Infection Prevention and Control

Orientation Guide
 Session Objectives

At the end of this learning session, each

participant will be able to:
 Outline the Importance, Aim, Goal of
Infection Prevention and Control (IPC)
 Describe the Purpose & Rationale of
National IPC Orientation Guidelines for
Healthcare Services in Tanzania

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2 November 24, 2014 Control Guidelines
 Existing challenges of IPC in Tanzania

Inadequate
– adherence to guidelines and standards
– equipment and materials
– monitoring and supportive supervision
– Knowledge and skills among healthcare workers
– materials and equipments
– Lack of renovation and maintenance of infrastructure
 Insufficient commitment from management
 Inadequate capacity of RHMT
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 The Importance of IPC

 Protect patients/clients against nosocomial infections,

Nosocomial infections are costly to deal with.
– Increase length of stay in hospitals
– Require treatment with expensive broad spectrum
antibiotics
– Increase use of other interventions (laboratory, surgery etc.)
 Protect the health workers from occupational exposures
– Risk of infection from blood borne pathogens (HIV, HBV,
HCV) is high
 Protect communities; and
 Protect the environment from being polluted.

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 Rationale

 Emerging era of HIV/AIDS, every person is

potentially infected
 Increased awareness of how risky and susceptible to
infection it is to work in healthcare facilities.
 Healthcare facilities are prone to infection
transmission due to:
– Routine invasive procedures
– Exposure: Healthcare providers and clients
– Patients with compromised immunity
– Services are congested

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 What’s new
The last decade has seen many IP advances:
 IP not only reduces the risk of disease transmission to patients, but
also protects healthcare workers at all levels.

 The role of hand washing in disease prevention and, the use of

inexpensive, easy-to-make alcohol-based antiseptic handrubs when
clean water is not available

 The importance of first decontaminating all soiled instruments,

needles and syringes and other items with dilute (0.5%) bleach
solutions if cleaning is to be done by hand

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 What’s new in Infection Prevention?
(Con’t)

 Need for thorough cleaning of  Multiple uses of dilute chlorine

soiled instruments, gloves and solutions made from
other items if final processing, inexpensive commercial
either by high-level disinfection products- decontamination of
(HLD) or sterilisation, is to be instruments and large surfaces,
effective HLD solution and even to
prepare safe drinking water
 Use of HLD by boiling or
steaming as cost-effective,  The use of “no touch” surgical
readily available and techniques has allowed
acceptable alternative to examination gloves to be safely
sterilisation (autoclave or dry substituted for sterile surgical
heat) for most surgical gloves when indicated
procedures

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 Aim, Goal and Objectives of
IPC orientation guidelines.

Aim
 The aim of IPC orientation guidelines
is to provide a comprehensive
reference for healthcare providers in
healthcare settings in Tanzania
Goal
 To achieve safe, effective
and efficient healthcare practices
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8 November 24, 2014 Control Guidelines
 Objectives of IPC

 To protect patients/clients from nosocomial

infections;
 To protect health care workers from
occupational infections/exposures;
 To protect the communities from infections,
and
 To protect the environment from pollution.

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 DISEASE TRANSMISSION CYCLE AND
STANDARD PRECAUTIONS

Objectives
At the end of this section the health care provider
will be able to:
– Describe the six components of the disease
transmission cycle.
– Define Standard Precautions
– Explain components of Standard Precautions
– Explain how Standard Precautions practices
break the disease transmission cycle
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 The disease transmission cycle

Cycle: AGENT

Susceptible Reservoir
Host

Place of
Place of entry exit
Method of
transmission

The cycle repeats itself; infectious diseases are prevented by breaking the cycle

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 Six components of the disease
transmission cycle

 In order for diseases to move from person to person the following

conditions must exist:

1. Agent (micro organism that produces disease)

2. Reservoir (place where agent lives such as in or on humans, animals,
plants, the soil, air or water)
3. Place of exit (where the agent leaves the host)
4. Method of transmission (how the agent travels from place to place or
person to person)
5. Place of entry (where the agent enters the next host)
6. Susceptible host (person who can become infected)

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 STANDARD PRECAUTIONS 1

Definition:
 Standard Precautions are a simple set of effective
practice guidelines (creating a physical, mechanical
or chemical barrier) to protect health care workers
and patients/clients from infection with a range of
pathogens including blood borne pathogens. The
practices are used when caring for all patients/clients
regardless of diagnosis.

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13 November 24, 2014 Control Guidelines
 Components of Standard Precautions 1

 The following actions provide the means for implementing

Standard Precautions:
– Consider every person (patient or staff) as
potentially infectious and susceptible to infection
– Use appropriate hand hygiene techniques
including hand washing, hand antisepsis,
antiseptic hand rub and surgical hand scrub
– Wear Personal Protective Equipment (PPE)
including gloves, masks, goggles, caps, gowns,
boots and aprons

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 Components of Standard Precautions 2

 Appropriately handle sharps, and patient care

equipment.
 Appropriately manage patient placement and patient
environmental cleanliness
 Safely dispose of infectious waste materials
to:
– protect those who handle them
– prevent injury or spread to the community
 Process instruments using recommended procedures

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 How Standard Precautions practices break the
disease transmission cycle

By:
 Reducing the number of infection-causing
micro-organisms present
 Killing or inactivating infection-causing micro-
organisms
 Creating barriers to prevent infectious agents
from spreading
 Reducing or eliminating risk practices
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 TRANSMISSION-BASED
PRECAUTIONS

Objectives
At the end of this section the healthcare
provider will be able to:
 Define transmission-based precautions
 Explain precautions based on signs and
symptoms presented by a patient/client
 Be able to identify precautions for air, droplet
and contact routes of disease transmission
using IPC manual
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 TRANSMISSION-BASED
PRECAUTIONS

Definition
 This is a second level of precautions intended for
use in patients known or highly suspected of being
infected or colonized with pathogens transmitted by:
– Air (tuberculosis, chicken pox, measles, etc.);
– Droplet (flu, mumps, rubella); or
– Contact (hepatitis A or E and other enteric
pathogens [includes fecal/oral transmission],
herpes simplex, and skin or eye infections).

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 TRANSMISSION-BASED
PRECAUTIONS cont.

 Apply primarily to hospitalized patients

 Allow for empiric use for those without a diagnosis
 Includes precautions such as patient placement,
transport, PPEs, treatment of patient care
equipment

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 Implementing Transmission-based precautions using signs and
symptoms

AIRBORNE DROPLET CONTACT

•Cough, fever and upper lobe •Severe, persistent cough •Acute diarrhea in an
chest findings (dullness and during periods when incontinent or diapered
decreased breath-sounds) pertussis/flu is present in patient
•Cough, fever and chest community •Diarrhea in adult with history
findings in any area in HIV- •Meningitis (fever, vomiting of recent antibiotic use
infected person or at high and stiff neck) •Bronchitis and croup in
risk for HIV •Hemorrhagic rash with fever infants and young children
•Rashes (vesicular or •Generalized rash of •History of infection with multi
pustule) unknown cause drug-resistant organisms
(except tuberculosis [TB])
•Vesicular rash
•Abscess or draining wound
that cannot be covered

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 HAND HYGIENE
OBJECTIVES
At the end of this section the health care provider will
be able to:
 Define the terms hand hygiene and hand washing
 List indications for hand hygiene
 Differentiate different hand hygiene techniques
 Identify strategies for improving hand washing at
work site
 Discuss other issues of considerations related to
hand hygiene

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 The #1 most important way to break the
disease transmission cycle!

 It’s ALL about the HANDS!

 Hand washing is the single

most important infection
prevention procedure!

 Hand washing is the

removal of dirt, organic
material, and transient
microorganisms from the
hands

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 DEFINITIONS

Definitions
 Hand hygiene practices (hand washing, hand
rub and surgical hand scrubbing) are
intended to prevent hand-borne infections by
removing dirt and debris and inhibiting or
killing microorganisms on skin.
 Hand hygiene includes care of hands, nails
and skin
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 Why do we wash our hands?

 BECAUSE IT WORKS!

 Hand washing causes a significant reduction in

potential pathogens carried on the hands

 99% of transient bacteria are removed with a simple

hand wash using soap and friction

 There is consistent evidence from many studies that

hand washing is linked to a reduction in infection
rates ( see slide 25)
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24 November 24, 2014 Control Guidelines
 Handwashing: Who Does It?

 We all think that we wash our hands much more often (and for longer)
than we actually do
 In a teaching hospital in Geneva, Switzerland:
– average compliance was 48%
– Nurses washed their hands more than doctors and nursing
assistants
– Noncompliance was higher in intensive care than in internal
medicine units

Annals of Internal Medicine Compliance with Hand washing in a

Teaching Hospital Didier Pittet, MD, MS; Philippe Mourouga, MD,
MSc; Thomas V. Perneger, MD, PhD, and the Members of the
Infection Control Program

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25 November 24, 2014 Control Guidelines
 When to Perform Hand Hygiene

Should be done before:

 Examining (direct contact with) a patient/client; and
 Putting on sterile surgical gloves prior to any invasive or surgical
procedure.

Should be done after

Any situation in which hands may become contaminated, such as:
 Handling soiled instruments and other items;
 Touching mucous membranes, blood or other body fluids
(secretions or excretions); and
 Having prolonged and intense contact with a patient.
 Removing gloves.

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26 November 24, 2014 Control Guidelines
 Steps

 Thoroughly wet hands.

 Apply a hand washing agent (liquid soap); an antiseptic agent
is not necessary.
 Vigorously rub all areas of hands and fingers for 10–15
seconds (tip: 10 average breaths), paying close attention to
fingernails and between fingers.
 Rinse hands thoroughly with clean running water from a tap or
bucket.
 Dry hands with paper towel or a clean, dry towel or air dry
them.
 Use a paper towel or clean, dry towel when turning off water if
there is no foot control or automatic shut off.
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27 November 24, 2014 Control Guidelines
 Hand Antisepsis

 This process removes soil and reduces or slows the growth of

both transient and resident flora on the hands.
 The technique is similar to plain hand washing except that it
involves use of an antimicrobial agent instead of liquid soap.
 Hand antisepsis should be done before:
– Examining or caring for highly susceptible patients (e.g.,
premature infants, elderly patients, those with advanced AIDS);
– Performing an invasive procedure such as placement of an
intravascular device; and
– Leaving the room of patients on contact precautions (e.g., flu,
hepatitis A or E) or who have drug resistance infections (e.g.,
methicillin-resistant S. aureus [MRSA]).

