HCW training

1. HOSPITAL INFECTION CONTROL
PRACTICES
INDUCTION TRAINING – 2023 OCTOBER

2. "Prevention and Control of Healthcare associated infections – Basic Recommendations”- PAHO,
2017

5. Influenza is a virus. Thinking about
the chain of infection, influenza is
the:
1. Portal of exit
2. Mode of transmission
3. Reservoir
4. Infectious agent

6. Humans are a host for influenza. Thinking
about the chain of infection, humans could
be described as:
1. Portal of exit
2. Mode of transmission
3. Reservoir
4. Infectious agent

7. A technician autoclaves contaminated
surgical instruments. This breaks what
link of the chain of infection?
1. Portal of exit
2. Mode of transmission
3. Susceptible host
4. Infectious agent

8. Standard and transmission-
based precautions
You learned that the role of IP is to break the chain of infection. Standard
and Transmission-Based Precautions are core IPC practices that
healthcare personnel use to reduce transmission of microorganisms in
all healthcare settings.
Standard Precautions aim to protect both HCP and patients from
infectious agents—they are required in all healthcare settings. Standard
Precautions are recommended for care of all patients in any healthcare
setting, regardless of their suspected or confirmed diagnosis.
BACKGROUND STORY – 1980’s HIV, HBV, HCV…

9. Standard precautions include:
Hand hygiene
Environmental cleaning
Injection and medication safety
Risk assessment with appropriate use of personal protective
equipment (PPE)
Reprocessing of reusable medical equipment
Waste management
Respiratory hygiene/cough etiquette

10. Transmission-Based Precautions are used in addition to Standard
Precautions for patients who are suspected or confirmed to be
infected or colonized with certain pathogens for which the mode
of transmission is known.
Transmission-based Precautions include:
Contact
Droplet
Airborne
The type of precaution assigned to a patient will depend on the mode
of transmission of the suspected or confirmed pathogen. You will learn
more in the Transmission-Based Precautions module.

11. Contact
precautions
–
MRSA, MDR
GNB & VRE

13. Read the three scenarios about risk recognition and answer
the questions.
Questions to Consider
Decision 1: Do I need protection for what I
am about to do because there is a risk of
exposure to blood and body fluids,
mucous
Decision 2: Do I need protection for what I
am about to do because the patient has
undiagnosed symptoms of infection?
Decision 3: What are the facility standards
for a patient that has an identified
infection?
Action to Take
I must follow Standard Precautions because
there is a risk that I might expose myself to
an infection that is transmitted via this
route, or expose the patient to my
microorganisms.
I must alert someone about the patient
showing symptoms so that a diagnosis can
be made, and I must determine what
precautions to perform to protect others
and myself.
I must follow Transmission-based
Precautions indicated for this infection to
protect others and myself.

14. HAND HYGIENE

16. “5 Moments for Hand Hygiene”

19. Personal Protective Equipment (PPE)
“A variety of barriers to protect HCW’s
mucous membranes, airways, skin, and
clothing
(whenever blood/body fluids splashes are
expected)”

20. Personal
Protective
Equipment
(PPE)
• Gloves – Use when touching blood, body fluids,
secretions, excretions, contaminated items; fortouching
mucus membranes and nonintactskin.
• Gowns – Use during procedures and patient care
activities when contact of clothing/ exposed skinwith
blood/body fluids, secretions, or excretions is
anticipated.
• Mask, goggles or face shield – Use during patient
care activities likely to generate splashes or spraysof
blood, body fluids, secretions, or excretions

22. Respiratory Hygiene / Cough
Etiquette
• A measures to contain respiratory secretions in patients
and accompanying individuals who have signs and
symptoms of a respiratory infection.
Cover the mouths/noses when coughing or sneezing.
Use and dispose of tissues.
Perform hand hygiene if hands have been in contact
with respiratory secretions.

25. HOSPITAL INFECTION CONTROL PRACTICES
Learning objectives -
Hand hygiene (water and soap or alcohol-based solutions)
Use of personal protective equipment (PPE) according to risk
Respiratory hygiene (or cough etiquette)
Safe injection practices & needle stick injury
Blood & body fluid spill management
Vaccination for health care personnel

26. NEEDLE STICK
INJURY

27. Definition
 Needle stick injuries (NSI’s) are penetrating stab
wound from a needle (orothersharp object) that may
result in exposure to blood or other body fluids.

