enviromental sampling, guideline for enviromental infection control in health care facilities
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Enviromental sampling, guideline for enviromental infection control in health care facilitiesTRANSCRIPT
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Hospital Acquired Infection
1.7 million Patient Acquire InfectionFrom hospitals each years
As a result, Almost 6% Die
Top 10 Most fatalCouse of Death
In Hospitals 1 out of 20 Patients develops an HAI
Nationwide, 2 million people develop an HAI each ear
Germs Causing Hospital Acquired Infections
Breakdown of Hospital Acquired Infection Types
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No. Ruang atau Unit Konsentrasi Maksimum Mikroorganisme (CFU/m³ Udara)
1. Operasi 10
2. Bersalin 200
3. Pemulihan/Perawatan 200 – 500
4. Observasi Bayi 200
5. Perawatan Bayi 200
6. Perawatan Premature 200
7. ICU 200
8. Jenazah/Autopsi 200 – 500
9. Penginderaan Medis 200
10. Laboratorium 200 – 500
11. Radiologi 200 – 500
12. Sterilisasi 200
13. Dapur 200 – 500
14. Gawat Darurat 200
15. Administrasi, pertemuan 200 – 500
16. Ruang Luka Bakar 200
Hazard / Hygiene Indicator
Timing / Frequency of
TestingResult Interpretation Action References
Conventionally ventilated theatres built/ refurbished before 2007:
Aerobic Colony Count
Post-maintenance /commissioning; in empty theatre after ventilation system has achieved steady state
35 cfu/m3
0 - < 35 cfu/m3
UNSATISFACTORY
SATISFACTORY
Take theatre out of use, clean thoroughly and re-test
N/A
NHS Estates, 1994
During a surgical operation
> 180 cfu/m3 (averaged over five-minute period)
UNSATISFACTORY Investigate and re-test
0 - < 180 cfu/m3
SATISFACTORY N/A
Table 3: Testing requirements and interpretation of results for operating theatre air quality (as determined by active air sampling)
Hazard / Hygiene Indicator
Timing / Frequency of
TestingResult Interpretation Action References
Conventionally ventilated theatres built/ refurbished after 2007:Aerobic Colony Count
Post-maintenance /commissioning; in empty theatre after ventilation system has achieved steady state
10 cfu/m3
0 - < 10 cfu/m3
UNSATISFACTORY
SATISFACTORY*
Take theatre out of use, clean thoroughly and re-test
*Note broad category of organisms present; there should not be a preponderance of fungi.
Department of Health, 2007
During a surgical operation
> 180 cfu/m3 (averaged over five-minute period)
UNSATISFACTORY Investigate and re-test
0 - < 180 cfu/m3
SATISFACTORY N/A
Ultra-clean theatres:
Microbiological testing of empty theatre not recommended on commissioning or post maintenance (but may be necessary if work may have affected air supply or distribution)
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Hazard / Hygiene Indicator
Timing / Frequency of
TestingResult Interpretation Action References
Aerobic Colony Count
Weekly >100 in 100 ml
20 – 100 in 100 ml
0 - <20 in 100 ml
0 in 100 ml
UNACCEPTABLE
UNSATISFACTORY
ACCEPTABLE*
SATISFACTORY
Take washer /disinfector out of use
Investigate cause and put corrective action in place
*Acceptable provided that Pseudomonas aeruginosa is not detected
N/A
NHS Estates, 1995
Willis (2006)
Environmental mycobacteria
Annually (or more frequently, depending on risk assessment)
> 0 in 100 ml
0 in 100 ml
UNSATISFACTORY
SATISFACTORY
Investigate immediately and take repeat sample
N/A
Pseudomonas aeruginosa
Optional – to be determined in discussion with local microbiologist
> 0 in 100 ml
0 in 100 ml
UNSATISFACTORY
SATISFACTORY
Investigate immediately and take repeat sample
N/A
Table 5: Testing requirements and interpretation of results for endoscopy final rinse water
Hazard / Hygiene Indicator
Timing / Frequency of
TestingResult Interpretation Action References
Dialysis fluid and post reverse osmosis fluid:
Aerobic Colony Count
Monthly (or more frequently if necessary)
>100 / ml
>50 - <100 / ml
0 - <50 / ml
UNSATISFACTORY
BORDERLINE
SATISFACTORY
Take out of use until corrective action implemented
Investigate cause and put corrective action in place
N/A
UK Renal Association, 2009
Endotoxin /ml >0.25 EU/ml
>0.125 - <0.25 EU / ml
<0.25 EU/ml
UNSATISFACTORY
BORDERLINE
SATISFACTORY
Take out of use until corrective action implemented
Investigate cause and put corrective action in place
N/A
Table 6: Testing requirements and interpretation of results for renal dialysis fluid
Hazard / Hygiene Indicator
Timing / Frequency of
TestingResult Interpretation Action References
Ultrapure fluid:Aerobic Colony Count
Monthly (or more frequently if necessary)
>10 in 100 ml
0 - <10 in 100 ml
UNSATISFACTORY
SATISFACTORY
Investigate cause and put corrective action in place
N/A
Endotoxin /ml
>0.03 IU/ml
<0.03 IU/ml
UNSATISFACTORY
SATISFACTORY
Investigate cause and put corrective action in place
N/A
Table 6: Testing requirements and interpretation of results for renal dialysis fluid
Test Required Sample Bottles
Coliforms, Escherichia coli, Pseudomonas aeruginosa, Aerobic Colony Counts, environmental mycobacteria
1 x sterile 500 ml plastic bottle containing an appropriate neutraliser to neutralise any residual disinfectant in the water.(The most commonly used neutraliser, which is appropriate for chlorinated or brominated water systems and those using ozone or hydrogen peroxide, is sodium thiosulphate. For mains water and hydrotherapy pools, 18 mg/L sodium thiosulphate should be added. However, for cooling towers, 180 mg/L (i.e. sufficient to neutralise 50 mg chlorine per litre) must be used. If alternative disinfection methods are used, the laboratory should be contacted to obtain the appropriate neutraliser, if one is available.)
Legionella (and other pathogenic bacteria such as Salmonella, Campylobacter and E. coli O157, where required)
1 x sterile 1 litre bottleOr 2 x sterile 500 ml plastic bottles (as above) (See note above regarding neutralisers)
Test Required Sample Bottles
Endotoxin Designated “Pyrogen-free” containers
Chemical parameters Specific bottles should be requested from laboratory depending on tests required
Table 1: Sample bottles required for the collection of water for different microbiological and chemical analyses
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