1. IP INFECTION
PREVENTION
Importance & purpose
of IP practices
1

2. IP Principles have Two main aims
• To reduce the rate of infection and disease
transmission to patients
• To protect health care providers
Universal Precautions are minimum level
of infection prevention required to prevent
the transmission of infection within all
health care settings
2

3. IP Universal Precautions
applications
• While handling blood, including
dried blood
• All other bodily fluids, secretion
and excretions,
• Non – intact skin: and
• Mucous membranes
3

4. IP Universal Precautions
Includes
 Good hygiene practices
 Safe handling of sharps
 Cleaning treatment
 Cleanliness of care areas
 Disposing of medical waste
4

5. IP Viral Transmission Risk
 Risk of acquiring HIV after being
stuck with a needle from an HIV+
client
4 : 1000 or 0.4 %
 Risk of acquiring HBV after being
stuck with a needle from an HBV+
client
27 - 37: 100 or 30 %
5

6. IP Accidental Exposure of
HBV Infected Blood
As little as 10-8 ml (0.00000001 ml)
of HBV-infected blood can transmit
HBV to a susceptible host.
Source: Bond et al 1982
6

7. IP Infection Prevention
Objectives
 To prevent major postoperative / post
procedure infections
 To minimize the risk of transmitting
infections such as Hepatitis ‘B’, ‘C’
and HIV not only to clients, but also
to service providers and staff
7

8. IP Importance of Infection
Prevention Practices
• Prevents post procedure infections
• Result in high quality and safe services
• Prevents infections in service providers
• Protect the community
• Prevent antibiotic resistant
• Lower the cost of health care services
8

9. IP Standard
• Precautions
Wash your hands
• Wear gloves and other protective
attires
• Correctly process instruments
• Maintain correct environmental
cleanliness
• Appropriate waste disposal practices
• Prevent injuries with sharps
9

10. Handling Needles
and Sharps Processing
IP Instruments
Hand washing
Waste Disposal
Protective
Barriers
10

11. IP Infection Prevention
Principles
 Consider every person (clients
and staff) infectious
 Wash hands - the most practical
procedure for preventing cross-
contamination (person to person)
11

12. IP Infection PreventionPrinciples
(cont'd)
 Wear gloves before touching
anything:
wet/broken skin, mucous membranes, blood
or other body fluids (secretions / excretions)
or solid instruments and other items.
 Use physical barriers (protective
goggles, face masks and aprons) if splashes
and spills of any body fluids (secretions /
excretions) are anticipated.
12

13. Infection Prevention
Principles (cont'd)
IP
Use safe work practices, such as
not recapping or bending needles
and safely passing sharps
instruments.
Isolate patients only if secretions (airborne)
and excretions (urine or feces) cannot be
contained.
13

14. Infection Prevention
IP Principles (cont'd)
Process instruments and other items
(decontaminate, clean, high-level
disinfect or sterilize) using
recommended infection prevention
(IP) practices
..........and finally:
14 Properly disposing medical waste.

15. IP Handwashing Practices
 Handwashing is the
most important way to
reduce the spread of
infections. But it is
often
underemphasized, and
15 not performed

16. Hand-
Washing
16

17. IP Handwashing Rules
Wash hands before and after
examining any client ( direct contact )
Wash hands after removing gloves.
Wash hands after exposure to blood or
any body fluid (secretions and excretions)
even if gloves were worn.
17

18. Types of
IP Handwashing
 Routine Handwashing
 Surgical Hand scrub
 Alcohol Hand rub
18

19. Routine Handwashing
IP Practices
1 Use plain or antiseptic soap.
Vigorously rub lathered hands
2
together for 15 - 30 seconds.
Rinse with clean running water
3
from a tap or bucket.
4 Dry hands with a clean towel or air dry
19 them

