1. INFECTION PREVENTION
&
STANDARD SAFETY MEASURES
PRESENTER: ARUNA SHASTRI
MSc NURSING, 2ND YEAR

2. INTRODUCTION
• Hospital associated infections account for
considerable economic loss through
prolonged hospital stay and adverse patient
outcomes.
• In most health care facilities the average
incidence of HAI is around 5-10 %

3. EFFECT OF HAI ON HEALTH CARE
 Increases morbidity and mortality
 Length of stay and cost of health care
increases
 Risk of being the target of litigations
 Bad reputation for the hospital

4. INFECTION
• Entry and multiplication
of an agent in the
tissues of the host.

5. CHAIN OF INFECTION
INFECTIOUS
AGENT
RESERVOIRHOST
PORTAL OF
ENTRY
PORTAL OF
EXIT
MODE OF
TRANSMISSION

6. THE INFECTIOUS PROCESS
Infections follow a progressive
course
1. Incubation period
2. Prodromal stage
3. Illness stage
4. Convalescence

7. HEALTH CARE ASSOCIATED
INFECTIONS
It’s also called nosocomial infection.
An infection occurring in a patient in a
hospital or other healthcare facility in
whom the infection was not present or
incubating at the time of admission.

8. COMMONLY OCCURRING TYPES OF NOSOCOMIAL
INFECTIONS
 Urinary tract infections
 Surgical wound infections
 Respiratory tract infections
 Catheter related blood stream infections
 Meningitis
 Gastroenteritis

9. IATROGENIC INFECTIONS
 Type of nosocomial infections resulting from
a diagnostic or therapeutic procedure.
 It can be exogenous or endogenous

10. COMMON ORGANISMS CAUSING HAI
 Staphylococcus aureus
 Gram – ve bacilli from solutions
 Viruses from blood and blood products
 Fungi

11. NURSING PROCESS IN INFECTION
CONTROL
ASSESSMENT
Status of defense mechanisms: Any
break in primary and secondary defenses
Client susceptibility: many factors viz
age, nutritional status, stress, disease
process, medical therapy etc..
Clinical appearance: the signs and
symptoms may be general or localized.
Laboratory data:

12. NURSING PROCESS
NURSING DIAGNOSIS
Risk of infection.
Risk for injury.
Imbalanced nutrition less than body
requirements.
Impaired oral mucosal membrane.
Risk for impaired skin integrity.

13. GOALS AND OUTCOMES
Preventing exposure to micro organisms
Controlling or reducing the extent of
infections
Maintaining resistance to infection
Educating the client and family about
infection control techniques

14. IMPLEMENTATION
INFECTIOUS
AGENT
RESERVOIR
HOST
PORTAL
OF ENTRY
PORTAL
OF EXIT
MODE OF
TRANSMISSI
ON
BREAKING
THE CHAIN
OF
INFECTION

15. INFECTION REDUCTION
Asepsis
Activities to prevent infection or to break chain of
infection.
Medical asepsis:
 Clean technique to reduce and prevent spread of
microbes.
 Examples : Hand hygiene, using clean gloves,
cleaning envt routinely.

16. MEDICAL ASEPSIS- PRINCIPLES
• Hand washing
• Don’t discard soiled linens on the floor.
• Don’t allow uniform to come in contact with bed linens.
• Always do damp dusting.
• Don’t shake bed linens.
• Discard wastes in appropriate bags.
• The water used for patient care is directly poured into
drain.

17. CONTROL OF INFECTIOUS AGENT
Proper cleansing, disinfection,
sterilization of contaminated objects
reduces and often eliminate micro
organisms.

18. CONTROL OF INFECTIOUS AGENT
CLEANING:
It involves use of water and mechanical
action with detergents or enzymatic
products.

19. CONTROL OF INFECTIOUS AGENT
Disinfection :
A process that eliminates many or all micro-
organisms with the exception of bacterial spores.
It is generally accomplished by the use of
chemical disinfectants.
 Types
Concurrent
Terminal
 Prophylactic

20. STERILIZATION
Physical or chemical process that
completely destroys or removes all
microbial life including spores. Steam under
pressure, ETO gas are examples.
 Sterilization by dry heat: hot air oven,
incinerators
 Sterilization by moist heat: autoclaving (
heating 121 c at 18lb pressure for 20-30
min )

21. CONTROL OF RESERVOIRS
Contaminated articles can act as
reservoirs for infection
These should be carefully discarded

22. CONTROL OF RESERVOIRS
Dressing: change dressings that
become wet/ soiled.
Contaminated articles: place tissue,
soiled dressings, soiled linen in
moisture resistant bags for proper
disposal.
Contaminated needles: engage
safety features of all sharp devices
and dispose in puncture proof
container. Don’t Recap needles.

