O11 i i INTRODUCTION

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An infectious disease is any disease caused by the growth of pathogenic organisms in the body. It may or may not be communicable. Modem science has controlled , eradicated, or decreased the incidence of many infectious disease. However , increase in other infections like antibiotic resistant organisms and emerging infectious diseases are of greater concern in hospital and community settings. , DFIN ITION j IN 1_

It is a condition in which the host interacts physiologically and

immunologically with the micro organism.( Brunner And Sudharth,2005) ,ATURE OF INFECTION An infection is the invasion of a susceptible host (e.g. a patient) by potentially harmful microorganisms (pathogens) resulting in disease. The principal infecting agents are bacteria, viruses, fungi, and protozoa.all persons have microorganisms on their skin butusually no disease results. Infection occurs only if the pathogens multiply and alter normal tissue function. ELEMENTS OF INFECTION 1) A causative organism: The type of micro organisms that cause infections are bacteria ,viruses , protozoa, fungi, he!rninths and rickettsiae. 0) Reservoir: It is the term used for any person ,plant ,anirnal, substance or location that provides nourishment for micro organisms and enables further dispersal of the organism. Infections may be prevented by eliminating the causative organisms from the reservoir.

3) Mode of exit: The organisms must have a mode of exit from a reservoir. An

Jinfected host must shed organisms to another or to the environment before

transmission can occur. Organisms exits through the respiratory tract the gastrointestinal tract and the blood. 4) Mode of transmission: A route of transmission is necessary to connect the infectious source with its new host. Organisms may be transmitted to through sexual contact ,percutaneous injection or infectious particles carried in air A person who carries or transmits an organism and who does not have apparent signs and symptoms of infection is called a carrier. When appropriate ,the nurse should explain routes of disease transmission to patients. For example, a nurse may explain that sharing a room with a patient who is infected with human immune deficiency virus (HIV) does not pose a risk because intimate contact ( ie sexual or parenteral) is necessary for transmission to occur. 0)usceptable host: For infection to occur the host must be susceptible( not V possessing immunity to a particular pathogen). Many infection are prevented because of the powerful human immune defense. 0) Portal of entry: A portal of entry is needed for organism to gain access to the host. For example, airborne M.Tuberculosis does not cause disease when it settles on the skin of an exposed host. The only entry route for the bacterium is that of concern is through the respiratory system.

INFECTIOUS PROCESS

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A complete chain of events is necessary for infection to occur The chain consists f several elements, they are

Susceptl*fe Wost

C h a I c t I o n ,'o, of Exit

PortalofEvjtry

Mod, bi TizuiiIssJon

HEALTH CARE ASSOCIATED INFECTIONS (HAIs) The patients in the healthcare setting, especially hospitals and long term care facilities are at higher risk for infection rather than those at home. Health care associated infections are the major cause of mortality and morbidity around the world
Nosocomial infection, also called "hospital acquired injection " can be defined as:

An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital other health care facility in whom the infection

w a not present or incubating at the time of admission. This includes s

infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility.( WHO, 2002)

The infections can be passed from health care staff, other patients or the people visiting, with the most common being the individual patient, equipment used, the environment, the health staff, and contaminated food. The mode of transmitting the microorganisms may be through direct or indirect contact, respiratory droplets e.g. influenza, airborne e.g. tuberculosis and smallpox, and vector borne which include transmission from insects or parasites. HIGH RISK AREAS IN THE HOSPITAL (
1

These are the areas in the hospital carry a greater risk: '- Intensive care units '- Dialysis unit '- Organ transplant unit .- Burns unit
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Operation theatres Delivery rooms

- Post operative wards - Isolation wards ' Cancer wards '- Patient factors Patient factors

IExtreme age
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Primary alirnents complicated by other associated diseases

'- Diminished body resistance use to immunosuppressive drugs ,- Indiscrirninative use of antibiotics .- Lengthy operative procedures

SITES AND CAUSES OF INFECTION IN HOSPITAL Major sites of HAl include the urinary tract, surgical and traumatic wound, respiratory tract and blood stream. A brief view of sites and their causes of infection are as follows 'Urinary tract ' Unsterile insertion of urinary catheter
V V

Closed drainage system become open Catheter and tube become disconnected

' Drainage bag port touching dirty surface

V V

Poor specimen collection technique Poor hand washing technique

-Surgical or traumatic wounds

V V V

Improper skin preparation Poor hand washing Failure to cleans skin sur1ce properly

