HAI and Infection Control_041049. .pptx

HOSPITAL ACQUIRED INFECTIONS
& INFECTION CONTROL
Dr. Lata Chandel
MD Microbiology

First principle of any
HEALTH CARE FACILITY
IS
“TO DO NO HARM”
TO BOTH THE CLIENTS.
---Florence Nightingale

SHORTCUTS ARE ALWAYS DANGEROUS
REMEMBER
THERE ARE NO
SHORTCUTS IN
INFECTION
CONTROL

HAI: definition
 Infections acquired by a patient in the hospital.
These were neither present nor incubating at the
time of the admission;
 Such infections occur within 48 hrs after
admission, 3 days after discharge or 30 days after
surgery or 1 year after implant.

Extent of Problem
6
 In developed countries: 5-10%
 In India…………………….? But the cost
exceeds the total Govt. spending on
healthcare.
 10 - 30 % of patients admitted to hospitals
& nursing homes in India acquire
nosocomial infection
A comprehensive study done in USA
showed a median infection rate of 3 per
hundred discharged.

 3.5 million healthcare workers in India
constantly at risk to occupational health
hazards.
 25-36% of these infections are preventable
through the adherence to strict guidelines by
health care workers when caring for patients.

Types of infections
 Endogenous: When the infection is derived from
the patient’s own body. It is also termed as
opportunistic infection. (50%)
 Exogenous: When the source of infection is
external.
 Cross infection from other patients or staff.
(35%)
 Infections due to environmental conditions.
(15%). Air 5%, Instruments 10%.

CAUSES
 Improper asepsis of environment, due to poor
BMWM.
 Poor sterilization and disinfection techniques.
 Improper sterilization of equipments/
instruments.
 Crowded conditions in the wards.
 Transmission by staff carriers.
 Consumption of infected food, milk and water.
 Any epidemic arising in the community and
spreading to the hospital.

PREDISPOSING FACTORS
 Extreme ages
 Immuno-compromised patients/patients of chronic
 Diagnostic and therapeutic interventions
 Underweight/overweight
 Anemia or multiple blood transfusions.
 Long duration of surgery.
 Poor OT conditions.
 Poor preoperative preparation and post operative care.
 Inadequate sterilization of surgical items and
instruments.

OUTCOMES of HAI:
 Increased Mortality, Morbidity and Disability
rate.
 Increased Financial implications.
 Increased Emotional stress.
 Increased in hospital stay and thus increase in
bed occupancy leading to increase in the hospital
expenditure.
 Affects nation’s GDP.

PROCEDURES WITH RISK
 Surgery.
 Diagnostic or therapeutic invasive
procedures.
 Collection of samples.
 Examination of patients.
 Cleaning and maintenance.
 Waste disposal.
 Handling of “at risk” samples.

Spread - entry and exit routes
. 13
 Natural orifices - mouth, nose, ear, eye,
urethra, vagina, rectum
 Artificial orifices - such as tracheostomy,
ileostomy, colostomy
 Mucous membranes - which line most
natural and artificial orifices
 Skin breaks - either as a result of
accidental damage or deliberate
inoculation/incision.

. 14
Chain of infection
Source/reservoir of micro-organisms
 infected person [host] or other source
Method of transmission
 hands, instruments, clothing, coughing, sneezing, dust etc.
Point of entry
 orifices, mucous membranes, skin
Susceptible host
 low resistance to infection.

HOSPITAL ACQUIRED INFECTIONS
 URINARY TRACT INFECTIONS (40%)
 WOUND INFECTIONS-SURGICAL, TRAUMATIC & BURNS (20%)
 LOWER RESPIRATORY TRACT INFECTIONS (15%)
 VASCULAR CATHETER ASSOCIATED INFECTIONS (15%)
 CNS INFECTIONS
 GIT INFECTIONS

SELECT THE Persons WITH COMMITMENT
ALWAYS
REMEMBER:
TOO MANY
COOKS SPOIL
THE BROTH

HIFCOM
 The hospital should have an hospital infection
control committee (HIFCOM) under the
chairmanship of in-charge of the hospital.
 The pathologist /microbiologist: infection
control officer.
 Other members: physician, surgeon, anesthetist,
matron, ward sister/ senior nurse (Infection
control nurse) dietician, personnel from
engineering and house keeping services & all
categories.

