1. BY:-
MR. BINDUSAGAR PATTANAIK
DY. HOSPITAL ADMINISTRATOR
B.COMM(MGMT. HONS)
MHA(MASTER OF HOSPITAL
ADMINISTRATION)

2. Hospital infection control(HIC)
Hospital Acquired Infection or
Nosocomial Infection
is one which manifests itself 72 hours or more
after admission to hospital.
Aim: To reduce the rate of Hospitals Acquired
Infections
Objective: To review good practices in infection
prevention and control

3. What is Hospital Acquired infection ?
“Hospital-acquired infections”, are infections
acquired during hospital care which are not
present or incubating at admission.
Infections occurring more than 48 hours after
admission are usually considered nosocomial.

4. Contd…
 An infection acquired in hospital by a patient who was
admitted for a reason other than that infection.
 An infection occurring in a patient in a hospital or other
healthcare facility in whom the infection was not present
or incubating at the time of admission.
This includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility

5. Frequency of Infection
 HAI occur worldwide and affect
both developed and resource-poor countries.
 Over 1.4 million people worldwide
suffer from such infectious
 Most frequent of these are infections of surgical wounds,
urinary tract infections and lower respiratory tract
infections.

6. Contd…
 The WHO study, have also shown that the
highest prevalence of HAI occurs in intensive
care units and in acute surgical and orthopedic
wards.
 Infection rates - higher among patients with
increased susceptibility because of old age,
underlying disease, or chemotherapy.

7. Impacts of HAI
 Add to functional disability
 Increases emotional stress of the patient and may,
lead to disabling conditions reducing the quality of
life.
 The economic costs are considerable.
 The increased length of stay for infected patients is
the greatest contributor to cost .

8. Contd…
 Hospital-acquired infections add to the imbalance
between resource allocation for primary and
secondary healthcare.
 Prolonged stay not only increases direct costs
to patients or payers but also indirect costs due to
lost work.

9. Factors influencing the development of
HAI
 The Microbial Agent
Patient’s exposure to a variety of microorganisms
during hospitalization increases the risk of HAI
 Environmental factors
Health care settings are an environment where both
infected persons and persons at increased risk of
infection congregate.

10. Contd….
 Patient susceptibility
Important patient factors influencing acquisition of
infection include age, immune status, underlying
disease, and diagnostic and therapeutic interventions.
Bacterial resistance
Many patients receive antimicrobial drugs. Through
selection and exchange of genetic resistance elements,
antibiotics promote the emergence of multi drug resistant
strains of bacteria.

11. Hospital Acquired infections are widespread
 They are important contributors to morbidity and
mortality.
 They will become even more important as a public health
problem with increasing economic and human impact
because of:
Increasing numbers and crowding of people.
More frequent impaired immunity (age, illness,
treatments).
 New microorganisms.
 Increasing bacterial resistance to antibiotics

12. Prevention of Hospital Acquired infections is the
responsibility
of all individuals and services providing health care.

13. Steps to be taken at a National
level to control HAI
 Set relevant national objectives consistent with
other national health care objectives
 Develop and continually update guidelines for
recommended health care surveillance, prevention,
and practice
 Develop a national system to monitor selected
infections and assess the effectiveness of
interventions
.

14. Contd…
 Harmonize initial and continuing training
programs
for health care professionals facilitate access to
materials and products essential for hygiene and
safety.
 Encourage health care establishments to
monitor
nosocomial infections, with feedback to the
professionals
concerned

15. Hospital Programs to prevent HAI
The major preventive effort should be focused
in
hospitals and other health care facilities
Risk prevention for patients and staff is a
concern of everyone in the facility, and must
be supported at the level of senior
administration.

16. Infection Control Committee
An Infection Control Committee provides a forum
for multidisciplinary input and cooperation, and
information sharing. This committee should include
wide representation from relevant programmes:
e.g.
management, physicians, other health care
workers,
clinical microbiology, pharmacy, central supply,
maintenance, housekeeping, training services.

17. Tasks of Infection Control Committee
 To review and approve a yearly program of
activity for surveillance and prevention
 To review epidemiological surveillance data and
identify areas for intervention
 To assess and promote improved practice at all
levels of the health facility
 To ensure appropriate staff training in infection
control and safety.

