This slide contains Infection control, MRSA Infection, Sterilization, Disinfection, infection control team, infection control nurse, nursing process in infection control

1. MR. VIKAS M MISKIN,
Assistant Professor,
M.Sc. in Medical Surgical Nursing
(Critical Care Nursing),
V. M. PATIL COLLEGE OF NURSING AND MEDICAL RESEARCH
INTITUTE, AKLUJ.
“INFECTION CONTROL IN INTENSIVE
CARE UNIT : ROLE OF NURSES”

2. INTRODUCTION:
1. A nosocomial infection — also called “hospital acquired
infection” can be defined as: “An infection acquired in
hospital by a patient who was admitted for a reason
other than that infection”.
2. Infections occurring more than 48 hours after hospital
admission.
3. Evidence of poor quality health service delivery.
4. The infection acquired by a client in the hospital
settings in known as nosocomial infection. The
performance of any hand-on-procedure provides an
opportunity for the transmission of host flora between
the provider and recipient of care.

3. CONT…..
 There are several basic principles and guidelines the health
care provider can follow that will aid to minimize the risk of
disease transmission.
 Clients may enter health care facility with an infection or
develop an infection while in the facility. The longer the stay
in the hospital, more is the risk of developing an infection.
Infection control involves monitoring the client, the
environment and the health care workers to prevent the
spread of infection.

6. DEFINITION OF INFECTION:
“The invasion of a host by organisms such as
bacteria, fungi, viruses, protozoa, helminthes or insects with
or without manifestation of disease.”

7. INFECTION CONTROL AND
PREVENTION:-
“Prevention and controlling of
infection is an effective strategy, based on knowledge of
agent, host and environment interaction, with having goal
in developing and implementing intervention to prevent
the spread of the infection agent from its reservoir or
source to susceptible hosts”

8. IMPORTANCE AND PURPOSE OF
GOOD INFECTION PREVENTION:-
 Prevents post procedure infections.
 Results in high-quality, safe services.
 Prevents infections in service providers and other staff.
 Protects the community from infections that originate from
health care facilities.
 Prevents the spread of antibiotic-resistant microorganisms.
 Lowers the costs of health care services, since prevention
is cheaper than treatment.

9. HOSPITAL ASSOCIATED INFECTIONS
OR NOSOCOMIAL INFECTIONS:
 Those infections that were neither present nor incubating at
the time the patient was admitted to the health care facility.
 The commonest forms of HAI are due to invasive
procedures carried out on patients such as surgical
operations, intravenous therapy, intubation and
catheterization.
A. Urinary Tract Infection .
B. Ventilated Associated Pneumonia.
C. Surgical site infections.

13. METHICILLIN RESISTANT
STAPHYLOCOCCUS AUREUS:-
 INTRODUCTION:
1. MRSA were first reported in 1961 in England.
2. Is not new – first identified in 1968.
3. The term Staphylococcus is derived from the Greek
expression staphyle (bunch of grapes).
4. The term aureus was named due to the organisms golden
appearance when viewed under the microscope.
5. Most frequently, skin and soft tissue infections, such as
boils.
6. Deeper infections, including invasion of the bloodstream
and spreading around the body to cause serious, life
threatening infections such as septicemia, abscesses,
meningitis and pneumonia.

14. CONT…..
 Is a bacteria that is resistant to a synthetic penicillin- methicillin.
 Has the ability to easily transfer resistant genes to other species
directly and indirectly.
 Type of staph bacteria that is resistant to certain antibiotics,
including methicillin, oxacillin, penicillin and amoxicillin.
 Infection acquired by persons who have not been hospitalized or
had a medical procedure.
 Infection presents as skin pimples or boils that may be mistakenly
identified as a spider bite.

15. FACTS ABOUT MRSA:-
1. MRSA infection has been making headlines all over
the country.
2. MRSA has been a major concern in hospital-based
institutions for many years.
3. Now “Community acquired MRSA” has become a
health concern for everyone.
4. 100,000 people are hospitalized each year with
MRSA infections.
5. Staph aureus bacteria are commonly carried on the
skin or in the noses of healthy people.
6. MRSA frequently lives harmlessly on skin surfaces of
the mouth, genitalia and rectum.

