Roshan Hadwani RN, RM, BScN

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Roshan HadwaniRN, RM, BScN
Infection Control Hospital SettingConcept
Principles
The Aga Khan University Hospital
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Infection control

• DEFINITION
• Infection control is a discipline that applies
  epidemiology and scientific principles and
  statistical analysis to the prevention or
  reduction in rates of nosocomial infections
• Infection Control Team
• HCWs

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• Objective of IC in Hospital Setting
• The main objective of the infection control team
  is to prevent and reduce nosocomial infections.
• By following intervention
• 1. Take responsibility for major decision e.g.
  outbreak
• 2. Be given reports on current problems and on
  the incidence of infection.
• 3. Arrange interdepartmental co-ordination and
  education in control of infection.
• 4. Introduce, maintain and when necessary,
• modify policies (e.g. disinfectant,
  isolation)
• 5. Advise on the selection of equipment for the
  prevention of infection (e.g. sharp boxes)
• 6. Make recommendations to other committees and
  departments on infection control techniques.

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Important Components of Infection Control

• Universal Precautions
• Hand washing
• Isolation Precautions
• Cleaning, Disinfections Sterilization
• Linen Management and Waste Disposal
• Needle Stick Injury and Hep B Vaccination

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Universal Precautions

• Definition
• Universal Precautions concept should stress
  that all clients should be assumed to be
  infectious for blood borne disease such as HIV or
  Hepatitis B and gram positive and negative rods
  colonized i.e. MARO MRSA.

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Recommendations

• Barrier Precautions
• Invasive Procedures
• Wash contaminated body part
• Proper sharp disposal
• Avoid Re-capping
• Masks, eye protection
• Cleaning of Patients equipment
• Environmental cleaning and terminal cleaning
• Linen Management
• Hand washing

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Hand washing

• Definition
• Hand washing is define as a vigorous, brief
  rubbing together of all surfaces of lathered
  hands, followed by rinsing under a stream of
  water.

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Classification of Hand washing
hand washed
Hand washing
Scrubbing
hand rub
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Recommendations

• Hand must be washed thoroughly with soap and
  water when visibly soiled.
• Hands must be cared by hand washing with soap and
  water
• Before and after contact.
• After contact with a source of microorganisms
  e.g. contamination object.
• After removing gloves.
• Wet hands with running H2O. Apply hand-washing
  agent and thoroughly distribute over hands, rub
  hands thoroughly together for 10 15 seconds,
  covering all surfaces of the hands and fingers.

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Recommendations (cont..)

• For general patient care, a plain,
  nonantimicrobial soap is recommended.
• Hand antisepsis achieved by HW with antimicrobial
  containing soap or use of alcohol based
  antiseptic hand rubs.
• Before performing invasive procedure
• When it is important to reduce numbers of
  resident skin flora in addition to transient
  microorganism.
• In setting where hand washing facilities are
  inadequate or in accessible and hands are not
  soiled with dirty or heavily contaminated with
  blood or other organic material, alcohol based
  hand rubs are recommended.

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Isolation

• Definition
• Isolation refers to the precautions that are
  taken in the hospital to prevent the spread of an
  infectious agent from an infected or colonized
  patient to susceptible persons

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Purpose of Isolation

• Isolation practices are designed to minimize
  the transmission of infection in the hospital,
  using current understanding of the way infectious
  can transmit. Isolation should be done in a user
  friendly, well accepted, inexpensive way that
  interferes as little as possible with patient
  care, minimizes patient discomfort and avoids
  unnecessary use.

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Isolation Precautions

• Isolation precautions are designed to prevent
  transmission of microorganisms by following roots
  in hospital.
• Contact transmission
• Direct contact e.g. between two patients
• Indirect e.g. needles, dressing, contaminated
  instruments
• 2. Droplet transmission e.g. generated by
  coughing, sneezing, talking
• 3. Airborne transmission e.g. droplet
  containing microorganism that remain suspend in
  the air or dust part.
• 4. Common vehicle transmission e.g. food,
  water, medication , devices , equipments
• 5. Vector-borne transmission e.g. by
  mosquitoes, flies, rats

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Recommendations

• Hand washing.
• Use of latex or other protective gloves.
• Masks, eye protection, face shield.
• Gowns.
• Proper handling of soiled patient care equipment.
• Proper environment cleaning.
• Minimal handling of soiled linen.
• Proper disposal of needles and other sharp
  equipment such as scalpels.
• Placement in a private room for patients who
  cannot maintain appropriate cleanliness or
  contain body fluids.

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Cleaning, Disinfectant and Sterilization.

• CLEANING
• Definition
• Cleaning is a process intended to remove any
  substances (soil) that is not part of the
  structure or designated to assist the function of
  item being cleaned.

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Cleaning

• Requirement
• Cleaning is usually adequate for any item that
  does not come into prolonged close contact with
  susceptible individuals

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Disinfections

• Definition
• Disinfections involves the destruction of
  microbes but not necessarily bacterial spores

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Disinfections

• Requirement
• Cleaning contaminated spillage.
• Decontamination of environment.
• The treatment of items to be brought indirect
  contact with patient.
• Routine cleaning of high-risk areas.

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Sterilization

• Definition
• Sterilization is usually described as the
  complete destruction or removed of all
  microorganisms.
• Requirement
• Surgical Instruments

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Linen Management and Waste management

• Definition
• The methods for handling, transporting and
  laundering of soiled linen are determined by
  hospital policy and any applicable regulations.
• An important element of infection control is
  appropriate disposable of waste. Hospital
  generally used a color-coded bag system for waste
  disposal.

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Needle Stick Injury (NSI) and Hepatitis B
Vaccination

• NSI are an important and continuing cause of
  exposure to serious and fatal disease among
  health care worker.
• These injuries can be avoided by eliminating
  the unnecessary use of needles, using devices
  with safety features and promoting education and
  safe work practices for handling needles and
  related systems

DANGER
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According to CDC..

• HIV 0.3
• HBV 6 to 30
• HCV 1.8

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THANK YOU
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References

• Ayliffe, G., Fraise, A., Geddes, A. Michele, K.
  (2000), Control of Hospital Infection A
  Practical Handbook (4th edition) London Arnold.
• Hammersmith Hospitals NHS Trust, Infection
  Control Policy,2002
• Center of disease control (CDC), Division of
  tuberculosis elimination (July 2000)
• Rotter M. Hand washing and hand disinfection
  Chapter 87. In Mayhall CG, ed. Hospital
  epidemiology and infection control. 2nd ed.
  Philadelphia, PA Lippincott Williams Wilkins,
  1999.
• Hepatitis B infected health care workers guidance
  on implementation of health service circular
  2000/020
• Infection control manual of AKUH (2003)
• AKUH, Infection control Newsletter, volume1,
  July, 2002.
• Needle Stick Injuries. Available online at
  http//www.Hospital.be/hospital1212002/features/ne
  edle. html
• Wang S.H.et al. (2003) health care associated out
  break due to pan-drug resistant Acinetobacter
  Baumanii in a surgical intensive care unit
  journal of hospital infection 5397-102.