This document outlines an infection control program and its success in reducing healthcare-associated infections (HAIs). It discusses the importance of infection control and reducing HAIs, providing data on HAI prevalence and impact. The program focused on improving hand hygiene, cleaning surfaces, using bundles to reduce central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. Through establishing protocols, audits, an infection control team, and emphasizing hand hygiene and environmental cleaning, the program was initially successful in reducing HAI rates.

1. INFECTION CONTROL PROGRAM
It Really Works!
Dr Prasad Rajhans
Chief Intensivist, Deenanath Mangeshkar
Hospital, Pune
Vice President, ISCCM
Consultant In EMS ,Symbiosis International
Unversity,Pune.

2. OBJECTIVES
• Everybody wants to control HAI but don’t know
where to start.
• Simple steps towards controlling HAIs.
• Would like to share with you our initial success.
• Would like to sensitize the doctors towards this
important issue.
• If you cant help the patient do no harm!

3. OBJECTIVES
• Environment
• Health Care Worker
• Patient
 Critical Care Specific
• VAP
• CRBSI
• UTI

4. Worlds Most Influential People

5. HAI QUOTES
• Hand hygiene is likely the most effective intervention
to reduce Health care Acquired Infection. Yet
clinicians do it only 30% of the time.
• Never doubt that a small group of thoughtful,
committed, citizens can change the world ... it is the
only thing that ever has." M. Meade
• 31,000 die from bloodstream infections each year.
That's the equivalent of a Boeing-747 crashing every
three days, killing everyone on board.

6. Prevalence of HAI

7. Prevalence of HAI

8. INFECTION RATES

9. HAI IMPACT

10. HAI IMPACT: Morbidity, Mortality, Cost

11. IT REALLY WORKS!

12. INDIAN DATA

13. ASIA
EPIC II study
Pseudomonas 28 %
Acinetobacter 19%
Candida 15%
MRSA 10 %
ASIA

14. Tropical Doctor > Volume 38, Number 4 > Pp. 233-235
Epidemiology of nosocomial infections in medicine intensive care
unit at a tertiary care hospital in northern India
This prospective observational study describes the rates of
nosocomial In 62 of the 182 enrolled patients 95 episodes
of NI were recorded (incidence rate 28.6/1000
person-days
Shabina Habibi MD et al
All India Institute of Medical Sciences, Ansari Nagar,
New Delhi 110029, India

15. MEDIA AWARENESS

16. •Excellent Infectious Disease and
Microbiology back up
•Dedicated Infection Prevention Protocol
•Avoid empiricism, culture guided therapy
Nosocomial Infections
Number of Positive Cultures

17. •Hand washing
adherence
•Surface cleaning
•Chlorhexidine body
Wipes and not
Sponging
•Clean the corners,
storerooms,
shelves
•Re Re Re Iteration
about
“ IATROGENICITY”
Versus
“INEVITABILITY”

18. Nosocomial Infections-- It works.

19. HOW TO START
• Take leave from clinical work.
• Sit in the Unit and observe all transactions.
• Make notes.
• Identify the problem areas.
• The eyes don’t see what mind doesn’t know.
 CONDUCT AN AUDIT OF THE PRESENT
SITUATION IN YOUR UNIT!

20. AUDIT TOOLS

21. Prevalence/Incidence

22. CONTAMINATED SURFACES

23. WATCH FOR ALL STORAGE
AREAS!
And what is being stored.
Are the clean and dirty items
getting mixed?

24. Handwashing

25. ALCOHOL BASED HANDRUB

26. HAND WASHING
• Single most effective method to
prevent cross infection
• Wash hands with soap and water :
– before procedure
– prior to & after removing gloves
– before pt care
– at beginning of duty
– prior to meals
– after using toilet
– after cleaning spillage

27. Attention! Health Care Workers

28. WASH BASINS

29. MATRESS/PILLOWS
Mattresses. Impermeable to fluids like Sweat,
Blood, Urine, Vomitus, Stools.
Alpha Beds –storage/cleaning.
Separate pillows for each patient for positioning
Curtains

30. SURFACE CLEANING

31. SPONGING

32. BED PANS/BED PAN WASHER

33. TAGGING

34. SCRUB DRESS

35. HCW FACTORS
1. Staff education
2. Hand washing compliance
3. Appropriate barrier precautions
4. Stethoscope disinfection between pts
5. Do not allow mobiles in pt care area
6. Short nails,no full sleeves ,no wrist
jewellery

36. LINEN
– Soiled linen should be collected in
impermeable bag at source
– Separate washing area for linen
– Transportation of clean and dirty linen should
be separate
– Handle linen with minimum agitation and with
appropriate precaution
– While washing soiled linen ,wear plastic gowns and
shoes

37. WASTE DISPOSAL
Proper segregation of waste and collection in colour
coded bins
– Handling of waste with barrier precautions
– Appropriate disposal of waste

38. PATIENT TRANSFER SLIDE
•Ambulation Chair
•Tansfer Boards
•Transfer Trolleys
•Transport Equipment

39. BUNDLE APPROACH
 A grouping of best practices with respect to a
disease process that individually improve care,
but when applied together result in substantially
greater improvement.
 Bundle elements are dichotomous and
compliance can be measured: yes/no answers.

40. VAP
• VAP occurs in 8% to 28% of patients undergoing
mechanical ventilation.
• Rates of VAP may vary from zero to 16 per 1000
ventilator days.
 Airway Equipment
• AMBU BAGS-
• Laryngoscopes/Stylets
• Nebulisation kits
• Closed Suction

41. VAP-DISPOSABLE HUMIDIFIERS

42. VENTILATOR BUNDLE

43. MOUTH CARE

44. VAP PREVENTION

45. CR-BSI BUNDLE
1) Hand hygiene
2) Maximal barrier precautions
3) Chlorhexidine skin prep
4) Optimal site selection
5) Daily review of line necessity

46. CA-UTI BUNDLE
1. Aseptic technique of isertion
2. Secure the catheter to lower
abdomen/thigh
3. Catheter should be continuously
connected to drainage system
4. Empty drainage bags in clean container
when full/Separate Containers for each uribag.
5. Provide pericare daily to the pt
6. Daily assessment of need of indwelling catheter

47. CA-UTI Causes

48. CA-UTI

49. INFECTION CONTROL TEAM

50. APIC
Association for Professionals in Infection Control And Epidemiology.

51. INICC

52. BSI
UTI
VAP
ALL
HAI!