1.
Infection control team
1) The infection
control team comprises of Medical Director, Ophthalmologist, Administrator, Quality
Manager, and their staff. Currently, following are the members.
a) Dr. (Chairperson)
b) Mr.
c) Mrs
d) Mr
e) Miss
2) The team is
responsible for :
a)
Day to day functioning: The team members take periodical
rounds to check any issues regarding infection.
b)
Supporting surveillance process: The team assists in all surveillance
activities that are carried out at ...............Hospital.
c)
Detecting outbreaks: If there is any infection out breaks
that takes place, the team will do a root cause analysis of the same and
recommend and monitor remedial action. Carrying out daily audits:
d)
Carrying out Audits: During the rounds the team also
carries out an audit of the area that could be a potential cause for infection.
e)
Infection prevention and control: The methods, precautions to be taken
to prevent an infection are discussed with all staff and are monitored. In case
any instances of an infection are present, the team takes necessary steps to
control its spread.
2.
Surveillance activities for infection control: The
high risk areas identified for infection in ...............Hospital are:
1.
Operation
theatre.
2.
Emergency
room
3.
Patient
waiting area
a)
Scope of surveillance
activities
:
1.
Tracking
risks
2.
Analyzing
the infection risks from the data collected
b)
The methods of
surveillance in these areas are as under :
1.
OT
Swabs, Air Sample & Water sample are taken for analysis every month.
2.
Regular
screening of staff for transmissible infection like
conjunctivitis.
3.
Equipment
cleaning and sterilization practices.
4.
Laundry
and linen management practices.
5.
Periodical
cleaning of various filters.
6.
Observation
of seepage and leakage.
7.
Inform
about notifiable diseases to appropriate authorities.
3. Hospital associated infections
The ...............Hospital lays lot of stress on the cleanliness and sterility maintenance. The
cleaning schedules are well maintained and followed strictly.
The
possible infections are:
a)
Spread
through patients with respiratory tract infections. This is a common situation
and once the patient is identified with such a problem, an alert is triggered
and barrier methods wherever possible are used.
b)
If
possible, patients known to have RTI are isolated from the other patients.
c)
In
case if eye/surgical site infection is observed, the pus/swab/ sample is taken
and sent for culture for further course of action.
Once the data from these are obtained, the
infection control team communicates regarding the same to the Medical Director
and staff involved. The team also suggests preventive steps to be taken based
on the findings.
4. Facilities provided for infection control
The
organization has adequate number of hand washing facilities for the staff and
patients. Hand sanitizers, disinfectants, soaps, etc. are placed at appropriate
places like OT, patient waiting area, all consultation rooms etc. Proper hand
washing technique is displayed in major areas.
During
the rounds conducted by the team, this procedure is also checked upon randomly.
If anyone needs assistance in understanding the process, they are helped by the
team members.
The
items required supporting infection control activities are maintained in
adequate quantity and the budget for the same is provided for.
5. Proper hand washing technique:
Hand
washing is the single most important procedure for preventing the spread of
biological contamination. All staff members are required to follow proper hand
washing technique. This prevents infection from spreading to patients and other
staff members thereby supporting general well-being.
Following
are some hand washing tips and procedures to be followed by all staff:
a)
Always
consider the sink, including the taps to be contaminated.
b)
Avoid
touching the sink while washing your hands, as the bacteria may spread even
after you finish washing your hands.
c)
Turn water on and wet your hands and wrists.
d)
Get
your liquid soap, antibacterial soap and apply it on your hand and work it into
lather.
e)
Vigorously
rub together all surfaces of the lathered hands for 15 seconds. Friction helps
remove dirt and microorganisms.
f)
Wash
around and under rings, around cuticles, and under finger-nails.
g)
Clean
your nails each time that you wash your hands
h)
Wash
and clean between your fingers.
i)
Rinse
hands thoroughly under a stream of water. Running water carries away dirt and
debris. Point fingers down so water and contamination won't drip toward your
elbows.
j)
Dry
hands completely with a clean dry towel.
k)
Use
a dry towel to turn the tap off or use the elbow tap to do so.
l)
To
keep soap from becoming a breeding place for microorganisms, thoroughly clean
soap dispensers before refilling with fresh soap.
m)
When
hand washing facilities are not available at a remote work site, use an
appropriate antiseptic hand cleaner or antiseptic towel. As soon as possible,
rewash hands with soap and running water.
n)
Always
wash your hands before you take care of a patient, if you wash your hands, you
will decrease the bacteria count on your hands.
o)
Dry
your hands well because wet hands can be just as dangerous as not washing your
hands.
p)
Dry
your hands immediately after washing.
q)
Ensure
that you don’t spill water anywhere to prevent bacteria from breeding.
