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BY:- MR. BINDUSAGAR PATTANAIK DY. HOSPITAL ADMINISTRATOR
B.COMM(MGMT. HONS) MHA(MASTER OF HOSPITAL ADMINISTRATION)
Hospital infection control(HIC) Hospital Acquired Infection or
Nosocomial Infection is one which manifests itself 72 hours or more
after admission to hospital. Aim: To reduce the rate of Hospitals
Acquired Infections Objective: To review good practices in
infection prevention and control
What is Hospital Acquired infection ? Hospital-acquired
infections, are infections acquired during hospital care which are
not present or incubating at admission. Infections occurring more
than 48 hours after admission are usually considered
nosocomial.
Contd An infection acquired in hospital by a patient who was
admitted for a reason other than that infection. An infection
occurring in a patient in a hospital or other healthcare facility
in whom the infection was not present or incubating at the time of
admission. This includes infections acquired in the hospital but
appearing after discharge, and also occupational infections among
staff of the facility
Frequency of Infection HAI occur worldwide and affect both
developed and resource-poor countries. Over 1.4 million people
worldwide suffer from such infectious Most frequent of these are
infections of surgical wounds, urinary tract infections and lower
respiratory tract infections.
Contd The WHO study, have also shown that the highest
prevalence of HAI occurs in intensive care units and in acute
surgical and orthopedic wards. Infection rates - higher among
patients with increased susceptibility because of old age,
underlying disease, or chemotherapy.
Impacts of HAI Add to functional disability Increases emotional
stress of the patient and may, lead to disabling conditions
reducing the quality of life. The economic costs are considerable.
The increased length of stay for infected patients is the greatest
contributor to cost .
Contd Hospital-acquired infections add to the imbalance between
resource allocation for primary and secondary healthcare. Prolonged
stay not only increases direct costs to patients or payers but also
indirect costs due to lost work.
Factors influencing the development of HAI The Microbial Agent
Patients exposure to a variety of microorganisms during
hospitalization increases the risk of HAI Environmental factors
Health care settings are an environment where both infected persons
and persons at increased risk of infection congregate.
Contd. Patient susceptibility Important patient factors
influencing acquisition of infection include age, immune status,
underlying disease, and diagnostic and therapeutic interventions.
Bacterial resistance Many patients receive antimicrobial drugs.
Through selection and exchange of genetic resistance elements,
antibiotics promote the emergence of multi drug resistant strains
of bacteria.
Hospital Acquired infections are widespread They are important
contributors to morbidity and mortality. They will become even more
important as a public health problem with increasing economic and
human impact because of: Increasing numbers and crowding of people.
More frequent impaired immunity (age, illness, treatments). New
microorganisms. Increasing bacterial resistance to antibiotics
Prevention of Hospital Acquired infections is the
responsibility of all individuals and services providing health
care.
Steps to be taken at a National level to control HAI Set
relevant national objectives consistent with other national health
care objectives Develop and continually update guidelines for
recommended health care surveillance, prevention, and practice
Develop a national system to monitor selected infections and assess
the effectiveness of interventions .
Contd Harmonize initial and continuing training programs for
health care professionals facilitate access to materials and
products essential for hygiene and safety. Encourage health care
establishments to monitor nosocomial infections, with feedback to
the professionals concerned
Hospital Programs to prevent HAI The major preventive effort
should be focused in hospitals and other health care facilities
Risk prevention for patients and staff is a concern of everyone in
the facility, and must be supported at the level of senior
administration.
Infection Control Committee An Infection Control Committee
provides a forum for multidisciplinary input and cooperation, and
information sharing. This committee should include wide
representation from relevant programmes: e.g. management,
physicians, other health care workers, clinical microbiology,
pharmacy, central supply, maintenance, housekeeping, training
services.
Tasks of Infection Control Committee To review and approve a
yearly program of activity for surveillance and prevention To
review epidemiological surveillance data and identify areas for
intervention To assess and promote improved practice at all levels
of the health facility To ensure appropriate staff training in
infection control and safety.
