Infection

control
 The condition in which the body or part of
the body is invaded by a pathogenic agent
(bacteria, virus, parasites etc.) which
under favorable conditions multiplies and
produces injurious effects.
Infection control
refers to policies and
procedures used to
minimize the risk of
spreading infections,
especially in human
and hospitals
 PPE

Hand Hygiene

BASIC STRATEGIES TO
CONTROL INFECTION

Patient Care
Occupational
Equipment Clinical waste Environment
Exposure
HAND HYGIENE
Proper hand
hygiene is the
single most
important
infection control
practice
• video
 Keep nails short, clean and polish free
 Avoid wearing wrist watches and jewellery
 Avoid wearing rings or stones
 Do not wear artificial nails or nail extension
 Cover any cuts and abrasions with a waterproof
dressing
 Wear short sleeves or roll up sleeves prior to
hand hygiene
When performing surgical
hand antisepsis using an
antimicrobial soap, long scrub
times are not necessary.
Recommended duration is 2-3
minutes but not exceeding 5
minutes and should include
wrists and forearms.
USE OF PERSONAL
PROTECTIVE
EQUIPMENT
 PPE

“specialized clothing or equipment

worn by an employee for protection
against infectious materials”
Gown

Cap/hair cover
Mask
Boots/shoe covers

Gloves
Caps

• In aseptic units,
operating rooms, or
performing selected
invasive procedures,
staff must wear caps
or hoods which
completely cover the
hair.
 Gloves
• Gloves should be worn whenever contact with blood
and body fluids, mucous membranes or non-intact
skin may occur, but should not be considered a
substitute for hand hygiene. Hand hygiene must
always be performed following the removal of
gloves.
• Gloves: should be selected according to need.
• Wearing gloves only when required .
When should gloves be changed?
• Change gloves between contact with different
patients.
• Change gloves between procedures on the same
patient to prevent cross contamination between
different body sites.
• Remove gloves immediately after use and
before attending to another patient.
• video
 Mask
• Wear a mask to protect mucous membranes
of the mouth and nose when undertaking
procedures that are likely to generate splashes
of blood, body fluids, secretions or excretions.
For example, suctioning, irrigating.
• Masks may also be necessary if infection may
be spread by an airborne route – tuberculosis
or other high risk infections transmitted via
the respiratory route.
 • Gloves
Mask requirement

Airborne infection

Isolation room

In the operating room

Performing examination
To care for immuno-compromised
patients
 Gown
• Gown must be worn to protect skin and
to prevent soiling of clothing during
procedures or patient care activities that
are expected to generate splashes or
sprays of blood, body fluid, secretions
and excretions.
 SEQUENCE FOR

PUTTING ON PPE REMOVING PPE

GOWN GLOVES

PROTECTIVE
MASK
EYEWEAR

PROTECTIVE
MASK
EYEWEAR

GLOVES GOWN
 Key Points About PPE
Don before contact with the patient, generally before
entering the room

Use carefully – don’t spread contamination

Remove and discard carefully, either at the doorway or

immediately outside patient room

Remove respirator outside room

Immediately perform hand hygiene

The most important procedure for the prevention of
infection from germs and viruses is:

Wearing gloves.

Mask.

Wearing protective eyewear.

Effective hand washing.

 If you have a sharps exposure while
providing patient care, you will need to:
A. Remain calm

B. Wash the area well with soap and water, letting the area bleed
freely

C. Report the exposure to the Employee Health/Infection Control

Nurse right away, to determine if it’s a true exposure or not

D. All of the above

 I should wash my hands:

Before handling or preparing food.

After taking off a mask and/or gown

Before going into a patient’s room and after coming out.

At the beginning and end of my shift.

All of the above.

DECONTAMINATION
OF EQUIPMENT
Decontamination is a combination of
processes – cleaning, disinfection
and/or sterilisation
CLEANING is the process that removes contaminants
including dust, soil, large numbers of micro - organisms
and organic matter (e.g. blood, vomit). It is an essential
prerequisite to disinfection and sterilisation.
DISINFECTION is a process used to reduce the number
of micro-organisms but not usually bacterial spores. The
process does not necessarily kill or remove all micro-
organisms, but reduces their number to a level which is
not harmful to health.

