Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Infection Prevention Control

Download as pptx, pdf, or txt
Download as pptx, pdf, or txt
You are on page 1of 126

INFECTION PREVENTION &

CONTROL

١
Infection Control Overview

•Infection control (IC) is a quality standard


that is essential for the well being and safety of
patients, staff and visitors.
•It affects most departments of the hospital and
involves issues of quality, risk management, clinical
governance and health and safety.
•It is a discipline that applies epidemiologic and
scientific principles and statistical analysis to the
prevention or reduction in rates of Healthcare
Acquired Infections (HAIs). ٢
Infection control
• Goal of infection control is to prevent the
spread of infectious diseases
• Infectious disease is any disease caused
by the growth of pathogens in the body
• Pathogens are disease-causing
microorganisms (germs)
• Infectious diseases can cause unnecessary
pain, suffering and death
Maintain a safe environment
• Follow specific polices and procedures
designed to reduce risk of transferring
infectious diseases
• Prevent pathogens from being
transmitted:
– Patient to client, staff to client, client to
staff, staff to staff
– Improperly cleaned instruments and
equipment
Infection
Infection can be:
• Generalized or systemic (throughout the body)
•Localized (affecting one part of the body)
Signs and symptoms of infection:
• Systemic: headaches, fever, fatigue, vomiting,
diarrhea, increased pulse and respiration
• Localized: redness, swelling, painful, warm to
the touch
Microbiology
• Microbiology: the study of microorganisms
• Microorganisms are one celled animals or
plants invisible to the eye, can only be seen
with a microscope
• 1600s: Anton van Leeuwenhoek invented the
microscope
• 1800s: Louis Pasteur developed germ theory.
Stated that microorganisms, called bacteria,
cause specific diseases in humans and animals
History of infection control
• 1843 Oliver Wendell Holmes: contagious
disease or communicable disease can be spread
directly or indirectly from one person to
another through contaminated hands
• Ignaz Philipp Semmelweis observed high
mortality rate from MDs going from morgue to
patients’ bedside without washing hands
• 1864 Joseph Lister: developed surgical aseptic
technique to prevent wound contamination
Facts about microorganisms
• Not all are harmful
• Normal flora (microorganisms) are found on
skin, in the intestines and vagina
• Some are necessary to maintain normal
bodily functions
– Escherichia coli (E. coli):
• Aids the digestive process in the
colon
• Can cause infection in the blood or
urine; can cause spontaneous abortion
Facts about microorganisms
• Some microorganisms are part of the normal
flora but have no beneficial role
• Normally they do no harm unless the person
is susceptible to infection due to
supression of the body’s immune response
• The immune response: the body fights
infection by producing antibodies (protective
proteins that combat pathogens)
Facts about microorganisms
• Antibiotics are drugs which inhibit the
growth of or destroy microorganisms
• They also suppress the body’s normal flora
and create an imbalance that can decrease
the body’s ability to resist other infections
• Age, overall health, stress, nutrition and
drugs can also weaken the body
• Opportunistic infections take advantage of
the body’s weakened state to grow
Growth of microorganisms
• Aerobic – 2
• Anerobic – do not require oxygen to live
• Many microorganisms thrive in warm, moist,
dark environments like the human body which
becomes a host to the microorganism
• Symbiosis – the host benefits
• Neutralism – no damage is done to the host
• Parasitic – the host is damaged, the pathogen
causing damage is called the parasite
Types of microbes
• Microbe – a pathogenic microorganism
• Classifications of plant and animal microbes:
– Bacteria
– Viruses
– Fungi
– Rickettsia
– Protozoa
Hospital Acquired Infections
or
Healthcare Associated Infections
( HAIs )
An infection meeting the following criteria:
a) Not present or incubating on admission.

b)An infection incubating at the time of admission that is


related to previous hospitalization at the same facility or
identified in an admission following performance of a
procedure during a previous ٣

admission.
HEALTHCARE ASSOCIATED
INFECTIONS
Remember

►Infection in a hospitalized
patient
►Not present or incubating on
admission
►Hospital acquired infection
٤
Why now the urgent need for
Infection Control Program
► HAIs are becoming more prevalent, especially
with the advent of more invasive procedures &
increase in use of immunosuppresive therapy.
► HAIs are preventable( can kill )
► HAIs are associated with prolonged morbidity.
► HAIs are associated with increased length
of stay & increased cost of care.