Contd. to review risks associated with new technologies, and
monitor infectious risks of new devices and products, prior to
their approval for use to review and provide input into
investigation of epidemics to communicate and cooperate with other
committees of the hospital with common interests such as Pharmacy
and Therapeutics Use Committee, Biosafety or Health and Safety
Role of the physician Physicians have unique responsibilities
for the prevention and control of hospital infections: By providing
direct patient care using practices which minimize infection By
following appropriate practice of hygiene (e.g. handwashing,
isolation)
Contd Supporting the infection control team. Protecting their
own patients from other infected patients and from hospital staff
who may be infected Complying with the practices approved by the
Infection Control Committee Obtaining appropriate microbiological
specimens when an infection is present or suspected Notifying cases
of hospital-acquired infection to the team, as well as the
admission of infected patients
Role of the hospital pharmacist The hospital pharmacist is
responsible for: Obtaining, storing and distributing pharmaceutical
preparations using practices which limit transmission of infectious
agents to patients Dispensing anti-infectious drugs and maintaining
relevant records (potency, incompatibility, conditions of storage
and deterioration)available Obtaining and storing vaccines or sera,
and making them as appropriate Maintaining records of antibiotics
distributed to the medical departments
Contd. Providing the Antimicrobial Use Committee and Infection
Control Committee with summary reports and trends of antimicrobial
use. providing summary reports of prevalence of resistance
monitoring sterilization, disinfection and the environment where
necessary Participation in development of guidelines for
antiseptics, disinfectants, and products used for Washing and
disinfecting the hands participation in guideline development for
reuse of equipment and patient materials
Contd providing summary reports of prevalence of resistance
monitoring sterilization, disinfection and the environment where
necessary participation in development of guidelines for
antiseptics, disinfectants, and products used for washing and
disinfecting the hands participation in guideline development for
reuse of equipment and patient materials
Role of the nursing staff Implementation of patient care
practices for infection control is the role of the nursing staff.
The senior nursing administrator is responsible for: Participating
in the Infection Control Committee Promoting the development and
improvement of nursing techniques, and ongoing review of aseptic
nursing policies, with approval by the Infection Control
Committee
Factors promoting Infection among hospitalized patients
Decreased immunity among patients Increasing variety of medical
procedures and invasive techniques creating potential routes of
infection;
Contd. Developing training programs for members of the nursing
staff. Supervising the implementation of techniques for the
prevention of infections in specialized areas for monitoring of
nursing adherence to policies.
Role of the central sterilization service As central
sterilization department serves all hospital areas, including the
operating suite, an appropriately qualified individual must be
responsible for management of the infection control program.
Oversee the use of different methods physical, chemical, and
bacteriological to monitor the sterilization process Ensure
technical maintenance of the equipment according to national
standards and manufacturers recommendations
Role of the food service The director of food services must be
knowledgeable in food safety, staff training, storage and
preparation of foodstuffs, job analysis, and use of equipment. The
head of catering services is responsible for: Defining the criteria
for the purchase of foodstuffs, equipment use, and cleaning
procedures to maintain a high level of food safety .
Role of the laundry service The laundry is responsible for:
Selecting fabrics for use in different hospital areas, developing
policies for working clothes in each area and group of staff, and
maintaining appropriate supplies Ensuring that liquid soap and
paper towel dispensers are replenished regularly Informing the
maintenance service of any building problems requiring repair:
cracks, defects in the sanitary or electrical equipment, etc.
Contd. Distribution of working clothes and, if necessary,
managing changing rooms. Developing policies for the collection and
transport of dirty linen. Defining, where necessary, the method for
disinfecting infected linen, either before it is taken to the
laundry or in the laundry itself.
Role of the housekeeping service The housekeeping service is
responsible for the regular and routine cleaning of all surfaces
and maintaining a high level of hygiene in the facility.
Classifying the different hospital areas by varying need for
cleaning Developing policies for appropriate cleaning techniques
procedure, frequency, agents used, etc., for each type of room,
from highly contaminated to the most clean, and ensuring that these
practices are followed
Contd.. Developing policies for collection, transport and
disposal of different types of waste (e.g. containers, frequency)
Ensuring that liquid soap and paper towel dispensers are
replenished regularly Informing the maintenance service of any
building problems requiring repair.