FUNCTIONS of HIFCOM
 Ensure facilities to maintain good infection control
practices.
 Establish standards for identifying the infectious
organisms.
 Assess the training needs of the staff and maintain an
ongoing educational program for staff,
 Establish objectives for the hospital in infection
control, by identifying problems and framing time
bound action plan.
 Monitor health of hospital staff to prevent spread of
infection from the staff to the patients and vice versa.

Functions of HIFCOM contd.
 Point out any area for intervention.
 Monitor the rational use of antibiotics.
 Document and monitor the use of
disinfectants, sterilization practices and
frequency of hospital cleaning.
 Monitor implementations of
recommendations made by the Quality
group.
 Monitor problems due to non-coordination
of sections/ financial constraints/otherwise.

Duties of Infection control nurse:
 Link between the HIFCOM and all sections of the
hospital.
 Identify the problems and implement their
solutions.
 Conducts round and maintain the related record.
 Take steps to educate the staff in infection
control.

COMPONENTS OF ICP
STANDARD WORK PRECAUTIONS (UNIVERSAL
PRECAUTIONS)
1.Hand washing;
2.Proper use of PPE’s;
3.Handling of patient care equipments and linen;
4.Handling of samples & body fluids.
5. Decontamination, disinfection and sterilization;
6. Proper BMWM;
7.Maintenance of sanitation and hygiene in patient’s environment;
8.Handling of accidents at the work place;
9.Immunization & examination of staff;
10.Safe injection practices
11. Antibiotic policy;
12. Adequate infrastructure & supplies;
13. Training of the staff and awareness of community;
14. Crowd Management.

1. HAND WASHING
 Greatest single most effective method in control
of HAI.
 Take all steps to develop a habit of hand
washing among the staff.
-Six steps of HW should be at hand washing
points.
-Training and observation of the staff.
-Visitors also sensitized about the importance of
hand washing.

Requirements for h/w
 Running water with large wash basin and
elbow operated tap.
 If it is not available, one bucket with tap
and one bucket to collect the waste/used
water is required.
 Soap
 Available in the form of bars. Kept in soap
rack with drain, ideally Liquid Soap.
 Soap dispensers cleaned
daily-disposable/reusable.
 Empty disposable soap container discarded.
 2-4% chlorhexidine or 7.5% PVI scrub.

Facility to dry hands:
 Disposable towels/reusable single use
towels/electrically operated driers.
 If nothing is available, it is best to “air dry” the
hands.
 Common towel must not be used.

Pre-requisites to wash hands:
 Remove jewelery (rings, bengals, bracelets etc.)
and watch before hand washing.
 Nails are clipped short.
 Roll the sleeves up to elbow.
 No focus of infection in hands.
 Any cut, apply water-proof dressing.
 24X7 water supply, adequate material.

COMMONLY MISSED AREAS IN
HAND WASHING

Reasons for non-Compliance
 Lack of appropriate facility to wash hands.
 High staff patient ratio.
 Allergy to hand washing products.
 Insufficient knowledge among staff about the
risk and procedure of hand washing.
 Time required.
 Casual attitude of staff towards hand washing.
 Supervisory audit???????????

Types Of Hand washing
 Routine Hand washing: Vigorously rub lathered hands
together for 10 - 15 seconds
 Hygienic Hand Washing: Before Aseptic procedures X 1
minute
 Surgical Hand scrub: The time required for surgical alcohol-
based handrubbing depends on the compound used. Most
commercially available products recommend a 3-minute
exposure, although the application time may be longer for some
formulations, but can be shortened to 1.5 minutes for a few of them
 Alcohol Handrub:
Use 3 - 5 ml of alcohol hand rub solution in to palm of your
hands together until they dry.

Methods of HW
1. Social hand washing:
 Before handling food, eating and feeding the
patients.
 After visiting the toilet.
 Before and after nursing the patient.
 When hands are visibly soiled.
 It should be done with soap and water for 10 to
15 seconds.

