INFECTION CONTROL

PRACTICES – STANDARD
SAFETY MEASURES

PRESENTER MODERATOR
MS. BHARATHI PRIYADHARSHINI.S.U DR. SMITA DAS
M.SC.NURSING (PAEDS) I YEAR ASSOCIATE PROFESSOR
COLLEGE OF NURSING COLLEGE OF NURSING
AIIMS NEWDELHI AIIMS NEWDELHI
 INTRODUCTION
Infection is one of the leading causes of preventable deaths in
hospitals every year. The center for disease control and
prevention estimates that there are approximately 2 million
preventable infections in hospitals every year, leading to 90,000
unnecessary deaths. The importance of keeping hospitals clean
and infection – free is greater now than ever, as information
regarding patient safety and the effectiveness of prevention
efforts continues to grow.
 INFECTION
• An infection is the invasion of a susceptible host (e.G., Human being) by
pathogens or microorganisms, resulting in disease.

INFECTIOUS DISEASES

Infectious disease refers to the pathological events that result from the
invasion and multiplication of microorganisms in the host. Toxins and
enzymes produced by microorganisms cause tissue injury
•COMMUNICABLE DISEASE

An illness due to a specific infectious agent or its toxic products

that arises through transmission of that agent or its products
from an infected person, animal or reservoir to a susceptible
host, either directly or indirectly through an intermediate plant,
animal host or the inanimate environment

•CONTAGIOUS DISEASE
A disease that is transmitted through contact. e.g., Scabies,
trachoma, STD and leprosy.
TYPES OF INFECTION
PRIMARY
INFECTION
SECONDARY
INFECTION

ACUTE INFECTION

CHRONIC
INFECTION

LOCAL INFECTION

SYSTEMIC
INFECTION
NOSOCOMIAL
INFECTION
IATROGGENIC
INFECTION
CHAIN OF INFECTION
 INFECTIOUS AGENTS
• MICROORGANISMS on the skin are either
resident or transient flora.
• Resident flora ( microorganisms) are permanent
residents of the skin and within the body, where
they survive and multiply without causing illness.
• Transient flora ( microorganisms) attach to the
skin when a person has contact with another
person or object during normal activities. E.g.,
When you touch a contaminated gauze dressing or
cleanse a patient following diarrheal episode,
transient bacteria adhere to your skin.
 A RESERVOIR / SOURCE

HUMAN ANIMAL ENVIRONMENTAL

RESERVOIRS RESERVOIRS RESERVOIRS
 PORTAL OF EXIT

Respiratory Reproductiv
blood Urinary tract
tract e tract

Gastrointesti
nal tract
MODES OF TRANSMISSION
 PORTAL
OF ENTRY
•Incubation period
• Interval between entrance of pathogen into body and appearance of first symptoms
(e.G., Chickenpox, 10 to 21 days after exposure; common cold, 1 to 2 days; influenza, 1 to 5
days; mumps, 12 to 26 days).
•Prodromal stage
• Interval from onset of nonspecific signs and symptoms (malaise, low-grade fever, fatigue)
to more specific symptoms. (During this time microorganisms grow and multiply, and patient
may be capable of spreading disease to others.) For example, herpes simplex begins with
itching and tingling at the site before the lesion appears.
•Illness stage
• Interval when patient manifests signs and symptoms specific to type of infection. For
example, strep throat is manifested by sore throat, pain, and swelling; mumps is manifested
by high fever, parotid and salivary gland swelling.
•Convalescence stage
• Interval when acute symptoms of infection disappear. (Length of recovery depends on
severity of infection and patient’s host resistance; recovery may take several days to months.)
 DEFENCE AGAINST
INFECTION

BODY DEFENCE MECHANISM

Anatomical and physiological barriers
Inflammatory responses
Vascular and cellular responses
Exudate production
Tissue repair
SPECIFIC DEFENCES
Antibody mediated defences
Cell mediated defences
Combination of both
Passive immunity
• Natural passive immunity
• Artificial passive immunity
Immunglobulins
FACTORS INFLUENCING
INFECTION
PREVENTION AND
CONTROL

• Age
• Nutritional status
• Stress
• Disease process
• Medication
• Hereditary
 INFECTION PREVENTION

• Infection prevention refers to practices and procedures aimed at preventing the

spread of infections, particularly in healthcare settings. The goal is to protect
patients, healthcare workers, and the community from infectious diseases,
including those caused by bacteria, viruses, fungi, and parasites. Infection
prevention is essential for ensuring patient safety and reducing the incidence of
healthcare-associated infections (HAIs).

