CHAPTER IV COMPARISON OF INFECTION CONTROL PRACTICES IN PICU WITH WHO STANDARD PROTOCOL

SECTION -A 1. INFECTION CONTROL PRACTICES

S.NO

STANDARD PRACTICE PROCEDURES FOR ENTERING THE PICU Woolens & shoes should be removed and nursery slipper should be worn before entering the PICU. The nails should be kept short and trimmed emove wat!hes and rings on entering PICU. o "o hand washing.

EXISTING PRACTICE

1.1

Separate slippers are in use.

Cut short nail.

Wat!h and rings are not removed. o Steps of proper handwashing are not followed. o Separate nonsterile hand towel is in use and o!!asionally hand drier and roller towel are being used.

4 5

o The hands should be dried with single use auto!lave sterile towel or preferably disposable paper towel.

inse the hands with sterilium# before tou!hing any !hild.

Pra!ti!e of rinsing the hand with sterilium hand rubs. Wearing !ap before entering %ICU not mask. The staff nurses working in the unit are wearing separate uniform before entering into the unit.

$ask and !ap should be worn. Separate suit or dress must put on before entering the PICU.

1.2 HAND WASHING S.NO 1.2.1 &. STANDARD PRACTICE FACILITIES AVAILA!LE FOR HAND WASHING '!!ess to !lean running water is essential *arge washbasins with hand free !ontrol tap FACILITIES AVAILA!LE FOR DR"ING HANDS &. "isposable paper towel (. +. 1.2.3 & eusable single use towel oller paper towel Presen!e of () hours running water supply. Presen!e of separate hand washing area with one sinks with hand free !ontrol tap. EXISTING PRACTICE

(.

1.2.2

"isposable paper towel is not available. eusable single use towel and oller paper towel are available. Plain soap is not in use 'ntimi!robial soap # "ettol is used for hand

). ,and drier MATERIALS Plain Soap

'ntimi!robial Soap Spe!ifi! antisepti!s

washingl 'ntisepti!s1 -. povidone iodine

-. / 0.-. Povidone iodine &. Tri!losan

'l!oholi! rub 02. (.). Chlorhe3idine

'," solution 4Sterilium5 whi!h !ontains ethanol 0-. '%" (.-..Chlorhe3idine glu!onate is in use.

1.2.4 & ( + ) -

HAND WASHING TECHNI#UE emove 6ewellery 4rings# bra!elets5 and wat!hes before washing hands 7nsure that the nails are !lipped short. oll the sleeves up to the elbow. Wet the hands and wrists 8eeping hands and wrists lower than the emove 6ewellery 4rings# bra!elets5 and wat!hes before washing hands %ails are !ut short. oll the sleeves up to the elbow. Wet the hands and wrists %ot in pra!ti!e.

elbows 4permits the water to blow to the banger tips avoiding aim !ontamination. 'pply soap 4plain or 'ntimi!robial5 and lather thoroughly. Use firm# !ir!ular motions to wash the hands and arms up to the elbows. ub hands palm to palm. ight palm over left dorsum with interla!ed fingers and vi!e versa. Palm to palm with finger interla!ed. <a!ks of fingers to opposing palms with finger interlo!ked. otational rubbing# ba!kwards & forwards with !lasped fingers of right hard in left palm and vi!e versa. &+ &) ub for minimum of &2 = &- se!onds. inse hands thoroughly. ubbing for &2 se!onds. inse hands thoroughly. %ot keeping the hand lower than the fore &8eeping the hand lower than the fore arms. "ry arms thoroughly with auto!laved &9 air dry. "is!ard the towel in an appropriate &0 &: !ontainer without tou!hing the bin lids with hand. "uration of entire pro!edure with soap and water/)2/92 se! al!ohol based formulation/ (2/+2 se! arm "rying the arms by reusable single use Use firm# !ir!ular motions to wash the hands. ub hands palm to palm ight palm over left dorsum with interla!ed fingers and vi!e versa. Palm to palm with finger interla!ed. 'pply soap 4dettol5 and lather thoroughly.

&2 &&

%ot in pra!ti!e

&(

%ot in pra!ti!e

napkins or disposable sterile paper to well or towel and roller towel.