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 What if there isn’t
running water

 Use a bucket with a tap which can be turned on to

wet hands, off to lather hands and turned on again
for rinsing.
 If a bucket with a tap is not available, a bucket and
pitcher can be used to create a running stream of
water. A helper can pour water from the pitcher
over the hands being washed.
 Similarly, a bucket and a tea kettle will function well.
 A “Tippy Tap” can be fashioned from a jerry can and
piece of wood to provide a steady stream of water.

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 Commonly Missed Areas

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 How to Wash Your Hands (WHO 2005)

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31 November 24, 2014 Control Guidelines
 Waterless, Alcohol-Based Antiseptic

 Another term for antiseptic handrub

 These can remove transient flora, reduce
resident micro organisms and protect the
skin
 Most contain 60-90% alcohol, an emollient
and often an additional antiseptic,
chlorhexidine, medicine that has a residual
action
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32 November 24, 2014 Control Guidelines
 Recipe for Making Antiseptic Handrub

To make your own, low cost handrub,

combine:
 100 ml of 60-90% Ethyl or Isopropyl
Alcohol
 2 ml of Glycerin

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33 November 24, 2014 Control Guidelines
 How to Improve Hand Washing Practices

 Provide an adequate water supply and liquid soap and

antiseptics
 Provide health facilities with running water
 Create awareness of all health workers of the importance of
improving hand washing practices through:
– Wide dissemination of current guidelines for hand hygiene
practices
– Involvement of everybody at the health facility
– Use successful educational techniques including monitoring and
positive feedback
– Use participatory performance improvement approaches targeted
to all health care staff to promote compliance

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34 November 24, 2014 Control Guidelines
 Before entering operating theatre and starting surgical hand
scrub preparation

 Keep nails short.

 Do not wear artificial nails or nail polish.
 Remove all jewelry (rings, watches, bracelets) before entering
the operating theatre.
 Wash hands and arms with a non-medicated soap before
entering the operating theatre area or again if hands are visibly
soiled.
 Clean under the nails. Use a soft brush, gauze or a toothpick.
(Hard brushes should not be used as they may damage the
skin and encourage shedding of cells.)
 Dry thoroughly with a clean, dry towel or air dry.
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35 November 24, 2014 Control Guidelines
 New surgical hand scrub:

 Remove rings, watches and bracelets.

 Thoroughly wash hands and forearms to the elbows with liquid soap
and water.
 Clean under the nails.
 Rinse with clean, running water thoroughly.
 Apply an antiseptic agent.
 Vigorously scrub all surfaces of hands, fingers and forearms for at
least 2 minutes.
 Rinse hands and arms thoroughly with clean water, holding hands
higher than the elbows.
 Put sterile surgical gloves on both hands.
 Keep hands up and away from the body, do not touch any surface or
article, and dry hands with sterile dry towel or air dry.
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36 November 24, 2014 Control Guidelines
 Alternate Hand Scrub
 ALTERNATIVELY:
 After Remove rings, watches and bracelets.
 Thoroughly wash hands and forearms to the elbows with liquid soap
and water.
 Clean under the nails.
 Rinse with clean, running water thoroughly washing with soap and
water:
 Apply 5 mL (about 1 teaspoonful) of a waterless, alcohol-based hand
rub to hands, fingers and forearms and rub until dry; repeat application
and rubbing two more times for a total of at least 2 minutes, using a
total of about 15 mL (3 teaspoonfuls) of hand rub.
 Put sterile surgical gloves on both hands.
 Keep hands up and away from the body, do not touch any surface or
article.

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37 November 24, 2014 Control Guidelines
 Lesions and Skin Breaks

 Cuticles, hands and forearms should be free

of lesions (dermatitis or eczema) and skin
breaks (cuts, abrasions and cracking). Cuts
and abrasions should be covered with
waterproof dressings. If covering them in this
way is not possible, surgical staff with skin
lesions should not operate until the lesions
are healed.
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38 November 24, 2014 Control Guidelines
 Fingernails

 Research has shown that the area

around the base of nails (subungual
space) contains the highest
microbial count on the hand.
 Long nails may serve as a reservoir
for gram-negative bacilli (P.
aeruginosa), yeast and other
pathogens.
 Long nails tend to puncture gloves
more easily.
 As a result, it is recommended that
nails be kept moderately short—not
extending more than 3 mm (or 1/8
inch) beyond the fingertip

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39 November 24, 2014 Control Guidelines
 Artificial Nails

 Artificial nails worn by HPs can contribute to

nosocomial infections and may serve as a reservoir
for pathogenic gram-negative bacilli.
 The use of artificial nails by HPs should be
restricted, especially by
– Surgical team members,
– Those who work in specialty areas such as neonatal and
intensive care units (ICUs),
– Those who care for patients highly susceptible to infection,
and
– Those who manage patients who have infections with
resistant organisms.

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40 November 24, 2014 Control Guidelines
 Nail Polish

 Chipped nail polish supports the growth of larger

numbers of organisms on fingernails compared to
natural nails. Dark colored nail polish may prevent
dirt and debris under fingernails from being seen and
removed.
Jewelry
 It is suggested that surgical team members and
other healthcare providers not wear rings or
bracelets because it may be more difficult for them to
National Infection Prevention and
41 put on surgical gloves without
November 24, 2014 tearing orControl Guidelines
 Some Current
Practices on Hand Hygiene

 When frequent hand washing is  In high risk areas such as the

required, a mild soap (without operation room, neonatal ICU,
antiseptic agent) should be hand scrub protocols that use
used to remove soil and debris soft brushes or sponges for a
shorter time (at least 2 minutes)
should replace harsh scrubbing
 If anti microbial activity is
with hard brushes for 6-10
desired (e.g., before an
minutes
invasive procedure in contact
with highly susceptible patients)
and hands are not visibly dirty,  For staff who frequently wash
an antiseptic hand rub should their hands (30 times or more
be used rather than washing per shift) hand lotions and
hands with medicated antiseptic creams should be provided in
soap order to reduce irritation of the
skin
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42 November 24, 2014 Control Guidelines
 PERSONAL PROTECTIVE
EQUIPMENT (PPE)

Objectives
 At the end of this section the healthcare provider
should be able to:
 Define personal protective equipment (PPE)
 Explain the importance of using personal protective
equipment when providing healthcare services
 Describe the various types of PPE and their uses
 Explain how PPE blocks the spread of
microorganisms.

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43 November 24, 2014 Control Guidelines
 Definition
 PPEs are barriers that help prevent the spread of
microorganisms from
– person-to-person (patients, healthcare clients or health
worker) and
– From equipment, instruments and environmental surfaces
to people.

PPEs includes: caps, eyewear, masks, aprons, gowns, gloves,

scrub suits, drapes and boots or closed shoes.

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 PERSONAL PROTECTIVE
EQUIPMENT

 It is important for healthcare providers to wear PPEs

whenever they are at risk of contact with
contaminated materials or blood and body fluids.
Managers are responsible for ensuring that
healthcare facilities have adequate protective
clothing for the staff.
 Remember: Caps, masks or drapes made from
paper should never be reused because there is no
way to properly clean them. If you can’t wash it, don’t
reuse it.
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45 November 24, 2014 Control Guidelines
 Gloves

GLOVES:
 Protect hands from infectious materials and protect patients
from microorganisms on staff members’ hands.
 Are the most important physical barriers for preventing the
spread of infection.
 Are usually worn any time there is likely to be contact with
mucous membranes, blood, body fluids, secretions or
excretions during patient/client contact or when handling
contaminated wastes or cleaning or disinfecting instruments,
equipment and surfaces.
 Should not be worn during routine procedures such as bed
making, unless items or surfaces are contaminated.
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46 November 24, 2014 Control Guidelines
 Principles:

 All staff should wear appropriate gloves prior to contact with

blood, body fluids, secretions or excretions from any
patient/client.
 A separate pair of gloves must be used for each patient/client to
avoid cross-contamination.
 It is preferable to use new and single-use (disposable) gloves.
 Gloves shall be removed before moving to another patient or
after completion of a specific task.
 Remove gloves and dispose them into the appropriate
container for contaminated waste

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47 November 24, 2014 Control Guidelines
 Which types of gloves to use:

 Disposable examination gloves should be used for

performing medical examinations and procedures
such as pelvic exams or drawing blood.
 Sterile surgical gloves should be used for
performing surgical or invasive procedures.
 Clean, heavy-duty household (utility) gloves
should be used for cleaning instruments, equipment
and contaminated surfaces and for housekeeping,
laundry and mortuary tasks as well as for handling or
disposing of contaminated waste.

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48 November 24, 2014 Control Guidelines
 Double Gloving 1

 Even the best quality, new latex rubber surgical gloves may
leak up to 4% of the time. Latex gloves—especially when
exposed to fat in wounds—gradually become weaker and lose
their integrity.
 Double gloving is of little benefit in preventing blood exposure if
needle sticks or other injuries occur, but it may decrease the
risk of blood-hand contact. The following are guidelines for
when to double glove:
– The procedure involves coming in contact with large amounts of
blood or other body fluids (e.g., vaginal deliveries and cesarean
sections).
– Orthopedic procedures in which sharp bone fragments, wire
sutures and other sharps are likely to be encountered.

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49 November 24, 2014 Control Guidelines
 Double Gloving 2

 In general, for surgical procedures that are short (30 minutes or

less) and involve minimal exposure to blood or mucous
secretions (e.g., laparoscopy or minilaparotomy), double
gloving is probably not necessary.
 Whether or not the surgeon, assistant or nurse should double
glove should be considered carefully, especially in areas where
the risk of contracting blood borne pathogens, such as HIV, is
high (>5% prevalence).
 If you need protection of forearm(s) you should use
gauntlet gloves or if not available, you can create a gauntlet
glove from surgical gloves.