18. Contd….
 to review risks associated with new technologies,
and monitor infectious risks of new devices and
products, prior to their approval for use
 to review and provide input into investigation of
epidemics
 to communicate and cooperate with other committees of
the hospital with common interests such as Pharmacy
and Therapeutics Use Committee, Biosafety or Health
and Safety

19. Role of the physician
Physicians have unique responsibilities for the prevention and
control of hospital infections:
 By providing direct patient care using practices
which minimize infection
 By following appropriate practice of hygiene
(e.g. handwashing, isolation)

20. Contd…
 Supporting the infection control team.
 Protecting their own patients from other infected
patients and from hospital staff who may be
infected
 Complying with the practices approved by the
Infection Control Committee
 Obtaining appropriate microbiological specimens
when an infection is present or suspected
 Notifying cases of hospital-acquired infection to the
team, as well as the admission of infected patients

21. Role of the hospital pharmacist
The hospital pharmacist is responsible for:
 Obtaining, storing and distributing pharmaceutical
preparations using practices which limit
transmission of infectious agents to patients
 Dispensing anti-infectious drugs and maintaining
relevant records (potency, incompatibility,
conditions of storage and deterioration)available
 Obtaining and storing vaccines or sera, and making
them as appropriate
 Maintaining records of antibiotics distributed to
the medical departments

22. Contd….
 Providing the Antimicrobial Use Committee and
Infection Control Committee with summary reports and
trends of antimicrobial use.
 providing summary reports of prevalence of resistance
monitoring sterilization, disinfection and the
environment where necessary
 Participation in development of guidelines for
antiseptics, disinfectants, and products used for
 Washing and disinfecting the hands participation in
guideline development for reuse of equipment and
patient materials

23. Contd…
 providing summary reports of prevalence of
resistance
 monitoring sterilization, disinfection and the
 environment where necessary
 participation in development of guidelines for
 antiseptics, disinfectants, and products used for
 washing and disinfecting the hands
 participation in guideline development for reuse
 of equipment and patient materials

24. Role of the nursing staff
Implementation of patient care practices for infection
control is the role of the nursing staff.
The senior nursing administrator is responsible for:
 Participating in the Infection Control Committee
 Promoting the development and improvement of
nursing techniques, and ongoing review of aseptic
nursing policies, with approval by the Infection
Control Committee

25. Factors promoting Infection among hospitalized patients
 Decreased immunity among patients
 Increasing variety of medical procedures and
invasive techniques creating potential routes of
infection;

26. Contd….
 Developing training programs for members of
the nursing staff.
 Supervising the implementation of techniques for
the prevention of infections in specialized areas
for monitoring of nursing adherence to policies.

27. Role of the central sterilization service
As central sterilization department serves all hospital
areas, including the operating suite, an appropriately
qualified individual must be responsible for
management of the infection control program.
 Oversee the use of different methods — physical,
chemical, and bacteriological — to monitor the
sterilization process
 Ensure technical maintenance of the equipment
according to national standards and manufacturers’
recommendations

28. Role of the food service
The director of food services must be knowledgeable in
food safety, staff training, storage and preparation
of foodstuffs, job analysis, and use of equipment.
The head of catering services is responsible for:
 Defining the criteria for the purchase of foodstuffs,
equipment use, and cleaning procedures to maintain
a high level of food safety
 .

29. Role of the laundry service
The laundry is responsible for:
 Selecting fabrics for use in different hospital
areas, developing policies for working clothes in
each area and group of staff, and maintaining
appropriate supplies
 Ensuring that liquid soap and paper towel dispensers
are replenished regularly
 Informing the maintenance service of any building
problems requiring repair: cracks, defects in
the sanitary or electrical equipment, etc.

30. Contd….
 Distribution of working clothes and, if necessary,
managing changing rooms.
 Developing policies for the collection and transport
of dirty linen.
 Defining, where necessary, the method for
disinfecting
infected linen, either before it is taken to
the laundry or in the laundry itself.

31. Role of the housekeeping service
The housekeeping service is responsible for the regular
and routine cleaning of all surfaces and maintaining
a high level of hygiene in the facility.
 Classifying the different hospital areas by varying
need for cleaning
 Developing policies for appropriate cleaning techniques
— procedure, frequency, agents used, etc., for each
type of room, from highly contaminated to
the most clean, and ensuring that these practices
are followed


32. Contd…..
 Developing policies for collection, transport and
disposal of different types of waste (e.g. containers,
frequency)
 Ensuring that liquid soap and paper towel
dispensers
are replenished regularly
 Informing the maintenance service of any building
problems requiring repair.