STERILISATION removes or destroys all forms of

microbial life including bacterial spores.
• Agents/methods that totally destroy all
microorganisms including viruses and spores
• Include chemical agents, gas, radiation, dry or moist
heat under pressure
• Most common method used is the autoclave, which
sterilizes by steam created by a pressurized heating
system
• Small units used in a medical office; large units used in
hospitals
 Nurses role in sterlization

Decontamination
Decontamination Cleaning Assembling
Assembling
Cleaning

Packing
Packing Storage
Storage
 Job description during sterlization
• Decontaminates and sterilizes instruments, medical
supplies and equipment, and assembles, wraps and
sterilizes trays of instruments. Follows proper Standard
Precautions while in decontamination and sterilization
areas.
• Monitors biological and chemical wash solution to
ensure quality and consistency for decontamination of
instruments and medical equipment.
• Sorts mismatched sets of instruments, trays, and
medical equipment and makes them available to sterile
processing customers in a timely manner.
• Restocks, labels, and maintains inventory, submits
requisitions, collects and distributes instruments, trays,
crash carts, and facility medical equipment. 5.
 Continue……….
• Performs environmental maintenance duties and
assists in maintaining inventory levels in sterile
processing, the operating room, and in equipment
storage areas.
• Verifies that equipment functions properly,
requisitions for equipment maintenance, repair or
replacement, and removes defective equipment.
• Maintains a clean work area
• Assists with maintaining established departmental
policies and procedures, objectives, and quality
improvement, safety, and environmental and
infection control standards.
• Communicates appropriately using good
interpersonal skills
Disinfection
A Hygienic and Scientific Hand Washing
continues to be best prayer in the
Hospital
 What is Disinfection
 Disinfection may be defined as: Cleaning an
article of some or all of the pathogenic organisms
which may cause infection
 Perfect disinfectant would also offer complete
and full sterilization, without harming other
forms of life, be inexpensive, and non-corrosive.
Unfortunately ideal disinfectants do not exist.
Most disinfectants are also, by their very nature,
potentially harmful (even toxic) to humans or
animals.
Disinfection
 Terminology

Antisepsis: Degerming: Sanitization

chemical mechanical : lowering
destruction of removal of microbial
vegetative microbes from counts on
pathogens on limited area eating and
living tissue drinking
utensils to safe
levels
 Terminology
Biocide or germicide: kills microorganisms
Fungicide: kills fungi
Virocide: inactivates viruses
Bacteriostatic agent: stops growth of bacteria
 Terminology

Sepsis: bacterial contamination

Asepsis: absence of significant

contamination

Aseptic technique minimizes

contamination
 Antiseptics versus Disinfectants

Antiseptics:
Use on skin and mucous membranes to kill microorganisms
Not for use on inanimate

Disinfectants:
Use to kill microorganisms on inanimate objects
Not for use on skin or mucous membranes
High-level versus low-level disinfectants
 Chemicals – Disinfection

Antiseptics - Bactericidal -
chemicals that kill chemical agents
microorganisms on capable of killing Bacteriostatic -
living skin or mucous bacteria. Similarly Chemical agents that
membranes. agents that are inhibit the growth of
virucidal, fungicidal or bacteria but do not
sporicidal are agents necessarily kill them.
capable of killing these
organisms.
 Disinfection
Process of reducing or
eliminating living
pathogenic microorganism
in or on material, so they
are no longer a health
hazard.
For example: use of
alcohol before drug
injection.
 High level disinfection
High level disinfection processes destroy
vegetative bacteria, mycobacteria, fungi and
enveloped (lipid) and nonenveloped (non lipid)
viruses, but not necessarily bacterial spores.
High level disinfectant chemicals (also called
chemical sterilants) must be capable of
sterilization when contact time is extended.
Items must be thoroughly cleaned prior to high
level disinfection.
 Intermediate level disinfection:
Intermediate level disinfectants kill vegetative
bacteria, most viruses and most fungi but not
resistant bacterial spores.
 Low level disinfection
Low level disinfectants kill most vegetative
bacteria and some fungi as well as enveloped
(lipid) viruses (e.g., hepatitis B, C, hantavirus,
and HIV). Low level disinfectants do not kill
mycobacteria or bacterial spores. Low level
disinfectants are typically used to clean
environmental surfaces
Disinfectant effectiveness depends on
many factors.
• Type of contaminating microorganism. Each
disinfectant has unique antimicrobial attributes.

