10 a prevention of infection 16 sept

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Prevention of Infection

Maternal Health DivisionMinistry of Health & Family

WelfareGovernment of India

BEMoC - Presentation 10 (a)

Session 10a

PREVENTION OF INFECTION



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Session Objectives

Understand the concept and importance of infection prevention

Know and practice the standard procedures to be undertaken in the facility and specifically the labour room




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WHY?

Minimise the risk of HIV, Hepatitis B, C and streptococcal/staphylococcal infections

Appropriate prevention practices to:• reduce post-procedure infection• prevent infection of health care personnel• protect the community• lower the costs of healthcare




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Sources of Infection

What are the common sources of infection?

Environment: Blood, body fluids, secretions, excretions, placenta, contaminated sharps and other equipments.

Other clients

People in the community

Health care delivery personnel




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Infection prevention principles

All objects that come in contact with a patient are potentially contaminated

Every person must be considered potentially infectious

If an object is disposable - discard appropriately

If an object is reusable - decontaminate




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Universal (Standard) Precautions

“Precautions to protect against exposure must be taken when there is any potential for exposure to bodily fluids. It is assumed that all bodily fluids have the potential to transmit disease”

The Universal Precaution Rule:

Treat all human blood, bodily fluids and other potentially infectious materials

as if they are infectious.




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Components of universal precautions

Hand washing

Careful handling of sharps

Safe techniques

Sterilization and Disinfection

Disposal of waste in a proper manner

Use of Personal barrier precautions

ASSUME ALL BODY FLUIDS FROM ALL PERSONS ARE POTENTIALLY INFECTIOUS




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Standard Precautions: Hand Washing

LongAntibacterial soap, Alcoholic solutions

Pre-operative disinfection

Surgical hand disinfection

DisinfectionAlcoholDisinfection after contamination

Hygienic hand rub

ShortNon medicated soap

Cleansing after client contact

Careful hand washing

ShortNon medicated soap

CleansingRoutine hand washing

Residual effect

AgentsMain PurposeTechnique




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Specific Indications for Hand Hygiene

Before: Patient contact Inserting urinary catheters, peripheral vascular,

I/V cannula ,catheters, or other invasive devices that don’t require surgery

After: Contact with a patient’s skin Contact with body fluids or excretions, non-

intact skin, wound dressings Removing gloves




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Steps of hand washing

Step 1Wet the hands and wrists. Apply soap.

Step 2Right palm over left,

left over right.

Step 3Palm to palm,

Fingers interlaced.

Step 4Back fingers to opposing

Fingers interlocked.

Step 5Rotational rubbing of right

Thumb clasped in left palm and vice versa.

Step 6Rotational rubbing

backwards and forwards with top of fingers and

thumb of rightHand in left and vice

versa.




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Missed Spots when Hand-washing




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Standard Precautions: Protective attire

Gloves Masks Eye-covers Gowns Caps Footwear

*use once then change




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Standard Precautions: Processing of used items

A. Decontamination

B. Cleaning

C. Sterilization or high level disinfection

(HLD)

D. Storage




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Processing of used items

Decontamination: kills pathogens• Place instrument in 0.5% chlorine for 10min• Wipe contaminated surfaces

Cleaning: with soap and water – scrub equipment

Sterilization: for surgical instruments and drapes




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Standard Precautions: Maintaining clean environment

For cleaning areas – operation theatres, procedure rooms, latrines

Disinfectant cleaning solution

To clean up spills of blood or other body fluids

Disinfectant 0.5 % chlorine solution

To remove dirt & organic material such as grease, oil

Plain detergent and water

UsesType of cleaning solution




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Steps of Decontaminnation

Monitor vitals

Take steps to stabilize woman’s condition

If condition worsens, assess the level of shock

Treat accordingly & refer the patient to an FRU with basic life support

Specific treatment: as mentioned according to the type of abortion




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Missed Spots when Hand-washing




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Recommended Disinfectants

.5 to 1% bleach

2% glutaraldehyde

70% ethyl and isopropyl alcohol.

4% formaldehyde.

.5-1% sodium hypochlorite.




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Sterilization: Sterilization ensures that items are free of all

microorganisms (bacteria, viruses, fungi and parasite) including endospores.

Three methods of sterilisation: Steam sterilisation / Autoclaving / Pressure

cooker autoclaving Dry heat sterilisation Chemical / cold sterilisation




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Sterilization: High level Disinfection HLD eliminates bacteria, viruses, fungi and

parasites, but does not kill all endospores which cause diseases such as tetanus and gas gangrene.

