SURVEILLANCE ------------ PREVENTION ------------- SAFE PRACTICE
Hospital’s infection Control Measures include Monitoring, Auditing, Safe Practice and Preventing Hospital Acquired Infection by reinforcing protocols to include:
Standard Precaution, Additional Precaution, Staff Training/Orientation,
Protection & Safety of Healthcare Workers, Identification of Hazards, Aseptic Measures in Routine Practice, Single Use Device & Instruments, Antibiotic Use, Management of Blood,
Management of Fluid Exposure, Handling of Blood & Fluid Products, Waste Management,
Incident Monitoring.
Outbreak Investigation
Aadil Hospital is committed to maintain risk free & controlled environment for the safety of its patients, staff & visitors. A simple procedure acts as guidelines for hospital’s “Infection Control Committee” comprising of the following personnel:
- Director Administration (Senior Management)
- Microbiologist/Pathologist
- Physician
- Management Representative
- Chief Medical Officer
- Admin Manager/Maintenance In-charge/O.T.A
- Lab In-charge
- Hospital Infection Control Nurse/Matron
- Waste Disposal In-charge
- Housekeeper/Nurse
Hospital’s Infection Control Team:
- Microbiologist/Pathologist
- Chief Medical Officer (C.M.O)
- Admin Manager/In-charge Maintenance
Hospital’s “Infection Control Committee” should be oriented to deal with hospital acquired infections. H.I.C.C is responsible for ensuring that the infection control protocols are followed by all departments in the hospital. The hospital infection control team shall conduct audit of every department at least 4 times a year on regular intervals. The infection control team will work & report to H.I.C.C.
For any epidemic or endemic the hospital’s “Infection Control Committee” must inform the P.M.I.U.C (Program Monitoring & Implementation Unit Committee) standard precaution for healthcare workers is to assume that all patients are potential source of infections & should attend patients by following this principal prevention & control through training, awareness & capacity building.
Objectives of Hospital Infection Control Committee (H.I.C.C):
- To create awareness & train staff for effective H.I.C.C.
- To identify, control & prevent potential or transmission based infections.
- To clean, disinfect & reprocess of reusable equipment & workspace.
- To supervise and check waste management.
- Protection of healthcare workers from transmissible infections.
- Infection control practices for special situations or endemics.
- To provide & get feedback from professionals on hospital infection control.
- To develop H.I.C.C protocols for safe practice as per MSDS & Pakistan National Infection Control Guidelines for isolation, sterilization & surveillance.
- To conduct infection control audits.
The hospital’s Infection Control Committee has developed a checklist to audit and monitor against each infection control protocol whether a particular department is adhering to H.I.C program or not. The hospital infection control committee must conduct a clinical audit every 3 months i.e. at least 4 times a year unless there is an outbreak/endemic when an emergency Infection Control audit is necessitated.
The H.I.C.C will monitor & evaluate performance of the program on regular intervals. The infection control team must be unbiased and effective in implementation of protocols.
INFECTION CONTROL PROTOCOLS
STANDARD PRECAUTIONS
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USE OF PERSONAL PROTECTIVE EQUIPMENT
Gloves
Mask
Apron/Lead Aprons
Gown
Boots/shoe covers
Cap
Avoid contact between contaminated personal equipment surface/clothing
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HANDWASHING IS REQUIRED
Wash & decontaminate hands
After handling blood, body fluids, secretions, excretions & contaminated items by staff or patient’s attendant.
Cross contamination of site on single patient.
After removing gloves.
Using plain soap, antimicrobial (pyodine), alcohol rub & antiseptic agent.
Handling patient specimen by staff.
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Hand washing is first line of safety and is not replaced by gloves alone
(See glove use information leaflet).
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LINEN
Handle with care if linen is:
- Soiled with urine
- Soiled with blood
- Soiled with body fluids
- Soiled with secretions
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PREVENTION OF NEEDLE STICK
Careful with:
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In all patient care areas & O.T.
Sharps must be disposed off in infectious waste protocols.
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GOWNS & PLASTIC APRONS
Wear gowns, clean & non-stale.
Wear aprons for affixing plasters.
Apron can be worn on top of the gown.
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CAPS/BOOTS/SHOE COVERS
Wear caps, boots & shoe covers to protect from:
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-Body fluids
-Secretions
-Excretions
-Splash
-Spill
-Leak on the shoes
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PATIENT CARE EQUIPMENT
Patient care equipment soiled with:
- Patient’s blood
- Body fluids
- Secretions
- Excretions
- Splash
- Spills
Must be cleaned & disposables are to be changed after each use.