Hygenic hand washing
Time: 10 – 15 sec. Agent used- Antiseptic liquid
soap.
Surgical scrub to be followed effectively as
follows:
Time 3 min. Agent used -Betadine 7.5%
Please follow correct procedure as displayed near
hand washing facility.
6. OT Sterilisation procedure
1) OT is cleaned and mopped daily with
Silvicide(silver nitrate 0.01% with 10% Hydrogen peroxide) Solution using 50 ml
solution in one litre of water.
2) Mopping is begun with the OT Trolleys, OT
table, OT platform, OT walls and OT floor.
3) Trolley are cleaned with Spirit spray and
flaming it.
4) OT is sterilized by fogging (Silvicide 250ml/lt
water) every day.
Procedure of Fogging:
a)
250 ml of Silvicide(silver nitrate 0.01% with 10%
Hydrogen peroxide) is added to 1000 ml water in Fogger.
b)
Fogger is kept near the door of the OT
directing towards OT table and is kept
on for 15 minutes .
c)
It gets switched off after 15 minutes and OT is closed overnight.
d)
OT is then opened on next day.
e)
OT cleaning is done daily after
finishing the surgeries.
7. Cleaning and disinfection
a)
Floors to be cleaned using detergent
and water and disinfected using Bacillocid acid solution( 20ml in 1 lit. of
water)
b)
Walls to be mopped till ceiling on
every sunday using Silvicide(silver nitrate 0.01% with 10% Hydrogen peroxide)
Solution.
c)
ALL Horizontal surfaces & Vertical
surfaces are wiped with Silvicide(silver nitrate 0.01% with 10% Hydrogen
peroxide) solution.
d)
Lamps and machinery are cleaned with
Spirit solution and then wiped..
8. Decontamination procedures for equipment.
Instruments used must be sterilized / disinfected
as follows:
|
Article |
Standard Procedure |
Comments |
|
Ambubag |
Clean with detergent and water; dried and
sterilized. |
|
|
Beds and couches Frame |
Should be cleaned with detergent and water
between patients and as required. |
If contaminated with body fluids, see spillage
policy. If used in isolation room - after cleaning, should be wiped with a
disinfectant |
|
Mattresses
and pillows |
Should be cleaned with detergent and water
between patients and as required. |
If contaminated with body fluids, the blood
spills policy should be implemented. Should not be used if cover is damaged.
Contaminated pillows must be discarded. Torn mattress covers must be replaced
before mattress is re -used. |
|
Curtains |
Should be changed as part of a rolling programme
by domestic services. |
Should be changed as part of terminal clean. |
|
Floors |
A damp
mop with detergent and water should be used. |
For blood splashes blood spillage policy should
be followed. |
|
Furniture |
Should be damp dusted with detergent and water |
|
|
Mops |
Re-usable to be cleaned daily |
Mops must not be stored wet or cleaned in
disinfectant solution. |
|
Soap dispensers |
Should be use disposable soap dispenser which
are thrown after used. |
|
|
Spillages |
Should be cleaned with detergent. |
|
|
Stethoscopes |
Should be
wiped with Sterilium |
|
|
Telephones |
To be wiped with sterilium. |
|
|
Thermometers |
To be covered with disposable sleeve before use
and stored dry in individual holder. In between patients, should be cleaned
and wiped with 70% isopropyl alcohol (swab). If disposable sleeve not used,
in between patients, should be washed in general purpose detergent and
lukewarm water then wiped with 70% alcohol (swab). To be stored in individual
holder inverted. |
|
|
Toilet seats |
To be cleaned daily with detergent |
|
|
Trolleys (Dressing) |
To be cleaned daily with detergent and water.