• Degree of contamination, This determines the

quality of disinfectant required and time of
exposure.

• Amount of proteinaceous material present, High

protein based materials absorb and neutralize
some chemical disinfectants.
 Conti..
• Presence of organic matter and other
compounds such as soaps may neutralize
some disinfectants.

• Chemical nature of disinfectant. It is

important to understand the mode of action
in order to select the appropriate disinfectant.
 Conti..
• Concentration and quantity of disinfectant. It
is important to choose the proper
concentration and quantity of disinfectant
that is best suited to each situation.

• Contact time and temperature. Sufficient time

and appropriate temperature must be allowed
for action of the disinfectant and may depend
on the degree of contamination and organic
matter load.
 Some of disinfectant are..
chart
Formaldehyde
Ortho-phthalaldehyde
Per acetic Acid and Hydrogen Peroxide
Quaternary Ammonium Compounds
Per acetic Acid
When things go wrong
• Inadequate cleaning
• Using the wrong
disinfectant
• Failure to follow
procedures
 Disinfection and sterilization are
affected by
• Initial cleaning of the
device
• Physical complexity of
the device
Biofilms and microbial
load
• Microbe type and
quantity
• HLD exposure time and
concentration
 No Disinfectant is substitute for the
following Procedures
• Hand washing (hand hygiene);
• The use of personal protective equipment
(e.g. gloves) when handling blood, body
substances, excretions and secretions;
• Appropriate handling of patient care
equipment and soiled linen;
• The prevention of needle stick/sharp injuries;
• Environmental cleaning
• Appropriate handling of waste and
• Taking care of yourself (e.g. immunization)
 Yet no substitute for washing hands Do
not forget to Wash Your Hands:
Before and after examining each client
After touching anything that might be
contaminated
After handling specimens
Before putting on gloves for clinical procedures
After removing gloves
After using the toilet or latrine
Immediately on arrival at work
Before leaving work
Make your contributions for safe
Hospitals
SAFE INJECTION PRACTICE
 What is Injection Safety?
Injection safety includes practices intended to
prevent transmission of infectious diseases
between one patient and another, or between a
patient and healthcare provider, and also to
prevent harms such as needlestick injuries

A safe injection does not harm the recipient, does

not expose the provider to any risks and does not
result in waste that is dangerous for the
community
 INJECTION SAFETY

A safe injection does not harm the

recipient, does not expose the provider to
any risks and does not result in waste that
is dangerous for the community
ISSUES IN MISUSE & OVERUSE OF
INJECTION

 Injection is one of the most common health care

procedures

 Each year at least 16 billion injections are

administered in developing & transitional
countries (WHO,2005).
 The vast majority, about 95% are given in
curative care, immunization accounts for about
3% of all injections, the remainder for other
indications including use of injections for
transfusion of blood/blood products &
contraceptives
 Safe Injection Practices
The CDC recommends the following apply to the
use of needles, cannulas that replace needles,
and, where applicable intravenous delivery
system
1. Use aseptic technique to avoid contamination of
sterile injection equipment
2. Do not administer medications from a syringe to
multiple patients, even if the needle or cannula
on the syringe is changed. Needles, cannulas,
and syringes are sterile, single-use items; they
should not be reused for another patient nor to
access a medication or solution that might be
used for a subsequent patient.
 Cont…
3. Use fluid infusion and administration sets (i.e.
intravenous bags, and connectors) for one
patient only and dispose appropriately after use.
Consider a syringe or needle/cannula
contaminated once it has been used to enter or
connect to a patient’s intravenous infusion bag
or administration set.
4. Use single-dose vials for parental medications
whenever possible
5. Do not administer medications from single-dose
vials or ampules to multiple patients or combine
leftover contents for later use.
6. If multi-dose vials must be used, both the
needle or cannula and syringe to access the
multi-dose vial must be sterile.
7. Do not keep multi-dose vials in the immediate
patient treatment area and store in
accordance with the manufacturer’s
recommendations; discard if sterility is
compromised or questionable.
8. Do not use bags or bottles of intravenous
solution as a common source of supply for
multiple patients.
WHY FOLLOW INJECTION SAFETY
PRACTICES

Safe injection practices are a set of measures to perform

injections in an optimally safe manner for patients.