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ADVANCED PRECAUTIONS
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AIRBORNE PRECAUTIONS
Identify transmission by air route
Through droplets
Nuclei < 5 micron in air (wet)
Droplets 1 – 5 microns in air (dry)
Examples are tuberculosis, measles, chicken pox, pulmonary plague, hemorrhagic fever, pneumonia.
ISOLATE PATIENT & implement standard precautions.
Counsel staff & family.
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DROPLET PRECAUTIONS
Identify transmission by droplet route (Mucus membranes of nose & mouth)
- Pneumonia
- Pertussis
- Diphtheria
- Influenza (B)
- Mumps
- Meningitis
WATCH FOR: Coughing, sneezing & talking
Isolate patient in single room.
Implement standard precaution.
Keep room ventilated.
Counsel staff & family.
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PATIENT PLACEMENT
To avoid cross contamination.
Ensure wide spacing between beds in wards.
Keep patients in separate rooms.
Limit movement of patients from rooms to diagnostic areas as much as possible.
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WASTE MANAGEMENT INSTRUCTIONS
Infectious waste, yellow bags, non-infectious waste, black bags, waste collection, waste creation, waste segregation, waste handling, waste disposal & incineration to be performed according to “Waste Management System” guidelines.
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STERILIZATION INSTRUCTIONS
Sterilization through:
- Surface disinfectants
- High level instrument disinfectants
- Floor & wall cleaning disinfectants
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CARE OF HEALTHCARE WORKERS
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- Tuberculosis
- Meningococcal/Meningitis
- S.A.RS
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ISOLATION
Hospital Infection Control Committee shall take measures to isolate patient with risk of transmission.
- See Isolation Protocol
- See CDC Guidelines H.I.C
- See Isolation Recommendations
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Staff’s Training & Education:
All staff at the time of hiring must get orientation on SOP’s of MSDS & hospital procedures. It’s the responsibility of M.R/C.M.O to assess for training needs, conduct training programs & check effectiveness of training programs. Such workshops are conducted in house and certificates must be distributed amongst participants and attendee sheet must be completed as evidence.
Surveillance:
The Hospital’s Infection Control Committee must conduct preventive surveillance to ensure and check the status of implementation at respective departments in hospital i.e. “Infection Control Program Checklist”. This should be done at least 4 times a year on quarterly basis. However in case of request by department in-charge the frequency can be increased. Special circumstances may require surveillance audit to be done at anytime. The priority shall be given to those areas or departments that are most sensitive and affect the health of the patient. The infection control test results and data need to be analyzed and statistical trends should be monitored and likewise frequency of surveillance/inspection maybe increased or decreased as per requirement.
` The calculation should include total number of patient’s population & number of patients with infections confirmed. The outcome surveillance shall be discussed in Management Review Meetings and must be given priority to reduce hospital acquired infection and allocate necessary resources to fight infection. The hospital shall use following techniques to collect samples:
- Swab Test
- Culture Test
- Analyzing patient’s infection or clinical symptoms.
- Any other test that is recommended by the Infection Control team
The hospital management shall train all members of infection control team through Avicenna Medical College for capacity building and better understanding on the issues & protocols of infection control.
The infection control team shall receive proper training and would plan surveillance activities. The infection control team shall recommend installation, proper supply replenishment, consumables, collection and handling systems related to:
- Hand washing
- Gloves
- Masks
- Sharp collection Containers
- Disposable Syringes
- Waste Management
All staff involved in creation, handling, disposal of medical waste shall be trained to handle waste safely in their daily routine. Their training records shall serve as evidence. It is the responsibility of H.I.C.C to check for staff’s training translates into their practice.
The hospital clearly segregates the sterilization area into:
- Dirty Area
- In Process
- Clean Areas
Staff orientation & training should translate into practice to fulfill the hospital sterilization protocols. The validation tests are done in routine to ensure sterilization of instruments; evidence is autoclave tape, date & performed by record available in register (See sterilization instructions). The H.I.C.C shall recommend, check and ensure that sterilization breakdown is immediately addressed as per procedure.
Safe Water:
The hospital provides water facilities to all patients and attendants for wash & clean purpose only. Purified water bottles are available at medical store & canteen.