2. Clinical (Hygienic) Hand Washing:
 Before performing non-invasive procedures.
 Before caring the immuno-compromised patient.
 Before and after the use of gloves.
 After contact with the body fluids.
 Done with the antiseptic detergent or alcohol for
40 to 60 seconds, if hands are not visibly soiled.
Washed with detergent if soiled.

3. Surgical hand washing
 Before surgery/invasive procedure.
 Done with antiseptic detergent.
 Scrubbing of the hands, web spaces and
fingernails is very crucial.
 Done for 3 minutes.
 After washing, water should not drip down from
the unwashed area to the washed one.
 To ensure this, the hands should be kept in
upright position, folded at the elbows.

2.PPE’s
 Gloves.
 Gown or aprons.
 Gum boots/ shoes/ shoe covers.
 Goggles (eye protection cover).
 Caps or hair cover.
 Masks.

WHEN TO USE PPE’S
 PPE’S used by staff, while handling the
patients/body fluids/secretions/excretions/ lab
samples/ linen etc.
 Used by attendants, if they are providing care to
patient.
 The PPE’s should be of proper size.

Gloves: Clean and unsterile gloves used:
For routine care of patients.
Changed between contacts with different
patients.
For touching body fluids, blood, secretions,
excretions & other contaminated items.
Making beddings of the patients.
Lab testing of samples.
Handling of hospital furniture.

Gloves: Heavy duty gloves
 For applying plaster.
 Cleaning and rinsing of used instruments.
 Cleaning the equipments and close vicinity of the
patient.
 Cleaning patient areas etc.
These can be washed and reused again.

Gloves: sterile disposable
Invasive procedure.
Handling any immuno-compromised patient.
Changed, while performing different procedures
on the same patient.
Gloves should not be used for more than 3 hours.
 Gloves should be:
of proper size,
properly fitting,
not punctured.

3. Handling of equipments &
linen: sterilizers
 Should be placed on Workable height.
 Water changed daily or SOS.
 Thoroughly scrubbed, washed and inspected for any loose
connection, every week.
 The element and electrical connections inspected for any
leakage daily and repaired if necessary.
 The water tank filled 2/3.
 The instruments unlocked, presoaked, decontaminated,
scrubbed and dried before putting them in the sterilizer. There
should be separate wash basin to wash the instruments.
 All the instruments put in one direction only.
•c.

Handling OF STERILIZERS CONTD
 All the lockable instruments in the “locked position” before
putting into the sterilizer.
 The lid of the sterilizer tightly closed.
 The sharp instruments and disposable materials not boiled.
 Boiling X 10-15 min. kills vegetative form and X 30 minutes kills
spores also.
 The sterilizer switched off and opened after a few minutes,
after the steam gets “cooled down”. It is opened for 1"-2" at first
to release the steam, if any, and then only it is opened
completely.
 All the instruments taken out in a tray and covered with the lid.
 The sterilizer is ready for the next load.
•c.

Handling of thermometers:
 Kept in a glass bottle having cotton base or
plastic bottle to avoid breakage while putting it
inside.
 Cleaned with soap and warm water, if to be
reused.
 If common: wipe with 70% Isopropyl alcohol.

Decontamination of silicon masks/ambu
bags
SN Method Process
1
Sterilization by
steam autoclaving.
132-137°C X 15 minutes. Allow parts to cool and
dry.
2
HL Disinfection with
Gluteraldehyde 2%
60 minutes Remove traces of
disinfectant by rinsing
in warm water (30-
40°C) X 2 minutes. Dry
the components
thoroughly.
3
Disinfection with
Sodium hypochlorite
1% X 30 minutes
----do--------

HANDLING OF CHITTLE’S
FORCEPS:
 Major source of infection in any hospital.
 Kept in a container having wide base and wide
open mouth with adequate depth for the forceps
to dip up to fulcrum level or more.
 “Only” one “Chittle” in one container.
 Savlon (1:100) with Silver Nitrate 4 gms/liter.
Changed on daily/SOS./2% Glutaraldehyde
 Washed with water before use.
 Do not handle anything else with the hand,
which holds the Chittle’s forceps.

Handling of suction apparatuses
 Sodium hypochlorite (1%) solution should be put
in the bottles to decontaminate the contents.