Role of the infection control team The infection control
programme is responsible for Oversight and coordination of all
infection control activities to ensure an effective programme.
Organizing an epidemiological surveillance programme for nosocomial
infections Participating with pharmacy in developing a programme
for supervising the use of anti-infective drugs Ensuring patient
care practices are appropriate to the level of patient risk
Contd. Checking the efficacy of the methods of disinfection and
sterilization and the efficacy of systems Developed to improve
hospital cleanliness participating in development and provision of
teaching programmes for the medical, nursing, and allied health
personnel, as well as all other categories of staff Providing
expert advice, analysis, and leadership assistance for smaller
institutions, and undertake
Contd.. Research in hospital hygiene and infection in outbreak
investigation and control Participating in the development and
operation of regional and national infection control
initiatives
Universal/Standard Precautions For Infection Control 1. Hand
Hygiene 2. Personnel Protective Equipments 3. Safe Handling and
Disposal of Sharps 4. Follow needle stick injury protocol 5. Safe
Handling and Disposal of Wastes 6. Managing Blood and Body Fluids
7. Disinfection of the Equipments 8. Environmental Disinfection 9.
Immunization 10. Isolation
Hand Hygiene Hand wash/ Hand rub is the most effective way to
prevent the spread of infections in hospitals. o Before and after
each patient contact o Before and after any procedure o Before and
after wearing gloves o After contact with body fluids
Why practice Good Hand Hygiene? To remove visible soiling from
hands To prevent transfer of bacteria from the home to the hospital
To prevent transfer of bacteria from the hospital to the home To
prevent infections that patients acquire in the hospital
Keep nails short, clean and polish free. Avoid wearing wrist
watches & jewellery, especially rings with ridges or stones.
Any cuts and abrasions should be covered with a waterproof
dressing. Dos & Don'ts
Personal Protective equipment Gloves Disposable plastic Apron
Masks. Eye protection
Safe handling and disposal of sharps The main hazards of a
sharps injury are: Hepatitis B, Hepatitis C, HIV. Ensure that:
Sharps are not passed from hand to hand. Needles are not broken or
bent before use. Sharps are disposed of at the point of use. Sharp
containers are not filled more than two third. Staff are aware of
inoculation injury policy.
Follow needle stick injury protocol Irrigate mucous membranes
by washing under running water. Do not suck/ Squeeze the injury
site Wash with soap and water Apply antiseptic lotion to the injury
site. Contact emergency room-medical officer for management
Complete the incident report & inform to ICN
Safe handling and disposal of waste Segregate the waste at
source. Know the policies and protocols of the state. Safe
disposal. Safe handling of spillage.
Bio-medical Waste means any waste, which is generated during
the diagnosis, treatment or immunisation of human beings or animals
or in research activities pertaining thereto or in the production
or testing of biologicals, and including categories mentioned in
Schedule I
Categories of BMW Option Waste category Treatment &Disposal
Cat 1 Human Anatomical Waste (human tissues, organs, body parts)
incineration@/deep burial* Cat 2 Animal Waste (animals used in
research, veterinary hospitals) incineration@/deep burial* Cat 3
Microbiology & Biotechnology Waste local autoclaving/micro-
waving/incineration@ Cat 4 Waste sharps disinfection (chemical
treat- ment@01/auto claving/micro- waving and mutilation/
shredding" Cat 5 Discarded Medicines and Cytotoxic drugs disposal
in secured landfills
Categories of BMW Option Waste category Treatment &Disposal
Cat 6 Soiled Waste (Items contaminated with blood, and body fluids
) incineration@ autoclaving/microwaving Cat 7 Solid Waste
(disposable items such as tubing's, catheters, iv sets etc).