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50 November 24, 2014 Control Guidelines
 Double Gloving 2

 In general, for surgical procedures that are short (30 minutes or

less) and involve minimal exposure to blood or mucous
secretions (e.g., laparoscopy or minilaparotomy), double
gloving is probably not necessary.
 Whether or not the surgeon, assistant or nurse should double
glove should be considered carefully, especially in areas where
the risk of contracting blood borne pathogens, such as HIV, is
high (>5% prevalence).
 If you need protection of forearm(s) you should use
gauntlet gloves or if not available, you can create a gauntlet
glove from surgical gloves.

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51 November 24, 2014 Control Guidelines
 DOs and DON’Ts about Gloves

 Do wear the correct size glove.

 Do change surgical gloves periodically during long cases.
 Do keep fingernails trimmed moderately short.
 Do pull gloves up over cuffs of gown .
 Do use water-soluble (non fat-containing) hand lotions and
moisturizers often to prevent hands from drying, cracking and
chapping.
 Don’t use oil-based hand lotions or creams.
 Don’t use hand lotions and moisturizers that are very fragrant
(perfumed).
 Don’t store gloves in areas where there are extremes in
temperature.

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52 November 24, 2014 Control Guidelines
 Dos and Don‘ts about gloves

•Do wear the correct size glove. •Don’t use oil-based hand lotions
•Do change surgical gloves or creams.
periodically during long cases. •Don’t use hand lotions and
•Do keep fingernails trimmed moisturizers that are very
moderately short. fragrant (perfumed).
•Do pull gloves up over cuffs of •Don’t store gloves in areas
gown . where there are extremes in
•Do use water-soluble (non fat- temperature.
containing) hand lotions and
moisturizers often to prevent
hands from drying, cracking and
chapping

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 Eyewear

 Eyewear protects staff in the event of an accidental splash of

blood or other contaminated fluid by covering the eyes.
Eyewear includes clear plastic goggles, safety glasses, face
shields and visors. Glasses with plain lenses are also
acceptable, if they have side shields attached.
 Masks and eyewear should be worn when performing any task
during which an accidental splash into the face could occur
e.g., when performing cesarean section or vaginal delivery or
when cleaning instruments) and when patients are on droplet
precautions.

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54 November 24, 2014 Control Guidelines
 Masks

 Masks should be large enough to cover the nose, lower face,

jaw and all facial hair (to contain it). They are worn to contain
moisture droplets expelled by HPs and to prevent accidental
splashes from entering the HP’s nose or mouth. Unless the
masks are made of fluid-resistant materials, however, they are
not effective in preventing either very well.
 Respirators are specialized types of masks, called particulate
respirators (such as N-95), which are recommended for
situations in which filtering inhaled air is considered important
(e.g., for the care of a person on airborne precautions).

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 Scrub Suits and Gowns

 Scrub suits or cover gowns are worn over,

or instead of, street clothes. The main use of
cover gowns is to protect the HPs’ clothing. A
scrub suit usually consists of drawstring
pants and a shirt. A V-neck shirt must not be
cut so low as to slide off the wearer’s
shoulders or expose men’s chest hair.

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 Surgical gowns
 Surgical gowns made of fluid-resistant materials help keep
blood and other body fluids off the skin of personnel,
particularly in operating, delivery and emergency rooms.
 Lightweight cloth gowns do not provide an effective barrier
because moisture can easily pass through them, allowing
contamination.
 Jeans material (denim) or canvas is too dense to autoclave, is
difficult to wash and takes too long to dry.
 The HP can wear a plastic or rubber apron underneath the
gown to prevent contact of the skin with blood and body fluids.
 If large spills occur, the best things to do is shower or bathe as
soon after completing the procedure as possible.

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 Aprons

 Mackintoshes or plastic aprons are usually

used to protect clothing or skin from
contamination. Aprons made of rubber or
plastic provide a waterproof barrier along the
front of the HP’s body and should also be
worn during procedures where the likelihood
of splashes or spillage of blood, body fluids,
secretions or excretions is likely (e.g., when
conducting deliveries).
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58 November 24, 2014 Control Guidelines
 Footwear

 Footwear is worn to protect feet from injury by sharp

or heavy items or fluids that may accidentally fall or
drip on them.
For this reason, sandals, “thongs” or shoes made of
soft materials (cloth) are not acceptable.
Rubber boots or closed shoes or leather shoes are
acceptable, but they must be kept clean and free of
contamination from blood or other body fluid spills.

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59 November 24, 2014 Control Guidelines
 Drapes

 Surgical drapes (sterile) made of cloth can be placed around

a prepared surgical incision to create a work area. Although this
area is often called the “sterile field,” it is NOT sterile. Cloth
drapes allow moisture to soak through and can help to spread
organisms from skin, even after surgical cleansing with an
antiseptic agent, into the incision. Thus, neither sterile gloved
hands nor sterile or high-level disinfected instruments and other
items should touch drapes once they are in place. Using towel
drapes to create a work area around the incision limits the
amount of skin that needs to be cleaned and reminds the
surgical team not to touch the patient.

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 SAFE HANDLING OF SHARPS DURING
PROCEDURES

Objectives
 At the end of this chapter, a healthcare provider
should be able to:
 Define sharps and safe injections
 Explain the importance of safe handling of sharps
 Describe the hands free technique
 Describe national perspectives of injection safety
 Describe data on injection safety practices in
Tanzania

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61 November 24, 2014 Control Guidelines
 SAFE HANDLING OF SHARPS DURING
PROCEDURES

Definitions
Sharps
 Sharp instruments include anything capable of
puncturing the skin (scissors, needles, scalpels or
blades, etc.).
 In healthcare settings, injuries can occur easily from
sharp instruments, especially during surgical
procedures. Preventing injuries and exposure to
infectious agent is mandatory.
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 Safe Injections

 A safe injection is one that:

 Does not harm the client,
 Does not expose the provider to any
avoidable risk, and
 Does not result in any waste material that is
dangerous to the community.

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 National perspectives of injection safety

 Infection safety practices incorporate the following:

 Handling of the injection by qualified personnel (e.g. an nurse)
 Washing hands before and after administering an injection
 Disposing sharps immediately after use
 Avoiding recapping the needles
 Proper use of safety boxes.
 In Tanzania, a study conducted in five referral hospital, to
identify factors contributing to poor and good injection practices
revealed the following findings:

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64 November 24, 2014 Control Guidelines
 National perspectives
of injection safety
-need source and date

Indicator Percent
Proportion of injection practices:
Performed mainly by nurses 95.0
Handled without washing hands 50.0
Disposal of sharps:
Immediately after use 54.2
Recapped needles 45.8
Did not use safety boxes 50.0
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 Situation analysis of injection safety practices in Tanzania

 Types of injections given in the health facilities

– 71.9% were curative
– 14.5% diagnostic
– 1.0% family planning
– 12.6% vaccination
 For safe injection handling, the preparation of
injections must be done on a clean dedicated table
– Only about 71.9% of the injections prepared on dedicated
tables

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 Factors leading to injections overuse

 Prescriber-associated factors
– Perceptions regarding injections
– Assumptions about patient’s expectations
 Patient-associated factors
– Perceptions regarding injections
– Therapeutic expectations
 System issues
– Lack of effective oral medications
– Financial implications
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 Hand hygiene compliance for injection
safety

 34.3% of the injection providers washed their

hands with soap and running water before
and after giving the injections, 65.7% did not.

 This is not the same % as given in slide 64

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68 November 24, 2014 Control Guidelines
 Safe Injection Practices:

 Preparation of the skin prior to injection

– Wash skin that is visibly soiled or dirty
– Avoid giving injections if skin integrity is compromised
 Injection sites
– Inject at the right site for age, dosage and type of injection
 Injection devices
– Use sterile needle and syringe for each injection and to
reconstitute each unit of medication
– Discard a needle and /or syringe if the package has been
punctured, torn or damaged by exposure to moisture
– Discard a needle that has touched any non-sterile surface
– Safely dispose of used needles and syringes immediately
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69 November 24, 2014 Control Guidelines
 Safe Injection Practices

 Reuse prevention injection devices:

– Use injection devices that have:
 Reuse prevention features (auto-disable syringe)
 Needle-stick prevention features (retractable syringe)
 Prevent contamination of equipment and medication:
– Prepare each injection in a clean area where blood or body
fluid contamination is unlikely
– Use single-dose vials rather than multi-dose vials
– Always pierce the septum of vials with a sterile needle
– Avoid leaving a needle in medicine vial stoppers

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 Safe Injection Practices
– Do not recap needles
– Discard used syringes and
needles at the point of use into
a puncture proof sharps
container that is sealed when
¾ full
 Prevent access to used
syringes and needles:
– Seal sharps containers for
transport to a secure area
– After sealing, do not open,
empty, reuse or sell them
– Dispose of sharps waste in an
efficient, safe and
environmentally friendly
way

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 Strategies for achieving Safe injection

WHO and SIGN recommend the following

strategies:
 Changing behaviour of healthcare workers
and patients
 Ensuring availability of equipment and
supplies
 Managing sharps waste safely and
appropriately
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 Qualities of
a safe injection

 Only given when there is no other suitable

alternative
 When the right drug is given to the right patient in the
right dose, using the right needle and syringe, at the
right site, by the right route and right time
 Given by a skilled healthcare worker and the right
way of disposal of waste that is causing no harm to
the provider, the recipient or the community.

