Infection Control

INFECTION CONTROL
Vikas Choudhary
PhD Scholar
INTRODUCTION
For years , you have heard the tenets of real
estate summarized in three words:

location, location, location.
The infection control field now has its own three
word maxim:
vigilance, vigilance, vigilance !!!
Many issues of infection control countered
by
technology (gloves, sharps covers, air
exchangesetc)
None works without constant vigilance on
the part
of health care workers (HCWs).
Caution is especially critical in the ICU.
Florence Nightingale, more than a century
ago, said
No stronger condemnation of any hospital or
ward
could be pronounced than the single fact that

zymotic
(infectious) disease has orginated in it or that
such a
disease has attacked other patients than those
brought
in with them still remains a problem world over
and no
Hospital Acquired Infection (HAI)

Most important factor adversely affecting
performance and image of the hospital.
Besides morbidity and mortality,

Prolongs the hospital stay of patients
Increases the bed occupancy
Undue pressure on the already strained
resources of the hospital , patients and

community.
DEFINITION
Hospital acquired infection is any
clinical infection (causing illness) that
was neither present nor incubating
when the patient entered hospital.
The illness may manifest during patients
stay in hospital or after she/he returns home.
Also includes infections acquired in
hospital by members of hospital staff or
visitors to hospital.
RISK FACTORS OF HAI

o INTRINSIC FACTORS :
Inherent to the patient.

Include the presence of acute
medical/surgical disease and severity of
illness.
o EXTRINSIC FACTORS :
Related to the types of medical practice

performed at individual , staff or hospital.
COMMON INFECTIONS
BLOOD
STREAM
Most common
Pathogens
associated:
Coagulase neg.
staphylococci,
Staph Aureus,
Entro cocci
VAP
UTI
2nd most
3rd most
Pseudomona
s
aeruginosa,
Entrobacter,
Staph
aureus
Ecoli
Pseudomona
s
aeruginosa,
Candida
albicans,
Entrococci
spp.
EPIDEMIOLOGY TRIAD
AGENT
HOST
ENVIRONMENT
THE CHAIN OF
INFECTION
AND
ITS BREAKAGE
Rapid Accurate
Identification of
Organism
INFECTIOUS AGENT
Bacteria Fungi
Chain 6
Viruses Rickettsiae
Protozoal
Treatment of underlying diseases

SUSCEPTIBLE HOST
RESERVOIRS
Immunosuppression
Barrier Nursing
Role of
health
personnel
Diabetes-SurgeryBurnsCardiopulmonary
Chain 5
Aseptic Technique
Catheter Care
Wound Care
Chain 1
People
GI Track
Respiratory Track
MODES OF
TRANSMISSION
Broken Skin
Air Borne Contact
Chain 4
Oral
Environmental
Sanitation
Disinfection/
Sterlization
Equipment
Water
Chain 2
Handwashing
PORTAL OF
EXIT
PORTAL OF
ENTRY
Employee Health
Excretions
Secretions
Droplets Skin
Chain 3
Parenteral
Handwashing
Food Handling
Isolation
Air Flow Control
Trash & Waste

Disposal
Excretion/Secretion
Control
BREAKING THE CHAIN 1 OF INFECTION
INFECTIOUS AGENT
Include entire spectrum of microbes
Bacteria
Viruses
Fungi
Protozae
BREAKING THE CHAIN 1 Cont..
RAPID & ACCURATE IDENTIFICATION

OF ORGANISMS
Routinely send Blood cultures, urine culture , skin swabs,
throat swabs, tracheal aspirate cultures.
Endotracheal Tube tip and central line tip to sent for
culture after removal.
Fungal cultures for patients whose stay is more than
5 days.
Repetition of blood cultures or other cultures
-Reoccurence of fever
-Unexplained Tachycardia
-Loose stools
-Or any other new s/s developing in patient
INFECTIOUS AGENT
Bacteria Fungi
Chain 6
Viruses Rickettsiae
SUSCEPTIBLE HOST
RESERVOIRS
Immunosuppression
Role of
health
personnel
Chain 5
Aseptic Technique
Catheter Care
Wound Care
Employee Health
Protozoal
Barrier Nursing
Rapid Accurate
Identification of Organism
People
Disinfection/
Sterlization
Equipment
Water
Chain 2
Proper Attire
PORTAL OF
EXIT
PORTAL OF
ENTRY
GI Track
Respiratory Track
MODES OF
TRANSMISSION
Broken Skin
Air Borne Contact
Chain 4
Oral
Environmental
Sanitation
Handwashing
Excretions
Secretions
Droplets Skin
Chain 3
Parenteral
Handwashing
Food Handling
Isolation
Air Flow Control
Trash & Waste