28. Risk of Infections
 Following a needlestick injury the healthcareworkers
areata great risk of transmissionof :
 Hepatitis Bvirus
 Hepatitis Cvirus
 HIV

29. Estimated risk of infection following
needlestick injury
30%
3%
0.30%
HBV
HCV
HIV

31. First aid management
DO’s
wash the site vigorously
with soap and water for
atleast 5mins.
Report to ICN
/Casualty
 DON’T’s
Do notpanic
Do not place the pricked
finger into mouth
Do not squeeze blood
from wound
Do not useantiseptics
and detergents

32. PREVENT
NEEDLE
STICK INJURY
NEVER RECAP NEEDLES
DISPOSE IN WHITE
PUNCTURE-PROOF
CONTAINER
AVOID OVERFILLING
DISPOSAL
CONTAINERS
HEPATITIS B VACCINATION

33. Safe Injection Practices
Do not
RE-CAP
the
needle!

34. ABG ??

35. Blood/Body fluids spill
management
Common health hazard in working environment.
Never wipe spillage with wet mop.
Wipe spill with absorbent material soaked in 1 % Sodium
hypochlorite.
Place it in Yellow bag
Mop area with cloth soaked in 1% Sodium hypochlorite
Allow to dry
Perform hand hygiene.
35

37. HEALTH CARE ASSOCIATED INFECTIONS

38. Major HAIs:
1. Cathether-associated urinary tract infection
(CAUTI)
2. Catheter-related blood stream infection
(CRBSI)
3. Ventilator-associated pneumonia (VAP)
4. Surgical site infection (SSI)

39. Prevention of HAIs: Bundle Care:
1. CAUTI: Bundle Care:
• Insert catheter only when indication is present
• Follow strict aseptic precautions
• Secure the catheter after placement
• Drainage bag below the bladder level
• Assess readiness of removal of catheter.
2. CRBSI: Bundle Care:
• Follow strict aseptic precautions while placement.
• Skin preperation: Chlorhexidine/Povidone iodine
• Document date and time of insertion
• Document local signs of infection
• Assess readiness of removal of catheter.

40. Prevention of HAIs: Bundle Care:
3. VAP: Bundle Care:
• Hand hygiene
• Head end elevation to 30-45ºC
• Oral care with Chlorhexidine mouth wash
• Need for Peptic ulcer disease prophylaxis assessed.
• DVT prophylaxis
• Assess readiness of removal of Ventilator
4. Surgical site infection: Bundle Care:
• Preoperative bathing
• Antimicrobial prophylaxis
• Proper skin preparation
• Proper scrubbing
• Normothermia & Normovolemia
• Surgical dressing

41. MICROBIOLOGY LABORATORY SAMPLE
COLLECTION

42. Sample collection:
• Label the samples properly
• Fill TRFs properly
• Refer lab Quality manual, Sample collection manual,
Safety manual, DOS
• Sputum: Instruct patient to give sputum sample &
avoid salivary samples
• Urine: Mid stream urine
• Blood sample: Skin disinfection with iodine/
Chlorhexidine/Ethyl alcohol
• Wound swab: Disinfect surrounding skin, irrigate wound
with sterile saline & collect swab from base of the wound

43. Recognizing risk - MUST KNOW SKILL
Risk recognition - every clinician and individual working in healthcare
identifying sources of infection, or
actions that can lead to infection.
Risk recognition is a broad approach to IPC that includes both direct
patient care and consideration of the surrounding environment.
“Real-time awareness” -- LOGIC
-- enables immediate action to reduce or eliminate risk.
-- assess and reduce risk related to environmental surfaces, new devices, or
procedures, or factors related to physical layout and furnishings in the
patient care area.

44. Whenriskhas been
recognized -
best control -
elimination or
substitution of a
hazard.
Wheneliminationor
substitution arenot
possible, engineering
controls can reduce
potential exposure to
hazards.
Administrative controls
and use of PPE at the
bottomof the
hierarchyrequireHCP
to take specificactions
to reducethe risk—
they do not control the
hazarditself.
The hierarchy of controls

45. Elimination and substitution
Remove the hazard or substitute it with something with less risk. These methods
are the most effective at reducing hazards; however, this tends to be the most
difficult to implement. This is especially true if the risk is associated with an
existing process.
Examples: Elimination: Using a suitable alternative instead of an injection
Substitution: Using blunt-tip suture needles instead of sharp-tip needles
Engineering controls
This control method is designed to isolate healthcare personnel from hazards.
Examples: Prevent sharps injury by using safety-engineered syringes, needle
shields, and sharps containers that prevent emptying.
Use ventilation systems (e.g., negative-pressure room: pulling air from the hallway
to the patient room and venting directly outside) that prevent airborne pathogens
from leaving isolation room and exposing others in the hallway.