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 Session Seven;

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 POST-EXPOSURE PROPHYLAXIS
(PEP) GUIDELINES 1

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 Session Objectives

At the end of this session a healthcare provider

should be able to:
 Define Post-Exposure Prophylaxis (PEP)
 Describe the common procedures presenting risk of
exposure to blood and other body fluids
 Explain levels of risks of transmission of blood borne
pathogens (HIV, HBV, HCV) for an exposed person
 Explain the roles and responsibilities of health facility
management
 Explain five stages of PEP
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 POST-EXPOSURE PROPHYLAXIS (PEP)
GUIDELINES

Introduction
 If a HP is exposed to blood or other body fluids,
either by a needle stick/sharps injury or a splash to a
mucous membrane, conjunctiva or non-intact skin,
the person should be offered PEP.
Definition
 PEP is the immediate provision of medication
following an exposure to potentially infected blood or
other body fluids in order to minimize the risk of
acquiring infection
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 The Risk of Transmission of HIV, HBV and HCV

The risk of transmission through

percutaneous (needle stick) exposures
from:
 HIV-positive patients is estimated at 0.3%
 Hepatitis B (HBV)-positive patients is
estimated at 27-37%
 Hepatitis C (HCV)-positive is estimated at 0–
10% (average 1.8%)
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 Body Fluids Known, Presumed, and Not
Known to be Infectious 1

Body fluids known to be Body fluids presumed Body fluids

infectious to be infectious NOT known to
be infectious (if
not visibly
bloody)
Blood Cerebral spinal fluid Tears
Any fluid with blood Pleural fluid Saliva
Semen Vaginal secretions Pericardial fluid Urine
Breast milk Peritoneal fluid Feces
Amniotic fluid Sweat
Synovial fluid Emesis
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 Common Procedures Which Present a Risk of
Exposure 1

The most common procedures presenting a risk of

exposure to blood and other body fluids include the
following:
 Taking blood samples and samples of other body fluids
 Inserting an IV line and handling drips especially in emergency
situations
 Activities related to surgery, particularly during major surgical
interventions for long duration or where hemorrhage may occur
 Handling of blood or infectious body fluids by laboratory staff
 Handling, pre-disinfection/cleaning of contaminated medical devices
 Handling and disposal of infectious waste
 Providing injections/intravenous medication

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 Roles of Clinicians responsible for PEP

 Clinicians responsible for PEP should assess

– the time of exposure,
– first aid measures taken and
– risk of HIV, HBV and HCV transmission following
accidental exposure.
S/he should know the risk of exposure

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 Roles of Health Facility Management to Ensure
Better Provision of Pep Services 1

In a health facility, the management should do

the following to ensure better provision of PEP
to health workers:
 Assign one person responsible for PEP and state
clearly where a HP should report immediately
following exposure.
 All staff including cleaners should be given
information to ensure they know about PEP.
 Ensure PEP services are available for all 24 hours of
each day, including weekends.
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 Roles of Health Facility Management to Ensure
Better Provision of Pep Services 2

 When the person responsible for PEP is off duty, inform all who
replace him or her.
 Ensure that PEP drugs are always accessible by the person
responsible for PEP.
 Guarantee confidentiality.
 There should be steps to follow if a HP is exposed to Blood and
Other Body Fluids including:
– treatment,
– reporting and documenting,
– Evaluating the exposure
– Evaluating the exposure source and
– Provision of Anti-Retroviral (ARVs) Drugs .
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 HIV—PEP
Remember:
 HIV—PEP should be:
– Initiated as soon as possible (within 2 hours)
– Administered for 4 weeks
– Discontinued if the source person is determined to be HIV-negative or the
exposed person is HIV-positive
 HBV—
– If HBV-susceptible, get hepatitis B immunoglobulin (HBIG) 5mL IM
(intramuscularly) within 7 days of exposure, and also give the first dose of
HBV vaccine, which should be repeated at 1 and 6 months.
 HCV—
– There is no post-exposure vaccine or drug prophylaxis for hepatitis C
(immunoglobulin is ineffective). Prevention of exposure, therefore, is the
only effective strategy for prevention of HCV.

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 SKIN PREPARATION PRIOR TO SURGERY AND
OTHER INVERSIVE PROCEDURES

Objectives
At the end of this session, a healthcare provider should
be able to:
 Define the terms antiseptics and antisepsis
 Explain the use of antiseptics prior to surgery and other invasive
procedures
 Identify types of antiseptics and their uses
 Identify criteria for selection of antiseptics
 Describe the procedure for skin preparation
 Describe the procedures for cervical or vaginal preparations for
minor procedures
 Explain the procedures for storing and dispensing of antiseptics
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 Definitions

Antiseptics
 Antiseptics or antimicrobial agent (terms used
interchangeably) are chemicals that are applied to
the skin or other living tissue to inhibit or kill
microorganisms (both transient and resident) thereby
reducing the total bacterial count.
Antisepsis
 Process of reducing the number of microorganisms
on skin, mucous membranes or other body tissue by
applying an antiseptic agent

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 Uses of Antiseptics

Antiseptics are used for:

 Hand hygiene
 Skin preparation prior to surgical procedures
 In cervical or vaginal preparations
 Wound dressing

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 Criteria for Selection of antiseptics

The following is the selection criteria:

 It should be safe
 Its microbial activity should be known
 It should have instructions on how to use
 It should have a residual effect
 Should be cost effective
 Should be accepted by the government/Authority
 On disposal should not be hazardous to the community and
environment
 Should be user friendly

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 Instructions for Skin
Preparation 1

 Do not shave hair around the operative site. Shaving increases

the risk of infection because the tiny nicks in the skin provide an
ideal setting for microorganisms to grow and multiply. If hair
must be cut, trim the hair close to the skin surface with scissors
immediately before surgery.
 Ask the patient about allergic reactions (e.g., to iodine
preparations) before selecting an antiseptic solution.
 If the skin or external genital area is visibly soiled, gently wash
it with soap and clean water and dry the area before applying
the antiseptic.

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 Instructions for Skin Preparation 2

 Do not allow the antiseptic to pool underneath the client’s body; this
can irritate or burn the skin.
 Using dry, sterile forceps and new cotton or gauze squares soaked in
antiseptic, thoroughly cleanse the skin. Work from the operative site
outward for several centimeters. (A circular motion from the center out
helps to prevent recontamination of the operative site with local skin
bacteria.)
 Use sterile gauze or cotton swab/pad to clean the skin prior to surgery.
 Allow the antiseptic enough time to be effective before beginning the
procedure. For example, when an iodophor is used, allow 2 minutes or
wait until the skin is visibly dry before proceeding, because free iodine,
the active agent, is only released slowly.

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 Instructions for Vaginal Preparation

 See detailed instructions on page 34 in your

pocket guide

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 Storage and Dispensing of Antiseptics

All antiseptics can become contaminated by

microorganisms, which can then cause subsequent
infection when used for hand washing or skin
preparation. To prevent contamination of antiseptic
solution:
 Use antiseptics in small quantities at a time.
 If antiseptics are provided in large containers, pour a small quantity at
a time into a smaller container for daily use.
 Do not “top off” antiseptic dispensers.
 Never soak or store gauze or cotton wool in any antiseptic.
 Prepare fresh solutions regularly (at least weekly).
 Clean and thoroughly dry antiseptic containers before refilling.
 Antiseptic solutions should be stored in a cool, dark area. Never store
them in direct sunlight or in excessive heat ( National Infection Prevention and
92 November 24, 2014 Control Guidelines
 PREVENTING INFECTIONS RELATED TO USE OF
INTRAVASCULAR DEVICES

Objectives
 By the end of this section a healthcare provider will
be able to:
 Define intravascular devices
 Explain how pathogens may enter blood stream
 Explain techniques for reducing the risk of
nosocomial infections (hospital-acquired or
healthcare-related infections) associated with the
use of intravascular devices
 Identify safe measures for changing fluids and
infusion sets
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 Definition

 Intravascular devices include butterflies,

needles, cannulae and central venous
catheters—both venous and arterial—to
deliver sterile fluids, medications and
nutritional products. They can also monitor
blood pressure and other hemodynamic
functions presents a risk for local and
systemic bloodstream infections.
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 How Pathogens May Enter Blood Stream

Once the intravascular device is inserted,

pathogens can be transferred into the
bloodstream in four ways:
 By traveling along the device at the insertion site
(pathogens on the skin),
 Through contamination of the hub (connection site of
the device used),
 Through contaminated infusion fluid, and
 Through the bloodstream from another site of
infection.
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 PREVENTING
INFECTIONS RELATED TO USE OF
INTRAVASCULAR DEVICES

 The risk of infection associated with the use of

intravascular devices can be reduced by following
recommended IPC practices related to their insertion
and by better management of the device once it is in
place. These are:
- Hand Hygiene and Gloves
- Site Care and Dressings
- Peripheral Catheters (Venous and Arterial)—Site Selection
and Change
- Central Venous Catheters—Site Care and Dressings
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 Changing fluids and
infusion (administration) sets

Fluids
 Change infusion bottles or plastic bags with parenteral solutions every
24 hours.
 Change infusion bottles or plastic bags with lipid emulsion given alone
within 12 hours.
Infusion (Administration) Sets
 These sets, including piggybacks, should be changed whenever they
are damaged and at 72 hours routinely. (If the tubing becomes
disconnected, wipe the hub of the needle or catheter with 60–90%
alcohol and connect it to a new infusion set.)
 Tubing used to administer blood, blood products or lipid emulsions
should be replaced within 24 hours.

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 PREVENTING INFECTIONS OF THE
URINARY TRACT

Objectives
 At the end of this section a healthcare
provider will be able to:
 Explain tips for preventing infections in
catheterized patients
 Identify alternatives to catherization

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 Tips for Preventing Infections in
Catheterized Patients - #1

 Remove the catheter as soon as possible.

 Ensure that the catheter collection system remains closed and
is not opened.
 Caution the patient against pulling on the catheter.
 Check urine flow through the catheter several times a day to
ensure that the catheter is not blocked.
 Don’t raise the collection bag above the level of the bladder.
 If it is necessary to raise the bag above the level of the patient’s
bladder during transfer of the patient, clamp the tubing.

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 Tips for Preventing Infections in
Catheterized Patients - #2

 Before the patient stands up, drain all urine from the tubing into
the bag.
 Empty the urine drainage bag aseptically through the emptying
tube.
 If the drainage tubing becomes disconnected, do not touch the
ends of the catheter or tubing. Wipe the ends of the catheter
and tubing with an antiseptic solution before reconnecting them.
 Do not allow the urine bag to touch or rest on the floor.
 Wash the head of the penis and urethral opening for men or the
perineal area and urethral opening for women after a bowel
movement.
 If frequent irrigation is required, change the catheter.