Handling of linen:
 Used linen put into appropriate bags.
 Soiled linen put into impermeable bags, transported
separately, sluiced, decontaminated & washed
separately.
 Do not sort linen in patient areas.
 Do not shake linen, while changing, in the patient
areas.
 Used linen washed in hot water (70-80°C) and
detergent, rinsed & then dried in sun.
 Theatre and procedure room linen autoclaved before
use.

Decontamination and washing of
mattresses
 Cover all the mattresses with water proof rexin or
plastic. Washing of covers can be done manually.
 Cracked covers replaced.
 Mattresses and pillows with plastic covers wiped with
disinfectant solution. The mattresses exposed to direct
sun light periodically.
 Mattresses and pillows without plastic covers:
steam cleaned or cleaned manually ensuring
adequate personal and environmental protection.
 Blankets are Exposed to formaldehyde vapors or
autoclaving.

4.Handling of samples & Body FLUIDS:
 Consider every patient/samples of patient/
unsterile sharp/soiled linen as potentially
infected.
 Five moments of Hand washing should be
adopted.
 The staff should take extra precaution to prevent
injury to themselves and patients, while doing
some procedure.
 PPE’s should be used as per the requirement.

CONTD.
 Only disposable syringes should be used. The
syringes/needles should not be recapped, bent or
broken by hand or against any hard surface.
 The syringes should be kept in one direction
only.
 The sharps and instruments should not be
handed over directly to other person. Use Kidney
tray for the purpose.

.
5. Decontamination, disinfection and sterilization
 High level disinfection: kills all vegetative
forms and some of spores. Used for heat sensitive
instruments like endoscopes by treating these
equipments with 2% gluteraldehyde X 1 hours.

PREPARATION & Disposal of Gluteraldehyde
 Used as a disinfectant in hospitals, as 1% or 2%
aqueous solution, to disinfect endoscopes,
bronchoscopes, dental and other instruments by
immersing them in closed containers.
 Used as 1 or 2% aqueous solution after activating it
with an activator (sodium bicarbonate). Solution
once activated can be used up to two weeks (14 days).
 Available as 2.45% solution and 5 liter packing for
use in hospitals.110 ml of activator is added to 5 liters
of gluteraldehyde (11ml in 500 ml).
 Solution turns green & ready to use.

DISPOSAL: CHEMICAL DEACTIVATION
Sodium bisulfate/ sodium hydroxide (caustic
soda) are used as deactivating/reducing agents.
 ½ oz or 15 gms. of “Glute out” (sodium
bisulfate/sodium hydroxide) is added to 4 liters
of gluteraldehyde.
 Wait for 5 minutes, when the solution turns into
red orange.
 Discard into the drains and run cold water
freely after disposal.

Sodium hypochlorite solution
 It is presently available in 5% & 10%
concentration.
 Concentration used for infected material = 1%
( 200 ml in 800 ml water) from 5%
 Concentration used for disinfection 0.5%
( 100ml in 900ml of water) from 5%
 The contact time of these chlorine salt solutions
is minimum ½ hour for any infected material.
 The stability: 3 hours, so prepared after 3 hrs.

Segregation of contaminated instruments
 Contaminated instruments should be unlocked,
presoaked, decontaminated in 1% chlorine
solution for ½ hour, followed by washing with a
scrubber to remove any organic material.
 Then dried and stored in “separate identified”
area.
 Autoclave before use.
 In “boiling method”: disinfection only. All the
lockable instruments locked and then put into
the sterilizer in one direction only.

Sterilization by
 Autoclaving (moist heat at more than
atmospheric pressure).
 Moist heat at atmospheric
pressure(pasteurization, inspissator, HTST, water
bath, simple boiling).
 Using dry heat (hot air oven)
 Chemical sterilization.
 Exposure to UV rays.

Fumigation
 Done once a month/ newly constructed or
repaired OT/after major spill e.g. fecal matter.
 Formaldehyde is the gaseous form of formalin
 Calculate the volume of the room. If figure comes
to be in between, it should be rounded off to the
next 1000.
 Wash all the walls/floor/windows/doors with
detergent and water and then seal all these
outlets. Detergent is concentrated form of soap
plus some more chemicals.