In the last decade, more than 150,000 patients in the

United States were advised to get tested for hepatitis B
virus (HBV), hepatitis C virus (HCV), and HIV due to the
reuse of syringes and misuse of medication vials.
 CONTI..

CDC reports 35 outbreaks of viral hepatitis acquired

by the action of healthcare providers between 2008 -
2012. Of these 33 (94%) occurred in a non-hospital
setting.

• Hepatitis B (total 19 outbreaks, 153 outbreak associated cases, > 10,000

persons notified for screening
• Hepatitis C (total 16 outbreaks, 160 outbreak associated case, > 90,000
at-risk persons notified for screening)
 How Does it Happen???
Understanding the basics of Transmission
TRANSMISSION OF PATHOGENS VIA CONTAMINATED
EQUIPMENT OR MEDICATIONS

CONTAMINATED
EQUIPMENT OR
MEDICATION CASE
SOURCE Susceptible,
Infectious person, non-immune person
e.g. chronic, acute
 Some of the incorrect practices that
have resulted in transmission
Using the same syringe to administer medications to
more than one patient, even if the needle was
changed
Using a common bag of saline or other IV fluid for
more than one patient, and
 Leaving an IV set in place for dispensing fluid
 Accessing the bag with a syringe that has already been used
to flush a patient’s IV or catheter
Accessing a shared medication vial with a syringe
that has already been used to administer medication
to a patient
 PREVENTION
• Healthcare providers should not provide any
avenue for transmission of bloodborne viruses
• Entirely preventable
– Standard Precautions / Aseptic Technique
• Aseptic techniques for handling parenteral medications,
administering injections, and sampling blood
• Use aseptic technique to avoid contamination of sterile
injection equipment
• Use single-dose vials for parenteral
medications, whenever possible
 PREVENTION
Needles, cannulae and syringes are sterile, single-
use items; they should not be reused for another
patient nor to access a medication or solution
that might be used for a subsequent patient
If you are using a SDV and it has already been
accessed (e.g. needle puncture) throw it away
If it is MDV, double check the expiration date and
visually inspect to ensure there is no visual
contamination.
When in doubt, throw it out!
 PREVENTION
• Use a new needle and syringe for every
injection
• Be sure to clean your hands immediately
before handling any medication
• Disinfect the medication vial by rubbing
the top with alcohol before drawing up
medication
• Draw up the medication on a clean
surface.
Source: www.southernnevadahealthdistrict.org
CONTI….
 Hospital waste

75-90%
Non Clinical Waste
Pharmaceutical
10-25% Genotoxic
Clinical Waste

Pathological
Infectious

Pressurized
containers Chemical
Needles /
Sharps Radioactive waste
Waste with heavy
Metal content
Major Considerations

Generation

Segregation Treatment & Disposal

Disinfection Monitoring & Record

Maintenance

Storage Transportation
 Segregation of waste

 Separating waste especially infectious and non-infectious waste. If mixed non-

infectious also becomes infectious.

 Segregation should happen at source with proper containment.

 Different color coded.

 With proper segregation scheme you can:

Reduce the risk of

infecting workers

Recycle waste
that is non-
infectious like IV
bottles X-ray
films etc.

Re-use wherever
possible for
example
Reduce costs of formaldehyde
treatment of waste from theatres can
be reused for
autopsy,
Pathology
 How to segregate ?

