MDI 2020 WEBINAR 03 On, “Safety And Risk Management For Healthcare Professionals “, September 8, 2020 , 12 Noon (India) & 9:30 am (Kenya) Focus : Safety, Infection Control, Biomedical Waste Management, Adverse Events

1. Infection Control Measures
Dr J L Meena
Joint Director
Hospital Networking & Quality Assurance,
Ayushman Bharat – Govt of India
Infection Control Measures
“IMDI 2020”

2. Prevention & Control of Infection is the responsibility of
each and every healthcare provider

3. Developing the Hospital Infection
Control Program

4. Sterilization
& Disinfection
Safe
Injections
Safe
Infusions
Prevention
of HAIs
Healthcare
Workers
Safety
BMW
Management
Infection
control in
Hospitals
Infection Control in hospitals
Surveillance - an integral part of this system
Standard
Precautions

5. The Infection Control Program
• Infection Control
Manual
• Standard and
additional precautions;
• Education and training
of health care
workers;
• Protection of health
care workers
• Surveillance and
incident monitoring
• Aseptic techniques
• Isolation of patients
• Use of single use devices
• Reprocessing of instruments and
equipment,
• Develop antimicrobial stewardship
• Outbreak investigation
• Proper biomedical waste disposal
• Environmental management
practices including support
services (e.g., Food, linen)

6. Infection control program
(ICP)
ICP, typically operates on two levels:
• an advisory body to the hospital management – the infection
control committee (ICC) – which adopts the ‘legislative’ role of
policy making.
and
• an executive body–the infection control team (ICT)

7. The ICC has the following tasks:
qTo review and approve the plan for infection control
qTo review and approve the infection control policies.
qTo support the IC team and direct resources to address problems as
identified
qTo ensure availability of appropriate supplies
qTo review epidemiological surveillance data and identify area for
intervention.

8. • To assess and promote improved practice at all levels of the health care
facility
• To ensure appropriate training in infection control and safety.
• To review risks associated with new technology and new devices prior to
their approval for use.
• To review and provide input into an outbreak investigation
• To communicate and cooperate with other committees with common
interests such as antibiotic committee, occupational health
committee….etc.
The ICC has the following tasks:

9. Infection Control Team (ICT)
qIt comprises the Infection control
doctor (ICD) – the Microbiologist and
Infection control nurses.
qThe ICT is responsible for the day- to-
day running of ICPs.

10. High risk areas
1.Operation Theatres
2.All Intensive care units / Haemo- Dialysis Unit
3.Post operative wards
4.Interventional Radiology
5.Blood Bank
6.CSSD / TSSU
7.Dialysis
8.Burns Unit
9.Delivery Room
10.Endoscopy Unit
11.Isolation Unit
12.Procedure Rooms

11. High risk procedures
1.Angioplasty
2.Angiography
3.Blood transfusion
4.Bone marrow biopsy
5.Dialysis
6.Deliveries.
7.Endoscopy
8.Surgeries
9.Ultrasound guided biopsies

12. Standard Precautions
• Hand hygiene
• Use of gloves
• Gown
• Mask
• Eye protection, or face shield
• Safe injection practices

13. Clean Hands ?
• Hands in the picture have just been washed and look clean
• But when checked under fluorescent and ultraviolet rays areas on the hands which have been missed.

14. Hand Hygiene
• Hand Hygiene
Hand hygiene is a general term that applies to any of following
• Hand wash - Washing hands with plain ( non antimicrobial ) soap and
water
• Antiseptic hand wash - Washing hands with soap having antiseptic
agent and water
• Antiseptic hand rub ( typically alcohol based) - Applying antiseptic hand
rub to all surfaces of the hand to reduce microorganisms
• Skin Flora
• Transient Flora - colonize superficial layers and more amenable to
removal
• Resident Flora - attached to deeper layers, more resistant to removal
CDC, Centre for Disease Control and Prevention, Guideline for Hand hygiene in health care settings, MMWR, 2002: 51 ( No. RR 16 )

15. 5 Moments of Hand Washing

16. Steps of Hand Washing

17. • Step 1 & 2
Remove all jewelry
Wet your hands and forearms thoroughly
• Step 3
Clean under each fingernail with a stick
or brush
• Step 4
Hold your hands up above elbow level
and apply antiseptic in a circular
motion fingertip to elbow.
Repeat for second hand
Continue in this way for 3-5 minutes.
Steps of Surgical Hand Wash

