The document discusses infection control practices in hospitals, including how infections spread, standard and transmission-based precautions, environmental management, and methods for decontamination, sterilization, and disinfection. It provides details on the various disinfectants used in the hospital and guidelines for cleaning different equipment and environmental surfaces. The history and importance of infection control is also reviewed.

2. Very Warm
Welcome to All

3. Contents
 Introduction
 Spread of infection in Hospital
 Infection control Practices
 Environmental Management of Infection
Control
 Decontamination, Sterilization and
Disinfection
 Application of Nursing Process in
Infection Control

4. Introduction
 Infection may be transferred
◦ patient-to-patient,
◦ patients to staff
◦ staff to patients,
◦ or among-staff.
 Infection control includes
◦ prevention (via hand hygiene/hand
washing, cleaning/disinfection/sterilization, vaccination,
surveillance),
◦ monitoring/investigation of demonstrated or suspected
spread of infection within a particular health-care setting
(surveillance and outbreak investigation),
◦ and management (interruption of outbreaks).

5. History of Hospital Infection Control
 Florence Nightingale was the first person to work for
infection control in hospital.
 In 1847 Dr. Ignaz Philip Semmelweis identified that
18% Mortality due to Puerperal Fever.
 Case control study significance of hand washing was
demonstrated.
 Concept of “nosocomial infection was born.

6. Background
 Infection rate in developing countries was 15.5 per 100
patients, compared to “.1 [per 100 patients] in Europe
and in the U.S., 4.5- BBC
 ICU infection - developing countries: 47.9 per 1,000
patient, compared to 13.6 in the U.S.
 In countries like India and Nepal, hospital infection data
not reliably estimated.
 Surgical infection at BPKIHS -1339 (7.3%) among
18325 total surgeries.
 Estimates vary from 10 to 30%, the least being about
3% in the best of hospitals
 Wound sepsis alone affects 20% of post-operative cases

7.  Hospital infection adversely affects the
image of hospital.
 Nosocomial infections :
◦ direct death 1%
◦ Indirectly mortality in 3%
 50% of nosocomial infections are
preventable.

8. The main health care related
infections are
1. Urinary tract infections
(catheter-associated)
2. Surgical site Infections
3. Bloodstream infections
(central line-associated)
4. Pneumonia (ventilator-
associated)

9. Healthcare-Associated Infections –
Numbers and Costs in USA
Total HAIs 1.7 million
Deaths 99,000
Average additional direct $13.6
cost to hospital billion
Overall net hospital cost $8.5 billion
Not counted are
•Costs to patient/QALY, payer, provider, society, caregiver
time/resource
•Intangibles such as pain and suffering
•Indirect: lost productivity, lost retirement savings and
benefits
•Decreasing HAIs by 25% would save $148,667 per hospital

10. Infectious
Immuno - Bacteria, Fungi,
Agent
Suppresse Virus, Parasites
d, Elderly,
Chronically
ill, trauma, Susceptib
Sources Human
newborn, s le Host
urgery Beings
Animal
Inanimate
Spread of Object
Mucus
Membrane, INFECTION
Non intact
Skin, GI
Sputum,
tract, GU
Portal of Portal of Emesis,
tract, Respi Entry Exit Stool, Bl
ratory Tract
ood
Mode of
Transmis Contact, Vehic
sion le, Air
borne, Vector
borne

11. 3. Infection control practices
Additional
Standard (Transmission
Precautions -Based)
Precautions

12. 3.1. Standard Precaution
Hand washing
Use of personal protective equipment
Appropriate handling of patient care
equipment and soiled linen
Prevention of needlestick/sharp injuries
Environmental cleaning and spills-
management
Appropriate handling of waste

16. Additional (Transmission-Based)
Precautions
Airborne
precautions
Contact Droplet
precautions precautions

17. 4. Environmental Management
for Infection Prevention
Air,
Waste Ventilation
Management
Vector
Water
Control
Cleaning The
Hospital
Environment

18. TYPES OF PATHOGENIC WASTE IN HOSPITAL
Radioactive Waste

19. 4.5.2. Color Coding of Container for
Bio- Medical Wastes Disposal
 Red Colour:
 Blood and its product, pad contaminated
with body fluid, dressing items, used
infusion sets, used catheter set, contaminated
cotton roll etc.
 Human anatomical waste(eg. tissues, organs,
body parts etc).

20.  Blue
 Free from blood contaminated items
such as; saline bottle, gauze, pad, I/v
set, drugs cover and literature.

21.  Green
 Fruits cover,kitchen waste, non ca.
medicine ampoule, and dry items
only.Non con blood taminated items
should be kept in green color's container.

22.  Plastic container or cartoon box
 Sharps items or skin pricking
materials Such as:
needles, syringes, scalpels, blades, gl
ass etc. that may cause puncture and
cuts. This includes both used and
unused sharps.

