Hospital Acquired

Infections-II

SONA
 Objectives

• Prevention of Hospital Acquired

Infections:
 Standard precautions
 Transmission based precautions
 Aims of Infection Control
• Reduce microbial population of hospital
• Eliminate danger of transmission of
microorganisms
• Practice safe methods of biomedical
waste disposal
• To prevent cross contamination
 Standard Precautions
• Minimum infection prevention practices
• Previously known as ‘Universal Precautions’

Indications:
• Handling all individuals - regardless of their
symptoms
• Specimens – blood & body fluids
• Sharps - needles
Why?

• To prevent transmission of disease

which can be acquired by contact
with blood body fluids,non intact
skin, mucous membrane.
Components of Standard Precautions

• Hand Hygiene
• Personal Protective Equipment(PPE)
• Biomedical waste managment
• Spillage cleaning
• Disinfection of Patient Care items
• Environmental cleaning
• Sharp Handling
• Respiratory Hygiene & Cough etiquette
 Hand Hygiene

Types Of Hand Hygiene Methods:

• Hand rub
• Hand Wash
• Surgical Hand scrub
 Hand Rub
• Available in: 70 – 80 % ethyl alcohol
and chlorhexidine( 0.5 – 4 %)
• Duration of contact: 20 – 30 seconds.
Advantages:
• Gets evarporated on it’s own
Indications:
• Routine patient care activities
• Taking rounds in wards or ICUs
 Hand Wash
• Antimicrobial liquids, gel or bars
• Content: 4% chlorhexidine
• Duration of contact - 40 - 60 seconds

Indications:
• Hands soiled with blood, excreta, pus
etc..
• Before and after eating
• Before and after shift of the duty
 Surgical Hand scrub
• Content: 4% chlorhexidine hand wash
• Duration of contact: 3 – 5 minutes

Indications:
• Prior to any surgical procedure
 Indications
• Five moments for Hand Hygiene –
WHO
1. Before touching a patient
2. Before clean/aseptic procedures
3. After body fluids exposure/risk
4. After touching a patient
5. After touching patient’s surroundings
Steps of Hand Rubbing & Hand
Washing
 Personal Protective Equipment
Why?
• Used to protect skin & mucous
membrane of health care workers
from exposure to blood and body
fluids during sterile and invasive
procedures.
 Selection of appropriate PPE
Based on
• Level of risk assosciated with
contamination of skin, mucous
membrane and clotting by blood.
• Route of transmission of suspected
organisms.
 Gloves
• Part of standard, contact and droplet
precautions
Indications:
• Before a sterile procedure
• Contact with patients
• Anticipation of contact with blood and
body fluids
Situations where gloves is not
recommended:
• Routine patient care
• Eg: Measuring blood pressure,
Temperature, Pulse, Transporting
patients, writting in patients’ case
sheet.

Why?
• Waste of resource & False sense of
security.
Indication for glove removal:
• As soon as gloves are damaged
• In between patients or patient care
activities
• When there is an indication for hand
hygiene.
Hand hygiene and glove use
• Hand hygiene before gloves use : To
prevent cross contamination.
• Hand wash after gloves use : As the
warm moist environment is a safe
heaven for microorganisms
• No hand hygiene over gloved hands.
Donning & Doffing of gloves
 Surgical masks
• Also known as 3 - ply masks or
medical masks
• Loose fitting, single use item
Why?
• To prevent splashes or sprays from
reaching the mouth and nose of the
person wearing those
• Protection from respiratory secretions
 Composition
3 layers:
1. Outer fluid repellent layer
2. Middle filter layer
3. Inner hydrophilic layer

2 layers:
4. Outer fluid repellent layer
5. Inner filter layer
 Instructions
• Shelf life: After 4 – 6 hours of use or
earlier if soiled.
• Hand hygiene should be performed
before donning and after doffing.
Hanging mask syndrome:
• Masks shouldn’t be left dangling
around neck as it may contaminate
the inner side of the mask
 N95 Respirator
• Device to protect the wearer from
airborne microorganisms
So when to use?
• Tuberculosis, H1N1 virus, Ebola
virus, SARS Cov- 2
• Not resistance to oil and ability to
filter 95% of airborne particles
Composition
• Outer layer and
inner layer of
spunbond
polypropylene
• Middle two layer of
cellulose or
polyester
• Melt blown
polypropylene filter
• Negative pressure inside facepiece
• Removal: Once in every 8 hours or earlier
if it get wet or dirty inside
• Single use only
• Clinical activity should be undertaken only
after Fit checking
Sealing
Positive pressure seal
Negative pressure seal
 Protective body clothing
Why?
• When there is a risk that clothing and
skin from the splash of blood or body
fluid .
 Laboratory coats
 Plastic aprons
 Disposable gowns
 Coverall
 Protective eye / face wear
• Goggles or face shields
Why?
• To protect the mucous membranes of
eyes, mouth and nose
• Eyewares must be worn during
procedures that are more likely to
generate droplets or aerosols of blood
or high risk body fluids
 Head cover
• Head cover or cap – used when
spillage of blood is suspected
• During major cardiac surgeries
 Shoe cover
Surgical shoes
• Used in ICUs and Operation Theatre

Gumboots:
• For anticipitated risk of sharp injuries
 Donning & Doffing of PPE
Donning : Doffing:
i. Gowns i. Gloves
ii. Masks or ii. Face shield or
Respirators goggles
iii. Goggles or face iii. Gown
shield iv. Masks or
iv. Gloves respirator
• Doffing – extrmely important
• Minor breach – huge risk of acquiring
infection (Might be a reason of HCW
infected by COVID 19)
• All PPE except Respirator should be
removed before exiting patient’s room
Discarding PPE:
• Yellow bag: Gown/ cover all, Mask/
Respirator, Shoe cover and cap
• Red bag: Plastic apron, goggles/Face
shield, gloves
 Blood Spill management
• Blood spills – Risk for transmission of
blood borne viruses
• Should be infectious
• Should be cleaned at the earliest
TRANSMISSION BASED
PRECAUTIONS
• Set of infection control practices –
should be followed over and above the
standard precautions
• Also known as Specific precautions
When?
• To patients having contact, droplet or
airborne transmissions
 Contact Precautions
• Direct transmission
Indirect transmission
 Infection control measures
• Hand Hygiene
• PPEs
• Equipments
• Patient Placement: Isolation or
Cohorting
• Disinfection of the room
 Droplet Precautions
• Respiratory droplets – large particles
• Generated during coughing, sneezing
or talking
• Droplets travel shorter distances
• Can also be transmitted by contact
mode
 Infection control measures
• Hand hygiene
• PPEs
• Cough etiquette
• Respiratory Hygiene
• Patient placement
• Disinfection of the rooms
 Airborne Precautions
Why?
• To prevent the spread of infectious
agents transmitted through aerosols
• Aerosols small particles generated
during coughing, sneezing , talking or
AGPs
• Suspended in the air for long period
and disperse to distant place.
 Infection control measures
• PPE
• UVGI
• Filtration
• Cough etiquette & Respiratory
Hygiene
• Restriciton of Visitors
• Ventilation
Hospital Infection Control Committee

• Hospital infection control Program –

organised and run by MS
• Multidisciplinary input and
cooperation and information sharing
required for hospital infection control
and prevention
 Functions of HICC
• HAI surveillance
• AMSP
• Staff health
• HICC meetings
• Outbreak management
• Education to HCW
REFERENCES:

Apurba S Sastry (3rd edition)

CP Baveja ( 7th edition)
Anandanarayanan & Paniker (11th edition)
Your ext Here