Infection Control, Spaulding Classification & Tikanga Māori

Task 1: Infection Control And Blood-Borne Diseases

You are training a new colleague in the sterile services unit. They ask why blood-borne viruses like hepatitis B, hepatitis C and HIV can sometimes be destroyed with disinfection, while other microbes require sterilisation.

1. (a) Describe the hierarchy of microbial resistance from least resistant (easiest to destroy) to most resistant (hardest to destroy). (10 marks)
   (b) For each level, give one example of a microorganism and briefly state the type of infection it can cause (include at least one blood-borne virus in your examples). (10 marks)
2. Explain how Spaulding’s classification of reusable devices helps determine whether cleaning, disinfection or sterilisation is required to prevent transmission of blood-borne viruses. Include examples of critical, semi-critical and non-critical items you reprocess that could carry blood-borne viruses, and make clear how reprocessing decisions help break the chain of infection and prevent transmission of blood-borne microorganisms. (10 marks)
3. (a) Describe how bacterial spores differ from viruses in structure and resistance to reprocessing methods. (10 marks)
   (b) Explain why instruments contaminated with bacterial spores must always be sterilised, even though disinfection may be sufficient to inactivate most blood-borne viruses. (10 marks)

Task 2: Infection Control And Cultural Awareness

You are working in the decontamination area. A co-worker places contaminated instruments on the floor temporarily while moving a load between sinks. Another staff member notices and comments that this is not only unsafe for infection control, but also disrespectful in terms of tikanga Māori, because contaminated instruments (which have been in contact with human tissue) are considered tapu.

1. Explain why this action (placing instruments on the floor) is unsafe from both (a) an infection control and (b) a cultural (tikanga Māori) perspective. (10 marks)
2. Describe how you would respond professionally to your colleague who placed the instruments on the floor. (15 marks)
3. (a) Explain how applying tikanga (tapu and noa) in your practice helps uphold one or more of the te Tiriti o Waitangi principles (partnership, participation, protection). (15 marks)
   (b) Suggest one practical team-wide improvement that would reduce the risk of this situation happening again. (10 marks)

Experts Answer on Above Questions on Infection Control

Infection control and blood borne diseases

Hierarchy of microbial resistance

The hierarchy from least resistant to most resistant includes enveloped viruses which are destroyed by appropriate disinfectant, vegetative bacteria which are susceptible to disinfectant, fungi highly resistant to vegetative bacteria, non enveloped viruses resistant to environmental conditions, mycobacteria resistant to disinfectant and bacterial spores resistant to routine disinfection and require sterilization.

Examples of microorganism and infection

The example of enveloped virus is Hepatitis B and the infection it causes is Hepatitis B. Staphylococcus aureus, a vegetable bacteria causes skin and wound infection, while candida albicans, a fungi is responsible for candidiasis. Norovirus, a type of non-enveloped virus, causes gastroenteritis while mycobacterium tuberculosis, a type of mycobacterium, causes tuberculosis.

Spaulding classification of reusable devices

This particular spaulding classification is helpful in identifying the required level of reprocessing on the basis of infection risk associated with medical devices. With respect to critical items, enter sterile body tissues or the bloodstream such as surgical instruments and vascular instruments which need to be cleaned and sterilized before reuse. For semi critical items, contact mucous membranes or non intact skin such as reusable endoscope and respiratory equipment which needs to be cleaned followed by the least level dis-infection or sterilization. Finally for the non-critical items, contact intact skin only such as blood pressure cuffs which require cleaning and appropriate low level disinfection.

Connection to blood Bond viruses – the instruments that are contaminated with blood can transmit Hepatitis B, C and HIV and requires thorough cleaning to inactivate microorganisms.

Differences between bacterial spores and viruses

Bacterial spores are dormant survival structures that are produced by certain bacteria while viruses are infectious agents that comprises DNA or RNA. Bacterial spores have protective layers while viruses have an outer lipid envelope. Bacterial spores are highly resistant to routine disinfection and envelope viruses are susceptible to disinfectants.

Why bacterial spores need sterilization

Bacterial spores need sterilization because it destroys or eliminates all forms of microbial life including bacterial spores. Disinfection may kill viruses and vegetative bacteria but they do not reliably destroy bacterial spores. This implies that the reusable critical instruments should be sterilized in order to prevent spore transmission and protect patients from serious infection.

Infection control and cultural awareness

You can review the infection prevention and PPE in sterile services answer to know more about infection prevention initiatives.

Why placing instruments on the floor is unsafe

From infection control perspective, the floors contain dust, dirt and microorganism, and contaminated instruments can pick up additional pathogens. The contact with the floor increases cross contamination risks and there is a possibility of spreading microorganisms to equipment and other surfaces.

Tikanga Maori Perspective

In Tikanga Maori, the instruments that contact human blood are considered as tapu (sacred or restricted). Placing them on the floor is considered as this respectful because the floor is related to noa (restricted spaces).

Professional response to the colleague

I would provide a detailed explanation that placing contaminated instruments on the floor would increase the infection risk and conflict with Tikanga Maori. I would therefore ask the colleague to stop and prevent further handling of the affected instrument, segregate such instruments, arrange re-processing of such equipment, clean the affected flour area, make the colleague aware of respecting Tapu and inform the supervisor as per workplace policy.

Tikanga Maori and Te Tiriti o Waitangi principles

The application of Tapu supports three important principles such as partnership, participation and protection. These practices are quite effective in promoting culturally safe healthcare and improve trust between Maori communities and healthcare providers.

One practical team wide improvement

This can be to introduce mandatory staff training on infection control and Tikanga Maori to make sure that the contaminated instruments are transported safely while reinforcing cultural respect and workplace practices.

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