23. Extra bucket or black plastic bag:
 From the site of operation theatre
items such as; body parts, tissues).
 Orange:
 Laboratory related items eg.
vial,chemical reagents etc.

24. 4.5.3.Laundry
 Handle all linen with minimum agitation.
 Place soiled/contaminated linen in impervious bags
for transportation.
 Disinfect by using hot water and/or bleach (use
heavy-duty gloves, eye protection and masks to
protect against splashes).
 Wash linen in hot water (70 C to 80 C) and
detergent, rinse and dry preferably in a dryer or in
the sun.

25.  Wash woollen blankets in warm water and dry in
the sun.
 Bed Cover: Change weekly or whenever soiled and
on discharge.
 Bed sheet: Change on alternate day or whenever
soiled and on discharge.
 Mattresses and pillows: Cover with inpervious
plastic. They can be cleaned by wiping with a
housekeeping disinfectant- detergent.
 Blood stained linen: Soak in 1% sodium
hypochloride for 30 min. and send to laundry.

26. Decontamination, Sterilization,
Disinfection
 5.1. Decontamination
 Decontamination of medical equipment
involves the destruction or removal of any
organisms present in order to prevent them
infecting other patients or hospital staff.

27. Sterilization
 Sterilization is the destruction of all
micro-organisms.
1. Autoclave (Steam Under Pressure)
2. Flamming
3. Chemical Sterilization
i. Glutaraldehyde
ii. Alcohol
iii. Formalin
4. Gas Sterlization
i. Ethylene Oxide
5. Iradiation

28. 5.2.2. Sterilization Method Available
In BPKIHS
 Autoclaving: 4 machine in CSSD, 1 not
functioning
 2% Glutaraldehyde solution : as necessity
in each ward
 Gas sterilization by formalin tablet in OT
for suction pipe, cautry wire, tip etc.

29. 5.2.2. Storage of Sterile Equipment
 Keep the storage area clean, dry, dust-free and lint-free.
 Control temperature and humidity (approximate
temperature 240C and relative humidity <70%) when
possible.
 Packs and containers with sterile (or high-level disinfected)
items should be stored 20–25 cm (8–10 inches) off the
floor, 45–50 cm (18–20 inches) from the ceiling and 15–20
cm (6–8 inches) from an outside wall.
 Do not use cardboard boxes for storage.
 Date and rotate the supplies (first in/first out).
 Change the cydex solution in each 28th day

30. Disinfection
 Disinfection removes micro-organisms
without complete sterilization.

31. 5.3.1. List Of Disinfectants
Available In BPKIHS
1. Methylated spirit (70%)
2. Isopropyl alcohol (70%)
3. Povidone Iodine solution (7.5%)
4. Povidone Iodine (7.5) and Detergent
(Surgical Scrub/ Betadine Scrub/ wokadine
Scrub etc.)
5. Sodium hypo chloride (1% solution)
6. Bleaching powder (14gms/Litre)
7. Formalin (40%Liquid)
8. Glutaraldehyde (2% activated)
9. Carbolic Acid (2%)
10. Detergent powder

32. 5.3.2. Selection of disinfectant
 There is no single ideal disinfectant.
 Glutaraldehyde is the generally the most
appropriate chemical disinfectant that will
provide high level disinfection.

33. 5.3.3.Common Disinfectants Used For
Environmental Cleaning In Hospitals
Disinfectant Recommende Precautions
s d Use
Sodium Decontamination of - Should be used in well
Hypochloride material ventilated areas.
contaminated with -Protective clothing required
blood and body fluids while handling and using
undiluted.
- Do not mix with strong acids
to avoid release of chlorine gas.
- Corrosive to metals
Bleaching Powder Toilet/ bathrooms Same as Sodium Hypochloride

34. Alcohol Smooth Metal - Flammable, toxic, to be used in
(70%): Ethyl Surfaces well ventilated area, avoid
Alcohol, Meth tabletops and inhalation.
ylated spirit other surfaces - Keep away from heat source,
where bleach can electrical equipment, flames, hot
not be used surfaces.
- allow it to dry completely,
particularly when using diathermy
as it can cause diathermy burn.
Carbolic Acid Floor mopping, - toxic
(Phenol) cleaning OT room,
Contaminated bed,
furniture etc
Phenyle, Lysol Black Phenyle is - Poisonous
used in cleaning
toilet and
bathroom.
White phenyl is
used in routine

35. 5.3.4. Common Antiseptic
Antisep Recommended Precaution
tics Use
Chlorhex Antiseptic for skin - Inactivated by soap
idine and mucous and organic matter.
combine membranes, - Relatively non toxic.
d with preoperative skin - Do not allow contact
alcohol preparation, with brain meninges,
or disinfection of the eye or middle ear.
detergent hands

36. Quaternary Antiseptic for - Relatively non toxic.
Ammonium cleaning dirty - Dilution are likely to get
wounds contaminated and grow gram
Compound:
negative bacteria, hence:
eg. Dettol - Use in correct dilution and
only pour enough solution for
single patient use.
- Discard any solution that is
left over single use.
Povidine In BPKIHS, 7.5% + detergent combination is
Iodine recommended to use in pre-operative hand
(Betadine) wash and part preparation.
5%, 7.5% and 7.5% solution is recommended for wound
10% dressing .

