Hospital infection control (Biosafety in
Health Care Practices to Prevent Health
Care Associated Infections)
By Dr. Rakesh Prasad Sah
Associate Professor, Microbiology

Components
• Hospital Acquired Infection
• Major Healthcare-associated infection Types
• Sterilization and Disinfection
• Biomedical waste management
• Needle stick Injury
• Antimicrobial Stewardship
• Environmental Surveillance

Hospital Acquired Infection
• An infection acquired by a patient during
hospital care which was neither present
nor incubating at the time of admission.
• Also called as “Nosocomial infection”.

Factors affecting HAI
• Immune Status
• Hospital environment
• Hospital organisms
• Diagnostic or therapeutic interventions
• Transfusion
• Poor hospital administration

Sources
• Endogenous sources
• Exogenous sources
– Environmental
sources
– Health care
workers
– Other patients

• E. coli
• SARS-CoV-2 (COVID-19)
• Candida albicans
• Clostridium difficile
• Blood borne (transfusion and Needle stick injury)
• HIV
• Hep-B
• Hep-C
Microorganisms

Mode of Transmission
• Contact
• Droplet
• Airborne

Who is at Risk of Infection?
Patient Healthcare worker Healthcare workers family
Patient Patient Patient family
HCW Patient

Benefits of Infection Prevention and Control

Infection Control Precautions
• Used to reduce transmission of microorganisms in Hospital &
laboratory
• Includes
– Standard Precautions
• Hand hygiene
• Personal protective equipment (PPE)
– Transmission based precautions

Prevention of HAIs
• Standard Precautions
• Include a group of infection prevention practices  apply to all patients,
regardless of suspected or confirmed infection status in any setting in
which healthcare is delivered.
• Rationale: all blood, body fluids, secretions(except sweat), excretions,
non-intact skin, and mucous membranes may contain transmissible
infectious agents.

Components of Standard Precautions
• Hand hygiene
• PPE (Personal protective equipment)
• Spillage cleaning
• Respiratory hygiene and cough etiquette
• Transmission based precautions
• Biomedical waste including sharps handling
• Disinfection

WHY is hand hygiene required?

Hand Hygiene
• Main source of transmission of infections
• Most important measures to avoid the transmission of microbes.

Hand hygiene
• Hand hygiene
– Hand rubbing
– Hand washing
• “My five moments of hand hygiene”
– Hand rub with alcohols
– Hand wash with soap and water

“My five moments of hand hygiene”
1. Before touching a patient
2. Before a procedure
3. After a procedure or body fluid exposure
4. After touching a patient
5. After touching a patient’s surroundings

In addition to the above, hand hygiene should be
performed in the following non-clinical situations
1. Before eating/handling of food/drinks (whether own or patients)
2. After hands becoming visible soiled
3. After visiting a toilet
4. After blowing/wiping/touching nose or mouth
5. After putting on and removing personal protective equipment (PPE)
6. After handling laundry/equipment/waste

Hand Rub with Alcohols
• They are a suitable and effective alternative to hand washing with
soap and water, provided the hands are visible clean.
• If the hands are soiled, they should be washed using a soap and
water first.
• Alcohol hand rubs must not be placed near electrical sockets,
switches or devices.
• Alcohol must be thoroughly rubbed in until dry before undertaking
any clinical procedure

Hand wash with soap and water
Alcohol hand rubs are not suitable:
1. When hands are visibly soiled
2. After using a rest room

• Video

Personal Protective Equipments (PPE)

STEP OF DONNING
1. Hand Rub with sanitizer
2. Gown
3. Mask/respirator
4. Wear goggles/face shield
5. Gloves

STEP OF DOFFING
1. Gloves
2. Goggles/Face shield
3. Gown
4. Mask/Respirator

Spill management for Blood and Body
Fluids
• Bring the spill kit to the site of spillage
– wear PPE (gloves, gown)  put ‘no
entry’ sign board near the spill area.
• Small volume (<10ml)
– Wipe up spill immediately with
absorbent material and discard into
appropriate bin
– Wipe the area with 10% sodium
hypochlorite and allow it to dry
– Remove PPE and perform hand hygiene

