• Hospital associated infections account for
considerable economic loss through
prolonged hospital stay and adverse patient
• 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
Risk of being the target of litigations
Bad reputation for the hospital
7. HEALTH CARE ASSOCIATED
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.
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
Gram – ve bacilli from solutions
Viruses from blood and blood products
11. NURSING PROCESS IN INFECTION
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.
13. GOALS AND OUTCOMES
Preventing exposure to micro organisms
Controlling or reducing the extent of
Maintaining resistance to infection
Educating the client and family about
infection control techniques
15. INFECTION REDUCTION
Activities to prevent infection or to break chain of
Clean technique to reduce and prevent spread of
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
17. CONTROL OF INFECTIOUS AGENT
Proper cleansing, disinfection,
sterilization of contaminated objects
reduces and often eliminate micro
18. CONTROL OF INFECTIOUS AGENT
It involves use of water and mechanical
action with detergents or enzymatic
19. CONTROL OF INFECTIOUS AGENT
A process that eliminates many or all micro-
organisms with the exception of bacterial spores.
It is generally accomplished by the use of
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,
Sterilization by moist heat: autoclaving (
heating 121 c at 18lb pressure for 20-30
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
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
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
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,
27. HAND WASHING - TYPES
Surgical hand washing
Hygienic hand washing
Social hand washing
29. SAFE HANDLING OF SHARPS
Never pass sharps from one person to
Always dispose your own sharps
Use forceps instead of fingers for
DO NOT RECAP needles
Dispose sharps in puncture
30. CONTROL OF PORTALS OF ENTRY
Maintaining integrity of skin and mucus
Skin should be lubricated to prevent
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
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
32. PROTECTION OF SUSCEPTIBLE HOST
Maintain personal hygiene
Maintenance of adequate fluid intake
Promote comfort and sleep
33. STANDARD PRECAUTIONS
It apply to blood, all body fluids, excretions
except sweat, non-intact skin, mucus
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
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
Gowns are worn if soiling of
clothes is likely from blood or
Perform hand hygiene after removing
gloves or gown.
37. STANDARD PRECAUTIONS
Client care items are properly cleaned and
reprocessed and single use items are
Contaminated linen is placed in leak proof
All sharps and needles are discarded in
puncture proof bags.
Processing all laboratory specimens as
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
Also known as transmission based
. Additional precautions include:
•Droplet precautions; and
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
Implement standard precautions.
Place patient in a single room (or in a room
with another patient infected by the same
42. CONTACT PRECAUTIONS
Contact Precautions will be used when there is
known or suspected risk of transmission of
pathogenic microorganisms by direct or indirect
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
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
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
Only sterile objects should be placed in a sterile field.
A sterile field out of vision or an object held below persons’ waist is
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
Beds and furnitures should be cleaned with
Linen should be removed from the bed without
Mattresses and pillow covered with durable plastic
covers should be washed thoroughly with
Wastebaskets should be thoroughly washed with
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
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
• 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
• 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
Compilation of ward wise, discipline wise
and procedure wise statistics for HAI
Monitoring and supervision of infection among
Training of nsg aids and paramedical personnel
on correct hygiene practices and aseptic
52. STAFF HEALTH ACTIVITIES
Elements of infection control practices of
Personnel health and safety education
Management of job related illnesses and
53. STAFF HEALTH ACTIVITIES
HIV;there is a separate regimen for
post exposure paophylaxis
Health counselling to be undertaken
to provide individually targeted
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
Report the efficacy of any intervention in reducing
Main strategies for control of infection
Removal of source
Enhancing the resistance of patients
Strict adherence to simple infection
control procedures go long way in
controlling nosocomial infections
Potter AP, Perry AG, Fundamentals of nursing,6
edition, Mosby, St:Louis,773-819
Seema Sood, Microbiology for nurses,2 edition 46-
AIIMS infection control manual