After each use should be wiped with 70% isopropyl alcohol |
|
|
Walls |
Should be cleaned with detergent and water as
part of planned preventative maintenance programme |
|
9.
Autoclave.
Vertical
High Pressure Autoclave:
1. ...............Hospital has Vertical High Pressure Autoclave.
2.
All the cataract instruments along
with linen are autoclaved in this.
3.
Cataract trays are put in the
Autoclave from the upper door,
4.
Sterilisation strips are put in each drum
5.
Distilled water is put from Top and it
is closed and door is locked,
6.
Usually Cycle No 3 (heating time
-45min.121 degree with exposure time of 20 min and dry time of 10 min) is used.
7.
The whole cycle is completed in about
65 minute.
8.
Then each tray is taken for surgery
after checking sterilization strip.
9.
Appropriate documentation for each
cycle is maintained by sticking vapour line indicator as well as autoclave tape
in Autoclave Register.
10. Monthly
Bowie dick’s test is performed.
11. Monthly
Biological indicator test is performed.
10.
Infection outbreak handling
Meaning of an outbreak: If the number of cases is
more than 5 per day it is treated as an outbreak.
1.
The
infection outbreaks in ...............Hospital can be conjunctivitis or endophthalmitis.
2.
Such
patients are identified from the reception area and are taken directly to the
doctor. Preliminary examination is not done to them and they are given
treatment on priority.
3.
If
it is an early case of infection, the patient is administered immediate
medication to reduce/cure the infection.
4.
The
other patients who were given medicines from the same batch of medicines / same
day of the surgery are checked for an early signs of infection. In case any are
present, then that batch of medicines / intra ocular fluids are recalled and the
whole batch is discarded.
5.
Isolation
of intracameral drugs used on that day.
6.
Taking
swabs from the high risk areas and fumigating the complete area again.
7.
The
infections are treated aggressively and ensured that it does not develop in to
a full blown infection.
8.
Prophylaxis
is avoided by not using bare hands while carrying out any procedure/surgery.
9.
Adequate
care should be taken to immediately dispose off the materials used for
treatment like gauze, cotton swabs, used needles, etc.
10.
Materials
used for already affected patients like AIDS, etc should be very carefully
disposed off to avoid any needle- prick infections.
11.
The
disposal methods should be followed strictly with respect to the bio medical
waste disposal rules.
11. Bio medical waste management :
...............Hospital does not have
facility to treat the waste. SWML have does safe and secure disposal of
Bio-medical waste. The hospital hands over the biomedical waste to Synergy
waste management limited for the disposal of bio medical waste. The
organisation segregates all waste into the categories as directed, secures and
places them in that particular colour bag. These bags are collected in covered
vehicles within 48 hours and disposed off in the proper method by the vendor.
The fees required to be paid to the authorities
concerned are paid well in time and the receipts are obtained and filed. The
staff handling the waste is properly trained to protect themselves against any
injuries or other infections being spread through the waste. The staff handling
such items should wear masks and gloves while transferring the bags from the OT
and procedure room to the disposal area. They should be very careful while
handling the cans in which needles are disposed. In the event of a needle prick
injury, the same is handled as follows and NACO guidelines.
The waste is segregated as per the guidelines
mentioned below:
|
Sr. No. |
Waste Category |
Type of waste |
Sources of generation |
Colour of the bag |
|
1 |
Human Anatomical waste |
Tissue, organs, Body parts |
O.T. |
Yellow bag, and
disposal through the contractor |
|
2 |
Waste Sharps |
Needles,blades, etc. |
OT, OPD,
Procedure room |
Use of puncture proof containers, and
disposal through the contractor |
|
3 |
Waste Sharps |
Broken Ampoules, Vials, other
broken glass items |
OT, OPD, Procedure room |
Blue bag/can, and disposal through the
contractor |
|
4 |
Discarded Medicines |
Outdated, contaminated and discarded medicines |
Medicine storage locations |
Black, and disposal through the contractor |
|
5 |
Solid waste |
Tubing, Catheter,
syringes, I.V. sets, IV bottles, Cotton, Guaze, etc. |
OT, OPD, Procedure room |
Red bag, and disposal through the contractor |
|
6 |
Liquid Waste |
Washing, Cleaning, Disinfecting |
OT, OPD, Procedure room |
Chemical Treatment & discharge into
drain. |
12.
