infection control for sanitation staff. how to clean, what to use and how to avoid spread of infections

1. Infection Control
Dr. Kanwal Deep Singh Lyall
M.D. Micorbiology

2. Working definition of NI
Localized or systemic condition
1. that was not present or incubating at the time of
admission to the hospital
2. that is acquired in a hospital or health care
facility and
3. > 48 hours for most bacterial infections
– OPD patients, shorter hospital stays- manifest
after discharge

3. Impact of NIs
• Leading cause of death
• Considerable economic costs
• Increased length of stay
• Direct costs to patients or payers
• Indirect costs due to lost work, increased use of
drugs, the need for isolation, and the use of
additional laboratory and other diagnostic studies
• Leads to imbalance between resource allocation for
primary and secondary health care
• Transmitting MDR into community

4. Who is Responsible?
• Hospital management
• The physician
• The microbiologist
• The hospital pharmacist
• The nursing staff
• The central sterilization service
• The food service
• The laundry service
• The housekeeping service

5. Factors Influencing The Development
of Infections in ICU
NI
The Microbial
Agents
Patients
susceptibility
Bacterial
resistance
Environmental
factors

6. Transmission Of Pathogens By Hands

7. Microorganisms on patient’s skin, clothing & other
inanimate objects in surroundings

8. Organism transferred to hands of HCW

9. Organisms survive for several mins on HCW’s hands

10. Hands remain contaminated because hand hygiene
is inadequate

11. Contaminated hands come into direct contact with
another patient or inanimate object

12. Aims of Infection Control
• To reduce the microbial population of the hospital
environment.
• To eliminate the danger of transmission of
microorganism from one individual to another from
hospital personnel to patient, from patient to
personnel to patient and from patient to patient.
• To prevent hospital items from becoming sources of
cross contamination

13. Types of Nosocomial Infections
• Urinary tract infections
• Respiratory infections
• Infections related to vascular access
• Surgical site infections
• Other Nosocomial infections

14. UTI - Portals Of Entry

15. Respiratory Tract Infections

16. CRBSI - Portals of Entry

17. Role of the housekeeping service
• The housekeeping service is responsible for the
regular & routine cleaning of all surfaces
• Maintaining a high level of hygiene in the facility.

18. What Are Some General Tips To
Remember About Sanitation?

19. Do…
• Follow recommended procedures and safe work
practices
• Check product labels to know the potential hazards and
safe work practices for all cleaning and disinfecting
products you use.
• Wear PPE & clothing recommended by your supervisor.
• Use cleaning products appropriate to your workplace and
according to the supplier's
• Always clean and wash surfaces/areas thoroughly before
disinfecting them.

20. • Use germicides or diluted bleaches (e.g. sodium
hypochlorite) to disinfect areas as required.
• Wash hands thoroughly with warm water and soap,
after removing gloves.
• Report to your supervisor all spills, accidents,
incidents, etc.

21. Don’t….
• Eat, drink, or smoke while using bleaches, cleaning
agents, disinfecting agents, or other chemical
products.
• Leave open containers of bleaches, paints and
solvents in the washrooms or other areas used by
other staff, students, visitors or other members of
the public.

22. What Are Some Tips About
Cleaning Blood And Body Fluids?

23. Body fluids to which
universal precautions apply
• Blood
• Vaginal secretions
• Semen
• Cerebrospinal fluid
• Synovial fluid
• Pleural fluid
• Peritoneal fluid
• Amniotic fluid
• Pericardial fluid
• Other body fluids containing
blood
Universal precautions DO
NOT apply to
• Feces
• Tears
• Sputum
• Sweat
• Urine
• Vomitus
• Nasal secretions

24. Spillage
• Spillages are, by nature, highly unpredictable.
• Contamination of the environment & risk of exposure
to infectious agents increases where the spillage is left
unattended, or ineffectively managed.
• The person witnessing the event should deal with
spillages immediately.
• Spillages consist of blood, body fluid or excreta and
carry a risk of infection transmission.
• All spillages of blood or body fluid should be
considered as potentially infectious.
• This will reduce the risk of exposure to infectious
agents or further contamination.

25. Contd..
• Infectious agents can survive for long periods of time in
spillages.
• It is essential, therefore, that all staff receive training in
spillage management and, where possible, appropriate
equipment is readily available.
• For the effective management of spillages in healthcare
facilities, surfaces such as walls, floors and upholstery
should be smooth, continuous and moisture repellent.
• Carpets should be avoided in all areas where patients
are managed.
• All surfaces should be able to withstand frequent
cleaning including cleaning with chlorine-based agents.