20. Process of Surgical Hand
IP scrub
 Remove all jewelry
 Wet hands and forearms thoroughly
 Clean under fingernail
 Apply antiseptic. Circular Motion. Continue
for 3-5 minutes.
 Rinse each arm separately.
 Use sterile towel to dry
20

21. IP Surgical Hand scrub Supplies
• Antiseptic or soap (plain)
- If an antiseptic is not available, use plain soap
followed by applying an alcohol solution and rub
until dry two times.
• Running water
• Stick or brush for cleaning the fingernails
• Soft brush or sponge for cleaning the skin
• Sterile Towels (sterile towels to be provided for the
operating room)
21

22. Process of Alcohol Hand
IP rub
Formula
2 ml glycerin or
propylene glycol in
100 ml of 60-90%
alcohol Use 3 - 5 ml for each
application and
continue rubbing the
solution over the hands
for about 2 minutes,
using a total of 6 - 10 ml
22
per scrub

23. IP Protective Barriers:Gloves
Wear gloves:
- when performing a procedure in
the clinic or operating room
- when handling soiled gloves,
instruments,and other items
- when disposing of contaminated
waste items (cotton gauze, dressings)
23

24. IP Types of gloves and
their Uses
 Surgical gloves
Should be worn during all procedures in which
there will be contact with blood stream or
tissues under the skin
 Single use examination gloves:
- To reduce the risk of exposing the service
providers to blood or body fluids
 Utility gloves:
- Should be worn for handling contaminated
instruments, linens and medical waste.
24

25. IP Protective Barriers:
Goggles, Face Masks, Aprons
Wear protective
goggles, face masks,
and aprons if
splashes and spills of
any body fluids are
likely.
25

26. IP
26

27. What parts of the field are
sterile?
27

28. IP Processing of Instruments
and other Items
• Decontamination
• Cleaning
• Sterilization
or
High-level disinfection
• Storage
28

29. IP Decontamination
• Definition
It is the first step in processing instruments
and kills viruses and many other
microorganisms making instruments and
other items safer to handle by staff who
clean them.
• Bleach ( Sodium Hypo chlorite)
• It is inexpensive,
• kills HIV, hepatitis B & hepatitis C quickly
• Can be used to decontaminate large surfaces
29

30. IP Processing Soiled
Instruments and Other Items
Decontamination
Place instruments and reusable gloves
in 0.5% chlorine solution after use
Soak for 10 minutes and rinse immediately
Wipe surfaces (exam tables) with chlorine
solution
30

31. Instructions for Preparing
IP Dilute Chlorine Solutions
% Concentrate
Total Parts (TP) (H O) =
2 ( % Dilute )-1
To make a 0.5% chlorine solution
from 5% bleach mix:
1 part bleach to parts water
31

32. Instructions for Preparing
Chlorine Solution from
Powder
IP
% Dilute desired
Gram / Liter = ( % Concentration
of chlorine in bleach
) x 1000
powder
To make a 0.5% chlorine solution from
a 35% chlorine powder mix:
15 Tea spc (14.2 grams) of
powder to 1 liter of water
32

33. Processing Soiled
IP Instruments & Other Items
Cleaning
Wash with detergent and water
Scrub instruments until visibly clean
Thoroughly rinse with clean water
33

34. High Level
IP Disinfection
 Disinfection:
Process that eliminates all
microorganisms but does not
reliably kill all bacterial
endospores which cause
diseases such as tetanus and gas
gangrene.
34

35. IP Methods of HLD
Boiling: Soaking in Chemicals:
• Boil instruments • Steam instruments,
and other items for gloves, and other items
20 minutes for 20 minutes
Steaming:
• (sufficient up to • An alternative to this is HLD
18,000 ft / 5,500 mtr by use of chemical
altitude) disinfectant. Soak for 20
minutes.
35

36. Boiling Tips
IP
Always boil for 20 minutes
in a pot with a lid.
Start timing when the
water begins to boil.
Do not add anything to the pot
after timing begins.
36 Air dry before use or storage.