"is!ard paper towel in an appropriate manner. "uration of entire pro!edure is &se! with antimi!robial soap. "uration of entire pro!edure is (2 se! with -. povidone iodine . "uration of entire pro!edure is &-

se! with -. povidone iodine

1.2.5 PICTORIAL STANDARD HAND WASHING TECHNI#UE

1.2.5 PICTORIAL EXISTING HAND WASHING TECHNI#UE

SECTION - ! 2. ENVIRONMENTAL MANAGEMENT PRACTICES S. NO STANDARD PRACTICE 2.1 PERSONAL PROTECTIVE E#UIPMENTS & G$%&'( Wear gloves when in !onta!t with blood# body fluids# se!retions# e3!retions and mu!ous membrane. T)*'( %+ ,-(*%(./$' 0$%&'( Clean>non sterile gloves for routine !are of the Sterile gloves for invasive pro!edures Sterile gloving is not pra!ti!ing whilie inserting iv !atheter and spe!imen !olle!tion. ( M.(1( Wear a mask to prote!t mu!ous membranes of the mouth and nose when undertaking pro!edures. T)*'( %+ 2.(1 % ;- = "uring open>a!tive infe!tious diseases % &22 = "uring invasive pro!edures Standard surgi!al splash proof masks = $ainly when dealing with droplet infe!tions + A*3%45G%64 Wear !lean# non/sterile gown to prote!t the stain 'pron is available only for from splashes of blood and body fluids. patient attenders and nurses are using separate suit. ) C.*( Wear disposable !aps Using disposable !ap in ea!h shift $asking is in pra!ti!e..

?loving invasive

is

pra!ti!ed pro!edures

while performing all the e3!ept I@ !annulation and spe!imen !olle!tion. %ot in pra!ti!e

infe!tious patients

!%%7(5($-**'3(1 Wear boots 4or5 slippers before entering into intensive !are unit.

Using slippers before entering into PICU.

2.1.1

WHEN LEAVING PATIENT CARE UNIT Using gloved hands# untie the gown string of tied emove gloves and dis!ard in an appropriate %ot in pra!ti!e "is!ard gloves in separate bin. %ot in pra!ti!e.

in front and remove shoe !overs manner

emove gown and apron# tou!h only inside of

"is!ard mask and !ap in separate bin. epla!e slippers on a stand. ,and washing te!hniAue is not in pra!ti!e before leaving PICU.

gown and apron while removing and pla!e in an appropriate disposal bag. emove mask and !ap in an appropriate !ontainer. emove boots and keep in an appropriate pla!e. Wash hands up to wrist thoroughly with soap and

water# dry and de!ontaminate with 02. al!oholi! hand 2.2 rub. HANDLING OF PATIENT CARE E#UIPMENTS 8-9 N'',$'( .4, ()3-40'( 8Use disposable only5 / "is!ard in pun!ture/proof !ontainer with a lid that !loses it.

,ub of the needles are immersed in (. hypo!hlorite solution for duration of ( hours in a separate bottle before the disposal.

8--9S%-$', *.7-'47 :.3' ';<-*2'47 S7'7=%(:%*'> (*-02%2.4%2'7'3 .4, 7='32%2'7'3(1 /Clean with detergent and water and dry /$ay be wiped with sodium hypo!hlorite &/(. or02. al!ohol and dried after !leaning. /'void immersing in anti septi! solution.

Cleaned with spirit and kept dry /Immersing in antisepti! solution is restri!ted. /Using separate thermometer and Stethos!ope for ea!h baby

8---9I4(73<2'47( 8L.3)40%(:%*' .4, /$.,'(> 73.:='.$ 7</'( .4, (<:7-%4 :.7='7'3(9. emove all protein# organi!# inorgani! matter at point of generation 4e.g. blood and body se!retions5 by !leaning with soap and water and return to the steriliBing servi!e department for appropriate repro!essing. 8-&9AM!U /.0 .4, 2.(1 Clean with detergent# dry and send to the steriliBing servi!e department steriliBe

*aryngos!ope and blades are !leaned with spirit before and after ea!h use. /Using disposable tra!heal tubes and su!tion !atheter.

Cleaning with spirit and send it to CSS".

8&9V'47-$.7%3> (<:7-%4 ';<-*2'47 .4, %?)0'4 .,2-4-(73.7-%4 ,'&-:'( /Clean ma!hine with detergent and water# dry# and disinfe!t with 02. al!ohol. Cilters should be single use. /$ask is single patient use and should be !leaned at least daily and also as it be!omes soiled.

@entilator and o3ygen tubing are !leaned with soap and water# dry in air# steriliBe with ethylene o3ide and kept in a sterile. /Using single mask for one baby. / D3ygen hoods are !leaned with soap and water and dried in air. /<ag and mask are washed with soap and water & "ry in air. Then it immersed in (. gluteraldehyde for (2 minutes. insed with sterile water# dried and kept in sterile !ontainer.

