5. HAND HYGEINE
Hand washing facility near point of use
Elbow/foot operated taps / sensor
Tap –96cm from the ground
Sink wide and deep enough
Regular water supply
Liquid soap
Display hand washing instruction
Hand drying
Staff training
Surgical scrub – 3-5mts
8. DECONTAMINATION AND CLEANING
• Procedure surfaces –1% sodium hypochlorite
Solution after every procedure.
• Instruments –in 0.5% sodium hypochlorite
solution for 10 mts
• Soiled linen – soaking in 0.5% sodium
hypochlorite solution for 30 mts.
• Detergent wash
• drying
9. DECONTAMINATION AND CLEANING
• How to make disinfectant
• Supervision
• Gluteraldehide –date of preparation and due
date of change of solution.
• Contact time required for chemical
sterilization
10. AUTOCLAVING AND STERILIZATION
CSSD :
Facility lay out ensures separation of
routes for clean and dirty items.
Demarcated separate area for receiving
dirty items ,processing
11. AUTOCLAVING AND STERILIZATION
CSSD :
Check window of drum
Not fill more than 3/4th
Trays--- double wrap with cloth
Temperature
Pressure
time
12. AUTOCLAVING AND STERILIZATION
CSSD :
• Sterile pack is marked with
• Date and time of sterilization
• Contents
• Expiry date and time
• Name and signature of technitian.
13. STORAGE OF STERILE ITEMS
• Sterile packs are kept in clean,dust free ,
moist free environment
• Separate place for clean and sterile items
• Dedicated trolly for its transportation
14. VALIDATION OF STERILIZATION
• Mechanical indicator –time, temperature and
pressure
• Chemical indicators – internal & external
• Biological indicator –( bacillus thermophilus
spores )monthly
• Lable the spore ampule
• Place in horizontal position
• Kept at the bottom or furthest part of autoclave
15. AUTOCLAVE REGISTER
• COLUMN FOR:
• DATE
• LOAD NUMBER
• LOAD CONTENT
• STARTED & FINISHED TIME
• TEMPERATURE
• PRESSURE
• AUTOCLAVE CHEMICAL INDICATOR TAPE
• SPORE TEST
• SIGNATURE OF THE TECHNITIAN
16. ANTIBIOTIC POLICY
• Facility has defied and established antibiotic
policy
• Doctors must be aware of it
• Antibiotics precribed as per the policy
17. HEALTH CARE ASSOCIATED INFECTION
HAI
SSI
1-72 HOURS AFTER
ADMISSION
3 DAYS AFTER
DISCHARGE
DATE OF SURGERY 30 DAYS
DATE OF SURGERY ONE YEAR
18. HAI SURVEILLANCE
• Microbiological surveillance
• Measurement of SSI Rates
• Measurement of device related infection rates
• Measurement of blood related and respiratory
infections
• Analysis and correcive action on survillance
findings.
19. MICROBIOLOGICAL SURVILLINCE
AIR SAMPLING:
Once in a week for OT with HEPA FILTERS
Once in a month for OT Without ventillation system and LR
Obtain the required number of culture media plate from the
microbiology lab ( room temperature)
Sampling– immediately after opening in the morning.
20. AIR SAMPLING
• LABEL—OT /LR no,,sample site etc before takingit
into the OT/LR
• Change in to protective dress
• Enter the OT/LR with media
• Ventilation system /AC should be turned on and
allowed to run for at least 10mts
• Follow asceptic technique
• Expose one plate on the OT Table for 40mts
• After 40mts plate should be closed ,sealed and
sent to lab.
21. MICROBIOLOGICAL SURVEILLANCE
SURFACE SAMPLING
In the morning before any cleaning is done
Swabs and media should be at room temperature
when the sample is taken
Label– OT/LR no., sample site
Change in to protective dress
Enter the OT /LR with swab and media
Ventilation system /AC should be kept off.