37. 5.3.5. Method of Diluting Chlorine
Solution
Product Chlorine How to dilute to How to dilute How to dilute
Available 0.5% to 1% to 2%
Sodium 3.5% 1 part bleach to 6 1 part bleach 1part of
Hypochlor parts of water to 2.5 parts bleach to 0.7
ite- liquid water parts of water
bleach
Sodium 5% 1 part bleach to 9 1 part bleach 1 part bleach
Hypochlor parts of water to 4 parts of to 1.5 parts of
ite- liquid water water
Beaching 34% 14gm powder
Powder in 1liter water
Chloramin 25% 20gm to 1Litre of 40gm to 1 80gm to 1 lt
e Powder water litre of water of water
(Virex)

38. 5.3.6. Disinfection of Linen and
Equipments
Equipments Standard Procedure In BPKIHS
According to WHO Protocal
Furniture, Clean with detergent and Cleaning by
bed, IV water and wipe dry. If detergent and water.
stand, wheel contaminated or use by In OT wiped by 2%
chair, fan and infected patient wipe by 1% carbolic acid.
light etc sodium hypochloride or
70% alcohol.

39. Mattress and Clean with If contaminated
Pillows detergent and with blood and
(always cover with water in between body fluid wipe
plastic bag) patients and as with or 1% sodium
required. hypochloride.
If contaminated
with blood and
body fluid wipe
with 70% alcohol
or 1% sodium
hypochloride.

40. Telephone Disinfect with 70%
alcohol daily.
Dressing trolley Clean with detergent
and water and wipe dry.
Disinfect with 70%
alcohol daily.

41. Ventilator, Clean machine with detergent and water, dry
Suction and disinfect with 70% alcohol.
Equipment and Mask and suction tube should be used for
Mask single use.
AMBU bag after use send for Sterilization to
CSSD.
Soiled patient Clean with detergent and water. If not
care equipment, washable wipe with 1% sodium hypochlorite
stethoscope, or 70% alcohol.
blood pressure
apparatus
Thermometer Clean with 70 % alcohol, store dry

42. 5.3.7. Cleaning of
Environmental Surface
Area Recommended by WHO In BPKIHS Protocal
Floor Damp mopping with Dry sweeping
detergent and water followed by
and some disinfectant wet mopping
twice in each shift. by 2%
carbolic acid.

43. Spilling of - Cover with the absorbent like
blood and cotton, wool, gauze, paper, towel
body fluid etc.
- Pour liberally 1% sodium
hypochloride/ bleaching powder
solution (14gm/lt)
- Allow to stand for 30 min.
Clean with carbolic acid.

44. Walls and Curtains If visibly soiled clean with
detergent and water.
Toilet and commode Clean with detergent and water
and wipe with 2% carbolic acid.

45. In BPKIHS Protocol
•Floor is cleaned with detergent and water
•Mopping by 2% Carbolic acid
•Seal the room with adhesive tape
•For each 1000 cu feet of space place 500 ml of formalin and
1000 ml of water in an electric boiler with a safety cut out and
a time switch. Switch on the boiler.
•Open the room after 24 hr, let some time to evaporate the
vapour.
•Ammonia gas is used to help the easy evaporation

46. Mooping of OT table and surrounding after every
case is with 2% carbolic acid.
Bacillocid special: Recommended use at all Jigh
Risk areas.
Spray 2% solution over all exposed surfaces with a
sprayer allowing 60 min. after sealing all doors and
windows.

47. Preparation of 2% Carbolic Acid
solution
Carbolic Available To make 2%
Acid concentration solution add 20
(Phenol) = 100% ml of carbolic
acid in 980 ml
of water
(aprrox.1 litre)

48. Application of Nursing Process in
Infection Control and Prevention:
 I. Nursing Assessment
1. Client’s susceptibility to infection
◦ Age, nutritional status, stress level, associated
disease like diabetes mellitus.
2. Cleanliness of ward environment
◦ Linen
◦ Ventilation
◦ Water supply
◦ Floor
◦ Health of staff
◦ Patient’s clothing and personal Hygiene etc.

49.  Decontamination, Disinfection and
Sterilization
 Procedure
 Dressing
 Hand washing
 IV insertion
 Catheterization etc.