18. • Step 5
Hold your hands above elbow and rinse
the finger tips first and each arm
separately
• Step 6
Use sterile towel, dry your arms--from
fingertips to elbow.
Use different side of the towel on each
arm
• Step 7
Keep hands above the wrist level.
Do not touch anything.
Put on sterile gloves.
Steps of Surgical Hand Wash

19. Hand hygiene is the
simplest, most effective
measure for preventing
hospital-acquired
infections.

20. Injection safety

21. Magnitude of Unsafe Injections
• Of all the injections administered in India, one third carried
a potential risk of transmitting Blood Borne Virus.
• Unsafe injection due to faulty technique was observed in
53.1 percent of injections.
• Together these two factors, at the country level made nearly
two third of the injections unsafe

22. What is a Safe Injection?
WHO states that a Safe Injection is one that –
• Does not harm the recipient
• Does not expose the healthcare
worker to any risk; and
• Does not result in waste that
is dangerous to the community
Reuse of equipment
Unsafe collection
Unsafe
disposal

23. How to make injections safe
to Patients
q One syringe, one needle one time
qUse correct gauge and length of needle required for injection
q Use correct site depending on volume and age of the patient
for delivering the injection.
q Use correct angle for insertion of the needle depending on
route of administration.
q Check expiry date of drugs and vaccines before using them on
the patient.
q Make sure that the vial/ampoule contains right drugs in the
appropriate strength and doses for the patient.
qProper storage of drugs

24. • Avoid needle stick injuries- be needle smart-Do not re
cap/bend/remove/ transport/reuse used needles.
• Use needle stick injury prevention Equipments.
• Ensure that all Health Care Providers in the health facility are
immunized with 3 doses of Hep B vaccine.
• Train all HCW on awareness of Needle Stick Injuries (NSI). Post
Exposure Prophylaxis (PEP) should be mandatory and handled by
the hospital in case of NSI.
How to make injections safe to
Healthcare Professionals

25. • Hazardous needle waste generated needs to be secured.
• This is possible by:
a. Bringing awareness among health workers,&
community about potential hazards of sharp waste.
b. Minimizing / segregating / decontaminating
(disinfecting) the hazardous waste.
c. Use Sharps Containers that prevent injuries to
healthcare workers
d. Destroy (mutilate) used items to prevent their reuse.
How to make injections safe to
the community

26. Cleaning disinfection
sterilization

27. 27
DEFINITION OF TERMS
• Sterilization describes a process that
destroys or eliminates all forms of
microbial life and is carried out in health-
care facilities by physical or chemical
methods. Steam under pressure, dry heat,
EtO gas, hydrogen peroxide gas plasma,
and liquid chemicals are the principal
sterilizing agents used in health-care
facilities.
• Disinfection describes a process that
eliminates many or all pathogenic
microorganisms, except bacterial spores,
on inanimate objects. In health-care
settings, objects usually are disinfected by
liquid chemicals or wet pasteurization.
CDC - Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

28. 28
DEFINITION OF TERMS
• High-level disinfection is defined as complete
elimination of all microorganisms in or on an
instrument, except for small numbers of
bacterial spores. The FDA definition of high-
level disinfection is a sterilant used for a shorter
contact time to achieve a 6-log10 kill of an
appropriate Mycobacterium species.
• Cleaning is the removal of visible soil (e.g.,
organic and inorganic material) from objects
and surfaces and normally is accomplished
manually or mechanically using water with
detergents or enzymatic products.
CDC - Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

29. 29
DEFINITION OF TERMS
• Decontamination removes pathogenic
microorganisms from objects so they are safe to
handle, use, or discard.
• Germicide is an agent that can kill microorganisms,
particularly pathogenic organisms (“germs”).
• Antiseptics are germicides applied to living
tissue and skin.
• Disinfectants are antimicrobials applied only
to inanimate objects.
CDC - Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

30. 30
Spaulding’s Classification
EH Spaulding believed that how an object will be disinfected depended on the object’s
intended use
• CRITICAL - objects which enter normally sterile tissue
or the vascular system should be sterile.
• SEMICRITICAL - objects that touch mucous membranes or skin that is not intact require
a disinfection process (high-level disinfection [HLD]) that kills all microorganisms and
high numbers of bacterial spores too.
• NONCRITICAL - objects that touch only intact skin
require low-level disinfection.
CDC - Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

31. 31
Recommended Practices
Monitor
Clean
Safe Device
No infection
Contaminated
Device
Rinse/
Flush
Dry
PackDisinfect/
Sterilize