The type,
placement and All bins must be
size of the lined with bags
Bins should be of
container is and must also
the same color as
usually have the
for segregation.
ascertained on biohazard
the waste stream symbol.
in that area.
 Hospital policy
Hospital policy regarding disposal of certain kinds of
waste

• Centralized policy for disposing contaminated drugs, date

expired or cytotoxic drugs and solid chemicals

A policy of returning items like IV bottles ,X-ray films,

cartons to the store could be recycled and some
funds generated to handle waste management
Handling waste

 Injuries can be caused by needles

 Needle stick injuries
 Armstrong E Sarah states that the incidence of NSI
is between
7.5 to 16 % per 100 employees
4.27 to 12.4 per 100 registered nurses
 Grossly underestimated as incidents go unreported
Handling Infectious waste

 Minimum handling is the cornerstone for minimizing

NSI
 Segregation should be done at source
 Transfer and repeated handling should be avoided
 Infectious waste should never be mixed with non-
Infectious waste
 All bags having international Bio-hazard symbol
should be tied securely and labeled
Handling sharps
 Sharps are generated in almost all departments
 Theatres, Labs and Injection rooms

 Cause Cut or Puncture

 WHO studies have revealed that HIV and HBV virus can
live up to 8 days in an infected needle/Syringe
Handling sharps
 Most injuries occur between the point of use and
disposal
 Always wear gloves
 Segregate sharps from rest of the waste at the point of
generation
 Clipping bending recapping or breaking of needles must
not be practiced
Handling waste
 When to change or remove bag from the bin
 Bags must be replaced when three fourth full or
twice a day
 In case of theatre it may be good to replace the
bag after every procedure
 The bag must be securely tied and labeled
Handling waste

 Beware!

 Do not mix any infectious waste with non-infectious

waste
• Do minimize use of DO’s• Do train & educate all
Injections categories of staff in
proper
• Do segregate
infectious sharps segregation & handling
waste of waste.

• Do collect in a blue • Do use Hub cutters &

/white transparent needle destroyers
color coded • Do use authorized
container persons/agencies to
handle/dispose
• Do decontaminate all
sharp & plastic waste . the needles.
Dont’s • Don’t mix the infectious & non infectious

waste.

• Don’t throw sharps in the trash/ non

puncture proof containers

• Don’t recap the needle

• Don’t disconnect the needle from syringe by

hand.

• Don’t use open buckets for infectious waste

/sharps
 Point of use Devices
Needle Pullers & Hub Cutter
Needle Puller Hub cutter
 Portable

Current industry standard is

1 quart flat top….

1.5 quart better meets NIOSH guidelines….

Visibility, with clear high top… Helps prevent overfill, helps

user identify hazards.
Functionality, with easy to use temporary closure for
security between uses.
Accommodation, with handle for safe transport of filled
collector…
…added volume & height accommodates larger, bulkier
safety needle devices.
 Hub cutters to separate
needle from hub

Sharp containers
Handling waste
 Situations that demand special handling
 Giving injections/Immunizations
 collecting blood samples
 Doing surgery/Invasive surgeries
 Labor room- while doing surgeries
 While examining patients, when touching blood any other
body fluid
 carrying out lab work
 collecting and cleaning linen
 cleaning spittoons ,urinals
 disposing of waste
 Handling non-infectious waste
 Can be treated like normal household waste
 Two categories
Bio-degradable-Food waste, peels, skins,
tea-bags etc.
Non-Bio-degradable-wrapping, foils, cups, paper
etc.
Handling non-infectious waste
 Non-biodegradable waste can be put into black bags and
treated like any municipal waste

 Crushing is a good method to reduce volume

 Bio degradable waste should be done by composting and

manure thereafter
Equipment's that come handy while handing
waste
 Needle cutters- A manual device that cuts needle and
nozzle manually with the movement of a lever
 Needle burners-An electrical device ,it burns out the
needle and cuts the nozzle
 Scissors-For cutting mutilating plastic and rubber waste
 Forceps-For picking up waste items
 Safety gear- Gloves, apron, masks, shoe, eye shields etc.
 Handling infectious liquid waste

 BMW rules advocates disinfection of infectious liquid waste

and neutralizing of liquid chemicals to below pH 7 before

draining into water.

