prevention of infection in labour room

2. Prevention and CONTROL OF
INFECTION IN LABOUR ROOM
Presented by: Mrs. M. Lakshmi,
Lecturer, AIIMS, Patna

3. INTRODUCTION
• Women are strong pillars of any society.
However, high maternal mortality during
pregnancy and childbirth is a matter of great
concern worldwide.
• In India 78,000 women die in childbirth every
year. The burden of maternal mortality is quite
high in India at 174 deaths per 100,000 live
births (WHO 2016).

4. Cont….
• The quality of services rendered and also
handling of Basic and comprehensive obstetric
care services at the health facilities has a
bearing on reduction of maternal mortality
rate.

6. Infection control
• Infection control refers to policies and
procedures used to minimize the risk of
spreading infections, especially in hospitals
and human and health care facilities

7. IMPORTANCE OF INFECTION PREVENTION
• Hospitals are notorious sources of infection,
which can be resistant to antibiotic treatment.
• Poor infection prevention practices in labor
and delivery units also cause puerperal sepsis,
neonatal sepsis and other infections of
childbirth.
• The health workers are also at risk of
contracting infections in L&D units.

9. PREVENTION OF INFECTIONS IN LABOUR
ROOM
STANDARD PRECAUTIONS
Hand washing
Use of protective attire
Processing of used items/ equipment
Proper handling and disposal of sharps
Maintaining a clean environment
Biomedical waste disposal

10. Safecarein labourroom
In LDR labor rooms, the pregnant woman
should be directly sent to the LDR unit after
admission. She can be transferred to the
postpartum ward 4 hour after the delivery
In case of convention labor rooms, the
pregnant woman should be brought in the
labor room in active phase of labor and can be
shifted to postpartum ward after 2 hours

11. Cont…
Pregnant woman should be brought in the
labor room/LDR unit after changing into
properly washed and dried delivery gown.
One birth companion of her choice should be
encouraged to be present in the labor room
for giving her emotional and physical support.

12. Cont…
The duty nurse and doctor should undertake a
thorough examination
If the woman is in active labor, the partograph
should be plotted.
The pregnant woman can be made
ambulatory or she can remain in a
comfortable position.

13. HISTROY OF HAND WASHING
• In the mid-1800s, studies by Ignaz Semmelweis in
Vienna, Austria, and Oliver Wendell Holmes in
Boston, USA, established that hospital-acquired
diseases were transmitted via the hands. In 1847,
Semmelweiss was appointed as a house officer in
one of the two obstetric clinics. He observed that
maternal mortality rates, mostly attributable to
puerperal fever, were substantially higher in one
clinic compared with the other (16% versus 7%).

14. • He also noted that doctors and medical students often
went directly to the delivery suite after performing
autopsies and had a disagreeable odour on their hands
despite handwashing with soap and water before
entering the clinic.
• He hypothesized therefore that “cadaverous particles”
were transmitted via the hands of doctors and students
from the autopsy room to the delivery theatre and
caused the puerperal fever. As a consequence,
Semmelweis recommended that hands be scrubbed in
a chlorinated lime solution before every patient
contact and particularly after leaving the autopsy
room. Following the implementation of this measure,
the mortality rate fell dramatically to 3% in the clinic
most affected and remained low thereafter.

16. Hand washing
Proper washing of hands is the most
important way to reduce the spread of
infection in any health care setting
appropriate times for health care staff to wash
hands:
Immediately after arriving at work
Before and after examining each patient

17. Cont…
After handling specimens
Before putting and after removing gloves
Before leaving work

18. Use of protective attire:
Gloves: Wear gloves when there is a risk of
touching blood, body fluids, secretions, excretions
or contaminated items during the procedure.

19. Cont…
Masks: Masks prevent microorganisms
expelled during talking, coughing or breathing
from entering the client and protect the
provider’s mouth from splashes of blood or
other fluids.

20. Cont…
Eye covers: Eye covers are used to protect the
eyes from accidental splashes of blood or other
body fluids. Example while conducting a
delivery or cleaning instruments

21. Cont…
Gowns/aprons: Gowns and waterproof aprons
prevent microorganisms from the provider’s
arms, body and clothing from entering the
client’s body and protect the provider’s skin
and clothes from splashes of blood and other
fluids

22. Cont…
Caps: Caps prevent microorganisms from the
hair and skin on the provider’s head from
entering the client

23. Cont…
Footwear: Footwear that is clean and sturdy
helps minimize the number of microorganisms
brought into the procedure area and protects
the service provider’s feet from injury or
splashes of blood and other fluids.

24. Processing of used instruments
Instruments should be cleaned after each use
with the following processes:
the instruments should be soaked in chlorine
solution for at least 10 minutes.
The chlorine solution should be stored in a
double bucket, where the inner bucket or the
container is fenestrated/ perforated. The
instruments should be put in the perforated inner
bucket which is then dipped in the outer bucket
containing the chlorine solution.

25. Cont…
After soaking, rinse the instruments and clean
them in a bucket of water using a brush
After thorough cleaning, the instruments
should be dried and sterilized by autoclaving.
Sterilized equipment should be stored in the
relevant trays on the trollies.

31. Proper handling anddisposal of sharps
Use each disposal needle and syringe only
once. Always wear utility gloves while
handling sharps. Don’t recap; make needles
unusable after single use by burning them in a
needle destroyer.

