Infection Control

Electrical Safety

All patient-related equipment is inspected for mechanical and electrical integrity.

  • Each piece of equipment will be kept in good working and will be visually inspected before and after each use.
  • Manufacturer’s recommendations will be followed for periodic monitoring of recording equipment
  • Electrical-safety testing  will be performed yearly by a certified electrician or biomedical engineer
  • Compliance with this policy will be documented

  • Equipment including but not limited to: reusable sensors (gold cup electrodes, snoring microphones, thermocouples and respiratory effort bands), junction boxes, CPAP machines, computers will be visually inspected before and after each shift.
  • Any defective or broken equipment will be replaced as soon as the problem develops.  Reserve equipment will be readily available.
  • Annual safety inspections are made in equipment used in the Sleep Disorders Center by the Clinical Engineering Department of the rental company.  Repairs to equipment are made by the Clinical Engineering Department of the rental company as required. 
  • Annual equipment checks are kept in a log in The Sleep Disorders Center.

§  Inspection of this equipment will be performed by the most qualified technician on that particular shift.

 

Equipment cleaning/sterilization procedures

All equipment will be cleaned in accordance with the approved procedures.  Cleaning is to be performed by all staff members.  Cleaning of patient equipment and positive-airway-pressure equipment is to be performed during the shift on which the study is completed.  The sleep laboratory is to be cleaned and straightened by the end of each shift.  Other cleaning is to be done as needed but will generally be completed during the day shift.  Deviations from these procedures must be documented in writing.

PROCEDURE:

 

Patient Equipment
Item   Frequency   Procedure
  1. O2 Cannula/Gas Tubing
  After each use   Disposable
2.     EEG, EMG, etc Electrodes   After each use   Wash in hot, soapy water. Use scrub brush, if necessary, to remove electrode paste from cup. Dip in water with bleach to disinfect.  Rinse and dry.
3.     Junction Boxes   After each use   Wipe with damp cloth or damp alcohol cloth. *
4.     Respiratory Bands   After each use   Wash in hot, soapy water. Rinse well and hang to dry or wipe with alcohol cloth.
5.     Oximeter Probe and Cord   After each use   Wipe with damp alcohol cloth.
6.     Thermistor   After each use   Wipe with alcohol pad.
7.     Beds   After each use   Patient beds are stripped of linens after each patient use.  Alcohol or Kleenaseptic is sprayed on the mattress and wiped dry.  Clean linens are applied.  When a bed or carpet is heavily soiled, then housekeeping is called upon to clean the rooms thoroughly.

 

Positive-Airway-Pressure Equipment
Item   Frequency   Procedure
1.     Masks   After each use   Soak in CaviCide** for > 12 minutes.  Rinse well. When possible use an equipment dryer; otherwise air dry in the clean utility space.
2.     Humidifier (if used)   After each use   Wash in hot (140-160°), soapy water. Rinse well. Air dry.
3.     Headgear/Chin Strap   After each use   Wash in hot (140-160°), soapy water. Rinse well. Air dry.
4.     Hoses   After each use   Run hot (140-160°), soapy water through hose. Rinse well. Hang to air dry.

 

 

Biophysiologic Monitoring Equipment

Item   Frequency   Procedure
1.     Computer systems   Weekly; more if needed   Wipe monitor screen and keyboard systems with damp cloth or use multi-purpose, anti-static cleaner cloth.
2.    Monitors, VCRs, Chart Recorders, Desks and Shelves   Weekly; more if needed   Use multi-purpose, anti-static computer cleaner cloth.
3.     Oximeter   Weekly; more if needed   Wipe with damp cloth.

 

Other Equipment
Item   Frequency   Procedure
1.     Refrigerator   Weekly   All food items in refrigerator must be marked with an expiration date. Food items that are not marked are to be discarded.  Non-condiment items that are more than a week old are to be discarded.  Condiments and beverages that are beyond their expiration date are to be discarded.  Frozen food may be retained for two months before being discarded.  
2.     Microwave   Weekly; more frequently if necessary   Clean the interior with soap and water, including under the rotating disk. Wipe with a dry cloth to remove excess water.  
3.     Toaster Oven   General cleaning – weekly.