Disposal
Excretion/Secretion
Control
RESERVOIRS
It includes- People
Equipments
Water
EMPLOYEE HEALTH
Immunization of health personnels e.g.
Hepatitis B vaccination.
Regular check up for early detection of any
communicable disease etc.
Restriction from work of patient contact when
infected with communicable disease.
ENVIRONMENTAL CLEANING
Cleaning with hospital approved cleaner
disinfectant e.g. phenol.
Thorough cleaning of bed and bedside
equipments before admitting new admission.
Separate mops should be used for cleaning of the
unit. (twice a day)
Damp dusting should be done.

Avoid Brooming.
Drains should be patent
AIR FLOW CONTROL

Keep windows and doors closed.
Maintain positive air pressure with 20
cycles /day.
Temperature between 24- 26 C
Humidity 50-60%.
HANDLING OF LINEN
Keep the bed sheets dry and clean.
Change of sheets every day.
Do not shake blankets and linen in ICU
area.
Do not throw them on floor.
Soiled linen counting should be done in
separate place.
TRAFFIC CONTROL
Traffic should be restricted except for
doctors, nurses & supportive staff.
Allow only one attendant.(3-4hrs).

Keep the doors and windows closed.
Instruct the attendants about hand
washing, disposal of waste , hygienic

preparation of babys feed etc.
No personal clothing, flowers and eatables
should be allowed.
Mobile phones should not be allowed inside
the area.
Machines(X-Rays ,echo machines
,ultrasound machines) from outside should

be cleaned with spirit before their use.
PEST CONTROL
Measures to be taken to avoid their entry
into the unit i.e. by proper cleaning, sealing

& draining.
Patient diet should be kept in covered
containers.
Fly trapper should be in working order.

Pesticides sprays should be used weekly.
DISINFECTION, STERILIZATION AND

DECONTAMINATION.
IMPORTANT TERMS
DECONTAMINATION : removal of infective
matter from the surface of an object i.e. thorough

cleaning.
DISINFECTION: kills micro organisms but not

spores.
STERILIZATION: kills micro organisms and
bacterial spores also.
Regular Cleaning and Disinfection of

Bed Trolleys
I.V stands
Infusion Pumps
Floor
Table & Chairs
Windows
Resuscitation equipments
Walls
Suction Apparatus
Ceiling
Wash Basins
Ventilator tubings
Drums for Biomedical Waste
Monitors
Leads
DISINFECTION, STERILIZATION AND

DECONTAMINATION.
APPARATUS/ EQUIPMENT
Disposable
Items
Reusable
Items
Ventilator
Circuits
For Sterilized Items

Store at dry & clean place
Put date of sterilization
Use within 72 hrs of sterilization
Check date before use
Put indicator tape

Follow manufacturers advice for particular
piece
of equipment & their preferable
method of sterilization
DISINFECTANTS
HIGH LEVEL DISINFECTANTS
Activated glutaraldehyde (cidex2%)
Sodium hypochlorite 1%.
Carbolic Solution 5%
Bleaching Powder 1%
LOW LEVEL DISINFECTANTS

Methylated spirit70%
Betadine solution10%
Savlon 1%
WATER
Use of safe drinking water-Purified
Use of Distilled water for Humidifiers
INFECTIOUS AGENT
Bacteria Fungi
Chain 6
Viruses Rickettsiae
Protozoal

SUSCEPTIBLE HOST
Role of
health
personnel
Chain 5
Aseptic Technique
Catheter Care
Wound Care
Employee Health
RESERVOIRS
Immunosuppression
Barrier Nursing
Rapid Accurate
People
Equipment
Water
PORTAL OF
EXIT
PORTAL OF
ENTRY
GI Track
Respiratory Track
MODES OF
TRANSMISSION
Broken Skin
Excretions
Secretions
Droplets Skin
Environmental
Sanitation
Disinfection/
Sterlization
Hand
washing
Trash &
Waste
Disposal
Air Borne Contact
Chain 4
Oral
Parenteral
Chain 3
Handwashing
Food Handling
Isolation
Air Flow Control
Excretion/Secretion
Control
HAND WASHING
Single most important & cost effective infection
control measure.
Should be followed religiously.
Mandatory for all medical,nursing & paramedical
who comes in contact with patient.