32. Maintaining a clean environment of labour room
• The labor room along with all equipment and
all surfaces should be cleaned every morning
and all equipment and surfaces used should be
cleaned after every delivery.
• Labor table should be cleaned in each shift and
after each delivery with (a) cloth soaked in
clean water (and soap water if required) (b)
cloth soaked in 0.5 chlorine solution.

33. CHEATLE FORCEPS

34. Cont…
• Cheatle forceps should not be kept in
antiseptic, and should be autoclaved daily and
kept in autoclaved holder with date and time
labeled each day.
• Toilet should be cleaned with phenyl or Lysol
at start of each shift and after each delivery.
• The overhead tank supplying water to the labor
room should be cleaned at least once a week.

35. Daily at the beginning of the day:
 The floor and sinks should be cleaned with
detergent (soap water) or chlorine solution
daily in the morning and thereafter every three
hours. The floor should be kept dry.

36. Cont…
 All the table tops and other surfaces such as
lamp shades, almirah, lockers, trollies etc.
should be cleaned with low level disinfectant
(2% carbolic acid).

37. Cont…
Monitor machines should be cleaned with 70%
alcohol.

38. After each delivery
• Table tops should be cleaned thoroughly with
chlorine solution or disinfectant (2% carbolic
acid).
• Disposable absorbent sheet placed on the labor
table should be changed.
• Any spillage of blood or body fluids on the floor
should be soaked with chlorine solution for 10
minutes. Should be absorbed in a spillage kit or
absorbent paper and then mopped. The soaked
absorbent paper should be discarded in
appropriate plastic bin.

39. prevention during infected mother

40. DOS’
FOR NURSE
• Use appropriate personal protective
equipment
• Minimize splash of blood and fluids
• Soak all used linen in bleach solution for 2
hours

41. Cont…
• FOR MOTHER
• Perform vaginal cleansing with 0.25%
chlorhexidine/ povidine iodine
• Avoid episiotomy
• Cut cord under cover of gauze with a fresh
blade
• Clean baby thoroughly of secretions
• Determine mother’s feeding choice

42. DONTS,
• Shaving pubic area
• Avoid enema
• Perform frequent PV exams
• Rupture membranes
• Use of instrumental delivery
• Suction of baby

43. Water birth

44. Whirlpool cleaning procedure
• The use of whirlpools/jacuzzis is a recent
addition to obstetrical practice.
• Because the water and the tub surfaces become
contaminated with the mother’s skin flora and
blood during labor and delivery,
• whirlpool/jacuzzis need to be drained after
each patient and the surfaces thoroughly
cleaned and disinfected.

45. Procedure for mopping
Prepare 3 buckets with clear water. Put phenyl or
lysol or bleaching solution in one of the buckets.
(So that you have two buckets of clean water and
one bucket containing disinfectant).The clean
water buckets should be labelled as 1st, 2nd and
3rd bucket. The 3rd bucket will be containing
disinfectant.
The cleaning begins on the floor starting from
inside to outside. Towards the end, all corners and
groves have to be cleaned.

46. Cont….
After each sweep of the floor, the mop should
be dipped first in the 1st bucket then in the 2nd
bucket and lastly in the 3rd bucket containing
disinfectant.

47. Protocols for entry to the labour room
Entry to the labor room should not be direct.
Ideally a buffer zone needs to be created if
possible for changing of shoes, wearing of
mask and cap before entering the labor room.

48. cont…
Entry to the labor room should be allowed only
to the pregnant woman, her birth companion,
doctor, nurse/ANM on duty, and other support
staff.
Before entering the labor room, slippers, cap
and mask should be worn by all visitors
including the birth companion.

49. Any visits of people other than on-duty staff,
pregnant women, and birth companion to the
labor room should be short and timed to the
task (such as cleaning etc.)

50. Protocols for working in the labour
room:
All the staff should wear personal protective attire
at the time of conducting delivery, and at all other
times caps and masks should be worn.
Disposable sterile gloves should be used after
thorough hand-washing while examining or
conducting the delivery.
Infection prevention protocols i.e., adherence,
segregation and disposable in the bins should
strictly be adhered

54. Don’t Harmful Practices
1.No routine enema

55. 2.No routine shaving

56. 3.No routine induction/augmentation of labor

57. 4.No place for routine suctioning of the baby

58. 5.No pulling of the baby

59. 6.No routine episiotomy

60. 7.No fundal pressure

61. 8.No immediate cord cutting

63. 9.No immediate bathing of the newborn

64. 10.No routine resuscitation on warmer

65. Biomedical waste disposal
• Always segregate waste into infectious and
noninfectious waste at the source of
generation.
• Segregate infectious waste into: sharps:
needles, blades, broken ampoules and vials.
These should be disposed of in a puncture
proof container

66. Cont…
• Non sharps: soiled waste, such as syringes,
dressings, gloves and masks. These are to be
disposed in the red plastic bin

67. Anatomical waste

68. SupportiveSupervisionforQualityof Care
 cleanliness checklist for cleanliness
assessment that should be completed and
signed by every supervisor
 The facility in-charge should visit the labor
room at least twice during each week.
 The nursing supervisor/nurse in-charge should
visit the labor room at least once in every
shift.

69. Cont…
 During every visit, the supervisors should
observe the cleanliness in the labor room and
mark appropriate responses in the cleanliness
(no wet areas) checklist
 Every month, a labor room practice review
meeting should be organized at each facility.
All staff involved in care in labor room,
including support and cleaning staff, should
participate in this meeting.