health

1. HOSPITAL INFECTION
CONTROL
PROCEDURES AND PRACTICES
DR ASHISH MANOCHA
BDS, MBA-HM, PGDPHM, PGDML

2. INTRODUCTION
 Infection Control—
 The process in which health care facilities
develop and implement specific policies and
procedures to prevent the spread of
infections among patients and health care
staff
 Hospital Acquired/ Health Care Associated
Infection—
 An infection contracted by a patient or staff
member while in a hospital or health care
facility (and not present or incubating on
admission)

3. Florence Nightingale
Ignaz Philipp Semmelweis
INFECTION CONTROL AND QUALITY HEALTHCARE IN THE NEW
MILLENIUM
ARE THERE LESSONS TO BE LEARNED ?
The very first requirement
in a hospital is that it
should do the sick no
harm
Pittet D, Am J Infect Control 2005, 33:258
Advocated Hand
washing to
prevent infections

4. Impact of Health Care Associated
Infections
Break the Chain of Infection…
PATIENT
Increased
Morbidity
Increased
Hospital Stay
Increased Cost
Hospital a Reservoir
Mode of Transmission
PATIENT

5. IMPACT OF HAI…..
 In addition to the patient morbidity and
financial implications of infections, they can also
contribute to
 Potential legal exposure
 Negative impact on organizational reputation
 Compromise the overall safety of patients and
staff.

6. INFECTION CONTROL
PROGRAMME
 Prevention and management of infections
within the health care facility through the
application of research based knowledge to
practices that include:
 Standard precautions
 Decontamination and Disinfection
 Waste management
 Surveillance
 Audit
Recommendations of WHO/CDC

7. INFECTION CONTROL
PROGRAMME…..
 Requires cooperation, understanding and
support of hospital administration and
medical/surgical/nursing leadership
 There is no simple formula:
• Every hospital is different
• Every hospital’s problems are different
• Every hospital’s personnel are different
 The hospital must develop its own unique
program

8. ORGANIZATION
Hospital Infection Control Committee
Members
 Doctors
 General physician
 Infectious disease specialist
 Surgeon
 Clinical microbiologist
 Infection control nurse
 Representatives from other relevant departments
 Central Sterile Supply Depot
 Housekeeping
 Pharmacy
 Administration
 Quality manager
Hospital Infection control team (ICT)
Microbiologist (Infection control officer)
Senior Resident (Infection Control)
Infection Control Nurses

9. LOGISTICS
The committee should meet at a set time and
place monthly or quarterly
The committee members should receive the
agenda in advance to allow them to prepare

10. MINUTES
The minutes of the infection control committee are a
legal document
They record the topics that the committee discussed and
the policies or procedures that the committee approved
Copies should be sent to committee members for review
The committee should approve the minutes at the next
scheduled meeting

11. HIC 1 –
 The organisation has a well-designed, comprehensive and coordinated
Hospital Infection Prevention and Control (HIC) programme aimed at
reducing/ eliminating risks to patients, visitors and providers of care
HIC 2 –
 The organisation implements the policies and procedures laid down in the
Infection Control Manual.
HIC 3 –
 The organisation performs surveillance activities to capture and monitor
infection prevention and control data.
HIC 4 –
 The organisation takes actions to prevent and control Healthcare
Associated Infections (HAI) in patients.
HIC 5 –
 The organisation provides adequate and appropriate resources for
prevention and control of Healthcare Associated Infections (HAI).
NABH Accreditation Standards - HIC

12. NABH STANDARDS…..
HIC 6 –
 The organisation identifies and takes appropriate actions to
control outbreaks of infections.
HIC 7 –
 There are documented policies and procedures for
sterilisation activities in the organisation.
HIC 8 –
 Bio-medical waste (BMW) is handled in an appropriate and
safe manner.
HIC 9 –
 The infection control programme is supported by the
management and includes training of staff and employee
health.