٥
TYPES OF HAIs

Devices Associated Infections


Catheter Associated Urinary tract infections
(CAUTI)
 Central Line Associated Blood Stream Infections
(CLABSI)
 Ventilator Associated Pneumonia (VAP)

Procedure Associated
Infections ٦

 Surgical Site infections (SSI)


Main Types of Infections

17
UT
%
44 I
% SSI
18 BSI
% Pneum
10 11
% o
%
Others

٧
Source Healthcare Associated
Infections

Patient’s Medical
Own Flora
HAIs
Equipment

Staff Member

٨
The GOAL
The goal of Infection Control Program is
to provide a safe healthy environment
through identification and reduction the
risks of acquiring and transmission of
HAIs among patients, medical staff,
administration staff, volunteers, students
and visitors.

١٠
Importance
of Infection Control Program

1.We have an obligation to reduce the morbidity


and mortality of our patients.
2.Accreditation requirements demand a strong
infection control program.
3.The infection control efforts are part of the ''
risk management'' efforts of any hospital.
4.Hospital outbreaks now occur frequently in the
average community hospital.
5. Financial deficit control has become a crucial
issue for many hospital. ١١
Prevention of healthcare acquired infections is the
responsibility of all individuals and services providing
healthcare.

Everyone must work cooperatively to reduce the risk


of infection for patients ,staff and visitors.

Infection control programs are effective, provided they


are comprehensive and including surveillance and
prevention activities, as well as staff training.

There must also be effective support at the national


and regional levels. ١٢
Infection Control is
Everyone’s Responsibility!

١٣
HOSPITAL ENVIRONMENT

HIV

CHIKENPOX

TB
١٤
Chain of infection
• Model of infectious disease transmission
• Six elements must be present for an
infection to develop
1. The infectious agent
2. Reservoir host
3. Portal of exit from
the host
4. Route of transmission
5. Port of entry
6. Susceptible host
Chain of infection
Infectious
agent