HLD only acceptable alternative to sterilisation. There are 3 methods of HLD:

• Boiling• Chemical HLD • Steaming




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Storage:

To prevent contamination after processing

Do not store instruments or other items such as

scalpel blades and suture needles in solution,

always store them dry

Follow the guidelines written on the container,

instructed by the manufacturer




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Standard Precautions: Proper Handling and Disposal of sharps

Needles and syringes Use disposable needle and syringe ONLY ONCE.

Always wear utility gloves while handling sharps

Do not recap, bend or break needles before disposal.

Make needles unusable after single use by burning them in a needle destroyer

Never burn syringes

Do not reuse disposable gloves




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Standard Precautions: Proper Handling and Disposal of sharps

Needles and syringes Dispose off needles and syringes in a puncture-proof

container such as metal box, cardboard box or an empty plastic box.

Syringes to be cut with hub cutters and chemically disinfected at source of generation before final disposal into sharps pit located at the PHC

Finally dispose as follows:

• Dispose the needles and broken vials in pit / tank, (made according to the GOI guidelines)

• Send the syringes and unbroken vials for recycling or landfill




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Standard Precautions: Maintaining clean environment

For cleaning areas – operation theatres, procedure rooms, latrines

Disinfectant cleaning solution

To clean up spills of blood or other body fluids

Disinfectant

0.5 % chlorine solution

To remove dirt & organic material such as grease, oil

Plain detergent and water

UsesType of cleaning solution




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What are the colour codes for segregation?

Yellow for infectious waste such as anatomical & pathological wastes, such as body parts and animal carcasses, soiled dressings such as gauze, cotton, linen, etc. contaminated with blood or other body fluids

Red for infectious plastics such as gloves, IV sets, tubings, catheters, canulas, microbiological waste, etc.

Translucent/puncture proof containers for metal sharps

Blue for glass Black for cytotoxic drugs, incinerator ash, chemical

waste, etc. White for recyclable non-infected general waste Green for collecting and transporting food waste from

wards, canteens, and dining halls.




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Standard Precautions: Biomedical Waste Disposal

It is the waste that is generated during diagnosis,

treatment or immunization of human beings

Purpose of waste disposal Minimize/Prevent the spread of infection to

hospital personnel who handle waste Prevent the spread of infection to the local

community




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Standard Precautions: Biomedical Waste Disposal

Steps of waste disposal

A. Segregation

B. Collection and Storage

C. Transportation

D. Treatment and disposal




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Biomedical Waste Disposal: Collection and Storage

Wrong Correct




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How to dispose of placenta

In a yellow bag

Not to be left in open places

To be buried in a deep trench away from the

water source




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Biomedical Waste Disposal: Transportation

Wrong Correct




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Biomedical Waste Disposal: Treatment and Disposal

Do’s

Disinfect and destroy the waste before its final disposal.

Remember

• Biological waste to be buried deep at the facility




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Key Messages

Hand-washing is essential for preventing infections

Always wear gloves especially where there is a risk of touching blood, body fluids, secretions, excretions or contaminated items

Decontamination: 0.5% bleach solution is the least expensive and the most rapid acting and effective agent to use for decontamination

Proper handling of contaminated waste minimizes the spread of infection to healthcare personnel and to the local community




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Key Messages (contd...)

Proper handling means: Wearing utility gloves Transporting solid contaminated waste to the

disposal site in covered containers Disposing of all sharp items in puncture-resistant

containers Carefully pouring liquid waste down a drain or

flushable toilet Burning or burying contaminated solid waste Washing containers, gloves and hands after

disposal of infectious waste

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Preparation of Chlorine Solution

IP: Instructions for Preparing Dilute Chlorine Solutions

To make a 0.5% chlorine solution from 5% bleach, mix 1 part bleach to 9 parts water.

Dilute %

eConcentrat %Total parts (TP) (H2O) = - 1

Total parts (TP) (H2O) =

Dilute .5%

eConcentrat 5%- 1 = 9 Total parts (TP) (H2O)

IP: Instructions for Preparing a Chlorine Solution from a Powder

To make a 0.5% chlorine solution froma 35% chlorine powder,

mix 14.2 grams of powder to 1 liter of water.

eConcentrat %

Dilute %Gram/Liter = X 1000

eConcentrat 35%

Dilute .5%Gram/Liter = X 1000 = 14.2 Gram/Liter

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Thank you

EXCERSIZE1. Which is the most important of the standard precautions practices?

2. Which is the first step in instrument processing and what is its purpose?

3 What are the key differences between sterilisation and high level disinfection?

4 What are the types of contaminated wastes produced in your HCF?

EXCERSIZE cont…5. How are you managing your waste?

6. How are you processing reusable items in your facility?

7. Name the chemical disinfectants available at your facility?

8. How is 0.5% hypochlorite solution prepared?

10 a prevention of infection 16 sept

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