46. Administrative controls
These controls reduce risk by providing protocols and procedures for tasks.
This type of control relies on people adhering to administrative rules.
Examples: Implementing contact precautions—for example, use of a single
room, and of gloves and gowns—stops the spread of potential pathogens.
A facility’s written IPC plans inform HCP of protocols.
Education and training requirements for HCP enforce protocols.
Screening assessment rapidly identifies infectious disease risk.
Personal protective equipment
PPE—gloves, gowns, surgical masks, respirators, eye protection, and other
specialized clothing—plays an important role in IPC but requires consistent
and correct use. It’s the least reliable control method because it does not
control the hazard itself but relies on human decision-making and
performance—meaning there is potential for human error. You can learn
more in the Standard Precautions PPE module.

47. RISK MGT - 1
Phlebotomy is performed at a patient’s bedside. Yuri is an experienced
phlebotomist. She spends much of her time performing repetitive tasks with her
hands and bending to adjust her position to make the patient comfortable while
she draws blood.
She knows that sharps injuries can cause transmission of bloodborne pathogens,
such as human immunodeficiency virus, hepatitis B, and hepatitis C. She attends
workshops annually to ensure that she is up to date on injection safety practices.
Think of other risks that could occur in Yuri’s day-to-day tasks that could cause
the spread of potentially harmful microorganisms. Select 3 risks that Yuri must
consider.
1. Preparing patient skin properly
2. Failure to perform hand hygiene
3. Not wearing appropriate PPE when coming into contact with blood or body
fluids
4. Sharps container within arm's reach for safe and immediate disposal

48. Based on the picture, can you list environmental risks in this exam room? Select
the best answer.
1. The sharps container is too small.
2. There are no risks in this exam room.
3. The supplies are near the sink, which could lead to contamination of the
preparation area from splashing or spraying. Also, there is no sharps
container within arm’s reach for after the biopsy.
RISK MGT -2

49. Isaac cleans the operating room in the mornings. While
wiping down the lights, he notices a stain on one of the
ceiling tiles. He wonders how long the stain has been there,
and if he should notify anyone. Surely someone other than
he has seen it.
If there is water damage, it could indicate the presence of a
larger problem. As environmental services staff, Isaac is
unsure of his role in mitigating risk.
As the IPC focal person, what would you advise Isaac to do?
1. Tell him to report the stain to his supervisor.
2. Ask him to attempt to find the source of the stain.
3. Ask him to create a risk assessment.
4. Tell him not to report the stain.
RISK MGT - 3

50. HICC - CDSIMER
1. WHO IS OUR INFECTION CONTROL
NURSE??
2. WHO IS OUR ICO ??
3. WHO ALL ARE IN HICC??
4. WHO CHAIRS HICC COMMITTEE?

52. Using a new, sterile needle for an IV catheter breaks which link in the
chain of infection? Select the best answer.
1. Susceptible host
2. Reservoir
3. Portal of entry

53. Environmental sources such as dry surfaces, wet surfaces, and the area
surrounding a patient is which step in the chain of infection?
1. Portal of entry
2. Portal of exit
3. Reservoir

54. A patient with seasonal influenza is in the male medical ward for care.
His symptoms include a persistent cough. The potential for influenza to
be transmitted from the cough is an example of:
1. Airborne transmission
2. Contaminated items
3. Droplet spread
4. Direct contact

55. Question 4
Practicing good cough etiquette is an example of a
1. Contact precaution
2. Droplet precaution
3. Airborne precaution
4. Standard precaution

56. Question 5
The most reliable methods of control are (select all that apply):
1. Elimination
2. Engineering
3. Substitution
4. PPE

57. Question 6
At a joint meeting with the hospital administrator, it is mentioned that new
furniture that will be procured for the waiting area in the emergency
department. You suggest that the new furniture will need to be chosen based
on the ability to clean and disinfect. Your suggestion is an example of which of
the following strategies? Select the best answer.
1. Implementing an engineering control
2. Eliminating a hazard
3. Implementing a multimodal strategy
4. Performing a risk assessment

58. Question 7
Sabra is preparing to draw a blood sample on a patient in the outpatient
department. Which of the questions below is most appropriate for her
to consider when thinking about risk?
1. Do I need protection because there is risk of exposure to blood and
body fluids?
2. Do I need protection because the patient has undiagnosed
symptoms of infection?
3. What are the facility standards for a patient that has an identified
infection?

59. Question 8
Which method of control best describes discontinuing use of injection
when oral medicines are available?
1. PPE
2. Elimination
3. Substitution
4. Engineering
5. Administrative

60. Question 9
Which of the following are Standard Precautions?
1. Waste management
2. Patient placement and isolation
3. Injection safety
4. Environmental cleaning

61. Question 10
Which of the following best describes an IPC program?
1. It is a vertical program in a facility.
2. It builds systems that reduces risk.
3. It applies to inpatient settings.