1. Best Practices in
Infection Prevention
Best Practices in Maternal and
Newborn Care
12/15/14 by MB 1
2. Session Objectives
By end of session, participants will be able to:
• Describe disease transmission cycle
• Outline key IP principles
• Discuss appropriate handwashing and antisepsis
• Discuss appropriate gloving and personal protective
equipment
• Outline safe handling of sharps
• Discuss proper instrument processing and waste disposal
12/15/14 by MB 2
3. The Six Components of the Disease
Transmission Cycle
1. Agent: Disease-producing microorganisms
2. Reservoir: Place where agent lives, such as in or on
humans, animals, plants, soil, air, or water
3. Place of exit: Where agent leaves host
4. Mode of transmission: How agent travels from place to
place (or person to person)
5. Place of entry: Where agent enters next host
6. Susceptible host: Person who can become infected
12/15/14 by MB 3
4. Question ??
• How can we prevent the spread of infection?
12/15/14 by MB 4
5. How can we prevent the spread of
infection?
• Break disease-transmission cycle
• Inhibit or kill infectious agent (applying antiseptic to skin
prior to surgery)
• Block agent’s means of getting from infected person to
susceptible person (handwashing or using alcohol-based
hand rub)
• Ensuring that people, especially healthcare workers, are
immune or vaccinated
12/15/14 by MB 5
6. How can we prevent the spread of
infection? (cont.)
• Providing health care workers with proper
protective equipment to prevent contact with
infectious agents
• Give some examples of ways to break
transmission cycle
12/15/14 by MB 6
7. Why is infection prevention
important?
• Protects patients/clients—helps provide
quality care that is also safe
• Lowers health care costs—prevention is less
expensive than treatment
• Prevents infection among health care staff
and community
• Limits number and spread of infectious
agents that can become antibiotic-resistant
12/15/14 by MB 7
8. Question ??
• What is the most important infection
prevention practice?
12/15/14 by MB 8
9. Handwashing
• When to wash hands:
– Before and after examining client
– After contact with blood, body fluids or soiled
instruments, even if gloves are worn
– Before and after removing gloves
– Upon arriving at and before leaving workplace
9
The single most practical procedure for
preventing infection: Handwashing
12/15/14 by MB
10. Handwashing: How to Wash Hands
• Steps:
– Use a plain or antiseptic soap.
– Vigorously rub lathered hands
– together for 10–15 seconds.
– Rinse with clean running water
from a tap or bucket.
– Dry hands with a clean towel or
air dry them.
10
.
12/15/14 by MB
11. Alcohol-Based Handrub
• More effective than handwashing unless
hands are visibly soiled
• 2 mL emollient (e.g., glycerin) + 100 mL ethyl
or isopropyl alcohol 60–90%
• Use 3 to 5 ml for each application and
continue rubbing the solution over the hands
until dry.
12/15/14 by MB 11
12. Antisepsis
• Antisepsis for mucous membranes:
– Ask about allergic reactions
– Use water-based product (e.g., iodophor or
chlorhexidine), as alcohols may burn or irritate
mucous membranes
• Skin preparation for injections:
– If skin is clean, antisepsis is not necessary
– If skin appears dirty, wash with soap and water
– Before giving injection, dry with clean towel
12/15/14 by MB 12
13. When to Glove
• When there is reasonable chance of contact
with broken skin, mucous membranes, blood,
or other body fluids
• When performing invasive
procedure
• When handling:
– Soiled instruments
– Medical, or contaminated, waste
– When touching contaminated
surfaces
12/15/14 by MB 13
14. Guidelines for Gloving
• Wear separate pair of gloves for each woman/ newborn to
prevent spreading infection from client to client
• What kind of gloves do you wear for:
– Procedures involving contact with broken skin or tissue under skin?
– Starting IV, drawing blood, or handling blood or body fluid?
– Cleaning instruments, handling waste and cleaning up blood and body
fluids?
– Never wear gloves that are cracked, peeling or have holes.
12/15/14 by MB 14
15. Personal Protective Equipment
• Gloves: utility, examination, HLD/sterile
• Eyewear: face shields, goggles, glasses
• Aprons
– Should be fluid-resistant
– Should be decontaminated after use
• Protective footwear
12/15/14 by MB 15
17. Global Statistics on
Occupational Exposure
• 3 million health care workers (HCWs) per year report
needlestick injuries per year
• 2.5% HIV infections
among HCWs are transmitted
by needlestick injuries
• 40% of Hepatitis C and
Hepatitis B infections
among HCWs are
transmitted by needlestick
injuries
17
(WHO, 2002)
12/15/14 by MB
18. Safe Handling of Sharps
• Never pass sharp instrument from one hand directly to
another person’s hand
• After use, decontaminate syringes and needles by flushing
three times with chlorine solution
• Immediately dispose of sharps in puncture-proof container
• Which is greatest, the risk of acquiring Hepatitis B or HIV from
a needlestick injury?