32. 32
The Instrument Cleaning Process
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Soak or wipe
with damp
cloth
at point of use
to prevent
drying
of biosoil on
instrument
Ultrasonic washer
with Enzyme
detergent
for complex
instruments
Manual Washing
with Enzyme
detergent
at a sink
Automatic Washer
with
Enzymatic Detergent
Rinse
with
large
amount
of water Dry & pack
for Steam or EO
for critical* items
Soak in High Level
Disinfectant
eg. Glutaraldehyde
for semi-critical*
items
Rinse with
sterile or
ultra-clean
water
or
or
or
or
Store for future
use for
non-critical* items
* According to Spaulding classification of types of instruments

33. 33
Bowie-Dick Test - negative Bowie-Dick Test – positive
Equipment Control

34. 34
Exposure Control
• External chemical indicator
• Use on the outside of
each package unless the
internal chemical
indicator is visible. If not
changed don’t
use package.

35. 35
Load Control – Biological Indicators
lBiological indicator weekly to every load
(recommendation is for daily)
lBiological indicator In every load that contains
an implantable device
- Quarantine until the B.I. result is negative
lBiological indicator in every load for ETO

36. Antibiotic policy
• Antibiotic resistance
• Antibiograms
• Adherence to antibiotic policy

37. Antibiotic Stewardship program
• Leadership Commitment
• Accountability: single leader responsible for program
• Drug Expertise: single pharmacist leader responsible
• Action: at least one recommended action, such as “antibiotic time
out” after 48 hours
• Tracking: Monitoring antibiotic prescribing and resistance patterns
• Reporting of antibiotic use and resistance to doctors, nurses and
relevant staff
• Education: Educating clinicians about resistance and optimal
prescribing

38. Laundry and linen
• Automated Mechanical Washing Machine and Tumble dryer, Calendar
Machine
• Soiled linen:
All linen that is contaminated with blood, excreta or other body fluids
is placed in yellow laundry bags and cleaned after disinfection.
• Clean linen:
Covered linen carts used to transport clean linen to the wards and
units. Stored in closed cupboards.

39. Kitchen sanitation
• All food handlers should undergo regular medical examination.
• All staff are immunised with HBV, Typhoid Vaccine and Tetanus toxoid.
• Staff trained on Kitchen sanitation and safe handling of food items
and guidelines are provided.
• Appropriate PPE provided and checklist for PPE maintained at
Cafeteria

40. Engineering controls
• Temperature should be maintained at 21 +/- 3 Deg C inside the OT all the
time.
• Humidity ‘Relative Humidity’ between 40 to 60%
• Air Change per Hour: 30 air exchanges per hour . The fresh air component of
the air change is 14 air changes out of total.
• HEPA filter installation in Major OT
• Air curtains at entrance of MICU, OT, Post OP, Onco Post Op,
• Biosafety cabinet for preparation of cytotoxic drug.
• Over Head tank schedule ( Schedule formulated).Water filter servicing
Schedule .Water testing done every 3 months. ( Schedule formulated)

41. House Keeping
• Disinfectants And Cleaning Solutions Used
• Toilet Cleaning checklist
• Cleaning Protocols provided
• Pest Control: done every three months.
• Spill kits with guidelines in every clinical area
• Blood And Body Fluid Spill kit
• Mercury Spill kit
• Cytotoxic Spill kit

42. Surveillance activities that needs to be
carried out:
1.Surveillance of the following HAIs':
• Central line associated blood stream infection (CLABSI)
• Catheter associated urinary tract infection (CAUTI)
• Ventilator associated pneumonia (VAP)
• Surgical site infection (SSI)
• Bed Sores
• Phlebitis
2. Hand hygiene compliance
3. Monitoring of equipment's for sterilization / disinfection
4. Biomedical waste disposal
5. Surveillance of Healthcare Workers Safety
vNeedle stick injuries (NSI)/
vblood & body fluid exposure to healthcare workers
6. Periodic microbiology data from the lab to be evaluated

43. Biomedical waste
management
• Authorization
• Segregation, collection, disposal
• Annual returns and other reports
• Visit to vendor site
• Use of PPEs

44. Spill management

45. Other measures
• Notifiable diseases- IDSP format, Forms
• Use of PPEs
• Isolation and Barrier Nursing
• Pre and Post exposure prophylaxis
• Outbreak management
• Regular training on Infection Control
• Budgeting for IC

46. THANKS
“Want your support for Improvement”