' Use of contaminated aseptic solutions -Respiratory Tract

V V V

Contaminated respiratory therapy equipment Failure to use aseptic technique while suctioning airway Improper disposal of mucus secretions

*Blood Stream
V
V

Contamination of IV fluids by tuning or needle changes Insertion of drug additives to IV fluid

V Addition of connecting tube or stop-cocks to intravenous system

' Improper care of needle insertion site

V Contaminated needle or catheter

V Failure to change intravenous access site when inflammation first appears Poor technique during administration of multiple blood products
7

Improper care of peritoneal or hemodialysis stunts.

In the wards, hospital infection may manifest in the form of bacteremic, respiratory infections, gastroenteritis, meningitis and skin infections. The highest incidence of nosocomial infection occurs amongst patients subjected to invasive technology. The nurse is responsible for providing the patient with a clean and safe environment. The conscientiousness and accuracy of the nurse performing clear and aseptic procedures iticleases the effectiveness of infectiuii To decrease the occurrence or continuation of nosoconiial infections may health agencies have an infection control department, which investigates and establishes policies to develop sanitary procedures. These procedures include clean technique, which is used in all areas, and sterile technique which is used in specialized areas. PREVENTION OF INFECTION Prevention of nosocomial infections requires an integrated, i,iouiitored, 1 program in e which includes the folio wing key components: -Limiting transmission of organisms between patients in direct patient care through adequate hand washing and glove use, and appropriate aseptic practice , isolation strategies, sterilization and disinfection practices, and laundry 'Controlling environmental risks for infection

Protecting
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patients with appropriate use of prophylactic antimicrobials, nutrition, and vaccinations Limiting the risk of endogenous infections by minimizing invasive procedures, and promoting optimal antimicrobial use -Surveillance of infections, identifying and controlling outbreaks Prevention of infection in staff members Enhancing staff patient care practices, and continuing staff education. Infection control is the responsibility of all healthcare professionals doctors, nurses, therapists, pharmacists, engineers and others
I .Risk stratification

Acquisition of nosocomial inlection is determined by both patient tactors, such as degree of immunocompromise, and interventions performed which increase risk. The level of patient care practice may differ for patient groups at different risk of acquisition of infection. A risk assessment will be helpful to categorize patients and plan infection control intervention
2. Reducing person-to-person transmission

a)Iland hygiene ; Strict hand washing is the best to prevent transmission of micro organisms. h)Persoiia1 hygiene: A ll staff must maintain good personal hygiene. Nails must be clean and kept short. False nails should not be worn Hair must be worn short or pinned up. Beard and moustaches must be kept trimmed short and clean,

c) Clothing: Working clothes

Staff can normally wear a personal uniform or street clothes covered by a white

coat. In special areas such as bum or intensive care units, uniform trousers and a short-sleeved gown are required for men and women. In other units, women may wear a short sleeved dress. Shoes An aseptic units and in operating rooms, staff must wear dedicated shoes, which must be easy to clean.
caps:

In aseptic units, operating rooms, or performini selected invasive procedures, staff must wear caps or hoods which completely cover the hair. Masks Masks of cotton wool, gauze, or paper are ineffective. Paper masks with synthetic material for filtration are an effective barrier against microorganisms. Masks are used in various situations; mask requirements differ for different purposes. Gloves Gloves are used for: Patk',i (protection:
staff wear sterile gloves for surgery, care for immune compromised patients,

invasive procedures which enter body cavities. Non-sterile gloves should be worn for all patient contacts where hands are likely to be contaminated, or for any mucous membrane contact.

Staffprotectioii:

staff wear non-sterile gloves to care for patients with communicable disease transmitted by contact, to perform bronchoscopies or similar examinations.. d)Safe injection practices To prevent transmission of infections between patients with injections: eliminate unnecessary injections -use sterile needle and syringe -use disposable needle and syringes, if possible prevent contamination of medications follow safe sharps disposal practices e) Preventing transmission from the environment To minimize the transmission of microorganisms from equipment and the environment, adequate methods for cleaning, disinfecting and sterilizing must be in place. Written policies and procedures which are updated on a regular basis must be developed for each facility.