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 Other methods of emptying urinary
bladder

 Other methods for management of urinary

tract problems include:
- Intermittent catheterization using a
reusable “red rubber” straight catheter,
- Condom catheters for male patients,
- Adult diaper pads and
- Bladder retraining.
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 INSTRUMENT PROCESSING

Objectives
At the end of this section a healthcare provider will
be able to:
 Define the terms used in processing instruments:
decontamination, cleaning, high level disinfection
(HLD) and sterilization
 Explain key steps in processing instruments
 Demonstrate ability to prepare dilute chlorine
solution from the concentrated liquid or powder form
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 Instrument Processing

Definitions
 Cleaning: A process that physically removes all
visible dust, soil, blood or other body fluids from
inanimate objects as well as removing sufficient
numbers of microorganisms to reduce risks for those
who touch the skin or handle the object.
 Decontamination: A process that makes inanimate
objects safer to handle by staff before cleaning by
soaking in 0.5% chlorine solution for 10 minutes (i.e.,
inactivates HBV, HCV and HIV and reduces the
number of other microorganisms but does not
eliminate them).
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 More Definitions

 High Level Disinfection (HLD): Process that eliminates all

microorganisms except some bacterial endospores from
inanimate objects by boiling, steaming or the use of chemical
disinfectants
 Disinfectant: A chemical that destroys or inactivates
microorganisms on inanimate objects and surfaces.
 Sterilization: Process that eliminates all microorganisms
(bacteria, viruses, fungi and parasites) including bacterial
endospores from inanimate objects by high-pressure steam
(autoclave), dry heat (oven), chemical sterilants or radiation.

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 Key Steps in Processing Instruments

 The basic infection prevention processes

recommended to reduce disease transmission from
soiled instruments and other reusable items are
decontamination, cleaning and either sterilization or
HLD.
 Regardless of the type of operative procedure, the
steps in processing surgical instruments and other
items are the same. The steps are illustrated in
Figure 11-1 (seen on next slide).
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 Key Steps in Processing Contaminated
Instruments and Other Items

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 Decontamination Tips

 Use a plastic, non-corrosive container for

decontamination to help prevent:
– dulling of sharps (e.g., scissors) due to contact with metal
containers, and
– Rusting of instruments due to a chemical reaction
(electrolysis) that can occur between two different metals
(i.e., the instrument and container) when placed in water.
 Do not soak metal instruments that are electroplated
(i.e., not 100% stainless steel) even in plain water for
more that an hour because rusting will occur.

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 Making chlorine
solution

 Check concentration (% concentrate)

 of the chlorine product you are using.
 Determine total parts water needed using
 the formula below.
 Total Parts (TP) water =(% Conc./%Dilute)-1
 Mix 1 part concentrated bleach with the total parts water required.

Example:Make a dilute solution (0.5%) from 3.5% concentrated

solution
– STEP 1: Calculate TP water: (3.5%/0.5%)-1 = 7 – 1 = 6
– STEP 2: Take 1 part concentrated solution and add to 6 parts
water.
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 Cleaning tips
 Use of soap is important for effective cleaning because water alone
will not remove protein, oils and grease.
 Liquid soap is preferred
 Instruments should be washed with a soft brush in soapy water to
remove all foreign matter—until they are visibly clean.
 Do not use abrasive cleaners (e.g., Vim® or Comet®) or steel wool as
these products can scratch plastic or pit metal or stainless steel.
 Rinse thoroughly to remove any soap residue, which can interfere with
sterilization or HLD. After rinsing, items should be dried, especially if
they will be sterilized or high-level disinfected using chemicals.
 Wear gloves (thick household or industrial gloves work well), protective
eyewear (plastic visors, face shields or goggles/glasses) and a plastic
apron while cleaning instruments and equipment.

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 Sterilization and HLD

 Sterilization destroys all microorganisms,

including bacterial endospores.

 HLD destroys all microorganisms (including

vegetative bacteria, tuberculosis, yeasts and
viruses) except some bacterial endospores

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 Sterilization Procedures

INCLUDE:
 High-pressure steam (autoclave),
 Dry heat (oven) or
 Chemical sterilants, such as glutaraldehydes
or formaldehyde solutions, or physical agents
(radiation)

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 HLD Procedures

INCLUDE:
 Boiling in water,
 Steaming (moist heat)
or
 Soaking instruments in
various chemical
disinfectants

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 DETAILED PROCEDURES

For detailed procedures for sterilization and

HLD, see pages 46-51 in your pocket guide

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 Disposal of Used Chemical Containers and
Used Chemicals

See detailed procedures on page 52 in your

pocket guide

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 Products That Should Not Be Used as
Disinfectants

 Many antiseptic solutions are used incorrectly as

disinfectants. Although antiseptics (sometimes called
“skin disinfectants”) are adequate for cleansing skin
before surgical procedures, they are not appropriate
for disinfecting surgical instruments. They do not
reliably destroy bacteria, viruses or endospores. For
example, Savlon (chlorhexidine gluconate with or
without cetrimide), which is readily available
worldwide, is often mistakenly used as a disinfectant.
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 Antiseptics that should not be used as
disinfectants - #1

 Acridine derivatives (e.g., gentian or crystal

violet)
 Cetrimide (e.g., Cetavlon®)
 Chlorhexidine gluconate and cetrimide in
various concentrations (e.g., Savlon)
 Chlorhexidine gluconate (e.g., Hibiscrub,
Hibitane)
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 Antiseptics that should not be used as
disinfectants - #2

 Chlorinated lime and boric acid (e.g.,

Eusol®)
 Chloroxylenol in alcohol (e.g., Dettol)
 Hexachlorophene (e.g., pHisoHex)
 Mercury compounds

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 Storage of High-Level Disinfected or Sterile
Instruments

Remember
 Before using any sterile item, look at the
package to make sure the seal is unbroken
and the wrapper is intact, clean and dry (as
well as having no water stains). If the
package is dry and intact, you can be
reasonably sure it is sterile, regardless of
when it was sterilized.
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 Shelf Life - #1

 The shelf life of an item (i.e., how long it can be

considered sterile) after sterilization is event-related.
– The item remains sterile until something causes the
package or container to become contaminated;
– time elapsed since sterilization is not the determining factor.
– An event can be a tear or worn area in the wrapping, the
package becoming wet or anything else that will allow
microorganisms to enter the package or container.
– These events can occur at any time.

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 Shelf Life - #2

 In some healthcare facilities where replacement of supplies is

limited and the cloth used for wrapping is of poor quality, time
as a limiting factor also serves as a safety margin. If plastic
covers (bags) are unavailable for the sterilized items, limiting
the shelf life to a specific length of time (e.g., 1 month) may be
a reasonable decision as long as the pack remains dry and
intact.

 Handle and store instruments according to how they are

processed, maintaining at least the same level of processing in
storing them that was used in processing them.

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 Handling Instruments

Sterile instruments:
 Must be handled only with sterile instruments (e.g.,
when removed from chemical sterilization solutions)
 Must be stored in sterile containers

High-level disinfected instruments:

 must be handled with high-level disinfected or sterile
instruments (e.g., when taken out of the boiler or chemicals)
 must be stored in high-level disinfected or sterile containers

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 Storage of Sterile
Instruments

Storage of Sterile Instruments

 All sterile items should be stored in an area and manner where they
will be protected from dust, dirt, moisture, animals and insects.
 The storage area is best situated next to or connected to the location
where sterilization occurs,
 The storage area should be separate and enclosed, with limited
access AND used just to store sterile and clean patient care supplies.
 Storage in a closed cabinet is preferred
 All stored instrument packs or containers must be clearly labeled with
the date of processing.

In smaller facilities, the storage area may be just a room off the Central
Supply Department or in the operating unit.

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 Storage of HLD Instruments

Storage of High-Level Disinfected Instruments

 HLD instruments should be stored in a dry, high-level
disinfected covered container (the cover as well as the
container must be high-level disinfected).
 The HLD should remain closed (no peeking) until the
instruments are needed.
 If the instruments have not been used, reprocess them after 1
week.
 Storage in a closed cabinet is preferred, in an area where dust
and lint are minimized.
 All stored instrument packs or containers must be clearly
labeled with the date of processing
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 WASTE MANAGEMENT

Objectives:
By the end of this section a healthcare provider
will be able to:
 Define common terms used in healthcare waste
management
 Explain steps in healthcare waste management
 Explain sharps disposal tips
 Explain the recommended methods for final waste

12 disposal
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 Definition of terms in Healthcare Waste
Management (HCWM) - #1

Definitions:
Healthcare Waste
 Healthcare waste is defined as total waste generated by
medical activities and includes both contaminated (potentially
infectious) waste and non-contaminated (non-infectious)
materials.
Handling of Waste
 Waste must be properly handled within the healthcare facility
setting, even before it is taken for incineration, burial or other
disposal, to protect clients, staff and the community

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 Definition of terms in HCWM - #2

Non-contaminated Waste
 Non-contaminated waste poses no infectious risk to persons who
handle it.
– Examples of non-contaminated waste include paper, trash, boxes, food
remains, and bottles and plastic containers that contain products delivered
to the clinic.
– Non-contaminated waste can be picked up by the local authorities for
disposal in municipal waste sites.
Contaminated Waste
 Contaminated waste is potentially infectious or toxic if not disposed of
properly.
– Contaminated waste includes blood, body fluids, secretions and excretions,
and items that have come in contact with them, such as sharps and used
dressings, as well as medicines, medical supplies or other chemicals that
may be toxic.
– Contaminated waste must be incinerated, burned or buried in designated
12 contaminated/hazardous waste areas.
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 Steps in Healthcare Waste Management - #1

Waste Minimization
Devise policies and practices to reduce
healthcare waste generation through:
 Restriction of purchase of supplies that
produce a lot of healthcare waste
 Use of recyclable products on site or off site.