16. OBJECTIVE OF MRSA:
To gain a broader
understanding of the resistance mechanisms and
virulence factors involved with MRSA and how this
disease impacts on a physical and global level.

17. PREDISPOSING FACTORS OF
SUSCEPTIBILITY:
Infection by staphylococci is usually from
a combination of bacterial virulence factors and
diminution in host defenses. Skin injury from
surgery, trauma burns can lead to a serious MRSA
infection, especially if the patient has a history of
chronic bacterial infections treated with multiple
rounds of antibiotics overtime.

18. CONT…..
1. Integument injury.
2. Burns and trauma.
3. Foreign objects.
4. A history of chronic Infections.
5. Hormonal changes and stress.
6. Immunocompromised host.

19. HOW IS MRSA TRANSMITTED?
1. Person to person via hands & skin-to-skin contact.
2. Sharing contaminated items such as soap, towels, clothing,
athletic equipment, razors and other personal care items.
3. Contaminated surfaces.
4. Draining infections must be kept covered.
5. Avoid sharing personal items.
6. Wipe objects down with alcohol.
7. Advise health care workers to wash their hands before touching
you or your hospital equipment.

20. WHAT NURSES NEED TO DO TO
PREVENT TRANSMISSION OF MRSA:
 Practice good hygiene:
1. Keep hands clean by washing thoroughly with soap and
water.
2. Use alcohol-based hand sanitizer if no access to soap
and water.
3. Keep cuts and scrapes clean and covered with a
bandage until healed.
4. Discard used bandages and tape in garbage.
5. Avoid contact with other people’s wounds or bandages.
 Adequate hand hygiene is the simplest, most
effective infection control measure for preventing
and containing MRSA infections.

21. CONT…..
 Draining infections must be kept covered.
 Talk to your physician about wound management
techniques.
 Wash hands frequently with soap and water.
 Avoid sharing personal items.
 Wipe objects down with alcohol.
 Advise health care workers to wash their hands before
touching you or your hospital equipment.

23. DEFINITION OF STERILIZATION:
“ The process of killing the pathogenic
micro-organisms with their spores through the
use of extremes of temperature, gas or
radiations.”
 Or
“Sterilization is the process by which
articles are free of all microorganisms both in
vegetative or spore state.”

24. METHODS OF STERILIZATION:
A. Physical method.
1. Sunlight.
2. Drying.
3. Heat; Dry heat.
: Moist heat.

25. CONT…..
 Chemical method.
1. Acids and alkalis.
2. Distilled water.
3. Metallic ion.
4. Inorganic anion.
5. Halogens.
6. Formaldehyde.
7. Phenol.
8. Gases.

26. A. PHYSICAL METHOD {THERMAL STERILIZATION}:-
1. Sunlight:
It proses appreciable bactericidal activity. The
action is due to ultra violet rays. This is one of the natural
methods of sterilization in case of water in tanks, river and
lakes.
2. Drying :
Drying in air has deleterious effect on many
bacteria.
3. Heat:
The factors influencing sterilization by heat are
a) Dry heat
b) Moist heat

27. Dry heat sterilization:-
1. Red heat : It is used to sterilize metallic objects by holding them in
flame till they are red-hot Eg. inoculating wires, needles, forceps etc.
2. Flaming: The article is passed over flame with out allowing it to
become red-hot. E.g. Mouth of culture tubes, cotton wool plugs and
glass slides.
3. Incineration: This is an excellent method for rapidly destroying
material.
Eg. Soiled dressing, pathological material.
4. Hot air oven. Sterilization by hot air oven requires temperature of
160 degree Celsius for one hour .

28. Moist heat sterilization
Temperature below 100 ºc :
1. Pasteurization of milk:
Temperature employed is either 63ºC for 30 min or 72ºC for 15 to 20 sec.
2. Vaccine bath:
It is used for killing non-sporing bacteria, which may be present in
vaccine. In vaccine bath the vaccine is treated with moist heat for one
hour at 60ºc.
3. Inspissation’s :
The slow solidification of serum or egg is carried out at 80ºc in an
inspissation.