0 Cleaning of the hospital environment

Routine cleaning is necessary to ensure a hospital environment which is visibly clean, and free from dust and soil. Ninety per cent of microorganisms are present within "visible dirt", and the purpose of routine cleaning is to eliminate this dirt. Neither soap nor detergents have antimicrobial activity, and the cleaning process depends essentially on mechanical action.

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There must be policies specifying the frequency of cleaning and cleaning agents used for walls, floors, windows, beds, curtains, screens, fixtures, furniture, baths and toilets, and all reused medical devices. Methods must be appropriate for the likelihood of contamination, and necessary level of asepsis. This may be achieved by classifying areas into one of four hospital zones:
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Zone A: no patient contact. Normal domestic cleaning (e.g administration, library).

Zone B: care of patients who are not infected, and not highly susceptible, cleaned by a procedure that does not raise dust. Dry sweeping or vacuum cleaners are not recommended. The use of a detergent solution improves the quality of cleaning. Disinfect any areas with visible contanation with wood or body fluids prior to cleaning. Zone C: infected patients (isolation wards). with a

detergent/disinfectant solution, with separate cleaning equipment for each room.

Zone I): highly-susceptible patients (protective isolation) or protected areas

such as operating suites, delivery rooms, intensive care units, premature baby units, casualty departments and haemodialysis units. ('lean using a detergent! disinfectant solution and separate cleaning equipment. All horizontal surfaces in zones B, C and D, and all toilet areas should be cleaned daily.
g)Disiiifectioii of patient equipment

Disinfection removes microorganisms without complete sterilization to prevent transmission of organisms between patients. Disinfection procedures must

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V Meet criteria for killing of organisms " Have a detergent effect V Act independently of the number of bacteria

Present, the degree of hardness of the water, or

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The presence of soap and proteins (that inhibit some disinfectants).

Types of disinfection
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High-level disinfection ('critical) this will destroy all microorganisms, with the exception of heavycontamination by bacterial spores.

Iiiterinediate disinfection (semi-critical) this inactivates M. Tuberculosis,

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vegetative bacteria, most viruses and most fungi, but does not necessarily kill bacterial spores.
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-

Lon-level disinfection (non-critical) :this can kill most bacteria, some

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uses uiid suilie lungi, but caiinui. be relied oil

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bacteria such as M. tuberculosis or bacterial spores. These levels of disinfection are attained by using the appropriate chemical product in the manner appropriate for the desired level of disinfection.
h)Sterilization

Sterilization is the destruction of all microorganisms. Operationally this is defined as a decrease in the microbial load by lOb Sterilization can be achieved by either physical or chemical means
PREVENTION OF INFECTION IN HOSPITAL ENVIRONMENT

a)BUILDINGS:Health services including public and private hospital services acilities, and facilities in developing countries, may not be able to achieve must meet quality standards (ISO 9000 and ISO 14000 series). It is recognized that

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these standards. However, the principles underlying these standards should be kept in mind for local planning and, where possible, renovations should attempt to achieve these standards
b )A IR

Airborne contamination and transmission Infection may be transmitted over short distances by large droplets, and at longer distances by droplet nuclei generated by coughing and sneezing . Droplet nuclei remain airborne for long periods, may disseminate widely in an environment such as a hospital ward or an operating room, and can be acquired by (and infect) patients directly, or indirectly through contaiiunated medical devices.
c)D R IN K IN G W A TER

I)rinking-water should be safe for oral ingestion. Unless adequate treatment is provided, faecal contamination may be suticient to cause infection through food preparation, washing, the general care of patients, and even through steam or aerosol inhalation. Even water that con1rrns to accepted criteria may carry potentially pathogenic micro organisms. Organisms present in tap water have frequently been implicated in nosocomial infections. These micro organisms have caused infection of wounds (burns, surgical wounds), respiratory tract, and other sites (semi-critical equipment such as endoscopes rinsed with tap water after they have been disinfected)
d) FOOD

Quality and quantity of food are key factors for patient convalescence. Ensuring safe food is an important service delivery in health care.

