10 a prevention of infection 16 sept

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Prevention of Infection
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
BEMoC - Presentation 10 (a)
Session 10a

PREVENTION OF INFECTION
Government of India
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Session Objectives
 Understand the concept and importance of
infection prevention
 Know and practice the standard procedures
to be undertaken in the facility and
specifically the labour room

Government of India
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WHY?
 Minimise the risk of HIV, Hepatitis B, C and
streptococcal/staphylococcal infections
 Appropriate prevention practices to:
• reduce post-procedure infection
• prevent infection of health care personnel
• protect the community
• lower the costs of healthcare

Government of India
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Sources of Infection
What are the common sources of infection?
 Environment: Blood, body fluids, secretions,
excretions, placenta, contaminated sharps
and other equipments.
 Other clients
 People in the community
 Health care delivery personnel

Government of India
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Infection prevention principles
 All objects that come in contact with a patient
are potentially contaminated
 Every person must be considered potentially
infectious
 If an object is disposable - discard appropriately
 If an object is reusable - decontaminate

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Universal (Standard) Precautions
“Precautions to protect against exposure
must be taken when there is any
potential for exposure to bodily fluids. It
is assumed that all bodily fluids have
the potential to transmit disease”
The Universal Precaution Rule:
Treat all human blood, bodily fluids and other potentially
infectious materials
as if they are infectious.

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Components of universal precautions
 Hand washing
 Careful handling of sharps
 Safe techniques
 Sterilization and Disinfection
 Disposal of waste in a proper manner
 Use of Personal barrier precautions
ASSUME ALL BODY FLUIDS FROM ALL PERSONS
ARE POTENTIALLY INFECTIOUS

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Standard Precautions: Hand Washing
LongAntibacterial
soap, Alcoholic
solutions
Pre-operative
disinfection
Surgical hand
disinfection
DisinfectionAlcoholDisinfection after
contamination
Hygienic
hand rub
ShortNon medicated
soap
Cleansing after
client contact
Careful hand
washing
ShortNon medicated
soap
CleansingRoutine hand
washing
Residual
effect
AgentsMain PurposeTechnique

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Specific Indications for Hand Hygiene
Before:
 Patient contact
 Inserting urinary catheters, peripheral vascular,
I/V cannula ,catheters, or other invasive devices
that don’t require surgery
After:
 Contact with a patient’s skin
 Contact with body fluids or excretions, non-
intact skin, wound dressings
 Removing gloves

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Steps of hand washing
Step 1
Wet the hands and wrists.
Apply soap.
Step 2
Right palm over left,
left over right.
Step 3
Palm to palm,
Fingers interlaced.
Step 4
Back fingers to opposing
Fingers interlocked.
Step 5
Rotational rubbing of right
Thumb clasped in left palm
and vice versa.
Step 6
Rotational rubbing backwards
and forwards with top of
fingers and thumb of right
Hand in left and vice versa.

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Missed Spots when Hand-washing

Government of India
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Standard Precautions: Protective attire
 Gloves
 Masks
 Eye-covers
 Gowns
 Caps
 Footwear
*use once then change

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Standard Precautions: Processing of used
items
A. Decontamination
B. Cleaning
C. Sterilization or high level disinfection
(HLD)
D. Storage

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Processing of used items
 Decontamination: kills pathogens
• Place instrument in 0.5% chlorine for 10min
• Wipe contaminated surfaces
 Cleaning: with soap and water – scrub
equipment
 Sterilization: for surgical instruments and
drapes

Government of India
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Standard Precautions: Maintaining clean
environment
For cleaning areas –
operation theatres,
procedure rooms, latrines
Disinfectant
cleaning solution
To clean up spills of blood or
other body fluids
Disinfectant 0.5 %
chlorine solution
To remove dirt & organic
material such as grease, oil
Plain detergent
and water
UsesType of cleaning
solution

Government of India
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Steps of Decontaminnation
 Monitor vitals
 Take steps to stabilize woman’s condition
 If condition worsens, assess the level of shock
 Treat accordingly & refer the patient to an FRU
with basic life support
 Specific treatment: as mentioned
according to the type of abortion

Government of India
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Missed Spots when Hand-washing

Government of India
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Recommended Disinfectants
 .5 to 1% bleach
 2% glutaraldehyde
 70% ethyl and isopropyl alcohol.
 4% formaldehyde.
 .5-1% sodium hypochlorite.