Thorough – monthly

  Generally, excess debris and food are to be removed. For more thorough cleaning wash interior and door with cleansing agent.  
4.     Coffee Machine and Coffee Pots   Daily; more frequently if needed   Rinse pots and clean machine with soap and water as needed.  

*Alcohol – 70% Isopropyl Alcohol.

** CaviCide is a germicidal solution.

 

Procedures for known infections

Patients being monitored in the sleep center, particularly those with obstructive sleep apnea or pulmonary disease are at risk for catastrophic cardiopulmonary events. The technologist must identify these events and take an appropriate course of action. The emergency medical procedures describe the appropriate action for a number of potentially lethal cardiopulmonary events. These procedures also address preferred actions for other emergency situations during which the safety of the patient or the technologist may be at risk.

I)       CODE BLUE – The tech that is monitoring the patient is responsible for patient assessment in case of a medical emergency.  If other sleep techs are present, they will monitor all other patients.

A)    Enter patient room and try to arouse the patient if you see any of the following:

1)      Asystole greater than 10 seconds (check backup lead first)

2)      Ventricular tachycardia greater than 10 seconds

3)      Ventricular fibrillation

4)      Apnea greater than 2 minutes

B)     If the patient does not arouse, begin ABC’s of CPR and call 911.  When EMS arrives, they will take responsibility for the patient and direct intervention until the patient is stabilized. The Medical Director must be notified as soon as possible.

C)     Conditions in which patient safety cannot be assured by sleep center personnel alone, or in which cardiopulmonary status appears seriously threatened. While waiting for additional help,  protect the patient from physical harm and maintain airway as necessary.

D)    The Medical Director needs to be notified if a code blue is called and under any of the following circumstances:

  • Acute cardiopulmonary conditions
    • Asystole greater than 10 seconds (Check backup lead first.)
    • Ventricular tachycardia greater than 10 seconds
    • Ventricular fibrillation
    • Apnea greater than 2 minutes
    • A new onset of:
      • Greater than 6 PVCs per minute for 2 minutes or more
      • More than two runs of 6 or more PVCs
      • Persistent bigeminy or trigeminy
      • Atrial flutter or fibrillation
      • Clinically symptomatic tachycardia or bradycardia
      • Any arrhythmia, EEG phenomenon, respiratory event or patient-reported symptom that in the opinion of the sleep technologist may lead to an emergency situation
  • Seizure
    • New onset seizure in a patient without a history of seizures
    • Seizure in a patient with a history of seizures
    • Electrical seizure without clinical correlate
    • Clinical seizure without electrical correlate
  • Neurologic Emergencies
    • Change in level of consciousness
    • Change in mentation (e.g., confusion)
    • Change in speech
    • Weakness in limbs or face
  • Psychiatric Emergencies
    • Psychotic thinking
    • Suicidal ideation (The patient must be visually monitored at all times until this is resolved.)

E)     If, in the opinion of the technician, there exists an unstable medical condition that warrants immediate treatment (e.g., insulin reaction).

 

II)     Emergency Initiation of Nasal CPAP and Oxygen Therapy.

A)    Initiate nasal CPAP and/or oxygen therapy on a patient according to criteria discussed in the protocols for titration of CPAP and oxygen.

 

III)  Other Emergencies.

A)    Call 911 for:

1)      Any sudden, violent or threatening behavior for which immediate help is needed to preserve the safety of sleep center personnel and other patients.

2)      Any situation in which the behavior of a patient or family member is erratic or threatening, in the opinion of the sleep technologist.

 

Always remember to notify your Medical Director

 

 

 

Universal precautions

Standard procedures to reduce the spread of infection help assure the safety of the staff and patients.

All sleep staff will follow Universal Precautions and Blood borne Pathogen Standards for contact with all patients.

§  All technicians are properly trained on dealing with infection control during their orientation period and also retrained once a year.

§  Technicians are responsible for washing their hands before and after contact with patient.

§  All sleep lab employees will routinely use barrier precautions to prevent skin and mucus membrane exposure to all blood and body fluids. Barrier precautions may include the use of gloves, gowns, masks, goggles aprons, etc., depending on the type of exposure.

  • Patients or technicians with any type of communicable illness or open wounds need to be rescheduled to a later date.

§  All Personal Protective Equipment (PPE) are located in the technician supply room.