infection control protocol - chinese

Infection Prevention and Control (IPAC) Best Practices for Traditional Chinese Medicine (TCM) Practitioners 防止及控制傳染性病毒擴散的操施同傳統中醫藥針灸執業人仕的最佳衛生守則須知

Presentation to the Chinese Medicine and Acupuncture Association of Canada Members and the Traditional Chinese Medicine Community

為加拿大中醫針灸學會及傳統中醫藥團體而設專題講座

Cecilia AltermanHealth Promotion Consultant 衛生推廣顧問June 26, 2010

IPAC Best Practices for TCM Practitioners

Agenda 重點內容

•MOHLTC PSS Best Practices Document, Jan 2009 安省衛生廳長期護理 - 有關個人服務之最佳指南同守則 , 6 月 2009

•Routine Practices 例行運作

•Bloodborne Diseases 血液內傳染性病毒

•General IPAC Guidelines 全面性 ( 防範病毒操施 ) 同指示

•Cleaning, Disinfection and Sterilization 清潔 , 消毒同無菌消毒

•Sharps 尖銳同利器 , 如用使用過的針…•Blood and Body Fluid Exposure Response 血液同其他身體液體外泄流散時的適當處理方法


Ministry of Health and Long Term CareInfection Prevention and Control Best Practices for Personal Services Setting安省衛生廳同長期護理 , 防止及控制傳染性病毒擴散及個人診症時之最佳衛生環境守則須知

January 2009

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/pssp_2008.pdf

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/pssp_2008.pdf


Purpose of PSS Program 單個人診治的綱領 :

To reduce the risk of transmission of bloodborne and other types of infection for both clients and personal service workers (PSW) during the delivery of personal services.是為幫助減低因在診治病患時會產生血液及任何體液外流出現時會做成病毒擴散的意外 , 這對於其他病患及醫療人員均構成安全性的威脅

Blood and body fluids do not have to be visible on an instrument/equipment for an infection to be transmitted.血液同其他體液並不須要肉眼看見於診症同治療工具上一樣可以成為病毒散播既傳媒


Routine Practices 例行運作

Based on the assumption that all blood, body fluids (except sweat and tears), secretions, excretions, non-intact skin, undiagnosed rashes and areas such as the eyes, nose and mouth may be potentially infectious, even if a person shows no symptoms of illness.

在進行診療時，即是病患者並無任何疾病既症狀，但當有涉及血液同流出體液時，仍需要嚴守傳染病毒既預防操施．例如排泄物，內汾泌物，損傷破裂皮膚，所有未經診斷既疹子，或紅斑，特別注意眼，鼻，口腔內滲透或流出的物質同液體，應當為防止傳染及擴散性病毒處理，以防萬一．注意患者既汗液同（淚水）除外．


Routine Practices includes 例行運作包括 :

•Performing hand hygiene between clients and when hands become contaminated 每當診症前必須進行衛生潔淨特別是手部已受到污染

• Alcohol hand sanitizers (70% isopropyl the whole bottle are the same alcohol) 診所用／藥用含７０％酒精 are acceptable when hands are not visibly soiled 專為衛生潔淨用既含酒精 70% 手部清潔劑

• Hand lotion (not petroleum based) is recommended 專為洗手用 ( 無含礦物油如石油類溶液 ) 既清潔劑為適合

•New disposable gloves are used for every client 每診治一個新病患者前必須要換上新的 ( 一次使用 ) 衛生手套

• Hand hygiene to be performed before and after glove use 雖然配帶手套但對每個病患者診治時仍須要用 ( 洗手劑 ) 進行手部衛生潔淨

• Finger cots are not acceptable 只帶上手指套就不會被接受


Routine Practices includes 例行運作包括 :

•The use of additional personal protective equipment if there is a possibility of splashing in the eyes, nose, mouth or on clothing

每當病患者血液或體液有可能被泄出體外時 , 醫療人員有須要配帶面罩 , 口罩 , 頭罩等等預防傳染病毒擴散的預防操施並作好防範準備 .