Cleaning of Hospital Environment:
Hospital areas are cleaned, washed, disinfected & sterilized as per the nature of patient activity in each department (See cleaning & sterilization guidelines for details).
Care of Healthcare Workers:
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Disease
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Routed Through
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Protective Measures
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H.I.V Infection
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-Sexual contact
-Needle stick injury 0.5%
-Sharing contaminated needles
-Transplantation of organs
-Blood transfusion
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-Source must be detected.
-Call AIDS control society at 0333-4363054,
-Notify the National Institute of Health, Chak Shahzad, Islamabad 051-9255367,
-051-9255368 email: info@nacp.gov.pk
-Use protective gear
-Mark patient’s file & bed site.
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Hepatitis B Virus
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Through body substances like;
-Blood
-Blood products
-Saliva
-Cerebrospinal fluid
-Peritoneal pleural
-Pericardial fluid
-Synonal fluid
-Amniotic fluid
-Semen
-Vaginal secretions
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-Immunization against Hep-B.
-Source to be detected to prevent further spreading.
-Counseling & treatment must be provided.
-Use protective gear
-Mark patient’s file & bed site.
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Hepatitis C Virus
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-Through parenteral
-Sexual transmission is less frequent.
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-Chemoprophylactic steps should be taken.
Immediate Treatment:
-Washing thoroughly with running water & antiseptic.
-Consult doctor
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Tuberculosis
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-Through TB positive patients
-Chest clinics
-Bronchoscope areas
-Radiology unit
-Laboratory TB testing
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-Proper counseling is a must.
-Close family members to be tested as well.
-Monitor patient’s program in O.P.D.
-Use protective gear
-Mark patient’s file & bed site.
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Meningococcal Meningitis
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-Respiratory contact with infected patient.
-Sharing of edibles & drinking fluids
-Sharing any form of tobacco.
-Staff is at risk within 24 hours of admission prior to starting anti-biotic or chemoprophylaxis.
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-Blood culture
-Use protective gear
-Mark patient’s file & bed site.
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S.A.R.S
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-Daily signs & symptoms must be monitored.
-Monitor temperature levels.
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-H.I.C.C will attempt to isolate patient.
-Use protective gear
-Mark patient’s file & bed site.
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Varicella, Influenza, Pertussis, Diphtheria, Rabies
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-Rare chance of transmission.
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-Hospital staff can be vaccinated for protection.
-Use protective gear
-Mark patient’s file & bed site.
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ISOLATION
Hospital Infection Control Committee should ensure that isolation facility is available to patients requiring such a health risk conditions. Preventing transmission of infections requires identifying:
-Source of Infection
-A susceptible Host
-Means of Transmission
- Contact transmission
- Direct contact
- Indirect contact
- Droplet transmission
- Airborne transmission
- Vector borne
Protocols of Isolation Room:
-Ensure additional precautions by indicating with appropriate signage on the door (for example, isolation room).
-Place a log book at the entrance of the isolation room. All health care workers or visitors entering the isolation area must sign the log book.
-Remove all non-essential furniture. The remaining furniture should be easy to clean and should not conceal or retain dirt or moisture, either within or around it.
-Collect linen as needed.
-Stock the hand basin with suitable supplies for hand washing.
-Place appropriate waste bags in the room on a foot-operated bin.
-Place a puncture proof container for sharps in the room.
-Keep the patient’s personal belongings to a minimum. Keep water pitcher and cup, tissue wipes and all items necessary for attending to personal hygiene within the patient’s reach.
-The patient should be allocated his/her own non-critical items of patient care equipment, e.g. stethoscope, thermometer and sphygmomanometers. Any item of patient care equipment that is required for other patient should be thoroughly cleaned and disinfected prior to use.
-Set up a trolley outside the door to hold personal protective equipment. A checklist may be useful to ensure all equipment is available.
-Place appropriate container with a lid outside the door for equipment that requires disinfection and sterilization. Once equipment has been appropriately cleaned it can be sent to the sterilizing service department.
-Keep adequate equipment required for cleaning and disinfection inside the patient’s room.
Other Care Instructions:
-Clean and disinfect room on daily basis.
-Respect patient – irrespective of infection status of patient.
-Teach visitors to wear protective gear & limit visitors.
-Crockery & utensils used for patient should be disposable.
-On discharge the patient’s room is to be totally washed, cleaned, fully sanitized & closed for 24 hours.
