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1
Prevention of Infection
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
BEMoC - Presentation 10 (a)
Session 10a
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
2
Session Objectives
Understand the concept and importance of infection prevention
Know and practice the standard procedures to be undertaken in the facility and specifically the labour room
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
3
WHY?
Minimise the risk of HIV, Hepatitis B, C and streptococcal/staphylococcal infections
Appropriate prevention practices to:• reduce post-procedure infection• prevent infection of health care personnel• protect the community• lower the costs of healthcare
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
4
Sources of Infection
What are the common sources of infection?
Environment: Blood, body fluids, secretions, excretions, placenta, contaminated sharps and other equipments.
Other clients
People in the community
Health care delivery personnel
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
5
Infection prevention principles
All objects that come in contact with a patient are potentially contaminated
Every person must be considered potentially infectious
If an object is disposable - discard appropriately
If an object is reusable - decontaminate
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
6
Universal (Standard) Precautions
“Precautions to protect against exposure must be taken when there is any potential for exposure to bodily fluids. It is assumed that all bodily fluids have the potential to transmit disease”
The Universal Precaution Rule:
Treat all human blood, bodily fluids and other potentially infectious materials
as if they are infectious.
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
7
Components of universal precautions
Hand washing
Careful handling of sharps
Safe techniques
Sterilization and Disinfection
Disposal of waste in a proper manner
Use of Personal barrier precautions
ASSUME ALL BODY FLUIDS FROM ALL PERSONS ARE POTENTIALLY INFECTIOUS
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
8
Standard Precautions: Hand Washing
LongAntibacterial soap, Alcoholic solutions
Pre-operative disinfection
Surgical hand disinfection
DisinfectionAlcoholDisinfection after contamination
Hygienic hand rub
ShortNon medicated soap
Cleansing after client contact
Careful hand washing
ShortNon medicated soap
CleansingRoutine hand washing
Residual effect
AgentsMain PurposeTechnique
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
9
Specific Indications for Hand Hygiene
Before: Patient contact Inserting urinary catheters, peripheral vascular,
I/V cannula ,catheters, or other invasive devices that don’t require surgery
After: Contact with a patient’s skin Contact with body fluids or excretions, non-
intact skin, wound dressings Removing gloves
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
10
Steps of hand washing
Step 1Wet the hands and wrists. Apply soap.
Step 2Right palm over left,
left over right.
Step 3Palm to palm,
Fingers interlaced.
Step 4Back fingers to opposing
Fingers interlocked.
Step 5Rotational rubbing of right
Thumb clasped in left palm and vice versa.
Step 6Rotational rubbing
backwards and forwards with top of fingers and
thumb of rightHand in left and vice
versa.
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
11
Missed Spots when Hand-washing
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
12
Standard Precautions: Protective attire
Gloves Masks Eye-covers Gowns Caps Footwear
*use once then change
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
13
Standard Precautions: Processing of used items
A. Decontamination
B. Cleaning
C. Sterilization or high level disinfection
(HLD)
D. Storage
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
14
Processing of used items
Decontamination: kills pathogens• Place instrument in 0.5% chlorine for 10min• Wipe contaminated surfaces
Cleaning: with soap and water – scrub equipment
Sterilization: for surgical instruments and drapes
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
15
Standard Precautions: Maintaining clean environment
For cleaning areas – operation theatres, procedure rooms, latrines
Disinfectant cleaning solution
To clean up spills of blood or other body fluids
Disinfectant 0.5 % chlorine solution
To remove dirt & organic material such as grease, oil
Plain detergent and water
UsesType of cleaning solution
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
16
Steps of Decontaminnation
Monitor vitals
Take steps to stabilize woman’s condition
If condition worsens, assess the level of shock
Treat accordingly & refer the patient to an FRU with basic life support
Specific treatment: as mentioned according to the type of abortion
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
17
Missed Spots when Hand-washing
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
18
Recommended Disinfectants
.5 to 1% bleach
2% glutaraldehyde
70% ethyl and isopropyl alcohol.
4% formaldehyde.
.5-1% sodium hypochlorite.
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
19
Processing of used items
Sterilization: Sterilization ensures that items are free of all
microorganisms (bacteria, viruses, fungi and parasite) including endospores.
Three methods of sterilisation: Steam sterilisation / Autoclaving / Pressure
cooker autoclaving Dry heat sterilisation Chemical / cold sterilisation
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
20
Processing of used items
Sterilization: High level Disinfection HLD eliminates bacteria, viruses, fungi and
parasites, but does not kill all endospores which cause diseases such as tetanus and gas gangrene.