•According to the centers for disease control and prevention, approximately 2

million patients each year develop health care associated infections (HAIs).
 ASEPSIS

Asepsis is the absence of pathogenic (disease-

producing) microorganisms. Aseptic technique refers to
practices/procedures that help reduce the risk for infection.
The two types of aseptic technique are medical and surgical
asepsis.
• MEDICAL ASEPSIS, or clean technique, includes procedures
for reducing the number of organisms present and preventing
the transfer of organisms. Hand hygiene, barrier techniques,
and routine environmental cleaning are examples of medical
asepsis.
• SURGICAL ASEPSIS, also known as sterile technique, refers to
practices and procedures used to prevent contamination by
pathogens during surgical procedures.
BREAKING THE CHAIN
OF INFECTION
 CDC GUIDELINES FOR
MEDICAL ASEPSIS
• HAND HYGIENE
1. PLAIN SOAP
2. ANTISEPTIC SOAP
3. ALCOHOL RUB
• GLOVING
1. SURGICAL GLOVING
2. SINGLE-USE GLOVING
3. UTILITY OR HEAVY DUTY GLOVING
4. DOUBLE GLOVING
• MASK / PROTECTIVE EYEWEAR
• DOUBLE BAGGING
 SPECIMEN COLLECTION
• WOUND SPECIMEN
• BLOOD SPECIMEN
• URINE SPECIMEN
• STOOL SPECIMEN
 RESEARCH INPUT
• World health organization world hand hygiene day, 5 may 2024. SAVE LIVES: clean your hands
campaign: promoting knowledge and capacity building on infection prevention and control, including
hand hygiene, among health and care workers Claire kilpatrick et al.,

Many countries are demonstrating strong engagement and advancements in scaling-up infection
prevention and control (ipc) strategies and actions, but overall, the prog­ress is slow, and gains are at risk. In
2021, only four out of 106 countries (3.8%) had all minimum requirements for IPC in place at the national
level.1 in multiple WHO sur­veys, training and education was the weakest component of IPC programmes
around the world both at the national and facility level.1 this is reflected in lack of standardized IPC
curricula for pre-graduate courses (e.G. Medicine, nursing, midwifery), in-service training, and for post-
graduate specialization, leading to discontinuous delivery of IPC training and lack of experts and mentors,
and of career pathways for IPC professionals.
That is why the world hand hygiene day 2024 focuses on “promoting knowledge and capacity building
of health and care workers through innovative and impactful training and education, on infection preven­
tion and control, including hand hygiene”. Furthermore, the 2024 SAVE LIVES: clean your hands campaign
coincides with the need for countries to rapidly con­sider implementation of the first ever global strategy on
IPC adopted by all countries in 2023,2 and supported by a forthcoming global action plan and monitoring
frame­work, which include a key strategic direction related to IPC education and training.
 SURGICAL ASPESIS

• Use surgical asepsis in the following situations:

• During procedures that require intentional perforation of the
patient’s skin such as insertion of IV catheters or central lines
• When the integrity of the skin is broken as a result of trauma,
surgical incision, or burns
• During procedures that involve insertion of catheters or
surgical instruments into sterile body cavities such as insertion
of a urinary catheter
 PRINCIPLES OF
SURGICAL ASEPSIS
• STERILE FIELD
• PATIENT PREPARATION FOR STERILE
PROCEDURE
• PERFORMING STERILE PROCEDURE
• DONNING AND DOFFING
• OPENING STERILE PACKAGES
• OPENING A STERILE ITEM IN FLAT
SURFACE
• OPENING STERILE ITEM WHILE
HOLDING IT
• PREPARING STERILE FIELD
• PORING STERILE SOLUTION
• SURGICAL SCRUB
 DISPOSAL OF CONTAMINATED EQUIPMENT
•Appropriate handling of soiled equipment and supplies is essential for
these reasons:
•• To prevent inadvertent exposure of healthcare workers to articles
contaminated with body substances
• • To prevent contamination of the environment.
• Articles contaminated, or likely to have been contaminated, with
infective material such as pus, blood, body fluids, feces, or
respiratory secretions (biohazard waste) need to be enclosed in a
sturdy container impervious to microorganisms before they are
removed from the room
• CDC guidelines recommend the following methods:
• A single bag or container, if it is sturdy and impervious to microorganisms, and if the
contaminated articles can be placed without soiling or contaminating its outside.
• Double-bagging if the above conditions are not met
• Place garbage and soiled disposable equipment, including dressings and tissues but not
sharps, in the appropriate and labeled bag or container and immediately close it
• Place non disposable or reusable equipment that is visibly soiled in a labeled container
before removing it from the client’s room or cubicle, and send it to a central processing
area for decontamination.
• Disassemble special procedure trays into component parts. Some components are
disposable; others need to be sent to the laundry or central services for cleaning
And decontaminating.
• Bag soiled client clothing before sending it home or to the agency laundry.
CONTD..
DIPOSAL OF
CONTAMINATED
EQUIPMENT
• LINENS
• LABORATORY
SPECIEMENS
• DISHES AND
UTENSILS
• BLOOD PRESSURE
EQUIPMENTS
 DISPOSAL OF CONTAMINATED
INSTRUMENTS
•Instrument processing
Proper processing of instruments and other items that will be reused
in clinical procedures is critical for reducing infection transmission to
clients.
•The steps of processing
•Proper processing involves several steps that reduce the risk of
transmitting infections from used instruments and other items to
health care workers and clients:
•• Decontamination
•• Cleaning
•• Either sterilization or high-level disinfection, and
•• Storage.
• Disposable of needles, syringes
and sharps
• Prevention of needle stick
injuries
 POST EXPOSURE PROPHYAXIS
•• For Hepatitis B: Hepatitis B immune globulin and hepatitis B vaccine can
reduce the risk of infection after exposure to blood or other body fluids
containing the Hepatitis B virus.
•• For HIV: Several antiretroviral drugs, used either alone or in
combination, have been recommended to reduce the risk of HIV
transmission following accidental exposure in healthcare workers. These
include zidovudine (AZT, retrovir), lamivudine (3TC, epivir), indinavir
(crixivan), and nelfinavir (viracept).
•• For Hepatitis C: there is no postexposure prophylaxis available for
Hepatitis C. Neither immune globulin nor antiviral drugs have been shown
to reduce the risk of Hepatitis C transmission.
 DISINFECTION

• Disinfection describes a
process that eliminates
many or all
microorganisms, with the
exception of bacterial
spores, from inanimate
objects.
 LEVELS OF DISINFECTION
•High-level disinfection
•Effective against all vegetative bacteria, viruses, fungi, TB, and bacterial spores. Used for
laryngoscopes, anesthesia equipment, flexible endoscopes, etc. By using disinfectant solution, e.g.,
Activated glutaraldehyde (cidex 2%).
•• Sodium hypochlorite 1%
•• Carbolic solution 5%
•• Bleaching powder 1%
•Intermediate-level of disinfection
•More powerful and kill resistant microorganisms and non-lipid viruses along vegetative bacteria,
viruses and TB beteria. They are not effective against bacterial spores, e.G. Chlorine, phenol,
alcohols.
•Low-level disinfection
•Kill most vegetative bacteria, fungi, and lipid enveloped virus. Do not kill spores and nonlipid
viruses. Less active against TB gram negative rods. Used for wipe down items or for environmental
surface disinfection, e.G. Methylated spirit 70%, betadine solution 10%, savlon 1%.
 TYPES OF
DISINFECTION

• CONCURRENT
DISINFECTION
• TERMINAL
DISINFECTION
• PRECURRENT
(PROPHYLACTIC
DISINFECTION)
 NATURAL CHEMICAL
AGENTS OF AGENTS OF
DISINFECTI DISINFECTI
ON ON
 STERILIZATION

Sterilization is the complete

elimination or destruction of all
microorganisms, including
spores. Steam under pressure,
ethylene oxide (ETO) gas,
hydrogen peroxide plasma, and
chemicals are the most
common sterilizing agents.
 HOT AIR
Hot air is a form of dry heat disinfection and sterilization. It relies on high
temperatures to kill or inactivate microorganisms, including bacteria, viruses, and
spores. Hot air sterilization is commonly used in settings where moisture-sensitive
materials need to be sterilized, as it does not involve water or steam.

The most commonly used temperature settings for hot air sterilization are:
 160°C for 2 hours
 170°C for 1 hour
 180°C for 30 minutes

 Glassware (e.G., Petri dishes, flasks, test tubes)

 Metal instruments
 Oils and powders that might be damaged by steam
 Certain fabrics and materials that cannot withstand moisture but can tolerate dry
heat.
 BURNING
•Burning is an extreme form of disinfection and sterilization known as
incineration. It involves the complete combustion of materials,
resulting in the destruction of all microorganisms, including bacteria,
viruses, fungi, spores, and prions, as well as the material itselfBurning
or incineration is widely used for the disposal of:

 Medical waste
 Laboratory waste.
 Animal carcasses
 Contaminated materials.
 AUTOCLAVING
•Autoclaving is a method of sterilization that uses moist heat in the form of
pressurized steam to kill microorganisms, including bacteria, viruses, fungi, and
spores. It is widely considered one of the most effective and reliable methods for
sterilization in healthcare, laboratories, and industrial settings.
•The key parameters in autoclaving are:
 Temperature: common settings are 121°C or 134°C.
 Pressure: 15-30 psi (pounds per square inch) is usually applied to raise the
boiling point of water and ensure proper sterilization.
 Time: the exposure time depends on the temperature and the materials being
sterilized. For example:
o 121°C for 15-20 minutes is a standard setting.
o 134°c for 3-5 minutes is used for rapid cycles.
 CONTD..
•Types of autoclaves
• Gravity displacement autoclave: the most
common type, which uses gravity to displace
air with steam. Suitable for sterilizing solid
materials, but less effective for materials with
cavities or porous materials.
• Pre-vacuum (high-vacuum) autoclave : uses a
vacuum pump to remove air before steam is
introduced. This allows for faster and more
effective sterilization, especially for porous
items and large loads.
• Benchtop autoclave: smaller, portable
autoclaves often used in small laboratories or
dental offices for smaller loads.
 RADIATION
• Radiation as a method of
disinfection and sterilization
involves using high-energy waves to
kill or inactivate microorganisms,
including bacteria, viruses, fungi,
and spores. This process disrupts
cellular functions, especially by
damaging nucleic acids (DNA and
RNA), making it effective for
sterilization of heat-sensitive items,
medical products, and even food
preservation.
 IONIZING RADIATION

•Ionizing radiation has enough energy to remove tightly bound electrons from atoms, thus
creating ions. It is highly effective for sterilization and disinfection purposes.
 Gamma radiation:
o Gamma rays, emitted by radioisotopes like cobalt-60 and cesium-137, are highly
penetrative and can sterilize large volumes or thick materials.
o Applications: used in the sterilization of medical equipment (e.G., Syringes, implants),
pharmaceuticals, food preservation, and the sterilization of disposable medical products
like bandages.
X-rays:
o Similar to gamma rays but generated by x-ray machines. X-rays have a slightly lower
energy level compared to gamma radiation but are still effective for deep penetration and
sterilization.
o Applications: sterilization of medical devices and food products.
 Electron beam (e-beam):
o This is a form of ionizing radiation where high-energy electrons are accelerated to sterilize
objects. The penetration depth is lower than gamma rays, so it is best for thin objects.
o Applications: sterilization of pharmaceuticals, medical devices, and packaging materials.
 NON-IONIZING RADIATION

•Non-ionizing radiation lacks the energy to ionize atoms but can still affect
microorganisms, particularly by damaging their DNA.
 Ultraviolet (uv) radiation:
o UV light, particularly UV-C (wavelength of 200-280 nm), is widely used for
disinfection purposes. It damages microbial DNA and RNA, preventing them
from replicating.
o Applications: commonly used to disinfect air, water, and surfaces. It is also
used in hospitals, laboratories, water treatment plants, and HVAC systems.
o Advantages: non-toxic, fast, and effective for surface disinfection.
o Disadvantages: limited to surface disinfection because uv light has low
penetrating power. It can only disinfect areas directly exposed to the light,
so shadowed areas may not be sterilized.
 FUMIGATION/ GAS STERILIZATION
Fumigation is a disinfection process that involves the use of gaseous chemicals (fumigants) to
eliminate or inhibit the growth of harmful microorganisms, pests, and insects in enclosed
spaces or on objects.
1. Ethylene oxide (ETO)
 Mode of action: ethylene oxide is an alkylating agent that disrupts proteins, DNA, and
RNA, killing microorganisms by preventing them from reproducing and functioning
properly.
 Applications: commonly used to sterilize heat-sensitive medical equipment (e.G., Plastics,
electronics, surgical instruments), spices, and some textiles.
2. Formaldehyde
 Mode of action: formaldehyde kills microorganisms by cross-linking their proteins and
DNA, inhibiting their growth.
 Applications: used to fumigate laboratories, biological safety cabinets, hospital rooms, and
animal care facilities.
 Contd..