Susceptible Reservoir
host Host

Portal of
entry Portal of
exit
Route of
transmission
Chain of infection
1. Infectious agent: a pathogen must be
present
2. Reservoir host: the pathogen must
have a place to live and grow – the human
body, contaminated water or food,
animals, insects, birds, dead or decaying
organic material.
• Humans who can transmit infection but how
no signs of the disease are called carriers.
Person may be unaware they are a carrier.
Chain of infection
3. Portal of exit: the pathogen must be able
to escape from the reservoir host where
it has been growing.
• Examples of portals of exit are blood,
urine, feces, breaks in the skin, wound
drainage, and body secretions like saliva,
mucus and reproductive fluids
Chain of infection
4. Route of transmission: When the pathogen
leaves the reservoir host through the
portal of exit, it must have a way of being
transmitted to a new host.
• Examples of routes of transmission are air,
food, insects, and direct contact with an
infected person
Chain of infection
5. Portal of entry: The pathogen must
have a way of entering the new host.
Common ports of entry are the mouth,
nostrils, and breaks in the skin
6. Susceptible host: An individual who has
a large number of pathogens invading the
body or does not have adequate resistance
to the invading pathogen will get the
infectious disease
Breaking the chain of infection
• Breaking at least one link stops the spread of
infectious disease
1. The infectious agent
– early recognition of signs of infection
– Rapid, accurate identification of organisms
2. Reservoir host
• Medical asepsis
• Standard precautions
• Good employee health
• Environmental sanitation
• Disinfectant/sterilization
Breaking the chain of infection
3. Portal of exit from the host
– Medical asepsis
– Personal protective equipment
– handwashing
– Control of excretions and secretions
– Trash and waste disposal
– Standard precautions
Breaking the chain of infection
4. Route of transmission
– Standard precautions
– Handwashing
– Sterilization
– Medical asepsis
– Air flow control
– Food handling
– Transmission-based precautions
Breaking the chain of infection
5. Portal of entry
– Wound care
– Catheter care
– Medical asepsis
– Standard precautions
6. Susceptible Host
– Treating underlying diseases
– Recognizing high-risk patients
factors that render individuals
more susceptible to infection:
 Extremes of age
 Presence of an underlying disease, such as
diabetes mellitus, or human immunodeficiency
virus (HIV) infection
 Use of certain medications, such as
antimicrobials, corticosteroids, chemotherapeutic
agents, or other immunosuppressive drugs
 Irradiation
 Breaks in the first line of defense mechanisms
caused by invasive procedures such as surgical
operations, anaesthesia, indwelling catheters, and
other procedures
Routes of Transmission
The five (5) main modes of transmission—contact,
droplet, air, common vehicle, and
1. Contact Transmission: the most important and
most frequent mode of HAI transmission.
It is divided into two subgroups:
Direct-contact transmission involves a direct body-
surface-to-body-surface contact and physical
transfer of microorganisms between a susceptible
host and an infected or colonized person. It can
occur when a HCW turns a patient, gives a patient
a bath, or performs other activities that involve
direct personal contact.
Direct-contact transmission can also occur
between two patients, with one serving as the
source of the infectious microorganisms and
the other as a susceptible host. Indirect-
contact transmission involves contact
between a susceptible host and a
contaminated intermediate object, usually
inanimate, such as contaminated instruments,
needles, dressings, contaminated and
unwashed hands, or gloves that are not
changed between patients.
Droplet Transmission
Droplet transmissions occur when droplets are
propelled a short distance through the air and
deposited on the hosts conjunctivae, nasal
mucosa, or mouth.
The droplets are generated from the source
person primarily through coughing, sneezing,
and talking and during certain procedures
such as suctioning and bronchoscopy.
For transmission to occur, the source and the
susceptible host must be within one meter
(approximately three feet) of one another.
Airborne Transmission
occurs by dissemination of either airborne droplet
nuclei (small-particle residue) of evaporated
droplets that contain microorganisms and remain
suspended in the air for long periods of time, or
dust particles that contain the infectious agent.
Airborne microorganisms can be dispersed widely
by air currents and can be inhaled by a
susceptible host within the same room or some
distance from the source patient, depending on
environmental factors.
Microorganisms transmitted by airborne
transmission include Mycobacterium
tuberculosis, rubella, and varicella viruses.
Control of airborne transmission is the most
difficult, because it requires control of airflow
through special ventilation systems
Common-Vehicle Transmission
Common-vehicle transmission refers to the
transmission of infection to multiple hosts by
contaminated items (vehicles).
This mode can result in explosive outbreaks.
Vehicles for transmission include the following:
 Foods, which can transmit salmonellosis
 Water, which can transmit shigellosis,
 Medications and intravenous solutions
 Blood, which can transmit hepatitis B (HBV) and
hepatitis C (HCV) and HIV, for example
 Equipment and devices
Vector-Borne Transmission

Vector-borne transmission refers to the


transmission of microorganisms through
vectors such as mosquitoes, flies, fleas, rats,
and other vermin. This mode can be prevented
by appropriate health care facility
construction and maintenance, closed or
screened windows, and proper housekeeping.
Standard Precautions Expanded Staff Protection
Precaution
Primary strategy for
preventing transmission Transmission Based
of microorganisms to Precautions for patient Employee
patients, They are with suspected or
applied to all patients confirmed Health
Hand hygiene &
Appropriate use of
communicable Program
PPE disease
١٧
Standard precautions should be implemented
when contact with any of the following is
anticipated: Blood All body fluids, secretions,
and excretions (except sweat), regardless of
whether or not they contain visible blood
Nonintact skin Mucous membranes
Practical Issues and Considerations
for Standard Precautions
► Hand Hygiene.
► Personnel Protective Equipment (PPE).
► Safe Use of Sharps.
► Monitoring Staff Health.
► Cleaning and Disinfecting Patient Care
Equipment.
► Disposing of Waste Safely.
► Cleaning the Environment.
► Removing Spills of Blood and
Body
Fluids ١٨
١٩
So Why All the Fuss About
Hand Hygiene?