13. COMPONENTS OF INFECTION CONTROL PROGRAMME
PREVENTION
 1/3rd
of all HAI can be prevented by effective HIC
programme (CDC)
SURVEILLANCE

14. HOT SPOTS FOR INFECTION
 High risk Areas
 OT
 Post op step down
 ICU
 CSSD
 Transplant units
High risk procedures
 Biopsy
 Lumbar puncture
 Central line dressing

15. CORE STRATEGIES TO PREVENT HAI
 STANDARD PRECAUTIONS
 CLEANING & STERILIZATION PRACTICES
 ENVIRONMENTAL SURVEILLANCE
 BIO MEDICAL WASTE MANAGEMENT
 ANTIBIOTIC POLICY
 ISOLATION POLICIES
 LAUNDRY & LINEN
 KITCHEN SANITATION & FOOD HANDLING
 EMPLOYEE HEALTH
 ENGINEERING CONTROLS

16. STANDARD PRECAUTIONS
• The measures designed to reduce the risk of
transmission of blood borne pathogens and other
micro-organisms from both recognized and
unrecognized sources of infection.
 Procedures
 Hand washing
 Use of PPE
 Mask
 Protective Eye wear and /or Face shields
 Gloves
 Plastic Aprons /Gown,
 Caps
 shoe covers

17. HAND HYGIENE
Single most important measure in infection
control

18. Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. J Hosp Infect
2007;67:9-21

20. Alcohol-based
handrub at point of
care
Access to safe,
continuous water
supply, soap and
towels
2. Training and Education
3. Observation and feedback
4. Reminders in the hospital
5. Hospital safety climate
+
+
+
+

The 5 core
components of the
WHO Multimodal
Hand Hygiene
Improvement
Strategy
1. System change
Monitor compliance

21. REMINDERS- « TALKING WALLS »

22. PERSONAL PROTECTIVE EQUIPMENT
DEFINITION
“specialized clothing or equipment worn by an
employee for protection against infectious
materials” (OSHA)

23. FACTORS INFLUENCING PPE
SELECTION
• Type of exposure anticipated
– Splash/spray versus touch
– Category of isolation precautions
OSHA specifies circumstances for which PPE
is indicated
CDC recommends when, what and how to use
PPE

24. VISITOR POLICY
 The patients relatives are informed of the measures to
be taken and the importance of restriction of visitors.
 Education is given about the cause, spread and
prevention of infection.
 Hand washing is done after all contact with the patients
 No more than two adult visitors are allowed ‘at a time’
during the hospital visiting hours and the length of stay
is governed by the needs of the patient.
 Children below 12 years are not allowed in the isolation
areas.

25. CLEANING & STERILIZATION PRACTICES
 Establish a regular schedule of hospital
cleaning with appropriate disinfectants in,
wards, and high risk areas like operating
theaters and ICU’S
 Cleaning strategies for spills of blood and
body substances
 Cleaning practices for non-critical
equipment and furnishings

26. STERILIZATION OF INSTRUMENTS
AND SUPPLIES
 Written policies and procedures are needed
 All objects to be disinfected or sterilized should first be thoroughly
cleaned
 Use steam sterilization / ETO
 Quality control in reprocessing is essential
 Monitor and record sterilization parameters (i.e., time,
temperature, pressure)
 Biological indicators should be used to ensure sterilization
 Chemical indicators are necessary to ensure proper sterilization
 Establish a recall procedure in case of sterilisation failure
 Sterilized items must be stored in enclosed clean areas
 Items or devices that are manufactured for single use should not be
reprocessed
 Label all items with machine no, batch no, shelf life

27. ENVIRONMENTAL
SURVEILLANCE
 Environmental Surveillance calander
 Air Surveillance
 Settle plate method
 Slit sampler method
 Effectiveness of fumigation
 Swabbing and culture for bacteria
 Effectiveness of sterilization processes
 Microbiological culture

29. BMW MANAGEMENT
BIO-MEDICAL WASTE MANAGEMENT RULES, 2016
 No untreated bio medical waste is stored beyond a period of 48 hours
 BMW is not mixed with other wastes
 Waste is collected in two shifts or when waste bin or sharps bin is 2/3 rd full.
 Before plastic bags are collected, they are labeled & properly tied in a manner
that does not allow for any leaks or spillage.
 Transportation route is unidirectional & areas like kitchen & laundry are
avoided
 Transportation timing is when the patient traffic is minimum
 The wheel-able bin is cleaned and disinfected with Sodium hypochlorite
solution once in 24 hrs.
 While transferring waste to storage bins , housekeeping staff wears protective
mask, heavy duty gloves, and rubber boots.