37. IP Steaming Tips
Always steam for 20 minutes.
Be sure there is enough water in the
bottom pan for the entire steam cycle.
Bring water to a rolling boil.
Start timing when steam begins to come out between pans.
Do not add anything to the pan after timing starts.
37
Air dry and store in the covered steamer pans.

38. IP Chemical High-level
Disinfection Tips
Cover all items completely with high - level
disinfectant.
-
- Soak for 20 minutes
- Rinse with boiled water
- Air dry before use and storage
38

39. Preparing a High-Level
Disinfected Container
IP
Boil (if small) ......... or
Fill a clean container with 0.5% chlorine
solution
- Soak for 20 minutes
- Pour out solution. (The chlorine solution can
then
be transferred to a plastic container and
reused.)
-39
Rinse thoroughly with boiled water

40. Sterilization
IP
 Definition:
Process that eliminates all
microorganisms including
bacterial endospores.
40

41. IP Methods of Sterilization
Steam (autoclave) or
Dry heat (oven)
Chemical
41

42. Standard Conditions for Heat
IP Sterilisation
Steam Sterilization
121°C (250 ° F) at 106 kPa
(15 lbs/square inch)
pressure
- 20 minutes for Allow all items to dry
unwrapped items before removal to dry
sterile container
- 30 minutes for
wrapped items
42

43. Standard Conditions for Heat
IP Sterilization
Dry Heat
By Electrical Oven
170° C. (340° F.)
for 1 hour ..... or
160° C. (320° F.)
for 2 hours
43

44. IP Chemical Sterilization
 Soak items in Glutaraldehyde
for 10 hours
 Rinse in sterile water
 Store in a sterile container
44

45. Sterilization of Various
Instruments
45

46. Sterilization of various
IP instruments
Instrumen Sterilization Time/press
t/Item ure
46

47. Sterilization of Various
IP Instruments
47

48. Processing MVA Equipment
IP
Step 3: P roc essing syringes
Syringes should be soaked in 0.5% Chl ori ne for 20 minutes,
then rinsed and dried
Syringes should be reassembled when dry, lubricated,
and stored in a clean, dry cont ainer
Do NOT boil syri nges.
Step 4: S torage
Pl ace cannulae in separate steril e
(or HLD) container usi ng steri le pi ckups
Use s teril e forceps to remove it ems from contai ner
Avoid contam inating other cannulae in container.
Do NOT autoclave
either syringes or cannulae!
48

49. IP Effectiveness of Methods for
Processing Instruments
Method Effectiveness End point
(removal/inactivation of
microbes)
Decontamination Kills HBV 10 minute soak
and HIV
Cleaning (water Up to 50% Until visibly
only) clean
Cleaning Up to 80% Until visibly
(detergent clean
and rinsing with
water)
Sterilization 100 % High pressure
steam (autoclave),
dry heat, chemical
High-level Disinfection * 95% (does not Boiling, steaming
*Prior decontamination inactivate Or chemical
and thorough cleaning some endopores)
required.
49

50. Waste Disposal
50

51. Waste
IP Disposal
Types of waste
 General Waste
 Medical Waste
 Hazardous Chemical Waste
51

52. Four Aspects of
Medical Waste
IP
Management
 Sorting
 Handling
 Interim Storage
 Disposal: Incinerator is always the
best method of disposal medical
waste.
52

53. IP Disposal of Sharps
Collect sharp items in
puncture proof
containers
Transport securely to
disposal place
 Decontaminate
and bury in safe place
Burn in high temperature
incinerator or
53

54. Waste Disposal
Practices
 Place contaminated items in leak-proof
container or plastic bag.
 Dispose by incineration or burial.
54

55. Antiseptics and
IP Disinfectants
Antiseptics:
A chemical agent used on the skin
and mucous membranes to remove
or kill microorganisms without
causing damage or irritation to the
skin and mucous membranes .
55