Most common mode of transmission


of pathogens is via hands!

 Infections acquired in
healthcare
 Spread of antimicrobial ٢٠

resistance
All health care works
involve the hands

٢١
Hands are contaminated

Hands
spread

germs

٢٢
The health care environment
is contaminated

٢٣
Colonized or Infected:
What is the Difference?
► People who carry bacteria without evidence
of infection (fever, increased white blood
cell count) are colonized
► Ifan infection develops, it is usually from
bacteria that colonize patients
► Bacteriathat colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
~ Bacteria can be transmitted even if the
patient is not infected ~ ٢٤
The Iceberg Effect

Infected

Colonized

٢٥
The inanimate environment is
a reservoir of pathogens
X represents a positive Enterococcus culture

The pathogens are ubiquitous

~ Contaminated surfaces increase cross-transmission ~


Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) ٢٦
Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.
The inanimate environment is
a reservoir of pathogens
Recovery of MRSA , VRE & ACINITOBACTER.

Devine et al. Journal of Hospital Infection. 2007;43;72-75


Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
٢٧
Trick et al. Arch Phy Med Rehabil Vol 83, July 2006
Walther et al. Biol Review, 2007:849-869
Patients are vulnerable to
infection

٢٨
Hand Hygiene is the simplest, most
effective measure for preventing
Hospital-Acquired Infections.

٢٩
30%-40% of all HAIs are
Attributed to Cross Transmission:
Importance of Hand Hygiene?
٣٠
Types of Hand Hygiene
► Normal hand washing
► Antiseptic hand washing
►Alcohol-based hand rub
Can be used instead of hand
washing , if hands are not visibly
soiled with blood or any other
patient body fluids
► Surgical hand wash
٣١
Routine Hand Washing

٣٢
Antiseptic Hand Washing

٣٣
Samples taken before and after
antiseptic handwashing

٣٤
Waterless Hand Rub
“alcohol-based hand rub

٣٥
Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good Better Best

Plain soap Antimicrobial Alcohol-based


soap hand rub

Guideline for Hand Hygiene in Health-Care Settings MMWR,2009. vol. 51, no. RR-16.
٣٦
Hand Hygiene Options
Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.

Apply to palm; rub


hands until dry

~ Use soap and water for visibly soiled hands ~


٣٧

~ Do not wash off alcohol handrub ~


Surgical Hand Wash

٣٨
٤١
HAHS © 1999
When must I hand wash?
upon arriving at and before leaving the health
care facility,
 Before and after performing any procedure
between patients or on the same patient
 Before and after examining (coming in direct
contact with) a client or patient
 Before putting on gloves
 After removing gloves
 After any situation in which hands might
become contaminated, such as: Handling
contaminated objects, including used instruments
Diapering or toileting children Using the toilet,
wiping or blowing one‟s nose, or performing
other personal functions
Touching mucous membranes, blood, body
fluids, secretions, or excretions Coming in
contact with a source of microorganisms
 Before preparing medication
 Before preparing, handling, serving, or
eating food
 Before feeding a patient
Personal Protective Equipment
(PPE)

٤٤
Personal Protective Equipment
PPE provides a physical barrier between
microorganisms and the wearer, thereby
preventing microorganisms from contaminating
hands, eyes, clothing, hair, and shoes. PPE also
prevents microorganisms from being transmitted
to other patients and staff.
PPE reduces, but does not completely eliminate,
the risk of acquiring an infection.
PPE must be used effectively, correctly, and
whenever there is a risk of contact with blood and
body fluids. Making PPE available and training
HCWs to use it properly are essential. Note: Use
of PPE does not replace the need to follow basic
IPC measures such as hand hygiene.
Principles for Using PPE
Health care workers should follow these guidelines for
using PPE:
 Assess the risk of exposure to blood, body fluids,
excretions, or secretions and choose items of PPE
accordingly.
 Use the right PPE for the right purpose.
 Avoid any contact between contaminated (used) PPE
and surfaces, clothing, or people outside the patient care
area.
 Discard used PPE in designated disposal bags.
 Do not share PPE.
 Change PPE completely and thoroughly your wash
hands each time you leave a patient to attend to another
patient or another duty.
Types of PPE used in Healthcare

Gloves

Masks Gowns

Head Shoes Face Eye


Covers Covers shields protection

٤٣
٤٥
Who should wear PPE?