29. Temperature at 100 ºc
1. Tyndallization: This is the process by which medium is
placed at 100º c in flowing steam for thirty min. each On three
successive days The mechanism underlined this method is
that vegetative cells get destroyed at 100ºc and remaining
spores will germinate storage interval are killed on subsequent
heating .
2. Boiling : For needles and instruments boiling in water for
10 to 30 minutes is sufficient to sterilize them.
3. Steam at atmospheric pressure:- Free steam is used to
sterilize culture media which may decompose if subjected to
higher temperature

30. TEMPERATURE ABOVE 100ºC
1. AUTOCLAVING:
In this apparatus material for sterilization is exposed to 121º c
for 15 to 20 minutes at 15 lb pressure per square inch.
Principles:
Steam above 100º c or saturated steam has a better killing
power than dry heat. Bacteria are more susceptible to moist heat .When
steam comes into contact with a cooler surface it condenses to water and
liberates its latent heat to that surface .The condensed water produces
moist condition for killing the microbes present.

31. PROCEDURE :-
 The cylinder is filled with with sufficient water and the
material to be sterilized is placed on the tray.
 The lid is closed with the discharge tap open .The
heater is put on. Safety valve is adjusted to the
required pressure.
 After boiling of water the steam and air mixture is
allowed to escape to all the air has been displaced.
 This can be tested by leading the escaping steam-air
mixture into a pail of water through rubber tubing.
 When the air bubble stop coming in the pail it
indicates that all the air has been displaced. The
discharge tap is now closed.

32. CHEMICAL METHODS:
1. ACIDS AND ALKALIES.
-Inhibitory to the growth of bacteria.
2. DISTILLED WATER.
-It causes loss of viability.
-It is due to traces of metal in distilled water.
3. METALIC ION.
- HgCl2 and AgNO3 prevent the growth of bacteria.
- This action is due to affinity of certain protein for metallic ion.

33. CONT…..
4. INORGANIC ANION.
-They are much less toxic to bacteria.
5. HALOGEN.
-It kills vegetative bacteria, fungi, viruses but not bacterial spores.
6. FORMALDEHYDE.
-It is useful in sterilizing bacterial vaccine and in inactivating bacterial
toxin.
-It is bactericidal, sporicidal and lethal to virus also.

34. CONT…..
7. PHENOL.
-It is used for sterilizing surgical instruments and for
killing culture accidentally spilt over in the laboratory.
8. GASES.
-It is employed for fumigation of operation theatre, wards
etc.
-It is achieved by condensation of gas on exposed
surfaces.

36. DEFINITION OF DISINFECTION:
“ The process of inhibiting the
growth of micro-organisms. Disinfection is always
done with the help of disinfectants.”

37. USES OF DISINFECTANTS:
1. Contaminated disposable material before
incineration.
2. Surfaces like table and trolley top.
3. Cleaning material in contaminated material has
been split.
4. Disinfection of instruments not amenable to heat.
5. Disinfection of skin.

38. Following are some of the commonly used
disinfectants:
 Dettol ( 1: 40 )
 Lysol ( 1: 20 )
 Savlon ( 1:20 )
 Spirit
 sodium hypochlorite ( 1: 8 )
 potassium permanganate ( 1: 5000)
 Following items can be disinfected with the use of
the disinfectants
 Rubber catheters
 Metal instruments which are required to be clean
 Bowls

39. PRECAUTIONS TO BE TAKEN WHILE
USING DISINFECTANTS
1. Proper concentration of the disinfectant should be
followed.
2. Check the expiry date of the solution before its use.
3. store the disinfectant at the cool temperature to avoid
chemical degradation
4. Keep the disinfectant away from the other medicines to
avoid accidental poisoning or misuse.
5. Label the disinfectant properly to avoid its misuse.
6. The time required for disinfection should be followed.

42. DEFINITION OF INFECTION CONTROL
“It is the practice to control infection
that helps to keep the person himself and his client
free from unnecessary exposure to infection, and
failure the adhere to these practices can also result
in an infection.”

43. INFECTION CONTROL PROGRAMME:
It is termed as some policies or
programmes which each hospital need to develop for
implementation of good infection control practices and
to ensure the well being of both patients and staff by
preventing and controlling HAIs.