3. Hydrogen peroxide vapor (HPV)

 Mode of action: hydrogen peroxide vapor releases free radicals that
oxidize and destroy proteins, nucleic acids, and cell membranes of
microorganisms.
 Applications: used to disinfect hospital rooms, pharmaceutical
manufacturing areas, and laboratory equipment. Often used for terminal
sterilization of sealed spaces.
4. Methyl bromide
5. Phosphine (aluminum phosphide)
6. Chlorine dioxide
7. Sulfuryl fluoride
 HEALTH CARE- ASSOCIATED INFECTION

• Patients in health care settings, especially hospitals and long-term care

facilities, have an increased risk of acquiring infections. Health care–associated
infections (HAIs), formerly called nosocomial or health care–acquired
infections, result from the delivery of health services in a health care facility.
They occur as the result of invasive procedures, antibiotic administration, the
presence of multidrug-resistant organisms, and breaks in infection prevention
and control activities
 RESEARCH INPUT
Comparing infection control and ward nurses' views of the omission of infection control activities
using the missed nursing care infection prevention and control (MNCIPC)
survey ,Julie Henderson et AL,
Methods: Data were collected through the missed nursing care infection prevention and control
(MNCIPC) survey delivered to 500 australian nurses prior to COVID-19.
Results: Significant differences were found on the mean scores between infection control and other
nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the
activity as more likely to be missed. Factors viewed as having greater contribution to omission of
infection control prevention were as follows: 'patients have to share bathrooms', 'urgent patient
situation' and unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control
nurses were more likely to highlight the role of organisational and management factors in preventing
effective infection control.
Conclusions: Differences in response between nurses suggest that the extent of omission of infection
control precautions may be under-estimated by ward nurses.
Implications for nursing management: Infection control specialists are more likely to identify
organisational barriers to effective infection control than other nurses. Work demands arising from
pandemic management may contribute to infection control precautions being missed.
Health care–associated infections are exogenous or endogenous.

•An exogenous infection comes from microorganisms found outside

the individual such as salmonella, clostridium tetani, and aspergillus.
They do not exist as normal floras. Endogenous infection occurs when
part of the patient’s flora becomes altered and An overgrowth results
(e.g., Staphylococci, enterococci, yeasts, and streptococci). This often
happens when a patient receives broad spectrum antibiotics that alter
the normal floras. When sufficient numbers of microorganisms
normally found in one body site move to another site, an endogenous
infection develops
 COMMON TYPES OF HAI
• Catheter-associated urinary tract infections (cautis): caused by urinary
catheters, which can introduce bacteria into the urinary tract.
• Central line-associated bloodstream infections (clabsis): occur when bacteria
or other germs enter the bloodstream through a central line catheter.
• Surgical site infections (ssis): occur after surgery in the part of the body where
the surgery took place.
• Ventilator-associated pneumonia (vap): develops in patients using mechanical
ventilation.
• Clostridioides difficile infections (c. Difficile): A type of bacterial infection that
often occurs after the use of antibiotics and can cause severe diarrhea
VENTILATOR ASSOCIATED PNEUMONIA

•Ventilator-associated pneumonia (VAP) is a type of lung infection that occurs in

people who are on mechanical ventilation for at least 48 hours
•Causes of vap:
•VAP is most commonly caused by bacteria, especially gram-negative bacteria such as:
 Pseudomonas aeruginosa
 Klebsiella pneumoniae
 Escherichia coli (E. Coli)
•Gram-positive bacteria like staphylococcus aureus, particularly the methicillin-
resistant form (MRSA), can also cause VAP.
Prevention of vap:
• Elevating the head of the bed.
• Daily assessments for weaning
• Oral careSubglottic suctioning
• Ventilator care bundles
 RESEARCH INPUT
•The impact of care bundles on ventilator-associated pneumonia (vap) prevention in adult icus: a systematic
review , maria mastrogianni et al,

Abstract: ventilator-associated pneumonia (vap) remains a common risk in mechanically ventilated patients.
Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined
interventions that have been used to by icus worldwide from the implementation of “institute for healthcare
improvement ventilator bundle”, i.E., From december 2004. A search was performed on the pubmed, scopus
and science direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions
monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and
hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff
pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene,
which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22
studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies
indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted
the “IHI ventilator bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning.
Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with
long-lasting education programs and measurement of bundle’s compliance should be the gold standard
 URIINAR TRACT INFECTION
• Urinary tract infections (UTIS) are one of the most common types of health care-associated
infections (HAIS), particularly those related to the use of urinary catheters. These infections
are referred to as catheter-associated urinary tract infections (CAUTIS) when they occur in
patients who have had a urinary catheter inserted for bladder drainage. Common pathogens
involved:
 Escherichia coli (E. Coli): the most common cause of UTIS, including CAUTIS.
 Enterococci
 Klebsiella pneumoniae
 Pseudomonas aeruginosa
 Candida species
•Prevention of CAUTIs
• Use catheters only when necessary
• Aseptic technique:
• Prompt catheter removal
• Closed drainage system
• Perineal care.
SURGICAL SITE INFECTIONS