•Proper cleaning, disinfection and sterilization of items and equipment適當的進行清潔 , 消毒及無菌消毒所有診療時所用的工具同儀器

•Proper handling and disposal of sharps適當操作技巧同尖銳鋒利的工具同器材廢棄物處理 ( 特定的針及鋒利物件廢棄箱 ).


Bloodborne Diseases (BBD) 從血液（體液）傳染病毒

• Transmitted through blood and body fluids 由血液或其他體液傳播的病毒

• Hepatitis B, hepatitis C and HIVhuman Immunodeficiency virus (not yet AIDS)　　　　　乙型肝炎，丙型肝炎　及藉體內流液 ( 血液 ) 接觸而傳播的疾病包括性病 (愛滋病 )

• Many who are infected with a BBD show no symptoms but are still infectious 雖然病患者 ( 帶菌者 ) 並未有病徵或症候但仍是帶有病毒同病菌仍可構成傳染的危險

Always assume a client is potentially infectious with a BBD, even if they tell you they are not. 若懷疑病患者可能是帶菌者或甚至高危傳染病患者時，應馬上進行適當消毒防範操施，當然部份患者會對醫療人員矢口否認，這必須特別處理


General IPAC Guidelines 全面性預防傳染病毒擴散同控制指示

The Worker 醫護人員 :• Hand hygiene 手部潔淨• Stay home if sick 若患病時留在中家休息• No eating, drinking, smoking while working 診所內工作間不應進食 , 吸煙或飲

用任何液體特別含酒精飲品• Proper immunizations (hepatitis B) 接受並進行各類定期防預注射如 (乙型肝炎

)

The Client 病患者 :• Free from cuts, wounds, rash 保持肌膚健康完整 , 避免任何破損流血同皮膚色素轉變 , 如紅疹 , 紅斑等出現

• Stay home if sick 如身體感覺不適，就應留在家中靜養


General Work Area 診所內全面性衛生操施 :

• Well lit, clean and in good repair

光線充足 , 衛生清潔 , 設備工具儀器適當維修• Smooth non-absorbent work areas

診療室衛生舒服所用床舖工具以防水為要• At least one hand sink for handwashing, one metre away from

clean/disinfected/sterile items

診療室內必須有一個醫療人員專用的衛生洗手盆，該面洗手盆應離開所有清潔，消毒同無菌消毒工具儀器最小一公尺範圍以外

• Linens, towels, etc. laundered between clients

診療室內之床舖 , 毛巾等用品在每次診療完畢後應馬上更換並進行消毒清洗


Cleaning, Disinfection and Sterilization

清潔，消毒及無菌消毒


Classification of Equipment and Instruments設備同儀器工具分門類別

• The rationale for disinfecting or sterilizing equipment and instruments is based on the intended use of the item 對各樣工具同儀器進行消毒同無菌消毒主要理由是在運用及診治時得以安全奏效

• Equipment and instruments are divided into three general categories 工具同儀器可分成三大項目 :

• Critical 嚴重或嚴格• Semi-Critical 次（或半）嚴格• Non-Critical 不嚴格

Table A: Classification for Methods of Disinfection/SterilizationSource: MOHLTC, BPPSS, Jan 2009: 18


Critical Items 嚴格項目• All critical items must be sterile 所有嚴格項目均須經過嚴厲的無菌消毒處理

• Sterilization kills all forms of life, including hepatitis B, hepatitis C and HIV

無菌消毒能殺除多數微生物 , 包括乙型肝炎 , 丙型肝炎同一般 ( 性病 ) 等的細菌所產生而可至殺死的病毒

• Includes needles (sterile, pre-packaged, single-use), and any instrument used to manipulate a sterile item 包括針灸用的針 ( 無菌消毒 , 無菌消毒包裝 , 只限一次用途等 ), 同所有用來接觸或控制針用途的一切儀器在內


Semi-Critical Items 次嚴格項目

High Level Disinfection (HLD) = Kills all forms of life except bacterial spores (e.g. pathogen that causes tetanus 破傷風 ). tetanus 破傷風：其病象為平時能隨意控制之肌肉，部份或全部的強直…