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Factors contributing to food poisoning The frequency of food borne illness is increasing. This may be due to increasing complexity in modern food handling, particularly in mass-catering, as well as increasing importation of potentially contaminated food products from other countries. There must also be adequate nutrients, moisture, and warmth for multiplication of organisms, or toxin production to occur between preparation and consumption of the food. Many inappropriate food handling practices permit contamination, survival and growth of infecting bacteria. The most coiiziizoii errors which
contribute to outbreaks include:

'preparing lood more than a half-day in advance of needs

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t r g e m - - t - p -n- -i r p r f i i r p -

'Inadequate cooling Inadequate reheating 'Use of contaminated processed food (cooked meats and poultry, pies and takeaway meals) -prepared in premises other than those in which the food was consumed 'undercook ing 'cross-contamination from raw to cooked food *contamination from food handlers. Hospital patients may be more susceptible to food borne infection, and suffer more serious consequences than healthy people. Thus, high standards of food hygiene must be maintained.

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Prevention of food poisoning The following food preparation practices must be hospital policy, and rigorously adhered to *Maintain a clean work area. Separate raw and cooked food to avoid cross contamination Use appropriate cooking techniques and follow recommendations to prevent growth of microorganisms in food. -Maintain scrupulous personal hygiene among food handlers, especially hand washing, as hands are the main route of contamination -Staff should chanze work clothes at least once a day, and keep hair covered. -Avoid handling food in the presence of an infectious disease cold, iniluenza, diarrhoea, vomiting, throat and skin infections), and report all infections. Other factors important ('or quality control are: -Purchased food must be of good quality (controlled), and bacteriologically safe. -Storage facilities must be adequate, and correspond to requirements for the food type. -The quantity of perishable goods should not exceed an amount corresponding to one day's consumption. -Dry goods, preserves, and canned food should be stored in dry, well-ventilated storerooms, and stocks rotated.

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'Frozen food storage and preparation must follow producers instructions, and be kept at temperatures of at least -1 8 C (-0.4 F); do not refreeze. Food handlers should receive continuing instruction in safe practices.
e)W A STE

Health care waste is a potential reservoir of pathogenic microorganisms, and requires appropriate handling. Health care waste includes all waste generated by health care establishments, research facilities, and laboratories. 75% to 90% of this waste is non-risk or "general'health care waste, comparable to domestic waste. This comes from the administrative and housekeeping functions of health care facilities. The remaining 10-25% of health care waste is regarded as hazardous, and may create some health risksBIOMEDICAL WASTE MANAGEMENT

BIOMEDICAL WASTES are wastes, which are generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing ol biologicals Bio-medical wastes are infectious and hazardous - need to be managed carefully.
Amount and composition of hospital waste generated (a) Amount

In undeveloped countries the waste generated is about 1.5 kg /bed/day while in developing countries produce 1 -2 kg/bed/day. Country India Quantity (kg/bed/day) 1.5

1.6

U.K. U.S.A. France Spain

2.5 4.5
2 .5

3.0

(b) Hazardous/non-hazardous Hazardous Hazardous but non-infective Hazardous and infective N on - hrdous
:

15% 5%
1011/ 0

CATEGORIES OF BIOMEDICAL JV4STE

Category r' No.1

lIwn wi anatoin ical wastes

Category No.2 Animal wastes, animal tissues, organs, body parts, carcasses, bleeding parts, fluidblood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses.
Category No. 3 Microbiologj' and biotechnology wastes

Wastes from laboratory culture, stocks or specimens of microorganisms, live o' attenuated vaccines, human and animal cell cultures used in research and infectiou agents from research and industrial laboratories, wastes from production q biological toxins, dishes and devices used for transfer of cultures.

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Category No.4

Waste sharp

Needles, syringes, scalpels, blades, glass, etc. Those are capable of causing punch

and cuts. This includes both used and unused sharps

Category No5

Discarded medicines and cytoroxic drugs:

Wastes comprising of outdated, contaminated and discarded medicines.

Category No.6

Solid wastes

Items contaminated with blood, and body fluids including cotton, dressings, soile*

plaster casts, linen, beddings, and other materials contaminated with blood.
Category No.7

Solid wastes-

Wastes generated from disposable items other than the waste sharps, such a\ tubiriis, catheters, intravenous sets.
Category No.8

Liquid waste-

Wastes generated from laboratory and washing cleaning, house keeping and

disinfection activities.
Category No. 9 Incineration ash

Ash from incineration of any biomedical waste.

Category No 10 Chemical waste:

Chemicals used in the production of hiologicals, chemicals used in disinfections, as insecticides.