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 Steps in Healthcare Waste Management - #2

 Good management and control practices e.g.

pharmaceuticals and chemicals through centralized
purchasing
 Frequent ordering of small quantities rather than
large amounts at one time
 Use of the oldest batch instead of the new (FEFO
and FIFO rules)
 Use all contents in each open container before
opening another container
 Frequent checking of expiry dates at the time of
delivery
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 Segregation of Waste
Materials

 Segregation of waste consists of separating the

different waste materials based on the type,
treatment and disposal practices.
 Segregation takes place at the point where waste is
generated.
 Segregation of waste shall be applied uniformly
throughout the country.
 Never sort mixed wastes (e.g., do not try to separate
uncontaminated from contaminated wastes, or
combustible from non-combustible, after they have
been combined).
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 Color Coding - #1

 The color-coding system ensures immediate

and non-equivocal identification of the
hazards associated with the type of
healthcare waste that is handled or treated. It
shall remain simple and be applied uniformly
throughout the country. All healthcare
facilities shall apply the following color-
coding system:
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 Color Coding - #2

COLOR TYPE OF WASTE

Yellow Safety box containing the following:
Needles and syringes, blades, broken
glass, lancets, scissors, broken
ampoules, slides and slide covers, etc.
Red Wet, infectious materials:
Blood, body tissues (amputations), body
fluids (discharges), specimens (stool,
sputum), placentas, wet dressings,
catheters, blood infusion bags, etc.
Blue/Black Non-infectious materials:
Office papers, pharmaceutical packaging,
13 plastic bottles, including water National
bottles,Infection
food Prevention and
1 remains, waste
November 24, 2014paper, trash, etc. Control Guidelines
 Collection

 Waste should not be allowed to accumulate at the point

of production
 Waste should be collected daily or as frequently as
possible
 No bags should be removed from the segregation point
unless they are labeled
 The bags or containers should be replaced immediately
with new ones of the same type
 A supply of fresh collection bags or containers should be
readily available at all locations where waste is produced

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 Storage - #1

 The waste storage area should:

– Have an impermeable, hard-standing floor with good
drainage, easy to clean and disinfect
– Be easily accessible to staff in charge of handling the waste
– Be possible to lock
– Have easy access for waste-collection vehicles
– Be inaccessible to animals, insects and birds
– Not be near the fresh food stores or food preparation areas
– Be located near a water supply, cleaning equipment,
protective clothing and waste bags

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 Storage - #2

 Healthcare waste handlers should weigh the

amount of healthcare waste generated in a
day and keep the record in a healthcare
waste register
 Is this done? How does it relate to IP?

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 Transport

On site transport:
HCW should be transported within the health
facility by wheeled trolleys, containers, or
carts that are not used for any other purpose and
are:
o Easy to load and unload
o Have no sharp edges
o Are easy to clean
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 Off-site transportation

o All healthcare providers are responsible for safe

packing and adequate labeling of waste to be
transported off-site and for authorization of its
destination (I don’t understand this)
o All vehicles shall be cleaned and disinfected after
use
o All healthcare waste handlers shall wear protective
equipment. They shall be properly trained in
handling, loading and unloading, transportation and
disposal of the yellow and red waste containers.
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 Treatment and Disposal of Healthcare Waste

 Treatment and Disposal of Waste

 Proper disposal of contaminated waste minimizes
the spread of infection to healthcare personnel and
to the local community. Infectious healthcare waste
should be preferably incinerated, burned or buried.
 Both the incinerator and burial site should be fenced
with a gate and lock to prevent scavenging by both
animals and people. Open piles of waste should be
avoided.

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 Contaminated Waste—Solids

 Contaminated wastes should be disposed of into a

waste container during or immediately following a
procedure.
 Waste bins should be decontaminated between each
use.
 Anyone handling waste containers should wear
appropriate PPE
 Body parts (or placenta) taken home for burial
should be placed in a plastic bag and then into a
rigid container (metal or plastic container) for
transport.
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 Contaminated Waste—Liquids

 Liquid infectious wastes can be disposed of through

a closed sewage or septic system by carefully
pouring wastes down a utility sink drain or into a
flushable toilet. Rinse the toilet or sink carefully and
thoroughly with water to remove residual wastes.
Avoid splashing.
 If a sewage system doesn’t exist, dispose of liquids
in a deep, covered hole, not into open drains.

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 In Case of a Cholera Epidemic

 Hospital or health facility sewage also must

be treated and disinfected. Vibrio cholerae,
the causative agent of cholera, is easily killed
with the use of disinfectants. Buckets
containing stools from patients with acute
diarrhea may be disinfected by the addition
of chlorine oxide powder or dehydrated lime
oxide.
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 Final Waste Disposal

 Burning
- Rural health centers and dispensaries can use this option
to burn waste in burning pits as per MOHSW guidelines.
- Open burning of contaminated waste is not
recommended because it is hazardous.
 Burying
– If incineration is not possible, all contaminated wastes must be
protected and buried in a burial pit and covered with fresh soil
daily.
– Rural health facilities can use this option of disposal to dispose of
placentas, sharps and other anatomical waste.

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 Incineration- #1

 Incineration is used to reduce organic and

combustible waste into inorganic incombustible
matter at high temperature.
 Incineration provides high temperatures and
destroys microorganisms and therefore is the best
method for disposal of contaminated wastes.
 Incineration also reduces the bulk size of wastes to
be buried.
 Placentas and other anatomical waste can be
disposed of in these incinerators.

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 Incineration- #2

 Ashes from the incinerator should be

disposed in an ash pit.
 HCW, which cannot be re-used, recycled or
dumped in a landfill site, should be
incinerated.
 There should be an efficient monitoring
system for proper functioning of incinerators

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 General View of a Double-Chamber (De Montfort) Incinerator

Figure 12-1.
Loadingdoor
Chimney
Air holes

Ashdoor

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 Contaminated Waste Disposal Tips - #1

 Use heavy-duty (utility) gloves and appropriate PPE when

handling wastes.
 Decontaminate and clean utility gloves between uses.
 Always wash hands after handling contaminated wastes.
 Handle wastes carefully to avoid spills or splashes.
 Avoid transferring contaminated waste from one container to
another.
 Incineration is the preferred method for waste disposal.
 If incineration (either high or low temperature) is not possible,
careful burial is the next best alternative.

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 Contaminated Waste Disposal Tips - #2

 Dispose of used containers from toxic chemicals or medicines

properly:
 Rinse glass containers thoroughly with water; glass containers
may be washed with detergent, rinsed and reused.
 For plastic containers that contained toxic substances such as
glutaraldehyde (e.g., Cidex or Sporicidin®), rinse three times
with water and dispose of by incineration and/or burial; these
containers may be used as sharps disposal containers, but do
not reuse them for any other purposes.
 Equipment that is used to hold and transport wastes must not
be used for any other purpose in the healthcare facility.

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 TRAFFIC FLOW and ACTIVITY PATTERNS

Objectives
 At the end of this section a healthcare provider will
be able to:
 Define traffic flow and activity patterns in healthcare
settings
 Explain space and equipment requirements for
infection prevention and control
 Explain organization of a surgical unit
 Explain the guidelines for working in an operating
room
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 TRAFFIC FLOW AND ACTIVITY PATTERNS

Definition
 Traffic flow and activity pattern means
regulating the flow of visitors, patients and
staff in order to prevent disease transmission
in healthcare facilities. The number of
microorganisms in designated areas tends to
be related to the number of people present
and their activities.
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 TRAFFIC FLOW AND ACTIVITY PATTERNS - #3

 An important objective of infection prevention is to

minimize the level of microbial contamination in
areas where patient care and instrument processing
take place. Such areas include:
 Procedure areas
 Labor and delivery wards
 Surgical units including preoperative and recovery
rooms
 Work areas where instruments are processed, and
then stored
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 organization of Surgical Unit

The surgical unit is often divided into four areas labelled and defined by their
activities as follows ;
 Unrestricted area: Entrance from main corridor through which staff,
patients and materials come into the unit.
 Transition zone: Consists of dressing rooms and lockers where staff put
on surgical attire to allow them to move from unrestricted to semi-restricted
or restricted areas.
 Semi-restricted area: Is the peripheral support area, includes preoperative
and recovery rooms, storage space for sterile and HLD items, and corridors
leading to the restricted area.
 Restricted Area: Consists of the operating theatre(s) and scrubbing areas.

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 Before Surgical Procedures

 Place a clean, covered container filled with 0.5%

chlorine solution for immediate decontamination of
instruments and other items once they are no longer
needed.
 Place a plastic bag or leak proof, covered waste
container for contaminated waste items (cotton
gauze, old dressings).
 Place a puncture-resistant container for the safe
disposal of sharps at the point of use but without
contaminating the sterile field.
 Place a leak proof, covered waste container for
15 soiled linen away from sterile items.
National Infection Prevention and
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 Before Surgical Procedures

 Organize tables, mayo and ring stands side by side in an area

away from the traffic patterns and without touching the walls,
cabinets and other non-sterile surfaces.
 Place a clean sheet, a lift sheet and arm-board covers on the
operating theatre bed.
 Check and set up suction, oxygen and anesthesia equipment.
 Place supplies and packages that are ready for use on the
tables, not on the floor.
 The mayo stand and other non-sterile surfaces that are to be
used during the procedure should be covered with a sterile
towel or cloth.

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 During Surgical Procedures

 Limit the number of staff entering the operating

theatre to only those necessary. Make the surgical
team self-sufficient.
 Keep the doors closed at all times, except during
movement of staff, patients, supplies and equipment.
 Keep movements to minimum.
 Keep talking to a minimum.

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 During Surgical Procedures

 Each scrubbed and non-  Clean accidental spills or

scrubbed member should wear contaminated debris in areas
surgical attire as described in outside the surgical field with 0.5%
the guidelines chlorine solution as promptly as
 Scrubbed staff should keep possible. (A non-scrubbed staff
their arms and hands within the member wearing utility gloves
operative field at all times and
touch only sterile items or should do this.)
areas.
 Non-scrubbed staff should stay
at the periphery of the operating
theatre, keeping their distance
from sterile areas; they should
not lean or reach over the
operative field
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 After surgical procedures

 Non-scrubbed staff wearing utility gloves should;

– Collect all waste and remove it from the room.
– Close and remove puncture-resistant containers when they
are three-quarters full.
– Remove containers of 0.5% chlorine solution with
instruments and surgical gloves from the room.
– Remove soiled linen.
– Remove , soiled linen, instruments, equipment, and
supplies that have been opened but not used, in a leak
proof, covered waste container. (Make sure that these items
do not re-enter the restricted area.)