高級消毒 (HLD)= 能殺死大多數微生物 (細菌 ), 除了部份有外膜保護著的細菌 , 例如破傷風菌等…

• Use on semi-critical items with visible contamination of blood and body fluids. 次嚴格消毒程序適用於明顯 , 眼可見到血液或體液外泄流散時受到其他細菌感染做成的病毒侵襲

OR 或是Intermediate Level Disinfection (ILD) = Kills most bacteria, viruses,

fungi and mycobacteria. 中級消毒 (ILD)= 能殺一般細菌 , 過濾性病原體包括含毒素 , 菌類形既寄生性微生物同微形細菌 ( 部份帶有毒素 ) 可直接或間接產生其他並發症

• Use on semi-critical items with no visible contamination of blood and body fluids. 中級程度消毒處理適用於一般不明顯 , 肉眼看不見的血同體液傳染性病毒感染


Non-Critical Items 不嚴格

Low Level Disinfection (LLD) = Kills some viruses, fungi and bacteria

低級程度消毒 (LLD)= 適用於一般傳染性病毒 , 寄生性微生物如真菌類同一般病菌 (感染性 )


Examples 例子

Cupping 進行拔罐 :• Used on intact skin完整皮膚 is considered a ?? item and must be

cleaned and disinfected with a ?? level disinfectant between clients在健康完整皮膚病患身上必先進行 ( 不嚴格消毒 )才拔罐，診治完畢立即對所有工具設備儀器進行 ( 次級消毒 )才可接見下位病患者

• Used on non-intact skin 有破損皮膚 (e.g. with an acupuncture needle), considered a ?? And must be cleaned and disinfected with a ?? Level disinfectant between clients 若病患者皮膚出現任何破損現象 , 則必先進行 ( 中 / 次 -級嚴格消毒 ) 所有工具同儀器先可接見下位病患者


• Electro-stimulation clippers that are attached to the handle of the needle, must be cleaned and disinfected with a ?? level disinfectant between clients. 所有電子治療儀器 , 所用可通電流的接駁挾 , 若會被用於操控及留針使用時 , 在每一次用作診療時將須要進行清潔及中級嚴格消毒 .

• Instruments (tweezers 兩片金屬做成既小鉗 , forceps 剪刀模樣 ( 不銹鋼 ) 鉗 ) that come into contact with a needle after insertion into the client must be cleaned and disinfected with a ?? level disinfectant between clients. 當入針後 , 所有用來操控或施針技巧的小鉗及大鉗均須要中級嚴格程度消毒 .

• Any item used to manipulate a sterile needle prior to insertion into a client must also be sterile. 所有工具儀器一旦被用來作入針的技術時必須要進行過無菌消毒 .


Seven star or plum-blossom needles 使用皮膚針：七星針或梅花針．

• All handles must be cleaned and HLD. 所有針把柄必須要經過高度消毒

• If cotton is inserted in the head of the hammer, the cotton must be discarded after use. 如綿球插在針柄上時 , 此綿球不可重復使用

• Disposable handles, where the package indicates it is “disposable”: 當包裝上標籤寫著 ( 可隨時使用 ), 這個工具可以隨時拿來應用

• The handle with a new needle can be used on the same client. 同一枝新針及針柄可以在同一個病患者使用但仍要注意適當消毒程序 .

• Client can take the handle and additional needle packs home. 病患者可將用過的針柄與未用過的其他新針一同帶回家裏收藏 .

• The handle must be cleaned and HLD between client sessions until all the single-use and sterile needle packs are used for that client.

只要是每次使用前都經過無菌消毒的同一個包裝內的針柄 , 可供給多位病患者使用 , 直至整個包裝內所有無菌針用完 , 然後將針柄連包裝一同報消丟棄 .

• Once all the needle packs are used, the hand must be discarded. 每個包裝內的針用完後 , 所有乘載在內的儀器連針柄必須全部適當報消處理 .


Sharps 尖銳 ( 無菌針 ) 同利器• Needles must be pre-packaged, single-use and disposable 所有應用於針灸用的針 ; 必須經無菌處理並適當標籤及包裝 , 這可

以隨時應用 , 同時只限於一次使用 , 因為針被使用過後就會受到感染.

• Ensure needles come from a reputable company that properly sterilizes their needles 醫療人員應從合法並有信譽的商號或供應商購買無菌消毒的醫療儀器同用品 .