 Health care workers who provide direct care


to patients and who work in situations in which
they might have contact with blood, body fluids,
excretions, or secretions  Support staff,
including waste handlers, cleaners, and laundry
staff, in situations in which they might have
contact with blood, body fluids, excretions, or
secretions  Laboratory staff who handle
patient specimens  Family members who
provide care to patients and could come in
contact with blood, body fluids, excretions, or
secretions
Procedures
►Putting on Gowns, Gloves, and
Mask
Gown: Put on gown so that its edges overlap in
back to cover clothing. Fasten closures.

Gloves: If worn with gown, pull up over cuffs of


gown to protect the wrists.

Mask: Apply mask over mouth and nose by


securing mask with ties so that it fits tightly over the
face.
٤٦
► Removing Gloves, Gowns, and Mask
Gloves: Remove gloves before exiting the patient
room by pulling them inside-out, so that the
contaminated side is not exposed. Discard in trash
receptacle lined with red bag.

Gown: Unfasten closures, pull off sleeves and


turn gown to the inside so that the contaminated
side is not exposed. Place in red bag prior to
washing hands and exiting the room .

Mask: Remove mask and place in trash receptacle


lined with a red bag.
٤٧
٤٨
ISOLATION PRECAUTIONS
Types of Isolation Precautions

1- Standard Precautions
Standard precaution (SP) is the primary
strategy for preventing transmission of
microorganisms to patients, They are
applied to all patients .
٤٩
Practical Issues and Considerations

► Hand Hygiene.
► Personnel Protective Equipment (PPE).
► Safe Use of Sharps.
► Monitoring Staff Health.
► Cleaning and Disinfecting Patient Care
Equipment.
► Disposing of Waste Safely.
► Cleaning the Environment.
► Removing Spills of and
Fluids
Blood Body ٥٠
Expanded Precautions

Expanded precautions are designed for patients


with documented or suspected infection with
communicable or epidemiologically important
pathogens for which additional precautions
beyond SP are needed to interrupt transmission.

The aim of isolating a patient is to prevent


the spread of communicable
٥١
Types of
Expanded Precautions

Airborne Precautions Droplet Precautions Contact Precautions

Pulmonary TB
Meseals
Meningitis MDR
Chickenpox Influenza A
H1N1
Mumps

٥٢
٥٤
٥
٥٦
٥٧
CONTACT PRECAUTIONS
► The patient is placed into a private room
whenever possible. Cohorting patients
with the same organism may be done if
needed.
► A GOWN AND GLOVES MUST BE WORN BY
ALL ENTERING THE ROOM! THIS
INCLUDES VISITORS. Dietary staff that
are delivering trays are required to wear
gloves, not gowns.

► When providing care, change gloves after


contact with any infective material such
as wound drainage.

► Remove the gown and gloves and perform


hand hygiene before leaving the room
(take care not to touch any potentially
infectious items or surfaces on the way
out).

► Dedicate the use of non-critical patient-


care equipment to a single patient. If use
of common equipment is unavoidable,
adequately clean and disinfect it before
use with other patients.
٥٨
Isolation Precautions

٥٩
Employee Health Program
PRE-EMPLOYMENT
SCREENING

IMMUNIZA
TION

WORK RESTRICTION

MANGEMENT OF
OCCUPATIONAL
EXPOSURE

T
٦١
OBJECTIVES
►What the risk of exposure?
►How we can prevent the
exposure?
►If the exposure is already
done, what is the exposure
management plan?
٦٢
Bloodborne Pathogen Exposures
TYPES OF EXPOSURE

Percutaneous Mucous
Exposure . Cutaneous
Membrane

High Risk Moderate Risk Low Risk


Exposure Exposure Exposure ٦٣
Exposure Control PLAN
The single most effective
measure to control the
transmission of Bloodborne
Pathogens is:

Standard
Precautions
Treat all human blood and other potentially
infectious materials like they are
infectiousfor Hepatitis B&C and HIV ٦٤
Safer Sharps

