hospital infection control

1. Hospital Infection Control(HIC)
Rajendra Acharya
Learning & Development
MHA(Hospital Administration)
M.sc. Nursing , BSc. Nursing,
CIA-NABH , CIPCP -2019, CIPCP -2020

2. - Infection control practices
1.Hand hygiene -( Hand wash ,hand rub)
2.Bio medical waste(Management & Handling) Rules-
1998,2000,2001,2008, 2016, Amended-2018,C-2020
3.Spill Management ( body fluid , chemical ,
4.Needle Stick Injury (Blood & Body fluid )
5. Care Bubdle ( All Indewaling Device )
6.Indicators HAI ( CAUTI, CLABSI,VAP,SSI, )
7. Barrier Nursing(Standard precautions use by staff)
8. High Risk Area Surveillance
9.CSSD -Sterilization, Autoclave, ETO, Plasma SterlizerProcess.
10.MSDS
11.Cleaning -Protocol high Risk Area & Equipment ,Surface
HIC-Objective

3. QUALITY INDICATORS ( HOSPITAL INFECTION
CONTROL)
• Monitoring Quality indicators
- No of hospital acquird infection
– No of NSI blood and body fluid handling by staff
– No of BLOOD tranfusion reaction
– No of bed sore in IPD patient
– Standard precauctions use by staff
– BMW Handling , dispose , discarded , Tansport
– Safe infusion Practice
– Hand Hygiene Compliance ( Dcotor, Nursing, technician, house keeping)
– Re-intubation rate
– HAI rate (VAP, CLABSI,CAUTI,SSI)

4. AT THE TIME OF ASSESSMENT
• Interview of staff -
• documentation -
• Assessment of staff and staff practice

5. DEFINITION
• Health care-associated infection
(HCAI), also referred to as "nosocomial" or
"hospital" infection, is an infection
occurring in a patient during the process of
care in a hospital or other health care
facility which was not present or incubating
at the time of admission.

6. Chain Of Infection

7. HAI…… Cont.

9. Sources of Infection
Other Patients
Environment
Health-care staff
Patient
Staff

10. Factors increasing risk of HAI
Hospital Atmosphere
Poor ward infrastructure
Lack of isolation rooms
Overcrowding
Indwelling catheters
Antibiotic overuse
Inadequate Aseptic procedure
Environment
al Factors

11. Common causes of HAI
 Urinary bladder Catheter
 Intravenous IV procedures
 Poor aseptic practices
 Surgery and wound
 Antibiotic Overuse
 Biomedical Waste
 Lack of awareness

12. Pneumonia,
33%
UTI, 31%
Blood stream
infection, 11%
Skin and soft
tissue, 8%
Others, 17%
Common HAI Infections
According to a 2016 research on HAI cases in ICU, below
mentioned were the common HAI infections identified.

13. Klesiella
29%
E. coli
22%
Acinetobacter
13%
Pseudomonas
12%
Burkholeredia
3%
others
21%
Common Causative agent
According to a 2016 research on HAI cases in ICU, below
mentioned were the common causative agents identified.

14. HAI….
• Direct—requires physical contact between hosts.
• Indirect—contact with body fluids or tissues of an
infected individual.
• Droplet—large infectious particles sprayed into the
air from the respiratory tract of an infected
individual.
• Droplet nuclei—small infective particles that are
suspended in the air, taken in by a host, and are
capable of traveling to the lung.

15. HCAI
• Common organisms:
– Staph aureus
– E.Coli
– Pseudomonas aeruginosa
– Vancomycin resistant enterococci
– MARSA (HAND)
• Common systems involved
– Urinary Tract—UTI
– Respiratory Tract—VAP
– Surgical Sites—SSI
– Blood Stream—CLABSI ( Bacteremia)
– Skin
– Eyes
– GI Tract

16. Standard Precaution

18. Standard Precaution
• PPE
• Hand hygiene( Hand washing 40-60 secs )
( Hand rubbing 15-20 secs)
• BMW
• Isolation
• Barrier Nursing