Efficaciously protects a HCW.
ASEPTIC HAND WASH Washing hands
with water and soap or other detergents

containing an antiseptic agents .e.g.
betadine scrub.
ANTISEPTIC HAND RUB applying an
antiseptic hand rub product to all surfaces

of the hand to reduce the number of micro
org. present.
DECONTAMINATE HANDS to reduce
bacterial counts on hands by performing

antiseptic hand rub or antiseptic hand
wash
5 MOMENTS FOR HAND

HYGIENE
HAND HYGIENE TECHNIQUE
Remove rings, watches, bracelets, bangles
before washing hands.

Cut nails short, keep polish free.
Roll up sleeves.
To do with- Soap, Betadine, Alcohol rub
Duration: Hand Wash- 40-60 secs
Hand Rub- 20-30 secs
STEPS OF HAND WASHING

No.1 HAND WASHING STEP
No.6 HAND WASHING STEPS
BIOMEDICAL WASTE
Biomedical waste (management and
handling) rules, 1998 is promoted by the

ministry of environment and forests , govt.
of India, under environment protection act,
1986.
These rules apply to all persons who
generate, collect, receive, store, transport,

treat dispose or handle biomedical waste in
any form.
Biomedical waste should not be mixed with
other wastes.
Segregation at the source( means
segregate into the containers at the point of

generation prior to its storage,
transportation, treatment, and disposal.
No untreated medical waste should be
stored beyond a period of 48 hrs.
Every HCW should be well versed with the
color coding containers used for biomedical

waste.
Human anatomical
waste.
Animal waste.
Microbiology &
Biotechnology waste.
Blood soiled waste.
(cotton, dressing,
P.O.P)
1% Sod. Hypochlorite
Plastic & Rubber Waste
catheters
syringes
I.V. Sets, Blood Sets,
Glucose Bottles
1% Sod. Hypochlorite
Waste sharps.
Glass syringes
Needles
Blades
Glass
Kitchen & paper

waste.
Discarded
medicines.
Incineration ash.
INFECTIOUS AGENT
Chain 6
Bacteria Fungi
Viruses Rickettsiae
Protozoal

SUSCEPTIBLE HOST
Chain 5
Aseptic Technique
Catheter Care
Wound Care
Role of
health
personnel
GI Track
Broken Skin
People
MODES OF
TRANSMISSION
Water
Handwashing
Isolation
Oral
Handwashing
Excretions
Secretions
Droplets Skin
Trash & Waste

Disposal
Excretion/Secretion
Control
Air Borne Contact
Chain 4
Environmental
Sanitation
Disinfection/
Sterlization
Equipment
PORTAL OF
EXIT
PORTAL OF
ENTRY
Respiratory Track
Employee Health
RESERVOIRS
Immunosuppression
Barrier Nursing
Rapid Accurate
Parenteral
Food Handling
Air Flow Control
AIR BORNE ROUTE

Vehicles droplets from
Mouth
Dry skin scales & dried pus secretions
Redispersal of organisms in dust due to broom sweeping.
Organisms on fabrics due to shaking of bed sheets/linen.
Liquid droplets generated in ventilator circuit, nebulizer.
CONTACT ROUTE
Direct
Contactnurses/doctors .
With
infected
patient
or
Indirect Contact- Contaminated hands and objects
infected
ORAL ROUTE
Through food / milk /water served to

patients.
PARENTERAL ROUTE
Via blood or blood product inoculation or
transplantation
ISOLATION POLICY
Isolate the infected patients in outside
isolation rooms with air borne disease

( diptheria ,meningococcemia, measles,
mumps, disseminated herpes simplex,
communicable T.B., etc.).
Separate staff to attend the patient.
Disinfect & Dispose all the used material
separately.
FOOD HANDLING
Proper Hand washing.
Separate utensils for each patient.
Store in air tight containers .
Separate refrigerator for food.
DRUGS AND I.V.FLUID

THERAPY
Aseptic Technique while catheter insertion.
Use of disposable syringes.
Meticulous cleaning of I.V puncture with betadine
and spirit.(3swab method).