• Discard needles if expired or packaging is compromised 所有針及附屬的包裝如有過期或任何損壞時理應當作醫療廢物處理 .


Sharps 尖銳 ( 無菌針 ) 同利器• Each individual needle must only be used on one site and for one

time, on the same client 每一枝針只適宜用於一個病患者身上 , 一個部位只用一次 .

• Sterile needles must not be placed on or in any non-sterile environment (tray, foam, cotton, solution) 所有無菌消毒針灸針應該放在原廠包裝盒直到用時才開封取出 , 同時要遠離所有未經無菌消毒處理過的設備同用具 , 例如治療盆 , 海綿 (泡沫膠 ), 綿花 , 或液體內 .

• Needles should be removed from their packaging in view of the client just prior to insertion 當進行針灸診療時 , 最適當做法就是讓病患者見到醫療人員從無菌針灸的包裝內解封及取針 , 然後馬上或盡快入針 . 這可以讓病人對整個療程提高信心及衛生常識 .


Sharps 尖銳 ( 無菌針 ) 同利器

• Needles must discarded immediately after use into an approved sharps container

使用過的無菌針應放入指定適當的尖銳廢物收集器皿內 .

• Full sharps containers (3/4 of capacity) must be securely closed and discarded appropriately (not with municipal garbage) 當專為尖銳廢物收集器皿到 3/4 或 7 成半滿時就應該封箱然後送到指定收集站處予以消毀 .


Blood and body fluid exposure response血液同體液外泄流散應變的解釋定義

The following could result in an exposure to a bloodborne disease (HBV, HCV, HIV) 以下幾種情況都會造成帶菌者的血液變成散播媒介:

• A needlestick or cut from a sharp object contaminated with blood and/or body fluid 被帶菌者使用過的針或任何鋒利的廢棄物意外刺入 , 劃到皮膚上或甚至穿破同割傷皮膚時 .

• Blood and/or body fluid contact with broken skin (open cut, wound, dermatitis), or 或被帶有病毒的血液或體液滲透到其他病患的損破的皮膚上 , 慎防 ( 尖銳或利器所造成的創傷特別是仍然流血的傷口 , 破損皮膚 , 或其他皮膚病患者 ). 或是

• Blood and/or body fluid contact with a mucous membrane (eyes, nose or mouth) 被帶有病毒的血液體液污染了其他病患者的眼 , 鼻 , 口腔內 (薄薄粉紅色的內膜 ) 的薄黏膜上 .


Procedures for blood and body fluid exposure:血液及體液流散時應當處理步驟

• Wear single-use gloves prior to handling or dressing the wound 配帶一次性手套進行各種診斷醫療工作 ( 特別處理出血傷口 ).

• Wash the exposed skin surface with soap and water 用肥皂及清水盡量洗去受污染的部位 .

• If bleeding, allow it to bleed

若有出血現象時 , 讓血液繼續流出 , 不要即時止血 .

• Apply a skin antiseptic 消毒劑　 and cover with a clean dressing/bandage 血液停止流出後 ,立即用皮膚消毒劑進行消毒 , 然後用經消毒過

的敷料包紮


Procedures for blood and body fluid exposure:血液及體液流散時應當處理步驟

• Splashes 濺 / 潑 to mucous membranes should be flushed thoroughly with water

當被帶有病毒血液或體液濺上 / 潑上黏膜時 , 應馬上用清水沖洗片刻 .

• The person exposed must immediately contact a physician

當懷疑可能受到感染時 , 應馬上向家庭醫生或醫院求助 .

• The PSW must document all incidents and keep records on site for a minimum of one year and on file for five year

• 在診所或個人治療病患的地方 , 如發生傳染性病毒擴散事件時應留下詳細紀錄 , 診所內保持記錄最少 1 年 , 記入檔案最少 5 年


Thank You

Additional information 詳盡資料 :

Toronto Health Connection at 416-338-7600 or visit our website at www.toronto.ca/health

請向大多市衛生處查詢或網址查閱

Questions請發表問題 ?

http://www.toronto.ca/health

infection control protocol - chinese

Documents