44. OBJECTIVES:-
1. Monitoring HAIs.
2. Training of staff on prevention and control of HAIs.
3. Investigation of outbreaks.
4. Monitoring of staff health to prevent staff to patient
and patient to staff spread of infection.
5. Advice on isolation procedures and infection control
measures.
6. Infection control audit including inspection of waste
disposal, laundry and kitchen.
7. Review the infection control policies periodically to
incorporate new protocols.

46. THE INFECTION PREVENTION AND CONTROL
TEAM/ COMMITTEE INCLUDES:
1. Infection control is a quality of standard and is essential for
the well being of the patients and the safety of both patients &
staff. To accomplish a reduction in infection rates an infection
control program has to be gives a firm structure.
2. The hospital manager or medical director should be
responsible for ensuring that appropriate arrangements are in
place for effective infection control and these is an Infection
Control Team (ICT), consisting of a physician, Infection
Control Officer (ICO), an Infection Control Nurse (ICN), and
an Infection Control Committee (ICC).

47. INFECTION CONTROL COMMITTEE (ICC):
Chairman : Director medical service.
 Coordinator : head of department, microbiology
 Secretary: infection control nurse
Members : OT superintendent.
-Matron.
-In charge of OT, ICU, CSSD.
-Supervisor- house keeping
-Physician.
-Surgeon.

48. RESPONSIBILITIES OF THE
INFECTION CONTROL TEAM:
 Advise staff on all aspects of infection control and
maintain a safe environment for patients & staff.
 Provide advice on clean water and proper facilities for
hand washing and drinking.
 Arrange for the separation of clean and dirty materials
and procedures (e.g. storage of sterile supplies in a
separate room to that used for reprocessing of dirty
equipment or storage of waste.
 Provide written policies for critical elements of
infection control.
 Investigate the spread of infection (epidemics) in
collaboration with medical or nursing staff.

49. Infection Control Nurse (ICN):
The duties of ICN are primarily associated with
Infection Control Practices with special responsibility for
nursing problems and education. According to
recommendations from US there should be 1 ICN per 250
beds but this is not practically possible. So, in a large
hospital the ICN can train another ward-based nurse to
maintain infection control with in her ward.

50. STEPS TAKEN TO PREVENT OR
CONTROL NOSOCOMIAL
INFECTIONS:-
 These can be of two types:
A) Using Medical asepsis.
B) Using surgical asepsis.

53. A) Medical Asepsis:
1. Hand washing: Hand hygiene is the single most
effective means of preventing the spread of nosocomial
infections among hospital patients and personnel. Hand
hygiene not only incorporates the traditional method of hand
washing .
2. Gloves:
Non sterile gloves should be worn for all cleaning
procedures. Gloves are worn when touching blood, body
fluids, secretions, and non-intact skin.
3. Mask:
Protective eye wear: These should be worn for
cleaning procedures involving the management of large
amounts of blood or body substances that may splash or
splatter, such as when emptying large volume suction
bottles or during bulk trash and linen removal.

55. CONT…..
4. Gowns:
Gowns are patients over the care givers clothing
when soil age of clothing is likely after a single use they are
discarded if disposable or sent to the laundry.
5. Linen & laundry services:
Soiled linen can be a source of microbial
contamination, which may frequently cause infection in
hospital patients & personnel.
6. Client placement:
Clients who are at risk for contaminating the
environment or who are unable to maintain appropriate
hygiene or environmental control should be placed in a
private room.

56. CONT…..
7. Isolation carts:
Some hospitals use isolation carts to store
gowns, masks, lines etc. for use with people requiring
isolation precautions.
8. Laboratory specimens:
Place specimens of human tissues or body
substances in containers with secure lids to prevent leaking.
9. Post mortem handling of bodies:
When handling a body after death, use the
same precautions to protect yourself that you would use if
the person were still alive.

57. B) Surgical Asepsis:
1. Scrubbing: Hand washing alone does not prevent
transmission of infection during surgical procedures and
invasive diagnostic procedure. Surgical scrubbing
lowers the total count of microorganisms on the hands
and arms.
2. Putting & removing a sterile gown:
Putting on sterile gloves.
3. Putting on surgical cap & mask: For a surgical
procedure, the nurse puts on disposable paper or clean
cloth cap. All hairs must be covered.