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 CENTRAL STERILIZATION SUPPLY DEPARTMENT
(CSSD)

Objectives
At the end of this section a healthcare
provider will be able to:
 Define central sterilization supply department
 Describe the four areas in the CSSD

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 CENTRAL STERILIZATION SUPPLY DEPARTMENT
(CSSD)

 The CSSD is the area where instruments and

equipment are processed, and where staff should be
specially trained in handling, processing and storing
instruments, equipment and other clean, sterile or
high-level disinfected items. The CSSD is considered
a semi-restricted area, so all the recommendations
for traffic patterns and proper attire described for the
operating thestre should be followed in the CSSD.

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 Areas of a CSSD

 dirty receiving/cleanup area Include

– a receiving counter
– two sinks if possible (one for cleaning and one for rinsing) with clean water supply
– a clean equipment counter for drying
 clean work area Include
– a large work table
– shelves for holding clean and packaged items
– a high-pressure steam sterilizer, a dry-heat oven, a steamer or a boiler
 clean equipment storage area Include
– an office desk for record keeping and
– CSSD staff only should enter through this area.
 sterile storage area Includes
– closed cabinets or shelves

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 Storage and Rotation of Instruments
and Supplies

For detailed instructions on proper storage and rotation

see page 66 in your pocket guide and also slides 117-
121

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 LINEN

Objectives
At the end of this section a healthcare provider
will be able to:
 Define terms commonly used in processing
linen
 Describe steps in processing linen

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 LINEN
Definitions
Linens
 Cloth items used by housekeeping staff and patients/clients (bedding, towels,
cleaning cloths, gowns, caps, masks, scrub suits, surgical gowns, drapes and
wrappers).
Soaps or Detergents (terms used interchangeably)
 These are cleaning products (e.g., liquid and powder soap) that lower surface
tension, thereby helping remove dirt, debris and transient microorganisms from
linen
Soiled or Contaminated Linen
 Linens from multiple sources within the hospital or clinic that have been
collected and brought to the laundry for processing, regardless of whether or
not they are visibly dirty.
Sorting:
 Inspecting and removing foreign and in some cases dangerous objects (e.g.,
sharps or broken glass) from soiled linen before washing.
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 Key Steps in Processing Linen

 Ensure that housekeeping and laundry personnel wear gloves and

other PPE as indicated when collecting, handling, transporting, sorting
and washing soiled linen.
 When collecting and transporting soiled linens, handle them as little as
possible and with minimum contact to avoid accident, injury and
spreading of microorganisms.
 Consider all cloth items (e.g., surgical drapes, gowns, wrappers) used
during a procedure as infectious. Even if there is no visible
contamination, the item must be laundered.
 Carry soiled linen in covered containers or plastic bags to prevent
spills and splashes, and confine the soiled linen to designated areas
(interim storage areas) until transported to the laundry.
 Carefully sort all linen in the laundry area before washing.
 Do not presort or wash linen at the point of use.
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 Laundering Linen

 All linen items (e.g., bed sheets, surgical drapes,

masks, gowns) used in the direct care of a patient
must be thoroughly washed before re-use.
 Soiled linen must be washed immediately to avoid
staining.
 Decontamination prior to washing is not necessary,
unless linen is heavily soiled and will be hand
washed.
 Workers should not carry wet, soiled linen close to
their bodies even if they are wearing plastic or
rubber aprons.
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 Laundering Linen

 See guidelines
for more detailed instructions
on hand and machine washing

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 Distributing
Clean Linen

 Protect clean linen until it is distributed for

use.
 Do not leave extra linen in patients’ rooms.
 Handle clean linen as little as possible.
 Avoid shaking clean linen. It releases dust
and lint into the room.
 Clean soiled mattresses by wiping with 0.5%
chlorine solution before putting clean linen on
16 them.
National Infection Prevention and
5 November 24, 2014 Control Guidelines
 Session sixteen
HOUSEKEEPING

Session Objectives;
At the end of this session a healthcare
worker will be able to:
 Define housekeeping
 Explain the importance of housekeeping
 Identify selection criteria for cleaning products
 Explain uses of PPE in housekeeping
 Describe cleaning methods
 Explain housekeeping guidelines
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 Definition

 Is the general cleaning of the hospital and

clinics including the floors, walls and certain
types of equipment, furniture and other
surfaces.
 It entails the removal of dust ,soil, and
microbial contaminants on environmental
surfaces since they are potential source of
nosocomial infections
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 Importance of Housekeeping

General housekeeping
 Reduces the number of microorganisms that
come in contact with clients or staff.
 Reduce the risk of accidents by preventing
falls caused by a slippery floor following
spillage of either body fluids or solutions.
 Provide a pleasant atmosphere.

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 How to Select Cleaning Products

An ideal cleaning product should accomplish the

following criteria:
 Suspend fats in water
 Make fats water-soluble
 Decrease surface tension of water and allow greater
penetration of the agent into the dirt or soil
 Break up soil into small particles
 Break up protein
 Removal of calcium and magnesium

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 PPE in housekeeping

Housekeeping Tasks
 Healthcare providers doing housekeeping
activities should wear personal protective
equipment to prevent themselves.
 The recommended PPE to be used during
housekeeping activities are shown in Table
16-1.

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 Cleaning methods

 Cleaning methods should be determined by the:

– Type of surface
– Amount and type of organic matter present
– Purpose of the area.

 Most areas of the facility can be cleaned with detergent and

water (low-risk areas such as waiting rooms and
administrative areas).

 In high-risk areas where heavy contamination is expected a

disinfectant cleaning solution (0.5% chlorine with detergent) should be
used.
Do not mix chlorine solutions with ammonia-based detergents, as a
17 toxic gas may be produced.
National Infection Prevention and
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 Wet Mopping

 This is the most common and preferred method for

cleaning floors.
 There are three techniques:
– Single-bucket (basin) technique: One bucket of cleaning
solution is used.
– Two bucket technique: one bucket for a cleaning solution
and the other containing water for rinsing.
– Three bucket technique: one bucket for a cleaning solution,
one containing rinse water plus a third bucket for wringing
out the mop before rinsing.
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 Damp Dusting

 used for cleaning walls, ceilings, doors, windows, furniture and other
surfaces.
 Clean cloth or mops are wetted with cleaning solution contained in a
basin or bucket.
 Avoid dry dusting never dust cloths and mops should be shaken to
avoid the spread of microorganisms.
 Dusting should be performed in a systematic way, using a starting
point as a reference to ensure that all surfaces have been reached.
 When doing high dusting (ceiling tiles and walls), check for stains that
may indicate possible leaks. (Leaks should be repaired as soon as
possible because moist ceiling tiles provide a reservoir for fungal
growth.)
 Always wear utility gloves when cleaning surfaces that may have come
in contact with blood, body fluids, secretions or excretions.

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 Damp Dusting

Remember:
– Cleaning should start with the least soiled and move to the
most soiled area and from high to low surfaces.
– Using cleaning equipment that is not properly maintained
can contribute to the spread of infectious agents.
– Dry all cleaning equipment completely before reuse; drying
mops and cloths in the sun is best because the sun’s
ultraviolet rays can aid in killing microorganisms (wet cloths
and mop heads are heavily contaminated with
microorganisms).

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 Cleaning Contact Surfaces

Surfaces that come in contact with clients, such as

examination tables and patient beds, must be kept clean
and decontaminated to avoid cross infection.
 wipe them with a disinfectant solution (0.5% chlorine solution)
after every client, regardless of whether they are visibly
contaminated.
 Any surface that is visibly contaminated must be
decontaminated by wiping with a disinfectant solution (0.5%
chlorine solution) immediately after the procedure.

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 Cleaning Spills

Spills of blood, body fluids, secretions or excretions

must be cleaned:
• Small spills must be decontaminated by wiping with a cloth
soaked in disinfectant solution (0.5% chlorine solution).
• Large spills should be flooded with disinfectant solution
(0.5% chlorine solution); if feasible, allow the solution to sit
for 10 minutes before mopping up, but do not create a
hazard whereby someone might slip and be injured.

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 Cleaning Schedules

For routine cleaning:

– Establish a schedule and provide written
guidelines for general housekeeping.
– Cleaning schedules should be developed
according to the needs of each area of the
healthcare facility.
– Outsourced agencies should collaborate with
health care providers to abide to IPC guidelines

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 CLEAN WATER

Objectives
At the end of this section, a healthcare
provider will be able to:
 Describe methods of preparing clean and
safe water
 Explain how to store clean and safe water
 Explain how to prevent the spread of cholera
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 Methods for Preparing Clean Water

By Boiling
 Water boiled for 5 minutes is considered safe to drink or to use in
making oral rehydration solution (ORS) and infant formula (count from
rolling boil).
By Chlorine
 Add a small amount of a chlorine-releasing compound such as sodium
hypochlorite. For example, only 10 mL (2 teaspoons) of a 0.5%
chlorine solution are needed to make 20 liters (over 5 gallons) of water
that is safe to drink.

For Turbid (cloudy) water:

 Filter or allow the particulate matter (sediment) to settle if tap or well
water is turbid.
 Carefully pour off the cleared water before being boiling or treating it.
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 Chlorination

Remember:
– Chlorination is not as effective in turbid (cloudy)
water because the organic material combines with
the free chlorine, reducing the concentration in
the treated water.
– Boiled water is easily recontaminated because,
unlike chlorinated water, it does not have any
residual capacity to inactivate microorganisms.