Fumigation
 Carbolize all equipment/furniture surfaces.
 Switch off all electric points.
 Use PPE’s including goggles BE QUICK and
then…………….
 Quantity: 500 ml 40% formalin per 1000 ft‴.
 Optimum humidity 70%, temperature 20⁰C.

Fumigation contd.
 Three methods:
 1.Use one 15 liters SS buckets for every 500 ml of
formalin and 250 ml KMnO4. It produces lot of
heat so put it in heat resistant vessel. OR
 2.Formalin in a container and put it on the
heating source till the whole of it gets
evaporated. OR
 3.Put it in the fumigator by adding 1 liter of
tap/distilled water to every 500 ml of formalin X
45 minutes.

Fumigation contd.
 Put a notice “fumigation in progress”.
 Close x 12-24 hours.
 No chlorinating agent (Bleaching Powder, Sodium
hypochlorite, chlorinated water) should be left inside as
it reacts with chlorine to produce carcinogenic gas.
 Neutralize with liquid ammonia. For 500 ml
formalin=250 ml 10% Liquid ammonia. Soak a absorbent
towel with the calculated amount of ammonia and throw
it inside X 2 Hour. Produces Hexamine a nontoxic.
 Non absorbent cotton can be converted into absorbent
by treating it with acetone.

Disinfection of the sputum cups
 The sputum cup is filled with 5 % phenol for 18
hours. Its cover is tightly closed and then it is put
in the container having 1% sodium hypochlorite
solution. Cups are then shredded.
 Decontamination of O.T./ Labour table:
Carbolize (phenol/carbolic acid) or use 1%
chlorine solution) these tables after use, every
time.

High risk Moderate risk Low risk
Areas OT/ICU/HDU/
CSSD/SNCU/Em/
Iso/Sur
W/LR/Brns/ Imm
Cmpmsd
MedW/Lab/BB/
Phrmcy/DutyR/
Landry/mrtry
Adm
areas,store/semin
arR, Non sterile
supply area,MR
Addit areas Staff areas of
these areas
Staff area of
these Areas
---------
Level of disinf. Cleaning&interme
diate disin
Cleaning &low
level
Only cleaning
Frequency of
cleaning
1 p 2hrs/SOS
SW,detrgnt,alc,ald
hy,H2O2,Phenol
(n-nur)
1 p 4hrs/SOS
SW,Ald/
h2o2,phnl (n-
nur)
1 p shift/SOS.
Dusting then with
SW
Evaluation Wkly FB--mnthly Wkly-FB 1 in1-2 1 in 3mnths

Cleaning schedule in operating rooms
also SOS if visibly soiled
SN Item to be cleaned Frequency
1 Ceiling including AC/ventilation grills/vents and light
fixtures
Twice yearly/monthly
2 Walls including doors and windows. Monthly /weekly
3 Floors including skirting, edges and corners. Monthly /daily
4 Store rooms and storage areas Monthly
5 Exterior surfaces of machines and equipments Monthly /weekly
6 Refrigerator Monthly
7 Furniture including wheels and castors Weekly
8 Sterilizers, cabinets and doors. Weekly
9 All horizontal surfaces (shelves, computer keyboards etc) Weekly
10 Offices, lounge and locker rooms. Daily

1.High touch surfaces
Have frequent contact with hands e.g. door
knobs, elevator buttons, telephone, call bell, light
switches, bed rails, computer key boards,
monitoring equipments, haemo-dialysis
machines, wall area around the toilets, edges of
curtains.
 Cleaned with detergent/ soap
water/disinfectant at least once a day/after
the discharge of the patient (more frequently
in case if ICU).

2.Low touch surfaces
 Have minimal contact with the hands e.g.
walls, ceiling, mirrors, window sills.
 Cleaned not on daily basis/ when not visibly
soiled with body fluids and splashes.

6. PROPER BMWM
 Universal precautions for handling the BMW:
 All the BMW treated as potentially infectious and
hazardous.
 Mercury not to be touched even with gloves & stored
under water.
 Early &proper segregation of the BMW: reduces its
quantity. Done at the point of generation.
 Proper color coded bins.
 Proper training of the staff.
 Proper use of “Personal Protective Equipments” (P.P.E.’s).
 Proper handling of the BMW.