 Waste human blood, including serum, plasma, body fluids like

CSF, Synovial fluid, pleural fluid, peritoneal fluid, vaginal secretions etc.
Handling infectious liquid waste
 Segregation handling and treatment
 Test tubes ,centrifuge tubes, culture tubes must be placed
inside leak resistant containers
 Cell culture petri dishes, tissue culture flasks and Elisa
plates-Red bags
 Infectious liquids bulk quantity 25ml or greater-Directly
into waste bags after disinfected or autoclaved and then
to sewer disposal
 Handling infectious liquid waste

 Tissue samples, body parts, organs Anatomical waste soaked

in formalin should be carefully decanted & Formalin put into
black bag for disposal

 All tissue body parts put into leak proof yellow bag/container
and sealed
 Handling infectious liquid waste
 All liquid waste must be disinfected or autoclaved

 Autoclaving is not accepted method for radioactive

infectious materials and must be done in conformity with the
BARC rules.
APPROPRIATE USE
AND MANAGEMENT
OF
INDWELLING
DEVICES
Indwelling devices are common in health care
but the use of indwelling devices is not
without risk of infection. 80 per cent of
urinary infections can be results of indwelling
urinary catheters. Similarly, over 60% of blood
infections are introduced by intravenous
catheters or similar devices.
Use the correct technique when using
indwelling devices as it is vital to reduce the
risk of patients acquiring infection.
Procedures requiring aseptic
technique (Intravenous Therapy,
Urinary Catheterization &
Respiratory Care Equipment
/Practices)
 Secured
1)Skin preparation.
In adults, use an correctly
2) Skin disinfectant
During Insertion upper- instead of a
solution should be
Wear clean gloves, lower-extremity
applied using Use either sterile
rather than sterile site for catheter
gentle friction – up gauze or sterile,
gloves, for the insertion. Replace a
and down, back transparent,
insertion of catheter inserted in
and forth strokes
peripheral a lower-extremity semi permeable
for 30 seconds ,
intravascular site to an upper- dressing to cover
catheters. extremity site as 3) The solution the catheter site
soon as possible. should be allowed
to fully air dry.
Although the CDC guidelines didn't find any clinical difference in infection
prevention between transparent and gauze dressing, they do recognize
transparent dressings' other advantages. These include allowing for
continuous visual inspection of the catheter site, permitting patients to bath
and shower without saturating the dressing, and requiring less frequent
changes than standard gauze and tape & saving healthcare personnel time
The peripheral IV catheter should be changed every 72 hours (even in the
absence of signs of infection)

In patients not receiving blood, blood products replace administration sets

that are continuously used, not more frequently than at 96-hour intervals.

Replace tubing used to administer blood, blood products, within 24 hours of

initiating the infusion.

Promptly remove any intravascular catheter that is no longer essential.

If multidose vials are
used; Refrigerate
multidose vials after they
are opened. Clean the
access with 70% alcohol
before inserting a device
into the vial. Discard
multidose vial if sterility
is compromised.
 Catheter
changes are
Hand hygiene
Catheter care not indicated
immediately
Remove for all patients
before and
at 4-week
after insertion Intermittent catheters that intervals;
or any catheterization are no longer timing of
manipulation is an needed catheter
of the catheter acceptable. changes
device or site.
should be
individualized.
• Keep drainage bag Obtain urine samples
from a sampling port
lower than patient’s using aseptic technique.
bladder at all times,
including during
transport. Avoid
contact with the floor.

• Avoid use of bladder

irrigation, instillation
or wash outs as routine
measures
Achieving and maintaining
a
clean clinical environment
 Before
and after
each clinic
session

Annually. Daily

Monthly Weekly
 Surfaces that are
All surfaces and touched often and
equipment in floors are cleaned
the patient care daily, while
environment surfaces that are
touched less often
are regularly (such as ceilings)
cleaned are cleaned less
frequently
• Cleaning equipment such as vacuums, floor scrubbing
machines and polishers should be cleaned and properly
maintained.
• Information on recommended methods of cleaning and
disinfection should be available for staff.
• local policies for the cleaning of patient equipment which
defines who cleans what equipment, how often and
where this should be undertaken.
• Regular monitoring or audits of cleanliness contracts
should be in place to provide assurance that systems are
working well .
 The very first
requirement in a
hospital is that it
should do the
sick no harm