• Large volume (>10ml)
– Place disposable paper towels over
spills to absorb the spillage and then
pour 10% sodium hypochlorite on
the top of absorbent paper towels
and leave for 15mins
– Remove the absorbent papers; put
fresh disposable paper towels to
clean the area and then discard these
into appropriate waste bin
Spill management for Blood and Body
Fluids

Respiratory hygiene/cough etiquette
• Avoid patient careare as if you havea respiratory infection. Stay home if
possible. Weara mask during hospitalvisits.
Wash hands with soap and water

Respiratory hygiene/cough etiquette
• If no tissues are available, cough or
sneeze into the inner elbow rather than
the hand
• Surgical masks can be used on the
coughing person when tolerated and
appropriate

Respiratory hygiene/cough etiquette
• Spatial separation, ideally > 6 feet, of persons with
respiratory infections in common waiting areas when
possible

Transmission Based Precautions
Introduction
• Additional precautions taken over and above the std.
precautions
• where std. precautions may not be sufficient
• Based on specific MOT

Transmission Based Precautions
• Hand Hygiene
• Gown
• Gloves
Contact Precautions
• Hand Hygiene
• Mask
Droplet Precautions
• Hand Hygiene
• Negative pressure room
• N-95 Respirator mask
Airborne Precautions
https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

Contact Precautions
• Physical contact  infected  susceptible host
• Apply to patients with any of the following conditions and/or disease
 Presence of stool incontinence (may include patients with norovirus, rotavirus,
or Clostridium difficile)
 Draining wounds
 Uncontrolled secretions
 Pressure ulcers or presence of ostomy tubes and/or bags draining body fluids
 Presence of generalized rash
 Highly contagious skin lesions
 MDROs
• MRSA (Methicillin resistant S. aureus)
• VRE (Vancomycin resistant Enterococci)

Precautions
• Isolation
– Individual room (optional)
– Cohorting (desirable)
– >3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of
items between the infected/colonized patient and other patients
• Patient movement
– Confined to room
– If transfer req.  hand hygine, PPE, patient’s colonized area must be covered.
• Patient dedicated equipment
– Stethscope, b.p. cuff, nebulizer  for single patient  must be disinfected before re-use
• Hand washing
– Before and after contact
• Environmental cleaning
– Floor, clothes, toilet and equipment cleaning with appropriate disinfectant

DROPLET PRECAUTIONS
• Large particle respiratory droplets (≥5 microns) from a source patient
– Coughing
– Sneezing
– Certain procedures (suctioning)
• Respiratory viruses
– Influenza
– Parainfluenza virus
– Adenovirus
– RSV
• Pertussis
• Meningitis
– N. meningitides
– Group A streptococcus
• Mycoplasma
• C. diptheriae
For first 24 hours of therapy

Precautions
• Isolation
– Essential, if single room not available  cohorting spatial separation ≥ 3 feet
– Negative pressure room (desirable)
• Patient movement
– Restricted movement of the patient
– Wears surgical mask  while leaving room
• Surgical mask  healthcare workers while entering the room
• Perform hand hygiene
– before and after touching
– after contact with respiratory secretions and contaminated objects/materials;
– note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)

Airborne Precautions
• Airborne
• Small-particle residue (≤5 μm) that remain suspended in the air for
long periods of time
– Varicella
– Pulmonary TB
– Measles
– Chickenpox
– SARS (severe acute respiratory syndrome)
– Herpes zoster (until lesions are crusted over)

Precautions
• Isolation
– Place immidiately in an airborne infection isolation room (AIIR)
– Adequate ventillation with negative pressure facility (essential)
• Patient movement  confined to the room all the time
• PPE:
– staff should wear high-efficiency masks (N95) before entering the room.
– Patient may wear surgical mask all the time

Will be discussed in other chapters
• Biomedical Waste Management
• Disinfection

The Key -
always be alert
Put on protective
gear when
needed
Thank you