Adaptation of the WHO's "Infection control standard precautions in health care" to GMLF Hospital, Chilakalapalli Village, India which is located in a remote area with little avaiable resources. This work was part of the Master's Internship in Global Health and Cooperation, Autonomous University of Barcelona.

1. REDUCING HEALTHCARE
ASSOCIATED INFECTIONS
AT GMLF HOSPITAL,
CHILAKALAPALLI, INDIA
Maria Noemi Croci
BSc (Hons) Nursing – Adult
Internship in M.S. Global Health and Cooperation

2. DEFINITION OF HEALTHCARE
ASSOCIATED INFECTIONS (HAIs)
HAIs are infections occurring during the process of care in a
hospital or other health care facility which were not present or
incubating at the time of admission.
This includes infections acquired in hospitals but appearing after
discharge, and also occupational infections among staff.
Source: WHO http://www.who.int/gpsc/country_work/burden_hcai/en/

3. HAIs affect hundreds of millions of individuals worldwide each
year. Different causes related to:
● processes of care provision;
● economic constraints on healthcare facilities and healthcare
systems;
● human behaviour.
Source: WHO Infection Control in Developing Nations, Dr. Benedetta Allegranzi
https://www.webbertraining.com/files/library/docs/242.pdf
Health care-associated infections are a
major patient safety problem

4. HOW TO REDUCE
THE BURDEN OF
HAIs?

5. Processes of care provision
● Organisation of work
● Workload
● Staff hierarchy and division of duties
● Replacement in case of sickness or leave
● Knowledge and skills needed to perform duties
● Definition of priorities
● Documentation
● Clear and strong leadership
● Tackle resistance towards change

6. Economic constraints on healthcare
facilities and healthcare systems
● National and international guidelines
● National and local definition of budget for HAIs
surveillance and prevention
● Take into account unexpected expenditures
● Priorities setting
● Cost effectiveness thinking: implementation of low or no
cost infection control measures in limited resources
contexts
● Healthcare rationing
● Alternative solutions

7. Human behaviour
● Risk perception: CONSIDER EVERY PATIENT POTENTIALLY
POSITIVE FOR BLOODBORNE INFECTIONS (BBI)
● Awareness of the magnitude of BBI’s consequences on the
individual, her/his family, social and economic costs,
preventable deaths
● Personal predisposition and willingness toward
improvement and change
● Education and information
● Work based training and re-training
● Understanding of risk,probability and consequences
● Human behaviour is one of the most challenging aspects to
work on

8. AND IN PRACTICE?

9. Infection control standard precautions in
health care Source: adapted from WHO Infection control standard precautions
in health care http://www.who.int/csr/resources/publications/4EPR_AM2.pdf
1. Hand hygiene
2. Gloves use
3. Facial protection (eyes, nose, and mouth)
4. Uniforms
5. Prevention of needlestick injuries
6. Respiratory hygiene
7. Environmental cleaning
8. Linens cleaning
9. Waste management
10. Patient care equipment
11. Safe use of antibiotics

10. 1. HAND HYGIENE

12. Reduction of HAI with simple hand wash
with water and soap
Source: Günter Kampf at al , Hand Hygiene for the Prevention of Nosocomial Infections, Dtsch
Arztebl Int. 2009 Oct; 106(40): 649–655
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770229/
40%

13. ● COST EFFECTIVE
● LITTLE TIME CONSUMING
● EASY TECHNIQUE
● GREAT QUALITY OF CARE
● HIGH IMPACT ON
REDUCTION OF HAIs
● ALLOCATION OF SPECIFIC
BUDGET

14. 2. GLOVES USE

16. ● EASY TECHNIQUE
● PROTECTION FOR THE PROFESSIONAL
● PROTECTION FOR THE PATIENT
● REDUCTION OF HAIs
● GLOVES CHANGE!!!!
● ALLOCATION OF SPECIFIC BUDGET
● USED GLOVES DECONTAMINATION AND REUSE NOT
RECOMMENDED BY THE WHO
2. GLOVES USE

17. 3. FACIAL PROTECTION

18. Wear a surgical mask and eye
protection (face shield, goggles) to
protect mucous membranes of the
eyes, nose, and mouth during
activities that are likely to generate
splashes or sprays of blood, body
fluids, secretions, and excretions:
● Healthcare related activities
(surgery)
● For suspected or confirmed TB
patients to reduce the number of
germs expelled by cough, sneeze,
breath
● Instruments decontamination
and cleaning
● Waste management: Incinerator
and ash removal

