Hospital Name:

PHC Registration # R-

Department Name: Emergency

Document Name: Hospital Infection Control Plan & Training Attendance Sheet

Issuance Date: Effective Date: Last Revision Date:

Particulars Name Designation Signature

Prepared by

Reviewed by

Approved by
 Hospital Infection Control Plan
Nosocomial Infection Surveillance
Surveillance is a systematic, active on-going observation of the occurrence and distribution
of a disease within a population and of the events that increase or decrease the risk of the
disease occurrence. The primary role of surveillance is to monitor Nosocomial Infection
Rate as the first step to identify local problems and priorities, and evaluate the effectiveness
of IC activity. Surveillance, by itself, is an effective process to decrease the frequency of
hospital-acquired infections.
I. Objectives:
The ultimate aim of surveillance programme is the reduction of nosocomial infections and
the cost of treatment whereas the specific objectives include:
A. To improve awareness of the clinical staff and other hospital workers (including
administrators) about nosocomial infections and antimicrobial resistance so that they may
appreciate the need for preventive action.
B. To identify possible areas for improvement in patient care.
II. Implementation at the hospital level
A. General Surveillance:
The Infection Control Team is responsible for general monitoring and surveillance of the
hospital including the patients’ beds, wash rooms, corridors and other patient care area.
The team will see if the waste segregation is practiced from the point of generation to the
disposal. In view of the Dengue fever risk it will be ensured that water is not let to stay
uncovered.
B. Microbial Surveillance:
Swabs from OT are collected every month for culture. The OTA (member of the HIC
Committee). The swabs are collected from the 6 sites including OT table, floor, light, air,
Anesthesia Machine and AC filter. External validation will be carried out every six
months. The periodicity of microbial surveillance can be shortened as per the advice of
the surgeon or the anesthetist depending upon the number of surgeries and nature of the
procedures.
III. Infection Control Practices
Infection control practices can be grouped in two categories:
A. Standard Precautions: Transmission of infections in healthcare facilities can be prevented
and controlled through the application of basic IC precautions which can be grouped into
Standard Precautions, that must be applied to all patients at all times, regardless of
diagnosis or infectious status
 B. Additional Precautions, which are specific to modes of transmission or transmission-
based i.e. airborne, droplet and contact.
Standard Precautions:
Treating all patients in the healthcare facility with the same basic level of “standard”
precautions involves work practices that are essential to provide a high level of protection to
patients, healthcare workers and visitors.
These include the following:
i) Hand washing and antisepsis (hand hygiene).
ii) Use of Personal Protective Equipment (PPE) when handling blood, body substances,
excretions and secretions.
iii) Appropriate handling of patient care equipment and soiled linen.
iv) Prevention of needle prick/sharp injuries.
v) Environmental cleaning and spills-management.
vi) Appropriate handling of waste.
HAND HYGIENE

Appropriate hand washing can minimize micro-organisms acquired on the hands by contact
with body fluids and contaminated surfaces. Hand washing breaks the infection transmission
chain and reduces person-to-person transmission. All healthcare personnel and family
caregivers of patients must practice effective hand washing. Patients and primary care givers
need to be instructed in proper techniques and situations for hand washing.
Compliance with hand washing is, however, frequently sub-optimal. Reasons for this
include: lack of appropriate equipment; low staff to patient ratios; allergies to hand washing
products; insufficient knowledge among staff about risks and procedures; the time required;
and casual attitudes among staff towards bio-safety.
Purpose
Hand washing helps to remove micro-organisms that might cause disease. Washing with
soap and water kills many transient micro-organisms and allows them to be mechanically
removed by rinsing. Washing with antimicrobial products kills or inhibits the growth of
micro-organisms in deep layers of the skin. Use of alcohol based gel is the preferred method
of hand cleansing.
Types of Hand Washing
Simple hand washing is usually limited to hands and wrists; the hands are washed for a
minimum of 10 – 15 seconds with soap (plain or antimicrobial) and water.
Hand antisepsis/decontamination removes or destroys transient micro-organisms and
confers a prolonged protective effect. It may be carried out in one of the following two ways:
 i) Wash hands and forearms with antimicrobial soap and water, for 15-30 seconds
(following manufacturer’s instructions).
ii) Decontaminate hands with a waterless, alcohol-based hand gel or hand rub for 15-30
seconds. This is appropriate for hands that are not soiled with protein matter or fat.
Immersion of hands in bowls of antiseptics is not recommended.
Surgical hand antisepsis removes or destroys transient micro-organisms and confers a
prolonged effect. Hands and forearms are washed thoroughly with an antiseptic soap for a
minimum of 2-3 minutes and are dried using a sterile towel. Surgical hand antisepsis is required
before performing invasive procedures.
Facilities and Materials Required For Hand Washing