Legal implications

Every occupier of an institution, generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio medical waste in any other manner, shall make an application in Form-1 along with the following fee structure to the Delhi Pollution Control Committee for grant of authorisation. The Form-I can be obtained after paying an amount of Rs. 100/- in the form of - Draft in favour of DP('('. It can also be downloaded from this web site-but an additional draft for Rs I 0Oi in favor of DPC'C may also be attached with the application at the time of submission of application.

MANAGERIAL

ISSUES.

POLICY

AND

PROCEDURES

IN

BIOMEDICAL WASTE MANAGEMENT 1. Systems Approach: The biomedical waste, management is a system in itself,

though it is a subsystem of the hospital system. The biomedical waste management has got subsystem like, waste generation.waste segregation, collection of waste treatment of waste, transportation intramural as well as extramural, treatment of waste and finally disposal of the waste. All the subsystems are interrelated, they base to work in synergy and in perfect coordination. If any of the subsystem fails, it will result into failure of whole system. If we concentrate only on one subsystem and ignoring others, that will also result into failure.
2Jlurnaii Resource Development: The system will function 1101 because of the

machines or equipments alone but due to the untiring efforts of the staff of the entire category The staff is to be educated in the field of waste management, I when they become aware about the implications of waste management in the hospitals, they are to be properly trained, maintained and utilized.

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3.Education of the General Public: The waste management is not restricted to the

four walls of the hospitals. It is a public health problem. The public is to be made aware through Information Education and Communication (IEC) programs The mass media has great role to play in making people aware about the importance of biomedical waste management.
4.hospital Waste Management iittee/Tearn: The hospital administration is expected to pay special attention to the biomedical waste management programs by constituting waste management teams and committees. In the initial stage for effective implementation of the prorarns task force are to be constitute. The

committee can he constituted of the lbllowing members:

v'

Chairman

Hospital administrator

Secretary -Waste Disposal Officer

N'ieiu'uei

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uiiiiu Ofi'kci , Liead U1 tile tile

depai iiiieiii

superintendent , Hospital Engineer , Radiation protection officer, Stores Officer Chief Pharmacist
0.Biomedical Waste Manual:

The hospitals should prepare a biomedical waste management manual for the hospital. It would act like a reference document for all the concerned staff members. It should be in contrmity with the prevalent rules.
1.Biomedical Waste Management Policy:

A hospital must have a written policy state in respect of the biomedical waste manager This will influence the staff as well as the side organizations regarding the import being given to the biomedical waste management by the hospital.

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7.Standard Operative Procedure: As it possible there should be standard operation procedures for all the activities related to biomedical waste management. It should right from the point of origin of waste to point of final disposal of waste. 8.1rnplernentation of the Biomedical Waste Management Program:
a. Stage I

i.Identification and designating an officer as the officer in-charge of biomedical waste management, 0.Survey and evaluation of wastes generated in the hospitals to categorize quantity. lii. Identification of location for equipments, iv.Procurement of equipments, material and supplies, 0.Installation of equipments. b. Stage II

i. Source rediietwii
By reuse of materials Recycling ii Strategy implementation Segregation and collection of waste Storage and transportation of waste Treatment of wastes c Stage III:

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Training and development of the staff

9.Social Responsibility: It is the social responsiveness and social responsibility of

health care organization to protect the health the people of the society. To educate the people those who are at risk is also the responsible of the hospitals.
0.Public Health Responsibility: There should compulsory notification of

infectious / notifiable diseases to the public health authorities. This is helpful in the surveillance of the infection
ISSUES ON BIOMEDICAL WASTES MANAGEMENT

Adequate attention not giveli Indiscriminate Disposal

Segregation Lacking Unscruplus Recycling No Treatment &. Dicpos1 Fci1itv No Training Awareness Monitoring Mechanisms Lacking Lack of infrastructure in hospitals to tackle the problem of bio-medical wastes. Inadequate/NIL allocation of funds. -Lack of training for nurses and other para-m edical staff.
Absence of personal protective gears like gloves etc., while segregating and

transporting wastes.