• Surgical site infections (SSIs) are infections that

occur at or near the site of a surgical incision within
30 days after surgery (or up to 90 days if implants
are involved).
•Types of surgical site infections (SSIs):
• Superficial incisional SSI: involves only the skin
and subcutaneous tissue (the top layers) around
the incision site.
• Deep incisional SSI: affects deeper soft tissues,
such as muscles and fascia.
• Organ/space SSI : occurs in any part of the
anatomy that was opened or manipulated during
surgery, such as organs or body cavities.
CAUSES OF SSIS
SSIs occur when microorganisms, such as bacteria, viruses, or
fungi, enter the surgical site during or after the procedure. The
most common pathogens involved are:
 Staphylococcus aureus (including methicillin-resistant
staphylococcus aureus, or MRSA, Escherichia coli (E. Coli),
Enterococci, Pseudomonas aeruginosa
PREVENTION OF SSIS
• Preoperative skin preparation.
• Antibiotic prophylaxis
• Proper hand hygiene and sterile techniques.
• Minimizing operating room traffic.
• Maintaining normothermia.
• Glucose control
• Postoperative wound care
 BLOOD STREAM INFECTIONS
•Bloodstream infections (bsis) occur when bacteria, fungi, or viruses enter the
bloodstream, causing a systemic infection. In health care settings, these are
commonly referred to as health care-associated bloodstream infections (ha-bsis)
or central line-associated bloodstream infections (clabsis) when they are
associated with the use of a central venous catheter (central line). Bsis can be life-
threatening, leading to conditions like sepsis, which can cause organ failure and
death if not promptly treated.
Types of bloodstream infections:
• Primary bloodstream infections: occur without an identifiable infection source,
often associated with the use of a central line catheter.
• Secondary bloodstream infections: result from an infection at another site, such
as a urinary tract infection, pneumonia, or surgical site infection, that spreads
into the bloodstream.
•Central line-associated bloodstream infections
(CLABSIS):
•CLABSIS occur when microorganisms enter the
bloodstream through a central line catheter, which
is inserted into a large vein to deliver medications,
fluids, or nutrition. These infections are a significant
cause of morbidity and mortality in hospitalized
patients.
•PREVENTION OF BLOODSTREAM INFECTIONS:
• Central line insertion bundles
• Daily review of central line necessity
• Proper catheter carehand hygieneuse of
antiseptic or antimicrobial-impregnated
catheters
 CARE BUNDLES

•A 'care bundle' is a collection of interventions that

may be applied to the management of a particular
condition

•VAP bundle
•CAUTI bundle
•ANTIBIOTIC bundle
•CLABSI bundle
 RESEARCH INPUT

Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle
income countries: a scoping review , Alexandra Moina García et Al,
•Methods
•Five electronic databases were searched between january 2001 and july 2020. A mixed-methods approach was
applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and
the contents of the classification groups were then described quantitatively.
•Findings
•3619 records were screened, with 44 eligible studies identified. The bundle element classification framework
created involved: (1) primary prevention, (2) detection, (3) case management, and implementation (3 + I). The 44
studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128,
43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12
elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of
these aimed at outbreak control.
•Interpretation
•The 3 + I classification framework was a feasible approach to reporting and synthesising research for infection-
relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles
of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.G., Self-
inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a
major gap.
 ISOLATION AND ISOLATION PRECAUTIONS

•Isolation is the separation and restriction of movement of ill persons with

contagious diseases.
•Barrier precautions include the appropriate use of personal protective equipment
(ppe) such as gowns, gloves, masks, eyewear, and other protective devices or
clothing.
•. The cdc issued new isolation guidelines in 2007 that build on the two-tiered
approach established in the 1996 guidelines.
• The first and most important tier is standard precautions. The second tier
addresses isolation precautions, which are based on the mode of transmission
of a disease
•CONTACT PRECATIONS
•DROPLET PRECAUTIONS
•AIRBORNE PRECAUTIONS
 UNIVERSAL PRECAUTIONS