CONTD
 Proper transportation of the BMW. The bins/bags
filled up to2/3 of its capacity to avoid accidents
during handling/transportation.
 Immediate response to the exposure/accident.
 Immunization of the staff against Hepatitis,
Tetanus and Swine flue.
 Do not put bleaching powder put in the pits.
 Sharps handled with utmost care to avoid any
injury.
 Sharps stored in puncture proof containers.

contd.
 Reusable items disinfected properly before it is put to reuse.
 Do not touch BMW directly.
 Never drag Bins/bags during transportation.
 Carry one bag at one time.
 Habit of proper hand washing.
 Never correct errors.
 Small amounts of chemical and pharmaceutical waste : put with
the infectious waste.
 Large quantities of obsolete and expired drugs returned to the
pharmacy for disposal.
 Large quantities of chemical waste packed in the chemical
resistant containers and sent to the specialized treatment facility.
 Spill management as per Guidelines.

7. Maintenance of sanitation and hygiene
 Adequate sanitation and disinfection of
environment: important in preventing
nosocomial infections.
 MOT/OT cleaned at the end of the day with
detergent and running water.
 The separate cloth used for shelves and table
tops.
 The walls cleaned with disinfectant at least once
a week & immediately, if soiled by any spill.
 All table tops wiped with disinfectant after each
patient.
 The disinfectant used in proper concentration.

contd.
 Separate mops for general and patient care areas.
 Do not use brooms???????? in critical areas.
 Mopping: unidirectional from inner area to the
outer area of the room.
 Three buckets used for mopping of the floor; one
for the disinfectant solution, other for plain
water and third for wringing of the mop.
 The floors washed with soap & running water
once a week.
 Leaking pipes repaired immediately.

contd.
 No water stagnation in the campus.
 All the drains kept covered & have a proper
slope.
 Stray animals not allowed to enter into the
complex. Animal traps.
 Insectocutors installed at strategic points.
 All waiting areas and dinning areas of the
visitors provided with dust bins.
 The drinking water facility area kept dry and
free from water spillage.

8. Handling of accidents at work place.
Exposure to infections:
 Needle-stick injury.
 Splashes in eyes.
 Exposure of open skin & mucus membrane to
blood, body fluids, secretions & excretions due to
any cause.

First aid in NSI
 N.S. Injury: clean the wound with soap and
running water. Let it bleed. Do not suck/rub/
squeeze. Do not apply detergent/antiseptics.
 Eyes: splash the eyes with water/saline several
times.
 Open wounds: clean with soap and running
water. Do not rub.
 Oral cavity: rinse with water several times, spit it
out.

Report THE incident
 Report the incidence & document it. The patient
identified with complete address and phone no.
Follow up of the patient is very essential.
 Counsel the patient for blood examination for
HIV.
 Repeat after 3 months, if found –tive.

PEp-for NSI
 If exposure code is 1(intact skin, few drops, short duration) and source code
is 1 (source is HIV-tive) then no need of PEPT.
 Take consent of the staff on the format.
 Start treatment with in 2-72 hours.
 Adults: TLE: Tenofovir 300, Lamivudine 300, Efavirenz 600 OD X 28 days;2-3
hours after dinner. Avoid fatty food.
 (New Born :NVP 10mg/ml).
 Children:
 <2000g - 0.2ml/Kg
 2000-2500g - 1 ml OD
 >2500g -1.5 ml OD x 6 weeks
 GI side effects.
 In case of sexual assault: PEP should be started to the exposed person as
early as possible.

PEPT CONTD: HEPATITIS
 If staff has been immunized for hepatitis, then
booster.
 If not immunized: three doses of hepatitis (0,1,6
months; 1 ml I/M in deltoid muscle).
 If Anti HBs Ag < 10 IU.
 HB Ig – 0.05 – 0.07 ml/kg within 6 hrs & before 48 hrs.
 Followed by vaccination within 7 days.
 Antibiotics if signs of secondary infection.
 If doctor recommends: special medical leave up to 6
weeks.