Secure I.V. lines well cover them with sterile pad.
Change I.V. site q48hrly or on indication.
Change of Administration sets-72 hrs
Lipid based solutions-24 hrs
Blood products-discard after use
Keep them labeled with date and drug name.
Wear gloves for I.V. drugs.

Medication preparation using no-touch technique.
Clean injection ports with spirit before access.
Cap stopcocks when not in use.
Use of distilled water ampoules.
Multiple dose vials & ampoules for more than one
pt are not recommended.

Destroy needles and syringes after use.
1-Primary contamination from improper

sterilizing/packaging procedure.
1
2
2-Secondary contamination when fluid

additives from contaminated multi dose
containers are used.
3- Breaks in aseptic tech. most likely at

connection in system.
4
4- Blood withdrawal through 3-way stop

cock leaves residual blood in system
providing medium for bacterial growth.
5- Flushing a blocked or malfunctioning
I.V. Line may lead to contamination.
6
6- Prolonged use of site may result in

phlebitis, septicemia
INFECTIOUS AGENT
Bacteria Fungi
Chain 6
Viruses Rickettsiae
Protozoal

SUSCEPTIBLE HOST
Employee Health
RESERVOIRS
Immunosuppression
Barrier Nursing
Rapid Accurate
Role of
health
personnel
Chain 5
People
Disinfection/
Sterlization
Equipment
Water
Proper Attire
PORTAL OF
EXIT
PORTAL OF
ENTRY
GI Track
Respiratory Track
MODES OF
TRANSMISSION
Broken Skin
Handwashing
Excretions
Secretions
Droplets Skin
Trash & Waste

Disposal
Excretion/Secretion
Control
Air Borne Contact

Oral
Environmental
Sanitation
Parenteral
Aseptic Technique
Catheter Care
Handwashing
Food Handling
Wound Care
Isolation
Air Flow Control
PORTAL OF ENTRY
Gastro intestinal tract:
oral mucosa , via
nasogastric tube.
Proper Oral care

Periodic change of
NG TUBE
Respiratory tract : via

any artificial airway i.e. ET
TUBE or TRACHEOSTOMY
TUBE .
Aseptic technique of
suctioning
Broken skin: pressure

sores or any wound or skin
lesion.
Aseptic method of
wound care
The Aseptic Technique

(During Invasive Procedures)
Wearing of cap, mask

Handwashing
Wearing of sterile gown
Gloving
Opening the sterile packet
Skin Preparation-
Purpose- To remove bacteria from the skin site.

Solutions Used- Betadine, Savlon ,Spirit.
Direction- From center to periphery.
Time- Allow it to dry fully.
Draping
Covering the patient with sterile linen

leaving a minimal area of skin exposed at
the site of procedure.
Purpose- To create & maintain adequate
sterile field.
PERSONAL HYGIENE OF
PATIENT
Use separate clean basin for each patient for
sponging.
Chlorohexidine mouthwash q6hrly.
Clean eyes with saline and put moisol eye drops.
Bladder and bowel care.
Back care and regular position changing.
Nails to be cut short.
INFECTIOUS AGENT
Treatment of
underlying diseases
Bacteria Fungi
Chain 6
Viruses Rickettsiae
Protozoal
SUSCEPTIBLE HOST
Aseptic Technique
Catheter Care
Wound Care
Employee Health
RESERVOIRS
Immunosuppression
Barrier
Nursing
Rapid Accurate
Role of
health
personnel
People
Disinfection/
Sterlization
Equipment
Water
PORTAL OF
EXIT
PORTAL OF
ENTRY
GI Track
Respiratory Track
MODES OF
TRANSMISSION
Broken Skin
Handwashing
Excretions
Secretions
Droplets Skin
Trash & Waste

Disposal
Excretion/Secretion
Control
Air Borne Contact

Oral
Environmental
Sanitation
Parenteral
Handwashing
Food Handling
Isolation
Air Flow Control
SUSCEPTIBLE HOST
Are the patients or HCW.
GOOD WORK
PRACTICE
Use disposable items as far as possible.
Never try to recap / reinsert the used
needle.
Use needle cutter to destroy needles.
Cut and abrasions should be covered with
water proof dressing.
Eating ,drinking and smoking should be
prohibited in the area.
Do not store eatables in ward refrigerator,
there should be a separate pantry.
Self discipline :no mobile inside the PICU ,
avoid talking during invasive procedure

and handling samples, avoid sharing of
articles between the patients.
Avoid touching eyes ,nose , mouth during
working.
Keep yourself neat and tidy , tie up long
hairs.
Avoid touching door knobs ,phone ,pen
,tapset etc ., with contaminated

hands/gloves.
UNIVERSAL PRECAUTIONS
OBJECTIVES
To protect the HCW himself /herself.
To prevent the spread of infection from one
patient to others.
To protect other co-workers.
ANTIBIOTIC POLICY
Anti- microbials to be used in a rational &
appropriate manner.
Regular audit of antibiotic.
Time to time Surveillance of infection
level.
TRAINING AND EDUCATION