disinfection by chemical treatment@@ autoclaving/ microwaving and
mutilation/ shredding## Cat 8 Liquid Waste (lab , washing &
disinfecting activities) disinfection by chemical treatment@@ and
discharge into drains. Cat 9 Incineration Ash disposal in municipal
landfill Cat 10 Chemical Waste (chemicals used in disinfection)
chemical treatment@@ and disinfection, discharge into drains for
liquids
Bio-Medical Waste Management
Label for Container / Bag Bio Hazard Symbol Cytotoxic
Symbol
Managing blood and bodily fluids Spillage is dealt quickly as
per the Hospital policy. Handle specimens safely Collection
Labeling Transfer
Managt. Of Small Spill .Wear gloves and eye protection
.Contamination should be wiped up with paper towels soaked in
freshly prepared Hypochlorite solution(1%) .If broken glasses are
present ,1st treat the spillage with Hypochlorite ,then carefully
remove the glass piece with disposable forceps to sharp bin &
wipe it up .Towel & glasses shld be disposed off in a yellow
clinical waste bag for Incineration . Wash hands.
Mangt. Of Large Spill .Mark that area as Large spill .Wear PPE
.Liquid Spill should be Covered up with Hypochlorite solution .Left
for 2 min. .use absorbent to absorbe .If glasses are present mangt.
same as above .Wipe that with water & detergent .Allow that to
dry .Put all the towels ,gloves to yellow bin for incineration
Chemical Spill Mangt. .Chemical neutralizer . Concentrated acid
& alkali are avaible .chemical spill disposed to a suitable
container with a tight fitting lid / a suitable sealable plastic
Bag. .The Head Of the Dept./ service manager is responsible for
ensuring the correct procedure of disposal of chemical waste.
Prevention of Chemical Spillage Pre-planning is essential.
Before working with a chemical, the Hospital worker should know how
to proceed with spill cleanup and should ensure that there are
adequate spill control materials available. Most spills are
preventable. The following can be done to prevent or minimize the
magnitude of a spill:
Place chemical containers in a hood or lab bench in a manner
that reduces the possibility of accidentally knocking down a
container. Plan your movements. Look where you are reaching to
ensure you will not cause a spill. Transport the chemicals safely.
Place absorbent liners on bench tops or in places where spills can
be anticipated. For volumes of liquid larger than what can be
absorbed by liners, use trays.
Radiation Spill .Generate during body organ imaging ,tumor
Localization & therapeutic process in radiology dept. .It
generate some solid radio active waste i.e vial, Syringe, absorbent
paper , protective clothing .store that in a large drum /container
.liquid form are generally diluted & dispensed in the sewers
.Gaseous form can be diluted through dispersal In the outside
atmosphere.
MANAGEMENT OF MERCURY SPILLAGE : In case of thermometer &
B.P. Instrument breaking follow the practice as given below. Wear
Nitrile gloves or double gloves before starting the procedure. Take
10 ml syringe without needle & draw the mercury. Push the
mercury into the water container. Document in the MERCURY
SPILLREGISTER. Inform Sr. Incharge. Medical director &
Supervisor. Inform house keeping to promptly remove the container.
Handover to the Biomedical department. Label it as a mercury spill
kit with date.
DATE TIME ACTION TAKEN INFORMATION GIVEN TO SIGNATURE OF THE
NURSING STAFF FORMAT FOR MERCURY SPILL : UNIT :
Environment Disinfection Achieving and maintaining a clean
clinical environment A very important aspect, yet overlooked??
Proper cleaning of the environment Fumigation as required
Immunization & Isolation Immunization Hepatitis B, Tetanus
Toxioid vaccination for all the employees who are coming in direct
contact with blood and body fluids Isolation Isolate patients with
communicable diseases
Good communication Communicate with peers. Communicate with
seniors. Communicate with doctors. Communicate with patients and
visitors. Communicate with support staff.
Infection control checklist Have you washed your hands? Do you
need to use personal protective equipment? Are you preventing sharp
injuries? Are you disposing off waste safely? Do you deal promptly
with spillages? Do you thoroughly decontaminate equipment? Are you
maintaining a clean environment? Do you know what to do in the
event of an accident? And finally, do you know your workplace's
procedures?