Government of India
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Sterilization:
 Sterilization ensures that items are free of all
microorganisms (bacteria, viruses, fungi and
parasite) including endospores.
Three methods of sterilisation:
 Steam sterilisation / Autoclaving / Pressure
cooker autoclaving
 Dry heat sterilisation
 Chemical / cold sterilisation

Government of India
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Sterilization:
 High level Disinfection
 HLD eliminates bacteria, viruses, fungi and
parasites, but does not kill all endospores which
cause diseases such as tetanus and gas gangrene.
 HLD only acceptable alternative to sterilisation.
 There are 3 methods of HLD:
• Boiling
• Chemical HLD
• Steaming

Government of India
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Storage:
 To prevent contamination after processing
 Do not store instruments or other items such as
scalpel blades and suture needles in solution,
always store them dry
 Follow the guidelines written on the container,
instructed by the manufacturer

Government of India
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Standard Precautions: Proper Handling and
Disposal of sharps
Needles and syringes
 Use disposable needle and syringe ONLY ONCE.
 Always wear utility gloves while handling sharps
 Do not recap, bend or break needles before disposal.
 Make needles unusable after single use by burning
them in a needle destroyer
 Never burn syringes
 Do not reuse disposable gloves

Government of India
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Standard Precautions: Proper Handling and
Disposal of sharps
Needles and syringes
 Dispose off needles and syringes in a puncture-proof
container such as metal box, cardboard box or an
empty plastic box.
 Syringes to be cut with hub cutters and chemically
disinfected at source of generation before final disposal
into sharps pit located at the PHC
 Finally dispose as follows:
• Dispose the needles and broken vials in pit / tank,
(made according to the GOI guidelines)
• Send the syringes and unbroken vials for
recycling or landfill

Government of India
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Standard Precautions: Maintaining clean
environment
For cleaning areas – operation
theatres, procedure rooms,
latrines
Disinfectant cleaning solution
To clean up spills of blood
or other body fluids
Disinfectant
0.5 % chlorine solution
To remove dirt & organic
material such as grease, oil
Plain detergent and water
UsesType of cleaning solution

Government of India
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What are the colour codes for segregation?
 Yellow for infectious waste such as anatomical &
pathological wastes, such as body parts and animal
carcasses, soiled dressings such as gauze, cotton,
linen, etc. contaminated with blood or other body fluids
 Red for infectious plastics such as gloves, IV sets,
tubings, catheters, canulas, microbiological waste, etc.
 Translucent/puncture proof containers for metal
sharps
 Blue for glass
 Black for cytotoxic drugs, incinerator ash, chemical
waste, etc.
 White for recyclable non-infected general waste
 Green for collecting and transporting food waste from
wards, canteens, and dining halls.

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Standard Precautions: Biomedical Waste
Disposal
It is the waste that is generated during diagnosis,
treatment or immunization of human beings
Purpose of waste disposal
 Minimize/Prevent the spread of infection to
hospital personnel who handle waste
 Prevent the spread of infection to the local
community

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Standard Precautions: Biomedical Waste
Disposal
Steps of waste disposal
A. Segregation
B. Collection and Storage
C. Transportation
D. Treatment and disposal

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Biomedical Waste Disposal: Collection and
Storage
Wrong Correct

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How to dispose of placenta
 In a yellow bag
 Not to be left in open places
 To be buried in a deep trench away from the
water source

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Biomedical Waste Disposal: Transportation
Wrong Correct

Government of India
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Biomedical Waste Disposal: Treatment and
Disposal
Do’s
 Disinfect and destroy the waste before its final
disposal.
 Remember
• Biological waste to be buried deep at the
facility

Government of India
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Key Messages
 Hand-washing is essential for preventing
infections
 Always wear gloves especially where there is
a risk of touching blood, body fluids,
secretions, excretions or contaminated items
 Decontamination: 0.5% bleach solution is the
least expensive and the most rapid acting and
effective agent to use for decontamination
 Proper handling of contaminated waste
minimizes the spread of infection to healthcare
personnel and to the local community

Government of India
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Key Messages (contd...)
Proper handling means:
 Wearing utility gloves
 Transporting solid contaminated waste to the
disposal site in covered containers
 Disposing of all sharp items in puncture-resistant
containers
 Carefully pouring liquid waste down a drain or
flushable toilet
 Burning or burying contaminated solid waste
 Washing containers, gloves and hands after
disposal of infectious waste

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Preparation of Chlorine
Solution

IP: Instructions for Preparing Dilute Chlorine
Solutions
To make a 0.5% chlorine solution from 5%
bleach, mix 1 part bleach to 9 parts water.






Dilute%
eConcentrat%
Total parts (TP) (H2O) =
- 1
Total parts (TP) (H2O) = 





Dilute.5%
eConcentrat5%
- 1= 9 Total parts (TP) (H2O)

IP: Instructions for Preparing a Chlorine
Solution from a Powder
To make a 0.5% chlorine solution from
a 35% chlorine powder,
mix 14.2 grams of powder to 1 liter of water.






eConcentrat%
Dilute%
Gram/Liter = X 1000






eConcentrat35%
Dilute.5%
Gram/Liter = X 1000 = 14.2 Gram/Liter

EXCERSIZE
1. Which is the most important of the
standard precautions practices?
2. Which is the first step in instrument
processing and what is its purpose?
3 What are the key differences between
sterilisation and high level disinfection?
4 What are the types of contaminated
wastes produced in your HCF?

EXCERSIZE cont…
5. How are you managing your
waste?
6. How are you processing reusable
items in your facility?
7. Name the chemical disinfectants
available at your facility?
8. How is 0.5% hypochlorite solution
prepared?

10 a prevention of infection 16 sept

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