8&-9W.32'3 .4, ,3'((-40 73%$$')1 Clean with sodium hypo !hloride &/( . or al!ohol 02.. 8&--9 FEEDING ARTICLES /Cleaning with soap and water / boiling for 0 min. 8&---9 F<34-7<3' @ /',> +3.2'(> 7./$'> I5V (7.4,> 6=''$ :=.-3> *-$$%6( .4, 2.773'(( Clean with detergent and water and dry Wipe with

Clean with detergent and !arboli! a!id Cleaning with soap and water and boiled for &2 min after ea!h use. Cleaning with & .sodium hypo!hlorite 4phenol5.

disinfe!tant su!h as 02. al!ohol or &. sodium hypo!hlorite and dry after !leaning. 8-?9 T'$'*=%4' .4, T%)( . Clean with detergent and water# and dry. If toys are !ontaminated with mi!ro organisms wipe with disinfe!tant or &/(. hypo!hlorite solutions. 2.3 HANDLING OF A SOILED LINEN LINEN If reusable1 launder as per the institutional guidelines for soiled linen. Sponge towels are washed with soap and water and drying under sun in laundry and sent for auto!lave in CSS". /"isinfe!ting mattress !over with (. !arboli! a!id 4phenol5 MOPS 2.4 Wash mops separately from other !loth or linen CLEANING OF ENVIRONMENTAL SURFACES IN THE PATIENTAS ROOM WALL AND FLOOR Cleaning with 'l!ohol 402.5 Isopropyl# ethyl al!ohol# methylated spirit. "amp mop with detergent and water Cleaning the floor and wall with 2.-. Sodium hypo !hloride or (. !arboli! a!id solution three times a day. /"ilution ratio1 (2ml of (. !arboli! a!id with ;:2 ml of water C%22%,'> 7%-$'7 ('.7( Clean seat and arms with detergent and water and dry whenever used. Wipe with disinfe!tant 4&/( . sodium hypo!hlorite5 2.5 1 and dry after !leaning. PREVENTION OF NEEDLE STICB INCURIES Pla!e used disposable syringes and needles s!alpel blades and other sharp items in a pun!ture resistant !ontainer with a lid. Cleaning seat and arms with detergent # water and disinfe!t with phenol. $op washes separately Clean with detergent and water disinfe!t with &.sodium hypo!horite solution.

Pla!ing the used syringes and needles in a separate tray

2 3

Take e3tra !all when !leaning sharp reusable instruments or eAuipments. %ever re!ap or bend needles.

%ot in pra!ti!e. e!apping of needles is not in pra!ti!e.

Sharp must be appropriately de!ontaminated and or destroyed or per the national standard or guidelines.

/,ub of the needles are immersed in (. hypo!hlorite solution for duration of ( hours in a separate bottle before the disposal.

2.6 1

SPILLAGE MANAGEMENT S*-$$.0' @ %+ /$%%,> /%,) +$<-,(> (':3'7-%4( .4, '?:3'7-%4(1 /Wipe with paper towel or reusable !loth to soak up the ma6ority of the spill /Clean with detergent and water /"ry the area with 0 . sodium hypo!hlorite 2.7 WASTE MANAGEMENT 2.7.1 STANDARD COLOR CODING AND T"PE OF CONTAINER FOR DISPOSAL OF !IOMEDICAL WASTE C%$%3 "'$$%6 W.(7' C.7'0%3) <andages# body fluids solid linen ,uman anatomi!al waste materials !ontaminated with blood# mi!robiology waste Sharp needles# syringes# s!alpels & blades glass that may !ause pun!ture and !uts I@ Sets Catheters R', Canulas ?loves !$.:1 $i!robiology & bio te!hnology waste 73pired medi!ine# !hemi!als used as disinfe!tions# inse!ti!ides !hemi!als used in biologi!al in!ineration# ash and Se!ured land fills "isinfe!tion & shred>mutilate D-(*%(.$ "ire!t in!ineration >deep burial "isinfe!tion& shred> mutilate Wiping with water and 0. sodium hypo!hlorite.

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!ytoto3i! drugs

2.7.2. EXISTING PRACTICE OF WASTE MANAGEMENT

"isposal of bio medi!al waste is taken !are by ,ouse keeping department. "isposal of waste is segregated a!!ording to the !olor !oding and type of waste material. C%$%3 W.(7' C.7'0%3) <andages# body fluids# solid linen ,uman anatomi!al waste $aterials !ontaminated with blood and body fluids Sharp needles and syringes <lades ?lass I@ sets Catheters Canuals ?loves 73pired medi!ine# "isinfe!tant ash Cytoto3i! drugs. D-(*%(.$ "ire!t in!ineration >deep burial

"'$$%6

<lue

"isinfe!tion& shred> mutilate

ed

"isinfe!tion & shred>mutilate

!$.:1

Se!ured land fills