Running water
Access to clean water is essential. It is preferable to have running water, large washbasins having
anti-splash devices, hands-free controls requiring little maintenance.
When running water is not available use either a bucket with a tap, which can be turned on and
off, a bucket and pitcher, or 60% - 90% alcohol hand rub.
Materials Used For Hand Washing/Hand Antisepsis
Use plain or antimicrobial soap depending on the procedure.
Plain Soap: Used for routine hand washing, available in bar, powder or liquid form.
Antimicrobial Soap: Used for hand washing as well as hand antisepsis.
i) If bar soaps are used: Use small bars with soap racks that can be drained.
ii) Do not allow bar soap to sit in a pool of water as it encourages the growth of some micro-
organisms such as pseudomonas.
iii) Clean dispensers of liquid soap thoroughly every day.
iv) When liquid soap containers are empty they must be discarded, not refilled with soap
solution.
Specific antiseptics recommended for hand antisepsis:
i) 2%-4% chlorhexidine
ii) 5%-7.5% povidone iodine
iii) 1% triclosan
iv) 70% alcoholic hand rubs
Waterless, alcohol-based hand rubs: with antiseptic and emollient gel and alcohol swabs, which
can be applied to clean hands. Dispensers should be placed outside each patient room.
Facilities for Drying Hands
i) Disposable towels, reusable single use towels or roller towels, which are suitably
maintained, should be available.
 ii) If there is no clean dry towel, it is best to air-dry hands.
iii) Equipment and products are not equally accessible to all HCEs. Flexibility in products
and procedures, and sensitivity to local needs will improve compliance.
iv) In all cases, the best possible procedure should be instituted.
Hand Washing-Steps

Preparing for hand washing:

i) Remove jewellery (rings, bracelets) and watches before washing hands.
ii) Ensure that the nails are clipped short (do not wear artificial nails).
iii) Roll the sleeves up to the elbow.
iv) Wet the hands and wrists, keeping hands and wrists lower than the elbows (permits the
water to flow to the fingertips, avoiding arm contamination).
v) Apply soap (plain or antimicrobial) and lather thoroughly.
vi) Use firm, circular motions to wash the hands and arms up to the wrists, covering all areas
including palms, back of the hands, fingers, between fingers and lateral side of fifth
finger, knuckles, and wrists. Rub for minimum of 10-15 seconds.
vii) Repeat the process if the hands are very soiled.
viii) Clean under the fingernails.
ix) Rinse hands thoroughly, keeping the hands lower than the forearms.
x) If running water is not available, use a bucket and pitcher.
xi) Do no dip your hands into a bowl to rinse, as this re contaminates them.
xii) Collect used water in a basin and discard in a sink, drain or toilet.
xiii) Dry hands thoroughly with disposable paper towel or napkins, clean dry towel, or
air dry them.
xiv) Discard the towel if used, in an appropriate container without touching the bin lids
with hand.
xv) Use a paper towel, clean towel or your elbow/foot to turn off the faucet to prevent
recontamination.
xvi) A general procedure for hand washing is given in the figure below and must be
conducted over at least one full minute using antiseptics, hand rubs, gels or alcohol
swabs for hand antisepsis.
xvii) Apply the product to the palm of one hand. The volume needed to apply varies by
product.
xviii)Rub hands together, covering all surfaces of hands and fingers, until hands are dry.
xix) Do not rinse.
xx) When there is visible soiling of hands, they should first be washed with soap and water
before using waterless hand rubs gels or alcohol swabs. If soap and water are unavailable
hands should first be cleansed with detergent containing towelettes, before using the
 alcohol-based hand rub, gel or swab.