23. CONTROL OF RESERVOIRS
Bottled solutions: don’t leave bottled
solutions open for prolonged periods.
Keep solutions tightly capped.
Surgical wounds: keep drainage
tubes and collection bags patent to
prevent accumulation of serous fluid
under skin surface.

24. CONTROL OF PORTAL OF EXIT
 To control microorganisms exiting via
respiratory tract , mask can be used . Avoid
coughing and sneezing directly over surgical
wounds and sterile dressing fields. Give
special attention to hand washing.

25. CONTROL OF PORTAL OF EXIT
Mask, gowns, protective eye wear should
be worn when there is a probability of
splashing.
The nurse should always wear disposable
gloves when handling exudate.
Laboratory specimens should be handled as
if they are infectious.

26. CONTROL OF TRANSMISSION
The most important and basic
technique in preventing and controlling
transmission of infection is HAND
HYGIENE
Hand washing is a vigorous, brief
rubbing together of all surfaces of
hands lathered in soap, followed by
rinsing under a stream of water. (CDC,
2002)

27. HAND WASHING - TYPES
 Surgical hand washing
 Hygienic hand washing
 Social hand washing

28. HHAND

29. SAFE HANDLING OF SHARPS
Never pass sharps from one person to
another
Always dispose your own sharps
Use forceps instead of fingers for
guiding suturing
DO NOT RECAP needles
Dispose sharps in puncture
proof bags

30. CONTROL OF PORTALS OF ENTRY
Maintaining integrity of skin and mucus
membrane
Skin should be lubricated to prevent
breakdown
Avoid recapping of needles. A needle
stick should be reported immediately.
All drainage system should be closed
and intact. Drainage receptacle should
only be opened to discard or measure
the volume.

31. CONTROL OF PORTALS OF ENTRY
 The nurse obtains specimens from drainage
tubes and IV tubing ports.
 The method of preventing entry of
microorganisms in wounds : clean wound
from inside to outside , clean to
contaminated area.

32. PROTECTION OF SUSCEPTIBLE HOST
Maintain personal hygiene
Maintenance of adequate fluid intake
Pulmonary hygiene
Balanced diet
Promote comfort and sleep
Immunization

33. STANDARD PRECAUTIONS
 It apply to blood, all body fluids, excretions
except sweat, non-intact skin, mucus
membrane
 The CDC uses isolation guidelines that
contain a two tiered approach.
 The first tier contains precautions designed
to care for all clients in any setting
regardless of their diagnosis or presumed
infectiousness.

35. STANDARD PRECAUTIONS
Hands are washed between client contacts ,
after contact with blood , body fluids,
secretions, excretions and after contact with
equipments or articles contaminated and
immediately after gloves are removed.
Gloves are worn when touching the blood,
body fluids, secretions, excretions, non-intact
skin, mucus membranes or contaminated items

36. STANDARD PRECAUTIONS
Masks, eye protection, face shields
are worn if client care activities may
generate splashes.
Gowns are worn if soiling of
clothes is likely from blood or
body fluid.
Perform hand hygiene after removing
gloves or gown.

37. STANDARD PRECAUTIONS
 Client care items are properly cleaned and
reprocessed and single use items are
discarded.
 Contaminated linen is placed in leak proof
bag.
 All sharps and needles are discarded in
puncture proof bags.
 Processing all laboratory specimens as
potentially infectious

38. ADDITIONAL PRECAUTIONS
 Additional precautions must be applied to clients
known or suspected to be infected or colonised
with infectious agents
• This includes specific measures above Standard
precautions
Also known as transmission based
precautions
 . Additional precautions include:
•Airborne precautions;
•Droplet precautions; and
•Contact precautions.

39. AIRBORNE PRECAUTIONS
 To reduce the transmission of diseases spread by
the airborne route.
 Diseases which spread by this mode include
open/active pulmonary tuberculosis (TB), measles,
chicken pox, pulmonary plague and haemorrhagic
fever with pneumonia.
 The following precautions need to be taken:
 Implement standard precautions.
Place patient in a single room that has a
monitored negative airflow pressure,

40. AIRBORNE PRECAUTIONS
 The air should be discharged to the outdoors or
specially filtered before it is circulated to other
areas of the health care facility.
 Keep doors closed.
 Limit the movement and transport of the patient
from the room for essential purposes only. If
transport is necessary, minimize dispersal of droplet
nuclei by masking the patient with a surgical mask.

41. DROPLET PRECAUTIONS
 Applicable to pneumonias, pertussis,
diphtheria, influenza type B, mumps, and
meningitis.
PRECAUTIONS
 Implement standard precautions.
 Place patient in a single room (or in a room
with another patient infected by the same
pathogen).