19. 4. UNIFORMS

20. ● PERSONAL PROTECTION
● NOT BRINGING GERMS AT HOME
● AT LEAST 3-5 PAIR FOR EACH
PROFESSIONAL
● SHORT SLEEVES
● LONG TROUSERS
● WASHABLE CLOSETOP CLOGS
● PROFESSIONAL IDENTIFICATION

21. 5. PREVENTION OF
NEEDLESTICK INJURIES

22. PAY EXTRA CARE WHEN:
● HANDLING NEEDLES, BLADES
AND OTHER SHARP
● DISPOSING OF USED
NEEDLES
● DISPOSING OF USED
SURGICAL BLADES
WASTE MANAGEMENT:
● SEGREGATION FROM OTHER
HOSPITAL WASTE (e.g. SOFT
WASTE AND ORGANIC
WASTE)
● RESISTANT PLASTIC
CONTAINERS WITH
INTEGRATED NEEDLE
REMOVAL SYSTEM

23. NEVER RECAP
USED
NEEDLES!!!!
HEP B VACCINATION TO STAFF EXPOSED TO BLOOD AND SHARPS
(INSTRUMENTS DECONTAMINATION AND WASHING, GIVING
INJECTIONS, USE OF BLADE AND OTHER SURGICAL INSTRUMENTS,...)
HEP B VACCINATION DOES NOT PROTECT AGAINST HIV OR HEP C

24. SAFELY SEPARATE THE NEEDLE
FROM SYRINGE: THE SHARPS
CONTAINER WILL LAST LONGER
AS THERE WILL BE MORE
SPACE AVAILABLE!

25. 6. RESPIRATORY
HYGIENE

26. Persons with respiratory symptoms
should: cover their nose and mouth
when coughing/sneezing with, hands,
tissue or mask, dispose of used tissues
and masks, and perform hand hygiene.
Health care facilities should: place
acute febrile respiratory symptomatic
patients at least 1 metre (3 feet) away
from others in common areas
If blood in the secrations think about TB
and give a mask to patients and make
appropriate referral.

27. 7. ENVIRONMENTAL
CLEANING

28. Use adequate procedures for the routine cleaning
and disinfection of environmental and other
frequently touched surfaces.
DRESSING ROOM:
● FLOOR
● BASIN
● CHIAR
● STOOL
● BENCH
● CLOSET
● ANY OTHER FREQUENTLY TOUCHED SURFACE

29. 8. LINENS CLEANING

30. Linen cleaning avoids
transfer of pathogens to
other patients and/or to
the environment.

31. 9. WASTE DISPOSAL

32. SERIOUS HAZARD FOR
PATIENTS, PROFESSIONALS
AND THE ENTIRE COMMUNITY!
SEGREGATION, STORAGE,
TREATMENT AND DISPOSAL
FOR:
● SOFT WASTE
● SHARPS
● ORGANIC WASTE
● HAZARDOUS WASTE
Ensure appropriate waste management
NO

33. 1. Segregation: separate waste per
category at the time and place it is
generated
2. Collection: on regular basis, safe
transport
3. Storage: place waste in a secure
area with limited access to
unauthorised persons
4. Treatment: method, technique or
process to change waste’s biological,
chemical or physical features
5. Final disposal: to impede waste
retrieval
NO

34. 10. PATIENT CARE
EQUIPMENT

35. ● SINGLE PATIENT SURGICAL
INSTRUMENTS USE
● SINGLE PATIENT SURGICAL BLADE USE
● STERILISATION OF SURGICAL
INSTRUMENTS
● SURGICAL COMPRESSES MAKING AND
THEIR STERILISATION
● DO NOT USE ANY OF THE ABOVE ITEMS
IF THEY FALL ON THE FLOOR OR IN THE
RUBBISH BIN
Handle soiled equipment with blood, body
fluids, secretions, and excretions in a manner
that prevents skin and mucous membrane
exposure (cuts, injuries), contamination of
clothing and skin, and transfer of pathogens
to other patients or the environment.
Always sterilise every piece of equipment
before using it again on the same or another
patient.

36. 11. SAFE USE OF
ANTIBIOTICS

37. THIS IS TO PREVENT ANTIBIOTIC RESISTANCE (= WHEN
BACTERIAS ARE NO LONGER SENSIBLE TO GIVE
ANTIBIOTICS)!
PRESCRIBE,
ADMINISTER,
HANDOVER
ANTIBIOTICS
ONLY WHEN
STRICTLY
NECESSARY!