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 Storage of Clean and Safe Water

 Keep boiled/chlorinated water in a clean (disinfected) container,

preferably one with a narrow mouth to prevent hands or utensils
from touching the clean water.
 Prepare clean water daily in all healthcare facilities. The
preparation of clean water containing up to 10 ppm (0.001%)
sodium hypochlorite solution is inexpensive, easy to do and
often is needed during emergency situations (e.g., during floods
or other natural disasters that may lead to heavy contamination
of the water system).

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 How to Prevent the Spread of Cholera

 Cholera is spread through contaminated water. For

several years it has been known that microscopic
organisms in the water, called plankton, are the
reservoir for Vibrio cholerae, the bacteria causing
cholera.
 To decrease the incidence of cholera, treat the
drinking water. First, filter the water through several
layers of cotton cloth and then add sodium
hypochlorite (0.001% final concentration).
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 Session Eighteen:

INFECTION PREVENTION IN HOME-BASED

CARE SETTINGS

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 Session Objectives

At the end of this session the participants

should be able to:
 Describe the principles of preventing
infection in home based care setting
 Explain the guideline on how to prevent
infection in HBC setting
 Explain how to prevent infection in home
delivery
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 INFECTION PREVENTION IN HOME-BASED CARE
SETTINGS

Introduction
 prevalence of chronic diseases ( TB , HIV/AIDS) are
on the increase.
 There is an increasing numbers of hospitalized
patients, and many patients are cared for within their
homes pausing families, caregivers and other
community members are at risk to infection.
 HPs have a responsibility to educate the families
and caregivers about these risks, and also about the
infection prevention practices that can reduce the
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 HOME-BASED CARE SETTINGS cont…….

 One of the benefits of home-based care is that it may

be more comfortable and friendly for the chronically
ill patient. Therefore the risks to caregivers and
family must be weighed against the need for
psychosocial support for the patient.

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 Issues to Consider When Giving Home-Based Care Services

Hand hygiene
 Refer to Hand Hygiene slides….

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 Other instructions

 Keep patients in rooms with fresh air and plenty of light.

 Ensure that patients take any prescribed medication
completely, as ordered.
 Make sure that patients have clean clothing and that they have
clean, dry bed sheets at all times.
 Change bedridden patients’ positions every two hours to
prevent bed sores.
 Wear clean clothes and use clean surfaces, to prevent infection
from dirty clothes or surfaces; surfaces such as clothing, cloth
or plastic sheets should be washed with soap or detergent and
dried in full sunlight; cloth should be ironed with a hot iron.

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 Other instructions

 Wear gloves when direct contact with tissue under

the skin, blood, body fluids, secretions or excretions
is expected.
 Ensure that women have sanitary pads, or pieces of
cloth that have been washed and dried in full
sunlight and ironed if possible, when they need
them, and dispose of these properly, as you would
other contaminated waste.
 Encourage patients with coughs to carefully cover
their mouths with a handkerchief (preferably) or their
18 hands when coughing.
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 Other instructions -

 Encourage patients with diarrhea to use a

toilet or latrine, and to carefully wash their
hands with soap and clean, running water
after every bowel movement and before
eating or handling or preparing any food or
drinks.
 Cover mattresses and the like with plastic
sheets that can be easily decontaminated
and washed.
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 Guidelines for HPs on How to Prevent
Infections in Home-Based Care Settings - #1

 For any procedures where the skin may be

broken, and there may be contact with an
open wound or sore, or where there may be
contact with blood or other bodily secretions,
caregivers should use the following
guidelines:
– Practice good hand hygiene.
– Use gloves and plastic aprons when contact with
19 blood and body fluids is anticipated.
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 Guidelines for HPs on How to Prevent
Infections in Home-Based Care Settings -#2

– If the patient has a skin condition with open lesions/sores ,

clean them with mildly salty water and cover them with a
clean, dry dressing.
– Dispose of all materials that have come in contact with
blood, body fluids, secretions or excretions carefully so that
they do not pose a risk to members of the community.
– If they are to be reused, decontaminate them in 0.5%
chlorine solution, clean and high-level disinfect them in
0.5% chlorine solution (or 0.1% chlorine solution prepared
with boiled or sterile water).

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 Guidelines for HPs on How to Prevent
Infections in Home-Based Care Settings -#3

– Dispose of any cloth or plastic sheets that come in contact

with blood, body fluids, secretions or excretions; if they are
to be reused, decontaminate them in 0.5% chlorine solution
for 10 minutes, wash with soap or detergent, and dry in full
sunlight (and iron the cloth).
– Wipe surfaces (e.g., mattresses, tables) that may have been
in contact with blood, body fluids, secretions or excretions
with a cloth that has been soaked in 0.5% chlorine solution.

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 Guidelines for HPs on How to Prevent
Infections in Home-Based Care Settings -#4

– Burn and bury all materials that have come in

contact with blood, body fluid, secretions or
excretions (cloth or plastic sheets, razor blades,
gloves, etc.); this is the best procedure. Waste
should be buried in a deep hole and completely
covered with soil so that it is not accessible to
community members or children; it can also be
disposed of in a deep pit latrine.
– Wear utility gloves when handling and disposing
of contaminated waste products.
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 Preventing Infection in Home Deliveries

 For women who deliver at home, in addition

to the above guidelines, there are some
specific requirements for conducting a clean
delivery.

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 Supplies - #1

 In the preparation for delivery, the following

delivery kit should be available:
– New razor blade
– New cord ties (string to tie the umbilical cord)
– Clean delivery surface (a plastic sheet is
recommended; a cloth that has been well washed
and fully dried in sunlight, and ironed if possible,
is the next best alternative)
– Gloves
19 – Soap
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 Supplies - #2

– Sanitary pads or pieces of cloth that have been

washed and dried in full sunlight and ironed if
possible
– Clean warm wrappings for the baby, which have
been washed and dried in full sunlight and ironed
if possible
Clean, safe running water for hand washing
Clean protective clothing for the birth attendant

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 Infection Prevention and Control Guidelines - #1

Together with the above supplies, the

following are recommended:
 Avoid shaving hair,
 Decontaminate, clean and boil any reusable
instruments, and
 Properly dispose of any waste products.

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 Infection Prevention and Control Guidelines - #2

 If there are large spills of blood, body fluids,

secretions or excretions, pour 0.5% chlorine solution
over the spill area and let it stand for 10 minutes
before mopping it up.

Note
 After delivery, place the placenta in a plastic bag or
leak proof container, and bury or burn it.

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 Infection Prevention and Control in the
Community
(From Kenya Jhpiego Orientation Package)

Objectives
At the end of this section the health care
worker will be able to advise community
members on:
 how one gets diarrhea
 How to treat diarrhea
 How to prevent diarrhea
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 Health Awareness and Understanding

 No lasting change in our behaviour will occur without health

awareness and understanding; people must believe that better
hygiene and sanitation will lead to better health and better living

 Many of the great improvements in health have been due to education

and a recognition of the relationship between public and private
sanitation facilities, behaviour and disease transmission routes

 Improvement in hygiene behaviour alone has been shown to have a

positive health impact whereas improvement in sanitation facilities
alone many not bring health benefits

 Right now, we will emphasize personal hygiene, however, the ideal

situation would involve both personal behaviours and facilities at the
same time
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 Disease Transmission by Faeces

 Diarrhoea is generally caused by eating food

or drinking water that is contaminated with
human faeces

 Infants may suffer from diarrhoea after being

hand-fed by someone with dirty hands, or
after having put dirty objects into their
mouths
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 What causes diarrhea?

 Germs found in human faeces entering the

mouth
 These germs can be spread in water, food
and by dirty hands or objects
 For example, children may get diarrhoea if
their mothers had dirty hands or dirt under
their nails when they prepared food for them

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 Why is Diarrhea Dangerous?

 Diarrhoea causes children and adults to lose too

much liquid from their bodies and can result in death

 It can make malnutrition worse because

– Nutrients are lost from the body
– Nutrients are used to repair damaged tissue rather than for
growth
– A person suffering from diarrhoea many not feel hungry
– Mothers may not feed their children normal if they have
diarrhoea

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 How do you know that someone has
diarrhea?

 When someone has diarrhoea their stool

contains more water than normal and may
also contain blood
 They have 3 or more loose or watery stools
in a day (24 hours)

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 What to do for someone with diarrhea

1. Give plenty of liquids to drink, any of the following

fluids:
• Breast milk
• Oral rehydration solution
• Plain water (boiled and cooled)
• Soup, rice water, yoghurt
• Juices, weak tea, coconut water
• Cooked cereal
2. Give food
3. Seek trained help, if the diarrhoea is serious
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 How to Prevent Diarrhea

 Safe disposal of faeces, particularly faeces of young

children and babies and of people with diarrhoea

 Handwashing after defecation or handling faeces,

before feeding, eating or handling food

 Maintain drinking-water free from faecal

contamination, in the home and at the source

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 Prevent Diarrhea by HANDWASHING

 It’s ALL about the HANDS!

 Hand washing is the single

most important infection
prevention procedure!

 Hand washing removes

removal of dirt and disease-
causing germs the hands

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 When should we wash our hands?

 Wash your hands

– After defecation
– After handling feces (babies, children and the
sick)
– Before and after
 feeding, eating or handling food, especially cleaning
vegetables, fresh meat or fish

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 Techniques for Hand Care

 Proper hand washing (technique is found in the

guidelines), using soap and water and friction
– Palm to palm
– Between fingers
– Back of hand
– Base of thumb
– Back of fingers
– Fingernails
– Wrists
 Keep fingernails short
 Teach your children when and how to wash hands
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 Preventing Diarrhea

1. Safe disposal of faeces, particularly faeces

of young children and babies and of people
with diarrhoea
2. Maintain drinking-water free from faecal
contamination, in the home and at the
source

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 Who Benefits from Preventing Diarrhea?

 We all do!

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 END

THANK YOU FOR PARTICIPATING

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 Rationale Cont.

 Services are provided in congested environment

 Availability of new scientific information which
simplifies provision of safe and effective prevention
measures;
 Need for practical guidelines to reduce risk of
nosocomial (facility or hospital-acquired or
healthcare related) infections;
 People’s right to health requires safe healthcare
environment for both providers and clients.

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