26. • Where possible, a spillage kit should be
available to all staff containing:
Plastic aprons.
Gloves.
Sanitizer granules.
Clinical waste bags.
Blue roll / paper towels or disposable cloths

27. Blood Spillages
Please ventilate room well prior to using chlorine product.
Hypochlorite method
• Wear protective clothing
• Soak up excess fluid using disposable paper towels
• Cover area with towels soaked in 10,000ppm (1%) of available chlorine
• This is 1 part chlorine to 10 parts water, put water in container 1st then
add chlorine
• Leave for at least 2 minutes
• Remove all organic matter and dispose of as clinical waste
• Clean area with hot water and detergent
• Dry area using disposable paper towels
• Dispose of protective clothing as above
• Wash hands

28. Decontamination Of Spills
Spot cleaning
• Wipe the spot immedately with a damp cloth,
tissue or paper towel
• An alcohol wipe may be used
• Discard contaminated material
• Wash hands

29. Spillages of any body fluid containing blood
• Any body fluid containing blood should also be
treated by the above process except urine or
vomit stained with visible blood.
• In this case the excess urine/vomit must be
mopped up with paper towels first.
• This is because if urine or vomit comes into direct
contact with the chlorine product toxic fumes will
be released.
• The room should be well ventilated (i.e. window
open) before this procedure is carried out.

30. Spillage on Soft Furnishing or Contamination of Brass
• Put on protective clothing, as needed
• Soak up as much of the spillage as possible using
kitchen roll or disposable paper towels.
• Remove towels and debris and dispose of as clinical
waste.
• Clean the area with hot water and a detergent using
paper towels or a disposable cloth
• Dry area thoroughly
• Dispose of protective clothing and cloths as clinical
waste
• Wash and thoroughly dry hands.

31. Spillage from a Sharps Container
If used sharps are spilled from a sharps container,
the following procedure should be followed :
• Wear protective clothing
• Gather up spilled sharps using a dustpan & brush
& put them into the appropriate sharps container
• Follow procedure as for blood spillage on floor
area where sharps were spilled
• Dispose of protective clothing
• Wash hands

33. What Should You Know About
Bio-hazardous Waste?

34. DO….
• Consider all biological wastes as infectious.
• Handle all contaminated wastes carefully to prevent
body contact and accidental injury.
• Wear puncture-resistant gloves and safety boots
appropriate for the situation.
• Dispose of infectious waste in a puncture-resistance
container such as a bucket or box with a secure lid
and lined with leak-proof, puncture-resistant plastic.
• Put a biological hazard symbol on the container.

35. • Wear leather gloves and empty waste paper baskets
(or other containers) by holding container on the
outside.
• DO NOT empty or carry the container by putting your
fingers on the inside.
• Call your local public health department or police for
further assistance.

36. Don’t….
• Do not load the container beyond its capacity.
• Do not compact infectious waste. This process may
disperse the contamination.
• Do not mix infectious waste with regular garbage or
trash.
• Do not reach into any waste container or receptacle
which may contain hazardous waste.

37. Use of protective barriers
• Gowns
• Gloves
• Masks
• Cap
• Protective glasses or eye shields
• Plastic aprons
• Shoe covers

38. BMW Management
Colour Container Category
Green Green bin with Green
plastic bag
General waste
Red Red bin with Red
plastic bag
Cat. 3 – Microbiology & Biotechnology waste,
Cat. 6 – Soiled waste, Cat. 7 – Solid waste (Plastic
waste)
Yellow Yellow bin with
Yellow plastic bag
Cat. 1 – Human anatomical waste, Cat. 2 – Animal
waste, Cat. 3 - Microbiology & Biotechnology
waste, Cat. 6 – Soiled waste
White White puncture proof
container
Category 4 – Sharps (Needles, blades etc)
Black Black bin with Black
plastic bag
Cat. 5 – Discarded medicines & Cytotoxic drugs,
Cat. 9 – Incineration ash, Cat. 10 – Chemical
waste

39. BMW Management
GREEN BAG RED BAG YELLOW BAG WHITE
CONTAINER
BLUE BAG
Non Infectious
Waste
Infectious Waste Infectious Cotton/
Anatomical Waste
Sharp Waste
(Infectious)
Sharp Waste
(Non-
Infectious)
Paper Waste
Cartons
Packaging material
Plastic sheets
News paper
Waste food items
Blood bags
Gloves
Urine bags
Disposables like
Catheters, I/V Drip
sets, Ryles tube,
Airways etc.
Bandages/ Dressings
Cotton Swabs
Plastic casts
Napkins soiled with
blood or body fluids of
patients
Linen material
Human tissues, organs,
body parts, placenta
Microbiological waste
Biotechnology waste
Animal waste
Mask & Caps
Needles should be
destroyed at
generation point
Lancets/ Blades
I/V Drip bottles
(Glass/ Plastic)
Injection Vials,
Ampoules
Syringes to be
dipped in 1 %
sodium
Hypochlorite after
destroying the tip
and with plunger
removed