22. SWAB
• OT/DELIVERY TABLE
• OT LIGHT
• STERILE INSTRUMENTS TROLLY/ DELIVERY SET
• MEDICATION PREPARATION SURFACE OF
ANAESTHESIA MECHEINE
• FLOOR – ADJACEMENT TO OT/DELIVERY TABLE
• NEW BORN WARMER
• ANY ONE WALL AT WAIST TO SHOULDER HEIGHT
23. UNACCEPTABLE RESULTS
• Postpone elective cases
• Do not use OT/LR until the problem is resolved
• Repeat cleaning ,disinfection and swab ,
procedure should be supervised
• All procedures in the duration between sampling
and reporting of unacceptable swab result
,should be identified and followed up for for the
surgical site infection
• Investigation for the causes of unacceptable
results
24. SSI RATE
NUMBER OF SSI X 100
-------------------------------------------
NO OF SURGERIES PERFORMED IN SAME PERIOD
29. SPILL MANAGEMENT
• PPE
• 1% HYPOCHLORITE SOLUTION
• TISSUE PAPER / TOWEL / NEWS PAPER
• WIPER
• DUST BIN
• YELLOW BIO HAZARD BAG
30. BLOOD SPILL MANAGEMENT
• SPILL ALERT
• SPILL MANAGEMENT KIT
• WEAR PPE
• SPREAD TISSUE PAPER ABOUT THE SPILL
• POUR 1 % HYPOCHLORITE SOLUTION ( 10% FOR LARGE SPILLS)
• WAIT FOR 15-20 MTS
• WIPE UP THE SPILLAGE
• NORMAL CLEANING WITH SODIUM HYPOCHLORITE
• REMOVE PPE AND DISPOSE PROPERLY
• WASH HANDS
• KEEP REGISTER
31. BLOOD SPILL MANAGEMENT
REGISTER SAMPLE
DATE &
TIME
AREA OF
INCIDENT
( LOCATION )
TYPE OF
SPILL (
SMALL/
LARGE
ACTION
TAKEN
MANAGED
BY ( NAME
OF HOUSE
KEEPING
STAFF )
EXPOSURE
TO STAFF
( IF ANY )
SIGNATUR
E
32. DEMARCATED ZONES
PROTECTIVE ZONE:
• RECEPTION AREA, WAITING AREA, STRECHER /TROLLYBAY, DRESS
CHANGING ROOMS, PRE AND POST OPERATIVE ROOMS.
CLEAN ZONE:
• DOCTORS AND NURSES ROOMS,ANAESTHESIA ROOM
,EQUIPMENT ROOM ,PACKING AREA
STERILE ZONE:
• OPERATING ROOMS,SCRUB STATION, ANAESTHESIA STATION.
DISPOSABLE ZONE:
• ONE WAY TRAFFIC
33. ENVIRONMENTAL CONTROL OF
PATIENT CARE AREAS
GENERAL INSTRUCTIONS:
• Training for house keeping staff
• Heavy duty gloves
• Never use brooms in patient care areas
• Dry mop using microfiber floor mops
• Three bucket system
• Wet mopping of the floor – 3 times /day and whenever
necessary
• Caution board
• Luke warm water and detergent
• Freshly prepared 1 % hypochlorite solution
• Unidirectional mopping
34. ENVIRONMENTAL CONTROL OF
PATIENT CARE AREAS
GENERAL INSTRUCTIONS:
• Disinfection of mops
• Cleaning of bucket
• Cleaning and disinfection of surfaces
• Hand washing
• Check list
• Supervision and corrective action
• Housekeeping register
35. ENVIRONMENTAL CONTROL OF
PATIENT CARE AREAS
FUMIGATION
NO FORMALIN USE
WITH PRODUCTS CONTAINING HYDROGEN
PEROXIDE AND SIVER COMPOUND
Entry to the sterile zone only after hand wash
,change of cloths and appropriate PPE
External footwear restricted
Positive pressure in OT
20- 25 Air exchanges per hour
36. BIO MEDICAL WASTE MANAGEMENT
( RULES )
• Committee ( atleast six monthly)
• Copy of bio medical waste management rules
• Colour codes ,foot operated , covered bins
and bags
• Non chlorinated , barcoded plastic bags
• Development of website and uploading of
annual reports.
37.
38. BIO MEDICAL WASTE MANAGEMENT
( RULES )
• Display of work instruction
• Bins should be covered
• Bins should not be filled more than 2/3 of its
capacity
• PPE
• Collection at specified time
• Transport in closed containers in dedicated
trolly.
39. BIO MEDICAL WASTE MANAGEMENT
( RULES )
• Dedicated storage facility with biohazard
emblem
• Away from patient care areas
• Secured against pilfirage and reach of animals
with lock and key
• Disposal within 48 hours
• Hand washing facility