A surgical scrub is performed before each surgical procedure with the aim of removing and
killing the transient flora and decreasing the resident flora in order to reduce the risk of wound
contamination if surgical gloves become damaged. It ensures the removal or killing of transient
micro-organisms and a substantial reduction and suppression of the resident microbial flora.
Agents are the same as for the hygienic hand wash.
1. Personal Protective Equipment (PPE)
Adequate and appropriate PPE, soaps, and disinfectants should be available and used correctly.
These should be available at the point of use and the organization shall ensure that it maintains
an adequate inventory and stock of items.
Using PPE provides a physical barrier between micro-organisms and the wearer and offers
protection by helping to prevent micro-organisms from:
i) Contaminating hands, eyes, clothing, hair and shoes.
ii) Being transmitted to other patients and staff.
PPE includes:
a) Gloves
b) Protective eye wear (goggles)
c) Masks
d) Aprons
e) Gowns
f) Boots/shoe covers
g) Caps/hair covers
PPE should be used by:
a) Healthcare workers who provide direct care to patients and who work in situations
where they may have contact with blood, body fluids, excretions or secretions.
b) Support staff including medical aides, cleaners, and laundry staff in situations where
they may have contact with blood, body fluids, secretions and excretions.
c) Laboratory staff, who handle patient specimens.
d) Family members who provide care to patients and are in a situation where they may
have contact with blood, body fluids, secretions and excretions.
Principles for use of PPE
PPE reduces, but does not completely eliminate, the risk of acquiring an infection. It is important
that it is used effectively, correctly, and at all times where contact with blood and body fluids of
patients may occur. Continuous availability of PPE and adequate training for its proper use are
essential. Staff must also be aware that use of PPE does not replace the need to follow basic IC
measures such as hand hygiene.
The following principles guide the use of PPE:
a) PPE should be chosen according to the risk of exposure. The healthcare worker
should assess whether they are at risk of exposure to blood, body fluids, excretions or
secretions and choose their items of personal protective equipment according to this
risk.
b) Avoid any contact between contaminated (used) PPE and surfaces, clothing or people
outside the patient care area.
Examples of use of PPE
a) Discard the used PPE in appropriate disposal bags, and dispose off as per the policy
of the hospital.
b) Do not share PPE.
c) Change PPE completely and thoroughly wash hands each time you leave a patient to
attend to another patient or another duty.
2. Patient care equipment
Handle patient care equipment soiled with blood, body fluids secretions or excretions with care,
in order to prevent exposure to skin and mucous membranes, clothing and the environment.
Ensure all reusable equipment is cleaned and reprocessed appropriately before being used on
another patient.
3. Prevention of needle prick/sharps injuries
Take care to prevent injuries when using needles, scalpels and other sharp instruments or
equipment. Place used disposable syringes and needles, scalpel blades and other sharp items in a
puncture-resistant container with a lid that closes and is located close to the area in which the
item is used. Take extra care when cleaning sharp reusable instruments or equipment. Never
recap or bend needles. Sharps must be appropriately disinfected and/or destroyed as per the
national standards or guidelines.
4. Cleaning of the hospital environment
Routine cleaning is important to ensure a clean and dust-free hospital environment. There are
usually many micro-organisms present in “visible dirt”, and routine cleaning helps to eliminate
this dirt. Administrative and office areas with no patient contact require normal domestic
cleaning. Most patient care areas should be cleaned by wet mopping. Dry sweeping is not
recommended. The use of a neutral detergent solution improves the quality of cleaning.
Hot water (80°C) is a useful and effective environmental cleaner. Bacteriological testing of the
environment is not recommended unless seeking a potential source of an outbreak. Any areas
visibly contaminated with blood or body fluids should be cleaned immediately with detergent
and water.
Isolation rooms and other areas that have patients with known transmissible infectious diseases
should be cleaned with a detergent/disinfectant solution at least daily. All horizontal surfaces and
all toilet areas should be cleaned daily.
5. Management of Healthcare Waste
i) Uncollected, long stored waste or waste routing within the premises must be avoided.
ii) A sound waste management system needs to be developed and closely monitored.
Additional Precautions (transmission- based)
Additional (transmission-based) precautions are taken while ensuring Standard Precautions are
maintained. Additional precautions include:
1) Airborne precautions
2) Droplet precautions
3) Contact precautions
Isolation Procedures
Isolation for the control of infection (Infection Control Measures Against Viral Infections) is
used to prevent infected patients from infecting others (source isolation), and/or prevent
susceptible patients from being infected (protective isolation). The methods of physical
protection are:
a. Barrier nursing - special nursing procedures which reduce the risks of person to person
transmission, especially by direct contact or by fomites.
 b. Segregation into single rooms, cubicles, or plastic isolators - which reduces airborne
spread to and from patients, and facilitates nursing techniques.
c. Mechanical ventilation - which reduces the risks of airborne spread by removing bacteria
from the patient’s room and by excluding bacteria present in the outside air from the
room.
The transfer of infection by the airborne route can be controlled only by confining the patients in
a single room, whether source or protective isolation. On the other hand, diseases spread by
contact such as enteric fever, depends primarily on barrier nursing. The term isolation is
commonly used in the sense of segregation of the patient in a single room. Barrier nursing is one
of the basic components of patient isolation and can be used on its own or together with the other
components. There are various types of isolation offering different degrees of protection;-
a. High security isolation units: These are usually part of an infectious diseases hospital.
Total environmental control is usually achieved by the use of negative pressure plastic
isolators. These units are designed for treating viral pathogens such as Lassa, Marburg,
and Ebola fevers.
b. Infectious diseases hospitals: These units are usually separate from other hospitals but
may be situated in the premises of a general hospital with separate ventilation and nursing
staff.
c. General hospital isolation units: These provide source isolation facilities for hospital-
acquired infections; they also provide facilities for protective isolation and for the
screening of patients with suspected infections before admission to a general ward or
transfer to a communicable diseases unit.
d. Single rooms of a general ward: These provide less secure source isolation than the
above because of the close proximity to other patients and sharing of nursing and
domestic staff with a general ward. Their value in protective isolation depends on the
type of patient in the general ward, on the thoroughness of barrier nursing, on whether the
room is self-contained (with WC), and on the type of ventilation used.
e. Barrier nursing in open wards: This can be effective in controlling infections
transferred by contact but not by air.
f. Isolators in open wards: Plastic enclosures for individual patients have been shown to
be of value as a form of protective isolation for high risk patients and of source isolation
for infected patients.
g. Ultra-clean wards: Experimental units have been set up in specialized centers for organ
transplantation, treatment of leukaemia and other diseases associated with extreme
susceptibility to infection.
 Attendance Sheet
Training on Hospital Infection Control Plan
Trainer………………………………… Date:…………………………….

Sr Name of Participants Designation Contact Signature

Signature and Name of trainer__________________________