42. CONTACT PRECAUTIONS
 Contact Precautions will be used when there is
known or suspected risk of transmission of
pathogenic microorganisms by direct or indirect
contact.
 Multi Resistant Staphylococcus Aureus (MRSA),
Vancomycin Resistant Enterococcus (VRE),
Respiratory Syncytial Virus (RSV), highly
contagious skin infections such as scabies, lice and
impetigo, hepatitis A, Shigella and other
gastroenteritis

43. CONTACT PRECAUTIONS
 If possible a clean, non-sterile gown or disposable overall
should be worn and discarded immediately after contact
with the patient ceases
 . Hands must be washed using a suitable anti-microbial
soap, preferably four percent (4%) chlorexidine
gluconate.
 All equipment used in the transport and care of these
patients should be cleaned thoroughly in hot soapy water
and and then a broad spectrum disinfectant.
 The patient compartment should also be washed with
hot soapy water and a broad spectrum disinfectant.

44. SURGICAL ASEPSIS
Sterile technique includes procedures used to eliminate all
microorganisms and spores, from an object or area.
PRINCIPLES OF SURGICAL ASEPSIS
 All sterile objects remain sterile only when touched by other sterile
objects.
 Only sterile objects should be placed in a sterile field.
 A sterile field out of vision or an object held below persons’ waist is
contaminated.
 A sterile object becomes contaminated on prolonged exposure to air.
 When a sterile object comes in contact with a wet contaminated
surface , sterile object becomes contaminated by capillary action.
 The edges of a sterile field are considered to be contaminated.

45. PROCEDURES FOR TERMINAL CLEANING
 Every item should be cleaned with appropriate
germicidal solution
 Beds and furnitures should be cleaned with
germicidal solution
 Linen should be removed from the bed without
shaking it
 Mattresses and pillow covered with durable plastic
covers should be washed thoroughly with
germicidal solutions
 Wastebaskets should be thoroughly washed with
germicidal solution

46. BLOOD AND BODY FLUID CLEANUP
 Appropriate PPE should be worn.
 Household heavy duty gloves should be used
 The area should be cleaned of organic material
 Area is disinfected with sodium hypochlorite.
Contact time= 10min
 The area is then wiped
 The towels should be discarded in yellow bags

47. BIOMEDICAL WASTE MANAGEMENT

48. ASEPTIC PRACTISES FOR
VARIOUS PROCEDURES

49. OCCUPATIONAL HEALTH HAZARDS
 HIV,HBV,HCV ,TUBERCULOSIS etc are the chief
occupational health hazards
 Needle stick injuries play an important role.

50. FUNCTIONS OF INFECTION
CONTROL NURSES
• Regular visits to all wards and
high risk units
• Checking nsg supervisors register
and records for cases suggestive of infection
• Collection of samples from different areas for
surveillance
• Daily visit to microbiology laboratory to ascertain
results of samples collected for surveillance and to
liaise between microbiology and clinical depts

51. FUNCTIONS OF INFECTION CONTROL
NURSE
 Compilation of ward wise, discipline wise
and procedure wise statistics for HAI
 Monitoring and supervision of infection among
hospital staff
 Training of nsg aids and paramedical personnel
on correct hygiene practices and aseptic
techniques

52. STAFF HEALTH ACTIVITIES
 Elements of infection control practices of
staff
 Medical evaluation
 Personnel health and safety education
 Immunization programmes
 Management of job related illnesses and
exposures

53. STAFF HEALTH ACTIVITIES
 HIV;there is a separate regimen for
post exposure paophylaxis
 Health counselling to be undertaken
to provide individually targeted
information.
 Records are maintained of all
accidental HAI acquired by the staff

54. STAFF HEALTH ACTIVITIES
 ACCIDENTAL EXPOSURES TO BE
REPORTED TO OFFICER I/C EMPLOYEES
HEALTH SERVICES, CASUALTY CONSULTANT,
AND/OR CASUALTY MEDICAL OFFICER

55. NURSING PROCESS -EVALUATION
 Monitor all invasive &surgical sites for swelling,
erythema or purulent discharge
 Review laboratory tests
 Document the clients response to therapies for
infection control.
 Report the efficacy of any intervention in reducing
infection

56. CONCLUSION
Main strategies for control of infection
include
 Removal of source
 Blocking transmission
 Enhancing the resistance of patients
Strict adherence to simple infection
control procedures go long way in
controlling nosocomial infections

57. REFERENCES
 Potter AP, Perry AG, Fundamentals of nursing,6
edition, Mosby, St:Louis,773-819
 Seema Sood, Microbiology for nurses,2 edition 46-
70
 AIIMS infection control manual
 http://www.wikipedia.org
 http:// www.cdc.gov