12/15/14 by MB 18
19. Safe Handling of Sharps (cont.)
• Do not recap, bend, break, or disassemble
needles before disposal
• Always use needle holder when suturing
• Never hold or guide needle with fingers
12/15/14 by MB 19
20. Instrument Processing
• Decontamination:
– Should be done immediately after use
– Makes objects safer to handle
– How do you make a 0.5% chlorine solution for
decontamination?
• Cleaning:
– Most effective way to reduce number of
organisms
– Removes visible dirt and debris
12/15/14 by MB 20
21. Instrument Processing (cont.)
• Sterilization:
– Destroys all microorganisms
– Includes autoclave, dry heat, chemicals
• High-level disinfection (HLD):
– Destroys all microorganisms
except bacterial endospores
– Includes boiling, steaming,
soaking
• Storage:
– After processing, must remain dry and clean
12/15/14 by MB 21
22. DECONTAMINATION
Soak in 0.5% Chlorine solution for 10 minutes
THOROUGHLY WASH AND RINSE
Wear glove and other protective barriers
(glasses, visors or goggles)
Preferred Method Acceptable Methods
HIGH-LEVEL
STERILIZATION DISINFECTION (HLD)
Chemical
Soak
10-24 hours
Autoclave
106 k Pa pressure
(15 lbs./in2)
1210C (2500F)
20 min. unwrapped
30 min. wrapped
Dry Heat
1700C
60 minutes
Boil or Steam
Lid on
20 minutes
Chemical
Soak
20 minutes
COOL
(Use immediately or store)
12/15/14 by MB 22
24. Housekeeping
• Each site should follow housekeeping
schedule
• Always wear utility gloves when cleaning
• Clean from top to bottom
• Ensure that fresh bucket of disinfectant
solution is available at all times
12/15/14 by MB 24
25. Housekeeping (cont.)
• Immediately clean up spills of blood or body
fluids
• After each use, wipe off beds, tables and
procedure trolleys using disinfectant solution
• Decontaminate cleaning equipment with
chlorine solution
12/15/14 by MB 25
26. Waste Disposal
• Separate contaminated waste from
noncontaminated waste
• Use puncture-proof container for sharps and
destroy when two-thirds full
26
Contaminated waste includes blood and other body
fluids, and items that come into contact with them,
such as dressings.
12/15/14 by MB
27. Waste Disposal (cont.)
• Follow these steps to destroy contaminated
waste and sharps:
– Add small amount of kerosene to burn
– Burn contaminated waste in open area downwind
from care site
– Dispose of waste at least 50 meters away from
water sources
12/15/14 by MB 27
28. Summary
• Everyone (staff and patients) is at risk for
infection
• This risk can be reduced through rigorous
adherence to IP practices:
– Handwashing or using alcohol-based handrub
– Antisepsis
– Personal protective equipment, including gloving
– Safe handling of sharps and needles
– Instrument processing
– Housekeeping and waste disposal
12/15/14 by MB 28
29. References
Clark A. Grab bag of questions adapted from grab bag developed by A.
Clark/ACNM.
Ganges F. 2006. Infection Prevention, a presentation in Accra, Ghana in
Maternal and Newborn Care Technical Update. (April)
Tietjen L, Bossemeyer D and McIntosh N. 2003. Infection Prevention
Guidelines for Healthcare Facilities with Limited Resources. Jhpiego:
Baltimore, MD. Accessed at:
http://www.reproline.jhu.edu/english/4morerh/4ip/IP_manual/ipmanual.
htm.
12/15/14 by MB 29
Editor's Notes
Elicit example about each place where transmission cycle can be broken:
1. Agent: Kill agent with antibiotics, disinfectants, decontaminant
2. Reservoir: Remove standing water so malaria carrying mosquito cannot live. Eliminate contaminated dressings. Burn placenta.
3.Place of exit: cover mouth and nose of person with flu who may be sneezing or coughing
4.Mode of transmission: personal protective equipment blocks transfer of organisms from one person to another
5.Place of entry: Use antiseptic to clean injection site
6.Susceptible host: Give Hep B vaccine or other immunizations or pre-exposure or post-exposure treatment to someone exposed to HIV virus
Gloves for procedures involving contact with broken skin or tissue under skin? High-level disinfected or surgical
Gloves for starting IV, etc? Examination gloves
Gloves for clearning? Utility gloves
Why do you wear footwear?
To protect from injury from sharps or heavy items
Not to prevent transmission of infection (unless foot will be in wound or mucus membrane!)
This 3 million is just those that report – number is most likely much larger, considering there are countries which do not have systems in place to document occupational exposure.
Worldwide, about 2.5% of HIV infections and 40% of HBV and C infections are due to occupational exposure – needlesticks on the job.
The risk of disease after exposure to HBV from a single needle stick injury ranges from 27-37% while the risk following a single needle stick exposure to HIV is much lower, 0.2 – 0.4!
To make a 0.5% chlorine solution from 5% bleach mix 1 part bleach to 9 parts water