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INFECTION CONTROL PROGRAM Each hospital needs to develop a programme for the implementation of good infection control practices and to ensure the well being of both patients and staff by preventing and controlling HAL. OBJECTIVES OF THE INFECTION CONTROL PROGRAMME
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Monitoring of hospital-associated infections; Training of staff in prevention and control of hAL Investigation of outbreaks; Controlling the outbreak by rectification of technical lapses, if any;

Monitoring of staff health to prevent staff to patient and patient to stat spread of infection; Advice on isolation procedures and infection control measures-,

' Inlection control audit including inspection of waste disposal, laundry and kitchen, and Monitoring and advice on the safe use of antibiotics AIM OF THE INFECTION CONTROL PROGRAM The main aim of the infection control program is to lower the risk of an infection during the period of hospitalization. The three thrust areas for infection control program are: - Development of an effective surveillance system. Surveillance implies that observed data are regularly analysed and reported to those who are in position to take appropriate actions. .- Development of policies and procedures to reduce the risk of hospital acquired infection.

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General cleanliness, terminate an infection > Surveillance, i - Maintenance of appropriate aseptic technique '- Disinfecton process i- Periodic immunization of personnel The committee will - conduct a periodical review of statistics on nosocomial infection ' Scarry out valuation of the routine surveillance activity Supervise epidemiological investigators. '- Review current policy . Convey infection control information to staff.
ROLE AND FUNCTIONS OF THE ICC

I .Determine the method of surveillance and reporting 2. Determine the criteria for reporting of infections
)

.Review occurrence of clusters of iniections

4.Review of records of all infected patients 5.Review with the medical audit committee the use of antibiotics and anti infective. 6.Recornniendation in relation to selection of equipment used for sterilization 7.Developrnent of forms or data sheets used for collecting and reporting of data for the infection control programme 8 Prepare and update procedure manuals of' aseptic techniques used in the hospital 9.Deterniine the policy on screening and immunization of hospital staff

NURSES ROLE

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Infection control officer alone cannot perform the day-to-day activities of the program. It can be best handled by the senior experienced nurse. There should be at least one infection control nurse for every 250 beds. The tasks of the infection control nurse will include the following: Daily visit to all wards and patients holding units. Checking the ward visitors report register for telling tale records suggestive of infection. -Collection and tabulation of daily data of incidence of hospital infection. Fnsuring that samples of blood, stool, sputum, urine, swab as the case may be are collected and dispatched to the laboratory in time. Laboratory reports and record also should be gathered and complied. 1 nitiating the hospital infection control irom while documenting for nosocomia 1 iii lct ions. *Complication of ward wise,discipline wise or procedure with statistics. -Daily visits to laboratory to ascertain results of previous day samples. Monitoring and supervision of infection among hospital staff.

Training of nursing aids and para practices and aseptic techniques.

medicals on correct use of hygiene

Assist in bacteriological studies in all cases.

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Nurse working in, intensive care unit; should be particularly conscious of aseptic practicesbecause those patients are already at risk for infection because of so manj' reasons.
Effective measures for hospital infection control will include the following: ' Good practice of hand washing before and after caring client, performing procedure, etc. Good practice of aseptic techniques. Segregation of contaminated instruments. Good disinfection practices The nurse play's a critical role in preventing and controlling infectious disease. The nursing faculty participates significantly in the prevention process from the initial introduction to nursing care. An important component in preparing lbr clinical
i i 4 )

P 1

k ' A C C n ,

ii

"

techniques. Microbiology and other science courses provide background information about pathogenic organisms. The transfer of these scientific principles to the applied art and science of nursing involves an awareness of the dynamics of the infectious process. STANDARD SAFETY MEASURES STANDARD PRECAUTIONS In 1996, ('I)C' and hospital infection control practice advisory committee to standardize procedures and reduce the risk for exposure through the development of standard precautions. It incorporates the major features of universal precautions(designed to reduce the risk of transmission of blood borne pathogens) and body substance isolation(designed to reduce the risk of transmission of pathogens from moist body substances they are applied to all patients receiving

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care in hospitals regardless of their diagnosis or presumed infections status. Standard precautions apply to blood, all body fluids, secretions and excreations, except sweat regardless of whether they contain visible blood, on intact skin and mucous rnernbranes(HICPAC 1 996)The three type transmission based precautions are referred to as air borne precautions, droplet precaution, contact precautions (1-IICPAC1997).ln November2000,the needle stick safety and prevention act became law, mandating health facilities to use device to protect against sharps inj uries( Worthington 2001) Hand washing/Hand hygiene Wash hands after touching blood, body fluids, secretions, excretions, contaminated items, whether or not gloves are worn. -Wash hands immediately after gloves are removed, between patient contacts and when otherwise indicates to avoid transfer of microorganisms to other patients or environments. Wash hands between task and procedures on the same patient to prevent cross contamination of' different body sites. -Use a plain soap or alcohol based hand rub for routine hand washing -Use an antimicrobial agent or waterless antiseptic agent for specific circumstances. Gloves Wear clean, on sterile gloves when touching blood, body fluids, secreations, and contaminated items