Staff at all level need to be educated especially
less literate staff e.g. hospital attendant and

sanitary attendant.
All staff (especially new doctors and nurses)
should be educated thoroughly about Universal
Precautions recommended by Centres for
Disease Control.
Safety manual should be available in the unit.
Health teaching to patients attendants regarding
infection control measure, hand washing, personal

hygiene and policies of hospital.
All the HCW should have full knowledge about
various methods of sterilization and disinfection

and their appropriate strength.
Immunization of health personnels e.g.
Hepatitis B vaccination.
Regular check up for early detection of any
communicable disease etc
PERIODICAL SURVEILLANCE
Surveillance of infection control committee
once in a month to review the problems of

drug resistance, the use /misuse of
antimicrobial in unit.
To keep a check for the correct method to
carry out procedures according to the hospital

policy for early detection of HAI.
CONCLUSION
1/3rd infections in Hospitals are Nosocomial.
Sepsis- the most common cause of death in ICU.
Common Infections in PICU - Blood Stream , VAP ,
UTI.
HAI can be controlled by various ways Hand
washing, Environmental Sanitation, Aseptic
techniques, Physical Barriers, etc.
None works without constant vigilance on the part
of Health Personnel.
SOAP , WATER AND COMMON SENSE CAN

PREVENT 90% OF HAI
k
n
a
Th u
Yo

Infection Control

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Infection Control

Caricato da

Copyright:

Formati disponibili

INFECTION CONTROL

estate summarized in three words:

Many issues of infection control countered

Florence Nightingale, more than a century

could be pronounced than the single fact that

Hospital Acquired Infection (HAI)

Besides morbidity and mortality,

resources of the hospital , patients and

RISK FACTORS OF HAI

Inherent to the patient.

Related to the types of medical practice

Treatment of underlying diseases

Air Borne Contact

Air Flow Control

Trash & Waste

BREAKING THE CHAIN 1 OF INFECTION

BREAKING THE CHAIN 1 Cont..

RAPID & ACCURATE IDENTIFICATION

Treatment of underlying diseases

Air Borne Contact

Air Flow Control

Trash & Waste

BREAKING THE CHAIN 2 Cont..

BREAKING THE CHAIN 2 Cont..

BREAKING THE CHAIN 2 Cont..

disinfectant e.g. phenol.

Thorough cleaning of bed and bedside

equipments before admitting new admission.

Separate mops should be used for cleaning of the

unit. (twice a day)

Damp dusting should be done.

BREAKING THE CHAIN 2 Cont..

AIR FLOW CONTROL

BREAKING THE CHAIN 2 Cont..

BREAKING THE CHAIN 2 Cont..

doctors, nurses & supportive staff.

Allow only one attendant.(3-4hrs).

washing, disposal of waste , hygienic

BREAKING THE CHAIN 2 Cont..

No personal clothing, flowers and eatables

,ultrasound machines) from outside should

BREAKING THE CHAIN 2 Cont..

into the unit i.e. by proper cleaning, sealing

Patient diet should be kept in covered

Fly trapper should be in working order.

BREAKING THE CHAIN 2 Cont..

DISINFECTION, STERILIZATION AND

matter from the surface of an object i.e. thorough

DISINFECTION: kills micro organisms but not

bacterial spores also.

BREAKING THE CHAIN 2 Cont..

Regular Cleaning and Disinfection of

BREAKING THE CHAIN 2 Cont..

DISINFECTION, STERILIZATION AND

BREAKING THE CHAIN 2 Cont..

For Sterilized Items

Put date of sterilization

Use within 72 hrs of sterilization

Check date before use

Put indicator tape

BREAKING THE CHAIN 2 Cont..

LOW LEVEL DISINFECTANTS

BREAKING THE CHAIN 2 Cont..

Treatment of underlying diseases