٦٥
Safe Handling of Sharps
Sharps (needles, scalpels, etc.)
 Do not pick up a handful of sharp instruments
simultaneously.  Position the sharp end of
instruments away from self and others. 
Exercise caution when rotating instruments are in
use.  Wear heavy-duty or strong utility gloves
while decontaminating, cleaning, and disinfecting
instruments.  Dispose of used sharps
immediately in designated puncture- and leak-
proof containers labelled with a biohazard symbol.
 Prevent access to used needles and syringes,
and other sharps while awaiting transport for final
disposal.  If injured by sharps, contact the
supervisor immediately.
SHARP INJURIES PREVENTION
► Avoid rushing when handling needles and sharps.

► Dispose all needles and other sharps promptly. Place used


disposable items in puncture resistant biohazard containers for
disposal.

DO NOT re-cap needles.


► In the event recapping is unavoidable, the one-handed scoop
technique or a needle recapping device shall be used.

► Sharps containers shall be labeled as “sharps waste” and


biohazardous with international biohazardous symbol. ٦٦
٦٧
► Sharp containers shall be filled up to
three quarters and taped closed or
tightly lidded.
► Sharps containers are placed in yellow
bags by housekeeping personnel for
storage and then processing.
► Sharps waste is disposed of in sharps
containers as close to site of use as
possible.
► In-patient rooms shall have wall
mounted “Sharps Container” system,
which is kept near the patient’s bed and
٦٨

is securely locked.
To safely recap needles use “the
one-hand” technique
Step 1
► Place the cap on a flat surface, then remove
your hand from the cap.

Step 2
► With one hand, hold the syringe and use the
needle to “scoop up” the cap.

Step 3
► When the cap covers the needle
completely, use the other hand to secure the
cap on the needle hub. Be careful to handle
the cap at the bottom only (near the hub).
٦٩
VACCINATION

٧٠
IMMEDIATE CARE
OF INJURY

Risk Management INCIDENT


Reduction PLAN DOCUMENTATIO

MANGEMENTOF
EXPOSED RISK ASSESMENT
HCWs ٧١
► The employee concerned should immediately
wash away the contaminating fluid. If blood
or body fluids get in the mouth, spit out
and then rinse mouth with water several
times.
► If there is a puncture wound, wash with soap
and water and disinfected by Alcohol or
Betadine.
► If the eyes are contaminated (may be more
dangerous than an NSI) rinse well with
tap water or saline.
٧٢
► Should be in detail with
completion of the appropriate form.
► Report should include details of the incident
,date & time of incident , people involved
,any witnesses to the incident.
► All occupational exposures must be fully
documented to meet relevant legal
requirement.

٧٣
Exposed
Source Injury
HCWs

Percutaneous exposure
CHECK ( High Risk
CHECK Exposure )
Mucous membrane
HBsAg ( Moderate Risk
Exposure )
Anti-HCV
Cutaneous-
Anti- to non-intact
exposure skin
٧٤
(Low Risk Exposure)
HIV
٧٥
►Source is –ve for HBV,HCV,HIV

Anti-HBs Ab titre

> 10 IU /ML < 10 IU /ML

IMMUNE NON IMMUNE


٧٦

POST-EXPORUE PROPHYLAXIS
Source is +ve or likely to be +ve
forHBV
Anti-HBs Ab

+Ve - Ve
IMMUNE NON IMMUNE
POST EXPOSURE PROPHYLAXIS ٧٧
Post Exposure

Prophylaxis

Immunogluline Vaccination Follow


up
٧٨
Clinical or serological
Repeat HBs Ag at
Evidence of acute
hepatitis 1 & 6 months

No plasma,bl,body tissue
donation.
Seek for clinical advise Protect sexual partner.
Highest risk
percuteneous ٧٩

exporure,modify WP.
Source is +ve or
likely to be +ve for HCV

Screening Confirmatory
HCV-IgG HCV-RNA by
real-time PCR

-Ve +Ve +ve -ve


-No infection -Current Confirms
-Early infection
active HCV
-False -ve -past infection
infection
-False +ve replication
Clinical or serological HCV-RNA by PCR repeated
After 2 months
evidence of acute
HCV-IgG repeated after
hepatitis 6 to 9 months