•Now, universal precautions have been made mandatory by OSHA (occupational safety and
health administration). These are:
• Disease-specific isolation method: certain practices are followed for each infectious disease,
e.G. Chicken pox in which the client is placed in a private room with precautions to prevent
respiratory spread.
• Client specific isolation: diseases requiring similar isolation perception are grouped in the
following categories:
•Strict isolation
•Contact isolation
•Respiratory isolation
•Enteric isolation
•Drainage and secretion precautions
•(Wound and skin isolation)
•Universal blood and body fluid precautions (blood isolation)
 HEALTH CARE- ASSOCIATED INFECTION CONTROL TEAM
•
•The HAICC Should have a small subordinate committee, which should be named “hospital-associated infection
control team”
•(HAICT).
•This team should consist of three persons:
•1. The infection control officer (ICO), who is a microbiologist.
•2. Infection control sister.
•3. A clinician.
•Functions of HAICT
•The team should be responsible for surveillance activity. The members of the team should meet at least once a
week.
•1. They should discuss the occurrence of different types of infections in the hospital, their etiological agents
and antimicrobial sensitivity pattern.
•2. In case of outbreaks, attempts must be made to find the source of infection and control this infection.
•3. Should also carry out periodical environmental survey for the carriage of pathogenic organisms by health
care workers.
•4. Should draw guidelines aimed at reducing HAI in different areas like wards,OTs, injection rooms, blood
collection centres, supportive services, (e.G. Kitchen and laundry), sterilization and disinfection procedures.
State-level hospital-associated infection control board
• A state-level network of all the hospitals in a particular state should be formed.
• This “state-level hospital infection control board” should be headed by the secretary of health services.
• The director of health services should be the chairperson.
• All medical superintendents of the state hospitals should be the members.
• A senior officer of state health services should be designated as state coordinator of hai control
program, who should act as a member secretary of the board.
National hopital-associated infection control board
• A national-level infection control program may also be developed.
• The “the national hospital infection control board” should be chaired by the secretary of health
services.
The director of health services should be the chairperson.
• The other members of the board should be state coordinators of hai control program or directors of
health services.
• A senior officer of state health services should be designated as national coordinator of hai control
program, who should act as member secretary of the board.
A mechanism should be developed for the periodical assessment of the implementation of the
recommendations of national haicb and state haicb.
 KAYAKALP
•The union health and family welfare minister Shri J P Nadda has launched ‘Kayakalp
Award Scheme’ on May 15, 2015 as an extension of 'Swachh Bharat Mission'. Aim of
initiative which to improve and promote the cleanliness, hygiene, waste
management and infection control practices in public health care facilities and
incentivize the exemplary performing facilities. The scheme is intended to encourage
and incentivize public health facilities (PHFS) in the country to demonstrate their
commitment for cleanliness, hygiene and infection control practices.
Initiated from district hospitals in 2015, the scheme expanded to phc level (2016)
and then covered all urban health facilities by 2017.
The objectives of the award scheme are :
• To inculcate a culture of ongoing assessment and peer review of performance
related to hygiene, sanitation and infection control.
• To incentivize and recognize public healthcare facilities that show exemplary
performance in adhering to standard protocols of cleanliness, infection control
and sanitation,
• To create and share sustainable practices related to improving cleanliness in
public health facilities which lead to positive health outcomes.
 HEALTH CARE ASSOCIATED INFECTION SURVEILLANCEIN INDIA

• Surveillance data from 2004 to 2013 from 40 hospitals in india reported a pooled prevalence of CLABSI to be
5·1 per 1000 central line days and of CAUTI to be 2·1 per 1000 catheter days.4 A 2019, single-centre study in
india reported a pooled CLABSI rate of 4·3 per 1000 central line days.5 in a global survey, the prevalence of
resistance to antibiotics including third-generation cephalosporins and carbapenems among
enterobacteriaceae, was significantly higher in lmics.6 high levels of resistance, including against
carbapenems among acinetobacter spp, pseudomonas spp, and klebsiella spp have been reported from india.

• In the lancet global health, purva mathur and colleagues8 report results of health-care-associated
bloodstream and urinary tract infections in 89 intensive care units of 26 tertiary care hospitals in india.8 the
authors modified the NHSN and ECDC case definitions to facilitate standardised HAI surveillance, adjusting for
the available resources in indian hospitals. In adult and paediatric ICU types, the pooled rates of BSI ranged
between 5·3–7·3 per 1000 patient days and CLABSI rates ranged between 8·3–12·1 per 1000 central line days.
The pooled UTI and CAUTI rates in these icus ranged between 1·7–2·8 per 1000 patient days and 8·3–12·1 per
1000 catheter days, respectively. Neonatal icus had higher pooled BSI and CLABSI rates in all birthweight
categories. The authors also report high levels of resistance to at least one carbapenem in hais caused by
klebsiella spp, escherichia coli, acinetobacter spp, and pseudomonas spp. The rates of HAI and associated
antibiotic resistance reported in this study are either similar to or higher than those from previous studies in
india.
 ROLE OF
THE
INFECTION
PREVENTIO
N NURSE
•The senior nursing administration is responsible for:

•1. Participating in the infection control committee.