40. NEEDLE STICK
&
POST EXPOSURE
PROPHYLAXIS

41. HCW/HCP EXPOSURE – NSI
An exposure that might place HCP at risk for HBV, HCV,
or HIV infection is defined as
• a per-cutaneous injury (e.g., a needle-stick or cut
with a sharp object) or
• contact of mucous membrane or non-intact skin
(e.g., exposed skin that is chapped, abraded, or
afflicted with dermatitis)
- with blood, tissue, or other body fluids that are
potentially infectious .

42. • Injuries from needles used in healthcare and
laboratory settings may result in transmission of
bloodborne pathogens to healthcare workers.
• The goal of this project is to reduce the anxiety,
expense and lost productivity associated with these
injuries by reducing needle-sticks

43. Cost Of Exposure
• Infectious diseases→ disability or death
• Psychological trauma →months of waiting,
fear of outcome
• Altered lifestyle
• Side effects of prophylactic medications
• Job discrimination →Loss of employment, lack
of compensation

44. Most Likely Causes
• Failure to use safety engineered needles
• Unsafe work practices (recapping, removal of
phlebotomy tube holder)
• Failure to dispose properly
• Disposal system failures (overfull containers,
needles sticking out of containers or piercing
sides)

45. Infections Transmitted By Sharps
Injury
Blastomycosis Malaria
Brucellosis
Mycobacteriosis
Cryptococcosis Mycoplasmosis
Diphtheria Rocky
Mountain fever
Ebola fever Scrub
typhus
Gonorrhoea
Staphylococcus aureus
Hepatitis B

46. 0%
5%
10%
15%
20%
25%
30%
35%
0.30%
3%
30%
Hepatitis B Virus Hepatitis C Virus HIV
Estimated Risk of Infection Following a Needle-stick from an
Infected Source-Patient

47. Standard Precautions
• Barriers Protection
• Hand washing
• Safe techniques
• Safe handling of
– Sharp items
– Specimens
– Spill of blood / body fluids
• Use of Disposable / Sterile items

48. Immediate Management of -NSI
• STOP THE PROCEDURE IMMEDIATELY!!!
• IMMEDIATELY clean Exposure site –The most important
part of PEP
• Skin wounds should be washed with soap and running
water
• No evidence that antiseptics are useful
• Caustic agents (bleach) may do more harm than good
• Flush mucous membranes thoroughly with water (no soap)
• Eyes irrigated with a liter of saline

49. Immediate Management of -NSI
• Report to the Casualty Medical Officer
• Promptly notify your supervisor.
• Fill out the Needle Stick Injury form

51. Exposure To Hep B – HCP Management
HCP Vaccinated
Antibody >10 iu/ml Antibody <10 iu/ml
No Addl T/T
Pt HBs Ag -ve Unknown Source Pt HBsAg +ve
HCP:Booster dose or
Complete series
HCP:Booster dose or
Complete series + HBIg
HCP Not Vaccinated
Immediate Vaccine –
(within 7 days) Along
with HBIg (0.06 ml/Kg)

52. Blood Test immediately and at 6 mths
LFT and Anti HCV at 4 – 6 Mths
Interferon not recommended for prophylaxis
No Active Prophylaxis-Immunoglobulins not
effective
Determine status of Source (Anti-HCV)
HEPATITIS C –
POST EXPOSURE MANAGEMENT

53. Post Exposure Prophylaxis
For HIV

54. Rationale for HIV PEP
• HIV infects dendritic cells (DC) then regional lymph nodes
before becoming systemic
• AZT blocks infectivity of HIV infected DC
• Goal of PEP : halt viral replication before systemic infection
is established
• Retrospective study : Risk of Seroconversion: 81% lower in
HCP’s who took AZT PEP.
• Several animal studies showing efficacy
• Peri-natal prophylaxis has been effective

55. Hand Hygiene
• HAI paramount importance throughout the world
• Affects quality of care & patient safety
• Adds tremendous and needless costs to health care
• Hand Hygeiene - important procedure for preventing
transmission of HAI
• ≈40% of HCP adhere to handwashing policies

57. Frequently Missed Areas When Handwashing

59. Your 5 Moments for Hand Hygiene

60. Thank You