19. 5 Movement of Hand Hygiene

20. Hand Wash – WHO

21. Hand Hygiene

22. PPEs (Personal Protective
Equipment)
PPEs for infection control( Prevention of cross infection)
•Cap
•Eye shield/Goggles- Glasses with side shields
•Mask/N-95 Mask
•Hearing protective devices in high noise areas
•Gowns/ Fluid resistant gowns for lab etc.
•Hand Sanitizers
•Gloves/double gloving
•Fluid impermeable shoes -, synthetic
•Emergency eye washers in labs

23. PPEs (Personal Protective Equipment)
Sequence of Donning and Doffing of PPEs (Wearing and Removal)
Perform Hand Hygiene
Donning
• Hand Hygiene
•Gown
•Mask
•Goggles
•Gloves

24. Doffing ( Removing)
• Gloves  Hand hygiene
• Gown
• Hand Hygiene
• Goggles/Face Mask
• Mask
(Remove mask after you leave patient room and
shut the door)
• Hand Hygiene

25. HIC Quality Indicators
• VAE -(VENTILLATOR ASSOCIATED PNEUMONIA)VAP
• CLABSI- (CENTRAL LINE ASSOCIATED BLOOD STEAM
INFECTION)
• CAUTI- (CATHETER ASSOCIATED URINARY TRACT
INFECTION)
• SSI- (SURGICAL SITE INFECTION)

26. HIC Critical Care Bundles
• Ventilator CARE Bundle
• Central Line CAREBundle
• CATHETER CARE Bundles
• SURGICAL SITE CARE Bundles

27. • Ventilator-Associated Pneumonia (VAP)Bundle:
– Head of bed (HOB) elevated to 30-45
– ET suctioning to remove secretion
– Daily Sedation Vacation
– Daily Spontaneous Breathing Trial
– DVT prophylaxis
– GI prophylaxis
– Peptic ulcer prophylaxis.
– Chlorhexidine mouth wash (every shift)
in those above 10 years of age.
1. The need for line use has been reviewed and recorded, & keep line
cover
2. The dressing is intact and was changed within the past 7 days. AS
PER ORDER & check redness, swelling etc
3.Hand hygiene before and after, is performed on all line
maintenance/access procedures.
4.Alcohol hub decontamination is performed before each hub access.
Optimal catheter site selection*
5.Chlorhexidin Skin Antiseptic (solution compatible with CVC) is used
for cleaning the insertion site during dressing changes.
6.Maximum Barrier Precaution Upon Insertion
Keep Collection bag below level of the bladder at all times.
Avoid unnecessary urinary catheters
The UC has been continuously connected.
Maintain closed drainage system
Daily meatal hygiene has been performed by healthcare staff.
Empty UC bag often, as a separate procedure, into a clean
container.
Hand hygiene performed before & after procedure and apron +
glovesworn during procedure.
Empty the collection bag when filled 3/4
Keep collection bag below level of the bladder at all times
1. Antibiotic Prophylaxis with in 45 min before surgery ( prior
incision)
2. surgical part preparation with single cliper
3. surgical bath or shower after part preparation ( with
chlorehexidine gluconate )
4. blood glucose level control or management
5. Hand washing each after movement.
6. Daily dressing on site & surgical area assessment .
7. Sterile item used for dressing
8. education patient & relative regarding symptoms of SSI .
9. Sterilization of surgical instrument and dressing tray .
 Hand washing before & after the procedure
 Chlorhexidine skin antisepsis/ and part prepratio

28. Ventilator Associated Infections (VAP)
 Ventilator-associated pneumonia (VAP) is pneumonia that
develops 48 hours or longer after mechanical ventilation is
given by means of an endotracheal tube or tracheostomy.
 VAP is the second most common nosocomial infection.
 VAP increases a patient's hospital stay by approximately 7-9 days

31. VAE BUNDLE

32. • Ventilator-Associated Pneumonia (VAP)Bundle:
–Head of bed (HOB) elevated to 30-45
– ET suctioning to remove secretion
–Daily Sedation Vacation
–Daily Spontaneous Breathing Trial
–DVT prophylaxis
–GI prophylaxis
–Peptic ulcer prophylaxis.
–Chlorhexidine mouth wash (every shift) in those
above 10 years of age.