58. CONT…..
4. Handling sterile objects: Sterile gloves or sterile forceps
are used for handling items when maintains sterility.
5. Opening a sterile package: Hand washing in necessary
before opening any sterile package. It may be opened after
being on a flat surface.
6. Using sterile forceps: Various forceps are available for
using in sterile procedures. Forceps should be kept above
the waist level and if handled with bare hands only the tips
are considered sterile.

59. CONT…..
7. Pouring a sterile solution: The outer surface of the bottle
and cap are unsterile. Remove the cap carefully and do not
allow the inner surface of his lid to touch an up sterile area.
8. Preparing a sterile field: Select a work area that is waist
level or higher.
- For sterile wrapped drape: Open outer covering. Removing
sterile drape lifting it carefully by its corners. Hold away from
your body.

61. CONT…..
The nursing process in infection control involve 4
phases:-
1. Assessment.
2. Nursing diagnosis.
3. Implementation.
4. Evaluation.

62. A. ASSESSMENT:
Early detection of infection is very
necessary on the part of a nurse. The measures to
be taken to control the infection are determined by
the susceptibility of the host, the virulence of an
organism, the signs & symptoms of the patient.
1. ASSESSMENT OF –
--Patient’s immunization status
--Past history of recurrent infections

63. CONT…..
2. LABORATORY INVESTIGATIONS-
 Blood investigations
 Urine examination
 Sputum examination
3. PHYSICAL EXAMINATION:
 Assess for the symptoms of increase in
temperature
 Rapid pulse
 Rapid respiration
 Pain & tenderness

64. B. NURSING DIAGNOSIS:
--Nursing diagnosis for the client can be listed down as follows
 Altered thermoregulation related to increased temperature
 PLAN OF ACTION:
1. Assess vital signs.
2. Assess the blood investigation reports for pathological
organisms.
3. Assess for neurological changes.
4. Provide tepid sponge or cold sponge as per the degree of
temperature.
5. Maintain hydration.
6. Provide cool environment.
7. Help to induce sweating.
8. Administer antibiotics, antipyretics as per the organism found.

65. C. IMPLEMENTATION:
A. PRACTICE:
1. Use medical & surgical asepsis
2. Regular hand washing
3. Follow universal precautions
4. Safe disposal of the contaminated articles.
5. Limiting the number of visitors.
6. Perform the procedures with standard protocols.

66. CONT…..
B. EDUCATION:
Educate the individuals, families and
communities on the following aspects
1. NUTRITION:
A well balanced diet with inclusion of sufficient green
leafy vegetables, fruits and proteins is very necessary for
prevention of the infection.
2. MAINTAINENCE OF THE HYGIENE:
Daily maintenance of the personal hygiene as well as
menstrual hygiene is very essential from prevention point of
view.

67. CONT…..
3. IMMUNIZATION:
Immunization for under five age group, pregnant
women, and adolescents should be followed as per the
National Immunization schedule.
4. EARLY DIAGNOSIS:
Early diagnosis should be done through
performance of the health screening & examinations.
5. TREATMENT OF OTHER DISORDERS:
If the individual has any previous medical or
surgical disorders, possible treatment should be started
for prevention of further invasion of pathological
organisms.

68. D. EVALUATION:
 Evaluation of the nursing process determines
whether the nursing interventions taken are
effective. It should result in either of the following.
 Prevention of infection.
 Control of infection.

69. SUMMARY:
Today we have learn about the infection
control in intensive care unit, nosocomial infection in
intensive care unit, MRSA infection in intensive care
unit, sterilization, disinfection, standard safety measures
and infection control in intensive care unit and its
management.

70. CONCLUSION:
As this topic will help you to understand
the infection control in intensive care unit in detail. So I
hope you will able to implement this knowledge and
develop skill in theory and practical about intensive care
unit.
So while working in hospital should
have use of all barrier nursing it will help to avoid the
problem & maintain the safety to both client & health
care personnel.