9. Immunization and medical examination
of the staff.
 Immunized against Hepatitis and Tetanus.
 Documented by a designated person.
 Medical examination for any
communicable disease at least twice a
year.
 Any staff suffering from such disease not
be allowed to work in patient’s care areas.
 Kitchen staff monitored for personal
hygiene.

Medical examination of kitchen staff
 At the time of entry to job.
 Yearly: GPE, CBC, Stool R/E, Chest X-ray, Widal
test.
 Monthly: GPE, Stool R/E.

10. Safe injection PRACTICES
 Definition of Safe injection (WHO)
 Harmless to patients/provider. (immunization of
staff, constant supply of sterile injection related
material, trainings).
 Doesn’t produce BMW, which is unsafe to
community i.e. proper handling of BMW.

Components of SI
 Correct technique.
 Proper BMWM.
 Immunization of staff.
 Injections are given only when required.

Indications of injections
nil orally,
unable to retain orally,
unable to take orally,
unable to absorb, in case of drugs of systemic use,
no oral preparation,
doubt about compliance,
semi/unconscious patients-oral feeding not
possible-child/psychic.
Acute severe pain, needs immediate relief/high
concentration of drug.

11. Antibiotic policy.
 Indiscriminate and inappropriate use of
antibiotics: leads to spread of drug resistant
strains of bacteria. Discourage it.
 Use of antibiotics only, when clearly indicated.
 Use of antibiotics in adequate dosage, for
sufficient period of time.

Antimicrobial committee
Recommends antibiotics formulary.
Establish prescribing policies.
Review and approves practice guidelines.
Audits antibiotics use.
Interacts with pharmaceutical representatives.

12.Proper storage and disposal of hospital
waste:
 Properly segregated & storage in a safe place,
away from the public area.
 A store for the BMW .

13.Training of staff & community
awareness
 Induction training in HAI and BMWM.
 Knowledge, skill and attitude to practice good infection control
practices.
 Assess training needs and arrange awareness & in-services workshops.
 Regular “in house” educational program/re-sensitization workshops
for hospital staff regarding HAI, BMWM, sterilization and safe injection
practices.
 The impact of the trainings monitored on regular basis.
 Monitoring of the health and immunization of the hospital staff.
 Measures to create awareness among the patients, visitors and other
members of the staff.
 Dangers of spitting, direct sneezing, coughing and importance of hand
washing, rectal hygiene and use of dust bins and so on, can be easily
propagated to them.

STAFF TRAININGS
Staff
education is
a never
ending
process.
It is a
continuous
education.

14. crowd management
 Visitors policy displayed.
 Timings of visitors displayed.
 Proper sitting arrangement.
 Waste disposal.
 Ventilation & illumination.
 Provision of TV.
 Clean toilets in waiting areas.
 Canteen facility.
 Eating/dinning facility.

14. Crowd management contd.
 Audio system.
 Reception counter.
 Relevant information:
working hours, Drs not
available & when available,
OT days, OPD days etc.
 Appointment system.
 Timings of diagnostic
services.
 Numbering of the rooms.

REPLACEMENT
 Intracath - 72-96 hours ( in children only
when indicated)
 Administration sets / drip set – 96 hrs
 Tubing used for blood/ products/ fat
emulsions – 24 hours
 Replace catheters inserted in emergencies
within 48 hrs

Illumination levels:
 Nursing station & reception-300 lux.(150-300-K)
 Corridors: 150-200 lux.
 Wards: 300 -500 lux (during rounds).(100 lux-K)
 Office: 300-500 lux.
 Examination area: 300-500 lux.(300 lux-K).
 OT: 40,000-1,60,000 lux.
 Toilets: 100 lux(K)
 Stores:400 lux

Appx. Quantity(gms)
Item Weight Item Weight
Catheter 15 POP AE 1000
Placenta 500 Gloves 20
Sputum 10 Tubings 25
Needle 5 Urosac 65
Syringe BCG, 2, 5 CC-5;
10 CC-15
Drip set 20
Blade 5 Bottles L-25;S-10
Slide 10 Vial 30
POP BK 1000 Ped micro set 60
POP AK 2000 Tooth 15
POP BE 500 EDTA vials 5

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