•2. Promoting that development and improvement of nursing techniques.
They should constantly review aseptic nursing policies
•With approval by the infection control committee.
•3. Developing training programs for members of the nursing staff.
•4. Supervision the implementation of techniques for prevention of infections
in specialized areas such as the operation theater,
•ICU, maternity unit and newborns.
•5. Monitoring of nursing adherence to policies.
•The nurse in-charge of ward is responsible for:

•1. Maintaining the hygiene consistent with the hospital policies and good nursing
practices in the ward.
•2. Monitoring aseptic techniques, including handwashing, use of isolation.
•3. Promptly reporting an evidence of infection to the attending physician.
•4. Initiating patient isolation, and ordering culture specimens from any patient
showing signs of a communicable disease,
•When the physician is not immediately available.
•5. Limiting the patient exposure to infections, visitors, hospital staff, other
patients or equipment, used for diagnosis or treatment.
•6. Maintaining a safe and adequate supply of ward equipment, drugs and patient
care supplies.
 ROLE OF HEALTH CARE TEAM

• ROLE OF HOSPITAL MANAGEMENT

• ROLE OF THE PHYSICIANS
• ROLE OF MICROBIOLOGIST
• ROLE OF HOSPITAL PHARMACIST
• ROLE OF LAUNDRY
• ROLE OF FOOD SERVICES
• ROLE OF HOUSEKEEPING SERVICES
 ROLE OF CENTRAL STERILIZATION
SERVICES
•The central sterilization services serve all hospital areas including the operation
theaters. The responsibilities of the CSS are to
•Clean, decontaminate, test, prepare for use, sterilize and store aseptically all
sterile hospital equipment. It works in collaboration
•With other hospital programs, to develop and monitor policies in cleaning and
decontamination of:
•• Reusable equipment
•• Contaminated equipment including:
•– Wrapping procedures according to type of sterilization
•– Sterilization methods, according to the type of equipment
•– Sterilization conditions (e.G. Temperature, duration, pressure, humidity, etc.)
 RESEARCH INPUT
•Reducing Hospital-acquired Infection Rate Using The Six Sigma DMAIC Approach Ahmed Al Kuwaiti, Arun Vijay
Subbarayalu, Deanship Of Quality And Academic Accreditation, Imam Abdulrahman Bin Faisal University.
•Background: Hospital‑acquired Infection (Hai) Is One Of The Most Common Complications Occurring In A Hospital
Setting. Although Previous Studies Have Demonstrated The Application Of Data‑driven Six Sigma DMAIC (Define,
Measure,
•Analyze, Improve And Control) Methodology In Various Health‑care Settings, No Such Studies Have Been Conducted On
HAI In The Saudi Arabian Context.
•Objective: The Purpose Of This Research Was To Study The Effect Of The Six Sigma Dmaic Approach In Reducing The Hai
Rate At King Fahd Hospital Of The University, Al‑khobar, Saudi Arabia.
•Methods: Historical Data On Hai Reported At Inpatient Units Of The Hospital Between January And December 2013
Were Collected, And The Overall Hai Rate For The Year 2013 Was Determined. The Six Sigma DMAIC Approach Was Then
Prospectively Implemented Between January And December 2014, And Its Effect In Reducing The HAI Rate Was Evaluated
Through Five Phases. The Incidence Of HAI In 2013 Was Used As The Problem And A 30% Reduction From 4.18 By The
End Of 2014 Was Set As The Project Goal. Potential Causes Contributing To HAI Were Identified By Root Cause Analysis,
Following Which Appropriate Improvement Strategies Were Implemented And Then The Pre‑ And Postintervention HAI
Rates Were Compared.
•Results: The Overall Hai Rate Was Observed As 4.18. After Implementing Improvement Strategies, The HAI Rate
Significantly Reduced From 3.92 During The Preintervention Phase (First Quarter Of 2014) To 2.73 During The
Postintervention Phase (Third Quarter Of 2014) (P < 0.05). A Control Plan Was Also Executed To Sustain This
Improvement.
•Conclusion: The Results Show That The Six Sigma “Dmaic” Approach Is Effective In Reducing The Hai Rate.
 CONCLUSION

• Infection control practices are crucial in preventing the spread of

infectious diseases within health care settings, safeguarding patient
health, and reducing overall morbidity and mortality. Effective infection
control practices encompass a range of strategies and protocols
designed to minimize the risk of health-care-associated infections
(HAIS) and ensure a safe environment for both patients and health care
workers
THANK YOU