33. • A central line associated blood stream
infection is a laboratory-confirmed
bloodstream infection (BSI) in a patient who
had a central line within the 48 hour period
before the development of the BSI, and that is
not related to an infection at another site

34. -Center line
-femoral line
-Jugular line
-Peripheral line
CENTER LINE TYPE

36. Risk factors of CRBSI
Poor personal hygiene,
Occlusive transparent dressing,
Moisture around the exit site,
S. Aureus nasal colonization,
Contiguous infections
 Catheter site selection & method matters in all the
patient

37. 1. The need for line use has been reviewed and recorded, &
keep line cover
2. The dressing is intact and was changed within the past 7
days. AS PER ORDER & check redness, swelling etc
3.Hand hygiene before and after, is performed on all line
maintenance/access procedures.
4.Alcohol hub decontamination is performed before each
hub access. Optimal catheter site selection*
5.Chlorhexidin Skin Antiseptic (solution compatible with
CVC) is used for cleaning the insertion site during dressing
changes.
6.Maximum Barrier Precaution Upon Insertion

39. A UTI in a patient who had an indwelling urinary
catheter in place at the time of or within 48 hours
prior to infection onset.
Types of CAUTI
 Symptomatic
 Asymptomatic
CATHETER ASSOCIATED URINARY TRACT
INFECTIONS (CAUTI)

40. CAUSES
the catheter may become contaminated upon
insertion
the drainage bag may not be emptied often enough
bacteria from a bowel movement may get on the
catheter
urine in the catheter bag may flow backward into
the bladder
the catheter may not be regularly cleaned

41. Symptoms
Cloudy urine
Blood in the urine
Strong urine odor
Urine leakage around your catheter
Pressure, pain, or discomfort in your lower back or
stomach
Chills
Fever
Unexplained fatigue
Vomiting

43. Keep Collection bag below level of the bladder at all times.
Avoid unnecessary urinary catheters
The UC has been continuously connected.
Maintain closed drainage system
Daily meatal hygiene has been performed by healthcare
staff.
Empty UC bag often, as a separate procedure, into a clean
container.
Hand hygiene performed before & after procedure and
apron + glovesworn during procedure.
Empty the collection bag when filled 3/4
Keep collection bag below level of the bladder at all times

44. • A surgical site infection is an infection that occurs
after surgery in the part of the body where the
surgery took place. Surgical site infections can
sometimes be superficial infections involving the
skin only.

45. TYPE OF SSI
Superficial incision SSI
Date of event for infection occurs within 30 days
operative procedure (where day 1 = the procedure
date) AND involves only skin and subcutaneous
tissue of the incision
Deep incision SSI
The date of event for infection occurs within 30 or
90 days after the operative procedure (where day 1
= the procedure date) involves deep soft tissues of
the incision (e.g., fascial and muscle layers)

46. Classification

47. 1. Superficial SSI
•i.The surgical procedure must have been performed within 30
days before the infection.
•ii.The infection involves only skin and subcutaneous tissue of
the incision.
•iii.The patient has at least one of the following:
•a.purulent drainage from the superficial incision.
•b.superficial incision that is deliberately opened by a surgeon
due to infection
•c.

48. 2.Deep SSI
i.Infection occurs within 90 days after
thesurgical procedure
ii.The infection involves the deep tissues / deep spaces / organs related to
the site of surgery (e.g., fascia / muscle / bone).
iii.The patient has at least one of the following:
a.Purulent drainage which is originating from the deep tissues.
b.The wound that spontaneously dehisces or is deliberately opened by a
surgeon and the patient has at least one of the following signs or
symptoms: fever (>100.4°C); localized pain or tenderness
c.an abscess or collection in the deep tissues / organ / body spaces that is
found on examination, during invasive procedure or by imaging.
d.diagnosis of a deep SSI by a surgeon.