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'Change gloves between tasks and procedures on the same patient after contact with materials that may contain a high concentration of micro organisms. -Put on gloves just before touching mucous membrane and non intact skin. 'Remove gloves just promptly after use, before touching non contaminated items and environmental surfaces and before going to other patients. -Wash hands immediately after removing the gloves.
Mask, Eve protection, face shield

Wear these to protect mucous membrane of the eyes, nose and mouth during procedure and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secreations or excretions

Gown

-Wear clean, on sterile gown to protect skin and prevent soiling of clothing during procedures and patient care activities that are likely to generate splash or sprays of blood, body fluids, secretions or excretions Select a gown that is appropriate for the activities and amount of fluid likely to be encountered. Remove a soiled gown as promptly as possible and wash hands to prevent the transfer of microorganisms to other patients
Patient care equipment

'Handle used patient care equipment soiled with blood, body fluid, and secreationand excretions in a manner that prevents skin and mucous membrane

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exposure contamination of clothing and transfer of micro organisms to other patients. Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately. *Ensure that single use items are discarded properly.
Environmental Control

-Ensure that the hospital has adequate procedures for the routine care, cleaning and disinfection of environmental surfaces, beds, bed rails, bed side equipment and others frequently touched surfaces. -Ensure that procedures are being followed.

Linen:-

Handle, transport and process used linen soiled with blood, body fluids, secretions and excretions in manner that prevents skin and mucous membrane exposures and contamination of clothing and that avoids transfer of microorganism to other patients.
Occupational health and blood borne pathogens

.'- Take care to prevent injuries when using needles, scalpels and other sharp instruments or devices:
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When handling sharp instruments after procedures.

'- When cleaning used instruments. .'- When disposing of used needles.

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Never recap used needles or otherwise manipulate them by using both hands or use any technique that involves directing the point of needle toward any part of the body - Use either one handed scoop technique or mechanical device designed for holding the needle sheath. ' Don't remove used needles from the disposable syringes by hand and don't bend, break otherwise manipulate used needles by hand. Place used disposable needles, syringes, scalpel blades other sharp items in appropriate puncture resistant containers as close as practical to the area in which the items were used. Place reusable syringes and needles in a puncture resistant container for transport to the reprocessing area. - Use mouth pieces, resuscitation bags or other ventilation devices as an alternative to mourn to mouth resuscitation methods iii areas where the need for resuscitation is predictable. Patient placein ent
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Place patient who contaminates the environment or who doesn't or can't be expected to assist in maintaining appropriate hygiene or environmental control in a private room.

If private room is not available, consult with infection control professionals regarding patient placement or other alternatives.

POST EXPOSURE PRO PIIYLAXIS FOR HEALTHCARE PROVIDER The prophylaxis needs to start immediately after exposure, therapy started more than 72 hours aflei exposure is thought to offer no benefit.

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The recommended course of therapy involves taking prescribed medications for 4 weeks
If you sustaiiz a needle stick inJurr, take the following precautions iiiiinediatelj

r-

Wash the area with soap and water Alert your supervisor and initiate the injury supporting system used in the setting

. Identify the source patient, who may need to be tested for HIV, HepatitisB. and I-IepatitisC. Report to employee health ser ices the emergency department or other designated treatment facility. Give consent for base line testing !r I IIV, Hepatitis B, and HepatitisC. '- Get PEP for HIV in accordance with CDC guidelines. Start prophylaxis medication within 7 hn1.,! testing is complete.
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Im o n i t o r e d f o r s y mp t o m s o f t o x i c i t y . P r a c t i c e s a fe r s e x u n t i l f b H o \ v u p

exposure. Make surc ftiat yu aic

Follow up with post exposure testing at 6 wks, 3months, and months perhaps one year.

'- Document the exposure in detail for your own records as vell as For the employey/ CONCLUSION Nosocomial infections affect approximately 2 million patients annually in acute care facilities in our country and their annual patient care costs several millions of rupees. Studies shows that nearly one third of nosocomial infections can be prevented by a well organised surveillance and control programme. But only 10 0 are actually prevented. For the effective infection control program shotid include
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