33. Role of the infection control team
The infection control programme is responsible for
 Oversight and coordination of all infection control
activities to ensure an effective programme.
 Organizing an epidemiological surveillance programme
for nosocomial infections
 Participating with pharmacy in developing a programme
for supervising the use of anti-infective drugs
 Ensuring patient care practices are appropriate to
the level of patient risk

34. Contd….
 Checking the efficacy of the methods of disinfection
and sterilization and the efficacy of systems
 Developed to improve hospital cleanliness
participating in development and provision of
teaching programmes for the medical, nursing,
and allied health personnel, as well as all other
categories of staff
 Providing expert advice, analysis, and leadership
assistance for smaller institutions, and undertake

35. Contd…..
 Research in hospital hygiene and infection in
outbreak investigation and control
 Participating in the development and operation
of regional and national infection control initiatives

36. Universal/Standard Precautions
For Infection Control
1. Hand Hygiene
2. Personnel Protective
Equipments
3. Safe Handling and
Disposal of Sharps
4. Follow needle stick
injury protocol
5. Safe Handling and
Disposal of Wastes
6. Managing Blood and
Body Fluids
7. Disinfection of the
Equipments
8. Environmental
Disinfection
9. Immunization
10. Isolation

37. Hand Hygiene
Hand wash/ Hand rub is the most effective
way to prevent the spread of infections in
hospitals.
o Before and after each patient
contact
o Before and after any procedure
o Before and after wearing gloves
o After contact with body fluids

39. Why practice
Good Hand Hygiene?
• To remove visible soiling from hands
• To prevent transfer of bacteria from the home to the
hospital
• To prevent transfer of bacteria from the hospital to the
home
• To prevent infections that patients acquire in the hospital

40. Keep nails short, clean and polish free.
Avoid wearing wrist watches & jewellery, especially rings
with ridges or stones.
Any cuts and abrasions should be covered with a
waterproof dressing.
Do’s & Don'ts

41. Personal Protective equipment
 Gloves
 Disposable plastic Apron
 Masks.
 Eye protection

42. Safe handling and disposal of
sharps
The main hazards of a sharps injury are:
•Hepatitis B,
•Hepatitis C,
•HIV.
Ensure that:
Sharps are not passed from hand to hand.
Needles are not broken or bent before use.
Sharps are disposed of at the point of use.
Sharp containers are not filled more than two
third.
Staff are aware of inoculation injury policy.

43. Follow needle stick injury protocol
 Irrigate mucous membranes by washing under
running water.
 Do not suck/ Squeeze the injury site
 Wash with soap and water
Apply antiseptic lotion to the injury site.
 Contact emergency room-medical officer for
management
 Complete the incident report & inform to ICN

44. Safe handling and disposal of waste
 Segregate the waste at source.
 Know the policies and protocols of the state.
 Safe disposal.
 Safe handling of spillage.

45. Bio-medical Waste
 means any waste, which is generated during the
diagnosis, treatment or immunisation of human
beings or animals or in research activities pertaining
thereto or in the production or testing of biologicals,
and including categories mentioned in Schedule I

46. Categories of BMW
Option Waste category Treatment
&Disposal
Cat 1 Human Anatomical Waste (human
tissues, organs, body parts)
incineration@/deep
burial*
Cat 2 Animal Waste (animals used in
research, veterinary hospitals)
incineration@/deep
burial*
Cat 3 Microbiology & Biotechnology
Waste
local
autoclaving/micro-
waving/incineration@
Cat 4 Waste sharps disinfection (chemical
treat- ment@01/auto
claving/micro-
waving and
mutilation/
shredding"
Cat 5 Discarded Medicines and
Cytotoxic drugs
disposal in secured
landfills

47. Categories of BMW
Option Waste category Treatment &Disposal
Cat 6 Soiled Waste (Items
contaminated with blood, and
body fluids )
incineration@
autoclaving/microwaving
Cat 7 Solid Waste (disposable items
such as tubing's, catheters, iv
sets etc).
disinfection by chemical
treatment@@
autoclaving/ microwaving
and mutilation/
shredding##
Cat 8 Liquid Waste (lab , washing &
disinfecting activities)
disinfection by chemical
treatment@@ and
discharge into drains.
Cat 9 Incineration Ash disposal in municipal
landfill
Cat 10 Chemical Waste (chemicals
used in disinfection)
chemical treatment@@
and disinfection,
discharge into drains for
liquids