49. • surgical wound type
1. Antibiotic Prophylaxis with in 45 min before surgery (
prior incision)
2. surgical part preparation with single cliper
3. surgical bath or shower after part preparation ( with
chlorehexidine gluconate )
4. blood glucose level control or management
5. Hand washing each after movement.
6. Daily dressing on site & surgical area assessment .
7. Sterile item used for dressing
8. education patient & relative regarding symptoms of SSI .
9. Sterilization of surgical instrument and dressing tray .
 Hand washing before & after the procedure
 Chlorhexidine skin antisepsis/ and part prepration

50. Prevention of SSI

51. • Class I/Clean- uninfected operative wound Uninfected, no inflammation
• Class II/Clean-Contaminated- biliary tract, appendix, vagina
No unusual contaminatioN
• Class III/Contaminated:- Open, fresh, accidental wounds
• Major break in sterile technique
• Class IV/Dirty-Infected- Old traumatic wounds with retained
devitalized tissueperforated viscera.
• Old traumatic wounds, devitalized tissue
• - Existing infection or perforation
• - Organisms present BEFORE procedure
• Examples: Abscess I&D, perforated bowel, peritonitis, wound debridement, positive cultures pre-op

52. Classification of
surgical wounds

53. • A. Endogenous: B. Exogenous

54. Prevention of SSI:

55. • i.Smoking cessation advice, if applicable.
• disposable razors for each patient
• ii.Identification and treatment of infections pre-
operatively before elective operation. Elective
surgery is postponed until infection has
resolved.
• iii.Use of topical chlorhexidine (Eg:
Chlorhexidine bath / Chlorhexidine foam
application) for 48 hours before surgery
• iv.Skin Preparation: An appropriate antiseptic
agent (Chlorhexidine or Povidone Iodine) is used
prior to surgery.

56. • v.Prophylactic antibiotic administration (given 1
hour prior to skin incision) according to the
antibiotic policy. Further dose of antibiotic
would be necessary if the duration of surgery is
>4 hours or in case of excessive blood loss.
• vi.Hair at the operative site is not removed
unless it will interfere with the operation. In
such cases, the hair is removed by clipping.
Razors are not to be used.
• vii.Strict pre-operative blood glucose control (to
be maintained <180mg/dl).
• viii.Short pre-operative hospital stay.

57. END
• Questions? QUARY

58. BIOMEDICAL WASTE
MANAGEMENT

59. DEFINITION
• "BIO-MEDICAL WASTE" means any waste,
which is generated during the diagnosis,
treatment or immunization of human beings
or animals or research activities pertaining
there to or in the production or testing of
biological or in health camps, including the
categories mentioned in the rules.

60. Hazards of Hospital Waste
Air Pollution Water
Pollution Land Pollution
Land Pollution
Transmission of
infections

61. Colour Coding for BMW

62. YELLOW BAG
(Waste for Incineration)
Waste Items
 Tissues
 Organs/Body Parts
 Cytotoxic drugs
 Laboratory Waste
 Non Plastic Contaminated Waste
 Plaster Cast
 Dressing/Bandages
 Swabs
 Microbiology & biotechnology
Waste

63. Red Bag
 Wastes generated from disposable
items such as tubing,
 Bottles,
 Intravenous tubes and sets,
 Catheters,
 Urine bags,
 Syringes (without needles and fixed
needle syringes) and vaccutainers
with their needles cut)
 Gloves.

64. Blue Bag
(Waste for Autoclaving, Microwaving, Chemical
Treatment & Destruction/Shredding)
Unbroken glass bottles and vials.
Hard plastics.
All metallic items.
Guide wires.

65.  Needles
 Scalpels
 Blades
 Broken ampoules
 Glass Pieces
 This includes both
used, discarded and
contaminated metal
sharps
Puncture Proof Bag
(Sharps)

66. SYMBOLS

67. Discard of blood bags
 Autoclaving of PVC blood bags is a safer and
reliable method compared to chemical
disinfection.
 Autoclaving at 15 lbs pressure for 2 hours
uniformly inactivated the vegetative forms and
B. stearothermophilus spores.

68. Discard of the cytotoxic
wastes
 All waste must be collected in the yellow bag
with cytotoxic label
 While discarding, we should ensure that we
have wore proper PPE
 Before disposal, the garbage bag will be tied
with a tie band with cytotoxic label on it.
 Final treatment would be incineration.