30. COLOUR CODING FOR BMW

31. World Health Day – 7 April 2011
“ Antimicrobial resistance:
no action today, no cure tomorrow”
ANTIBIOTIC RESISTANCE

32. ANTIBIOTIC POLICY
 To ensure that antibiotics are used prudently
 Develop Hospital antibiotic policy based on National
recommendations and local prescribing practices
 Measure antimicrobial use to identify misuse
 Antibiotic audit
 Implement interventions to improve antimicrobials
use
 Receive updates from laboratory on
 Antibiotic susceptibility patterns
 Alerts on emergence of wide spread resistance

33. HOSPITAL ANTIBIOTIC
COMMITTEE
Key
persons
…
…
…
 …
 …
 …
Physicians
Nurses
Pharmacist
Microbiologist
Hospital
administrators
Infection control
committee Members

34. ISOLATION POLICY
 To prevent the transmission of pathogenic microorganisms
within the healthcare setting
 Infections with epidemiologically important
microorganisms such as MRSA, VRE, MDR strains,
Varicella, TB, SARS, Swine flu
 Private rooms and wards for patients with specific diseases
 Cohort placement – Avoid over crowding
 Unauthorised visitor's entry - prohibited
 Donning of adequate PPE - mandatory
 Only dedicated HCWs to be posted

35. Unit
6
-
Infection
Control
Measures
35
Isolation
Precautions
Patient
Transport
Linen & laundry
Patient care equipment
And articles
Routine and
Terminal
Cleaning
PPE
Hand hygiene
Patient
placement
Isolation
Precautions

36. TRANSMISSION BASED
PRECAUTIONS
 Contact precautions
 Infections spread by direct or indirect contact with patients
or patient-care environment .
Eg: Shigellosis, C. difficle, MRSA, VRE, MDR strains
 Airborne precautions
 Used for diseases transmitted by infectious agents
that remain infectious over long distances when suspended
in air.
Eg: Tuberculosis,Varicella, SARS, H1N1
 Droplet precautions
 Reduce the risk of transmission by pathogens spread
through close respiratory contact.
E.g., influenza, rubella, mumps, Measles

37. CONTACT PRECAUTIONS SIGNS
37

38. DROPLET PRECAUTIONS SIGNS
38

39. AIRBORNE PRECAUTIONS SIGNS
39

40. LAUNDRY & LINEN
Linen policy
Linen Used Linen Soiled Linen Contaminated
Linen
Contamination No contamination
with Blood/Body
fluids
Contaminated with
Blood/Body fluids
From bio hazard
patients
Transport Packed in white
sheets and sent to
laundry
Put in yellow
bag,labeled
“SOILED” and sent
to laundry
Dipped in 1% hypo for
30 min , squeezed and
put in yellow bags
labeled “BIOHAZARD”
symbol then sent to
laundry
All washed clothes are transported in clean trolleys to the wards
All washed clothes which need to be sterilized will be sent to CSSD
from the laundary

41. TRANSPORT OF LINEN ACCORDING TO NABH
 Closed bin for transportation of soiled linen

42. FOOD AND WATER PRECAUTIONS
 Contamination of food and water supply
frequently occurs in hospitals.
 Inadequate cooking may lead to
overgrowth of pathogenic bacteria.
 Food handlers may contract an infectious
disease.
 Policies and procedures to prevent food
and water contamination are necessary.

43. KITCHEN SANITATION
 Layout of kitchen ensure unidirectional flow & avoids criss crossing
 Pre – preparation and preparation of food is carried out in hygienic
conditions.
 Each meal is freshly prepared, leftover, if any, is discarded within 5
hours
 Training of food handlers on food handling techniques and personal
hygiene is done
 Food handlers wear gloves & cover their heads with a cap
 Employees with respiratory infection, intestinal disease, or
diarrhoea, jaundice boils, or any skin infection are not allowed to
work.
 Food handlers are subjected to stool examination for pathogenic
organisms and parasites once in six months

44. EMPLOYEE HEALTH AND TRAINING
PROGRAM
 Treat work-related illnesses
 Vaccination for Hepatitis B given to all health care
workers
 Typhoid vaccine to food handlers
 Annual health check up
 Staff training on safety aspects
 All needle stick injuries reported to infection control
nurse and medical officer ,post exposure prophylaxis is
provided

45. ENGINEERING CONTROLS
 Ventilation system and water system performance
 Maintainance of HEPA filters in OT
 Water Testing of drinking water: Qualitative coliform
testing, Chemical testing
 An assessment of risks to patients, healthcare workers,
and the public during Hospital construction,
renovation, and demolition
 Planning for air handling and water systems
 Education of construction workers on containment of dust
 Risk assessment work permit
 Spacing of beds

46. REQUIRED
ATTITUDES
Being an effective team player
Commitment to preventing HAIs

47. With today’s climate and emphasis on
safety, quality, and cost containment
Infection Control has come of age
It is an exciting time! !
THANK YOU