-12 hours, and 35 DEET lasts 4-6 hours. For
children, use concentrations of less than 35 DEET. Use sparingly and only on exposed skin. Remove DEET when no longer exposed. Please refer to PROPER
APPLICATION OF REPELLANT.
•
protective clothing the most effective is permethrin-impregnated. Avoid mosquitoes by limiting exposure during times of typical blood meals. Wearing
long-sleeved clothing may also prevent infection. •
insecticide-treated bed nets The usefulness of insecticide-treated bed nets at night is limited since Aedes mosquitoes bite during the day.
•
insecticides- “knockdown resistance” may occur in some locations.
•
Untreated bed nets form a protective barrier around persons using them. However, mosquitoes can feed on people through the nets, and nets with even a few small
holes provide little, if any, protection. •
Aedes mosquitoes bite during the day; hence, these measures must be taken during the day, particularly in the morning and late afternoon.
•
Fogging or area spraying is primarily reserved for emergency situations: halting epidemics or rapidly reducing adult mosquito populations when they have become
severe pests. Fogging and area sprays must be properly timed to coincide with the time of peak adult activity, because resting mosquitoes are often found in
areas that are difficult for the insecticide to reach.