48. Bio-Medical Waste Management

50. Label for Container / Bag
Bio Hazard Symbol Cytotoxic Symbol

51. Managing blood and bodily fluids
Spillage is dealt quickly as per the Hospital policy.
Handle specimens safely
 Collection
 Labeling
 Transfer

52. SPILL—
TYPES— 4 types
1-Biological Spill
2-Chemical Spill
3-Radiation Spill
4-Mercury Spill

53. Biological Spill—
2 types
A-Small spill/ spotted Spill
B-Large Spill

54. Managt. Of Small Spill—
.Wear gloves and eye protection
.Contamination should be wiped up with paper towels
soaked in freshly prepared Hypochlorite solution(1%)
.If broken glasses are present ,1st treat the spillage with
Hypochlorite ,then carefully remove the glass piece
with disposable forceps to sharp bin & wipe it up
.Towel & glasses shld be disposed off in a yellow
clinical waste bag for Incineration
. Wash hands.

55. Mangt. Of Large Spill—
.Mark that area as Large spill
.Wear PPE
.Liquid Spill should be Covered up with
Hypochlorite solution
.Left for 2 min.
.use absorbent to absorbe
.If glasses are present mangt. same as above
.Wipe that with water & detergent
.Allow that to dry
.Put all the towels ,gloves to yellow bin for
incineration

56. Chemical Spill Mangt.—
.Chemical neutralizer
. Concentrated acid & alkali are avaible
.chemical spill disposed to a suitable container
with a tight fitting lid / a suitable sealable plastic
Bag.
.The Head Of the Dept./ service manager is
responsible for ensuring the correct procedure of
disposal of chemical waste.

57. Prevention of Chemical Spillage
Pre-planning is essential. Before working with a
chemical, the Hospital worker should know how to
proceed with spill cleanup and should ensure that
there are adequate spill control materials available.
Most spills are preventable. The
following can be done to prevent or
minimize the magnitude of a spill:

58. •Place chemical containers in a hood or lab
bench in a manner that reduces the
possibility of accidentally knocking down a
container.
•Plan your movements. Look where you
are reaching to ensure you will not cause a
spill.
•Transport the chemicals safely.
•Place absorbent liners on bench tops or in
places where spills can be anticipated. For
volumes of liquid larger than what can be
absorbed by liners, use trays.

59. Radiation Spill—
.Generate during body organ imaging ,tumor
Localization & therapeutic process in radiology dept.
.It generate some solid radio active waste i.e vial,
Syringe, absorbent paper , protective clothing
.store that in a large drum /container
.liquid form are generally diluted & dispensed in
the sewers
.Gaseous form can be diluted through dispersal
In the outside atmosphere.

60. MANAGEMENT OF MERCURY SPILLAGE :
In case of thermometer & B.P. Instrument breaking
follow the practice as given below.
•Wear Nitrile gloves or double gloves before starting the
procedure.
•Take 10 ml syringe without needle & draw the mercury.
•Push the mercury into the water container.
•Document in the” MERCURY SPILL”REGISTER.
•Inform Sr. Incharge. Medical director & Supervisor.
•Inform house keeping to promptly remove the
container.
•Handover to the Biomedical department.
•Label it as a mercury spill kit with date.

61. DATE TIME ACTION
TAKEN
INFORMATION
GIVEN TO
SIGNATURE OF
THE NURSING
STAFF
FORMAT FOR
MERCURY SPILL :
UNIT :

62. Environment Disinfection
Achieving and maintaining a clean clinical
environment
A very important aspect, yet overlooked??
Proper cleaning of the environment
Fumigation as required

63. Immunization & Isolation
Immunization
 Hepatitis B, Tetanus Toxioid vaccination for all the
employees who are coming in direct contact with
blood and body fluids
Isolation
 Isolate patients with communicable diseases

64. Good communication
 Communicate with peers.
 Communicate with seniors.
 Communicate with doctors.
 Communicate with patients and visitors.
 Communicate with support staff.

65. Infection control checklist
 Have you washed your hands?
 Do you need to use personal protective equipment?
 Are you preventing sharp injuries?
 Are you disposing off waste safely?
 Do you deal promptly with spillages?
 Do you thoroughly decontaminate equipment?
 Are you maintaining a clean environment?
 Do you know what to do in the event of an accident?
 And finally, do you know your workplace's procedures?