No plasma,bl,body tissue
Seek for clinical advise donation
Protect the sexual partner .
Hihgest risk percutaneous ٨١

exposure,modify WP.
Source is +ve or likely to be
+ve for HIV
► Postexporue Prophylactic treatment is
indicated.
► It must be commenced as soon as
possible
.preferably within hours rather than
days .
► It should be administrated for 4
weeks.
► If PEP is offered & taken &the source is
later determined to be HIV -ve ,PEP should ٨٢

be discontinued.
Repeated HIV screening
at 1 & 3 & 6 months

Until screening for


seroconversion
is completed
٨٣
PREVENTION IS
PRIMARY !

٨٤
Waste segregation
Waste generation refers to the quantity of
materials or products that enter a waste stream
before compositing, incinerating, or recycling.
Waste is generated during patient management
and care and in other areas of the health care
setting.
Segregate contaminated and noncontaminated
wastes at the point of generation. Separating
wastes minimizes costs by reducing the volume
of contaminated waste that must be treated
with the expensive procedures that are required
for managing and disposing of contaminated
waste properly.
Use appropriate colour-coded separate
containers for noninfectious, infectious, and
highly infectious waste.  Fill the waste
containers not more than three-quarters full.
 Use colour-coded bins and bin liners or
label the waste containers (see Figure 14). 
Never sort through contaminated wastes. Do
not try to separate noncontaminated waste
from contaminated waste, or combustible
from noncombustible waste, after they have
been combined.
Decontamination of Used
Instruments and Equipment
The recommended decontamination agent is a
0.5 percent chlorine solution.
Make a fresh solution every morning, or after 8
hours, or more often if the solution becomes
visibly dirty. A 0.5 percent chlorine solution can
be made from readily available liquid chlorine or
chlorine tablets (NaDCC).
The formula for making a dilute solution from
concentrated solutions is as follows: Total Parts
(TP) water = (percentage chlorine in
manufacturers concentration ÷ % desired
chlorine concentration) - 1 Mix 1 part
concentrated bleach solution with the total parts
water required. Example: To make a 0.5 percent
chlorine solution from 5 percent concentrated
chlorine solution: TP water: (5.0% ÷ 0.5%) - 1=
10 - 1 = 9 Add 1 part concentrated solution to 9
parts water. Cover containers containing 0.5
percent chlorine solution and protect them from
light
Decontaminate large surfaces that might
have come in contact with blood and body
fluid, such as pelvic-examination, operating,
or delivery tables. Wipe them with a cloth
soaked in the 0.5 percent chlorine solution.
Decontaminating Used
Instruments and Other Items
Keep surgical or examination gloves on after
completing the procedure. Decontaminate the
instruments while wearing the gloves: 
Immediately after use, place all instruments in
an approved disinfectant, such as 0.5 percent
chlorine solution, for 10 minutes to inactivate
most organisms, including HBV and HIV.  Use
plastic, noncorrosive containers for
decontamination to prevent sharp instruments
from getting dull (due to contact with metal
containers) and to prevent instruments from
getting rusted (due to electrolysis between two
different metals when placed in water).
 Remove instruments from 0.5 percent
chlorine solution after 10 minutes and
immediately rinse them with cool water to
remove residual chlorine before thoroughly
cleaning them.  Remove gloves and dispose
of them appropriately. Note: To prevent
rusting, do not soak metal instruments in
water for more than one hour, even if they are
electroplated. Once instruments and other
items have been decontaminated, they can
safely be cleaned and sterilized or high-level
disinfected.
Cleaning
After decontamination and prior to disinfecting
or sterilizing, all instruments and equipment
MUST be cleaned to remove organic materials or
chemical residue. If instruments and equipment
are not cleaned properly, organic matter could
prevent the disinfectant or sterilizing agent
from making contact with the instrument or
piece of equipment and might also bind and
inactivate the chemical activity of the
disinfectant. Ensure that all surfaces of
instruments and equipment, including channels
and bores, are cleaned.

You might also like