56. IP Disinfectant
Definition:
A chemical agent used to kill
microorganisms on inanimate
objects, such as instruments and
surfaces. Disinfectants are not
meant to be used on the skin or
mucous membranes.
56

57. IP Uses of antiseptics
 Surgical hand scrub
 Skin, cervical and vaginal
preparation
 Hand washing in high risk
situation:
57

58. Skin Preparation Prior to
IP Surgical Procedure
Purpose:
To minimize the number of microorganisms
on the skin or mucous membranes by:
- Washing with soap and water
- Applying antiseptics
58

59. Skin Preparation Prior to
IP Surgical Procedure
59

60. Skin Preparation Prior to
IP Surgical Procedure
Purpose:
To minimize the number of microorganisms
on the skin or mucous membranes by:
- Washing with soap and water
- Applying antiseptics
60

61. Skin Preparation Prior to
IP Surgical Procedure
61

62. Skin and Mucous Membrane
IP Preparation
Do not shave hair ! Clip with scissors if
necessary.
Ask the client about allergic reactions.
Wash first with soap and water if
visibly soiled.
Apply antiseptic starting from the
operation site and working outward
in a circular motion for several inches.
62

63. IP Cervical and Vaginal
Preparations
Apply antiseptic solution liberally to the
cervix and vagina (2 times)
It is not necessary to prep the external genital
area if it appears clean.
- If heavily soiled, it is better to have
the client wash her genital area
thoroughly with soap and water
before starting the procedure.
63

64. IP Management of sharp
injuries
 Wash needle sticks and cuts with
soap and water
 Flush splashes to the nose, mouth
or skin with water
 Irrigate splashes to the eyes with
water or saline
64

65. Avoid dipping hands in a
IP basin containing stand
water
65

66. IP
66

67. Conclusion
 IP can’t be a stand-alone
practice; it needs to be
integrated into all areas of the
clinical reproductive health
environment.
 IP principles can be adapted to
any environment.
 IP is important; it’s cheap; you
can do it!
67

68. Hand Washing
 Wet hands with running water
 Rub hands together with soap & lather
well, covering all surfaces, for 30
seconds
 Weave fingers & thumbs together 7 slide
them back & forth
 Rinse hands under a stream of clean,
running water until all soap is gone
 Blot hands dry with a clean personal
towel or air dry
68

69. Usually left out parts during
Hand Washing
69

70. Hand Washing
70

71. Hand Washing
71

72. Steps of Surgical Hand washing
1. Remove all jewelry, watch etc. on
hands forearms & wrist
2. Wet hands & forearms thoroughly
3. Clean all finger nails with soft nailbrush
4. Apply antiseptic soap/solution
5. Using a circular motion, continuing
from finger tips to elbow, create lather
& wash between fingers
6. Repeat for the second hand & arm
72

73. Steps of Surgical Hand washing
contd……
7. Continue washing for 3 – 5 minutes
8. Rinse each arm separately, fingertips
first, holding your hands above the level
of your elbow.
9. Use a sterile towel to dry hands or air dry
10. Keep hands above the level of waist and
do not touch any thing.
73

74. Steps of Putting on Sterile
Surgical Gloves
74

75. Steps of Putting on Sterile
Surgical Gloves
75

76. Steps of Putting on Sterile
Surgical Gloves
76

77. Processing Instruments, gloves
and other items
Decontamination
Soak in 0.5% Chlorine solution 10 minutes
THROUGHLY WASH & RINSE
Wear gloves & other protective barriers
Preferred Acceptable
Methods Methods
STERILIZATION HIGH LEVEL DISINFECTION
AUTOCLAVE CHEMICAL BOIL CHEMICAL
15lbs/in ² Soak in Lid on 20 Soak in CIDEX
pressure CIDEX for 8- minutes for 20 min.
121˚C,20 min. 10 hours. Rinse with
unwrapped 30 Rinse with water boiled for
min wrapped sterile water 20 minutes
77
COOL & DRY (use immediately or Store)