50.  Isolation of Infected case
 Standard Precaution
 Availability of Personnel Protective Equipment
eg. Gloves, mask, gown etc.
 Stock of sterile items
 Waste disposal
 Adherence of health personnel to IP guideline
 Familiarity of staff about IP guidelines

51. II. Nursing Diagnosis
1. Risk for infection related to
 Improper technique while inserting cannula
 Using same syringes, cannula, IV set for prolonged time
 Failure to recognize early sign of infection and infiltration
 Indwelling catheter
 Unsterile technique while inserting catheter
 Touching the connection tubing with contaminated hands
 Back flow of urine from the tubing and uro bag.
 Failure to follow aseptic technique during change of dressing
 Contamination of opened wound with soiled linen, cloths and
hands
 Cross infection with other patient or health personnel.
 Transmission of disease from patient to patient, patient to staff
and staff to staff.

52.  Knowledge deficit among nursing and
cleaning staff about the procedure of
making disinfect solution of different
concentration
 Risk for impair skin integrity
 Social Isolation

53. III. Nursing Goal
 Prevention of exposure to infectious
organism.
 Controlling and reducing the extent of
infection
 Maintaining resistance to infection
 Educating the clients and family about
infection control technique.

54. Expected Outcome
 The overall goal of IP program is the reduction of nosocomial
infection in the ward
 Client will remain free of infection as evidenced by
 Client will remain afebrile
 Client will develop no signs and symptoms of local infection (eg.
Remain free of cough, purulent drainage from wound or normal body
opening)
 Client will become knowledgeable of infection risk.
 Client will identify routine to follow in the hospital as well as in
hospital that reduce transmission of micro organism.
 Client will identify signs and symptoms to report health care provider
indicating infection.

55. IV. Nursing Intervention
 Monitor client’s body temperature routinely, inspect oral cavity
for lesions, inspect urethral and vaginal orifice for drainage or
discharge, assess IV assess site for sign of infection and observe
the client for evidence of cough.
 Practice hand hygiene routinely before caring for client,
between clients, and before any invasive procedure.
 Supervision and education of cleaning staff in preparation of
solution for floor mopping, carbolization, decontamination etc.
 Use aseptic technique perfoming all surgical procedure like
dressing, catheterization, ET tube suctioning etc.

56.  Use aseptic technique while inserting IV cannula,
change cannula, IV set in 72 hrs, Change labeled
syringe for IV injection in every 24 hours.
 Teach the patients’ relative about the way of
emptying urobag.
 Provide catheter care to the patient.
 Change foley’s catheter in every 7 days.
 Follow standard precautions.
 Provide education to the patient and relatives about
importance and process of deep breathing and
coughing.

57.  Proper disposal of waste in color coded bucket,
monitor and supervise the use by all staff, patients
and patient’s relatives.
 Controlling of visitors.
 Change dressing that become wet and soiled.
 Adequate supplies of clean and sterile gloves,
gown, mask, detergent, disinfectants should be
there in the ward.
 Monitoring of use of antibiotics.
 Change Gltutareldehyde solution in every 28th days

58.  Monitoring of the shelf life of sterile equipment, if not used
Take Home Message
within 7 days send to CSSD for resterilization without
reopening the pack.
 Supervise the cleaning of equipment like AMBU bag, mask,
O2 mask, tubing, Nebulizer set etc.
 Wipe the thermometer with 70%alcohol after using each
patient.
 Send periodic culture of different sites like dressing, treatment
trolley, cydex container, tap water etc.
 Appropriate use of isolation procedure for infected case.
 Maintain the ventilation of the ward.
 Stay healthy, take nutritious food.
 Use available protective device and also encourage others to
use.

59. Person to Contact if any
confusion about Infection Control

61. References
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Koirala Institute of Health Sciences, Dharan, Nepal.
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International Society of Infection Control. Hamilton. Ontario. BC
Decker Inc; 2nd Edition; 2002.
3. Sakarkar BM. Principles of Hospital Administration and Planning.New
Delhi. Jaypee Brothers Medical Publishers P. Ltd; first Edition; 1998.
4. WHO. Practical Guidelines for Infection Control in Health care
Facilities. WHO; 2003.
5. WHO. A manual on Infection Control in Health Facilities. WHO
Regional Office for South East Asia. New Delhi; 1990.
6. Hospital Infection Society. Department of Health, England. Third
Prevalence Survey in HCAI in England. Wilington House. Waterloo
Road. London 2006.
7. Poudyal P.Simkhada P. Bruce J. Infection control knowledge, attitude
and practice among Nepalese health care workers. American Journal
of Infection Control; October 2008; 36(8) : 595-597.
8. Potter PA, Perry AG. Fundamental of Nursing. St. Louis. Missouri.
Mosby; 6th Edition; 2005