HLD only acceptable alternative to sterilisation. There are 3 methods of HLD:
• Boiling• Chemical HLD • Steaming
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
21
Processing of used items
Storage:
To prevent contamination after processing
Do not store instruments or other items such as
scalpel blades and suture needles in solution,
always store them dry
Follow the guidelines written on the container,
instructed by the manufacturer
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
22
Standard Precautions: Proper Handling and Disposal of sharps
Needles and syringes Use disposable needle and syringe ONLY ONCE.
Always wear utility gloves while handling sharps
Do not recap, bend or break needles before disposal.
Make needles unusable after single use by burning them in a needle destroyer
Never burn syringes
Do not reuse disposable gloves
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
23
Standard Precautions: Proper Handling and Disposal of sharps
Needles and syringes Dispose off needles and syringes in a puncture-proof
container such as metal box, cardboard box or an empty plastic box.
Syringes to be cut with hub cutters and chemically disinfected at source of generation before final disposal into sharps pit located at the PHC
Finally dispose as follows:
• Dispose the needles and broken vials in pit / tank, (made according to the GOI guidelines)
• Send the syringes and unbroken vials for recycling or landfill
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
24
Standard Precautions: Maintaining clean environment
For cleaning areas – operation theatres, procedure rooms, latrines
Disinfectant cleaning solution
To clean up spills of blood or other body fluids
Disinfectant
0.5 % chlorine solution
To remove dirt & organic material such as grease, oil
Plain detergent and water
UsesType of cleaning solution
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
25
What are the colour codes for segregation?
Yellow for infectious waste such as anatomical & pathological wastes, such as body parts and animal carcasses, soiled dressings such as gauze, cotton, linen, etc. contaminated with blood or other body fluids
Red for infectious plastics such as gloves, IV sets, tubings, catheters, canulas, microbiological waste, etc.
Translucent/puncture proof containers for metal sharps
Blue for glass Black for cytotoxic drugs, incinerator ash, chemical
waste, etc. White for recyclable non-infected general waste Green for collecting and transporting food waste from
wards, canteens, and dining halls.
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
26
Standard Precautions: Biomedical Waste Disposal
It is the waste that is generated during diagnosis,
treatment or immunization of human beings
Purpose of waste disposal Minimize/Prevent the spread of infection to
hospital personnel who handle waste Prevent the spread of infection to the local
community
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
27
Standard Precautions: Biomedical Waste Disposal
Steps of waste disposal
A. Segregation
B. Collection and Storage
C. Transportation
D. Treatment and disposal
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
28
Biomedical Waste Disposal: Collection and Storage
Wrong Correct
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
29
How to dispose of placenta
In a yellow bag
Not to be left in open places
To be buried in a deep trench away from the
water source
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
30
Biomedical Waste Disposal: Transportation
Wrong Correct
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
31
Biomedical Waste Disposal: Treatment and Disposal
Do’s
Disinfect and destroy the waste before its final disposal.
Remember
• Biological waste to be buried deep at the facility
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
32
Key Messages
Hand-washing is essential for preventing infections
Always wear gloves especially where there is a risk of touching blood, body fluids, secretions, excretions or contaminated items
Decontamination: 0.5% bleach solution is the least expensive and the most rapid acting and effective agent to use for decontamination
Proper handling of contaminated waste minimizes the spread of infection to healthcare personnel and to the local community
PREVENTION OF INFECTION
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
33
Key Messages (contd...)
Proper handling means: Wearing utility gloves Transporting solid contaminated waste to the
disposal site in covered containers Disposing of all sharp items in puncture-resistant
containers Carefully pouring liquid waste down a drain or
flushable toilet Burning or burying contaminated solid waste Washing containers, gloves and hands after
disposal of infectious waste
34
Preparation of Chlorine Solution
IP: Instructions for Preparing Dilute Chlorine Solutions
To make a 0.5% chlorine solution from 5% bleach, mix 1 part bleach to 9 parts water.
Dilute %
eConcentrat %Total parts (TP) (H2O) = - 1
Total parts (TP) (H2O) =
Dilute .5%
eConcentrat 5%- 1 = 9 Total parts (TP) (H2O)
IP: Instructions for Preparing a Chlorine Solution from a Powder
To make a 0.5% chlorine solution froma 35% chlorine powder,
mix 14.2 grams of powder to 1 liter of water.
eConcentrat %
Dilute %Gram/Liter = X 1000
eConcentrat 35%
Dilute .5%Gram/Liter = X 1000 = 14.2 Gram/Liter
?
38
Thank you
EXCERSIZE1. Which is the most important of the standard precautions practices?
2. Which is the first step in instrument processing and what is its purpose?
3 What are the key differences between sterilisation and high level disinfection?
4 What are the types of contaminated wastes produced in your HCF?
EXCERSIZE cont…5. How are you managing your waste?
6. How are you processing reusable items in your facility?
7. Name the chemical disinfectants available at your facility?
8. How is 0.5% hypochlorite solution prepared?