Laundry and linen
...............Hospital uses
disposable linen as far as possible. Disposable Trolly covers, Eye drapes, Foot
cover, etc. are used for every Ophthalmic Surgery except Surgical gown , Hand
towel , Troley sheet ( linen )which are autoclaved daily.
a)
Introduction:
Safe management of linen is important due to risk
of contamination during the delivery of care.
We have no in-house laundry services, laundry
material is collected in linen trolley and transported to laundry
b)
Terminology of
linens & good practices:
1. Clean used Linen- This refers
to the clean used linen.
a) Avoid shaking
linen as this may result in the dispersal of potentially pathogenic
microorganisms and/or skin scales into the environment.
b) Do not wrap
linen together when disposing into the laundry bag.
c) Ensure used
infected linen is stored within a designated area which cannot be accessed by
the public.
d) Not to be
stored in corridors.
2. Used, Soiled, Infected, Contaminated linen- This term
refers to soiled linen or contaminated linen with blood or other body fluids. It
specifically applies to linen that has been used by a patient who is known or
suspected to be carrying potentially pathogenic microorganisms.
a) Contaminated
linen is disinfected at source by dipping in 1% sod. hypochloride solution & then sent to laundry in separate bag
b) Precautions
while handling used /infected linen
i.
A
disposable gloves & mask always be
worn when handling used linen.
ii.
Hand
hygiene is performed following handling of used linen
3. Clean linen – This has been
disinfected & washed and meant for use.
a) Clean linen is
randomly checked to ensure it is clean and fit for use.
b) Distribution
of clean linen is controlled.
c) Clean linen
always is stored in a clean, designated area, in cupboard to prevent
contamination with dust.
d) Clean linen is
dispatched on clean trolley & delivered to required areas.
4.
Sterile linen
- Which
has been autoclaved for use in Operative procedures
5.
Condemnation
of linen
–
a) Linen which
cannot be reused or torn linen is condemned
b) Infected linen
which is so heavily soiled that it cannot be cleaned or reused is discarded in
yellow colour bag.
13. Pre and Post Exposure
Prophylaxis
Health care workers are at risk of acquiring
infection through occupational exposure. They can also transmit the infection
to the patients and other employees.
Needle
prick injury
First
Aid
1.
Allow bleeding and wash with soap and
running water
2.
Clean the site with disinfectant like
70% alcohol
3.
Take blood for virology (HIV, Hep B,
Hep C) from injured worker
4.
The source should also be tested for
HIV, Hep B & Hep C
Follow
up
If the status of the patient & healthcare
worker is unknown and
immune status cannot be obtained within 48 hours,
then give:
Hep B immunoglobulin
Hep B vaccine
If the healthcare worker is HBV immune then no
further Hep B vaccine is required
but if HBV susceptible, then treat with
immunoglobulin and vaccine
Complete the course of Hepatitis vaccine
Follow up serology 6 weeks, 3 months, 6 months
& 12 months.
Pre
exposure prophylaxis:
Vaccination of the employee at the time of
employment as per the following schedule:
First dose (1ml IM) Day 0
Second dose (1ml IM) 1 month
Third dose (1ml IM) 6 months
Post
Exposure prophylaxis:
1.
For Hepatitis B
Test the source person for HBsAg.
If source person is HBsAg
negative: no further treatment required for HBV.
If source person is HBs Ag
positive: Test the HCW for HBs Ag and Anti HBs antibody.
HCW
is HBs Ag positive: no further treatment required for HBV.
HCW
is HBs Ag negative:
a) For previously
immunized HCW with Anti HBs antibody titre of above 10mIU/ml, no further treatment
required.
b) For non
immunized HCW: Give Intramuscularly Hepatitis B immunoglobulin preferably
within 48 hours and not later than a week after exposure. This is followed by a
complete course of Hepatitis B virus vaccine.
2.
For HIV infection
Protocols to be followed
a) Pre-test/post-test counselling
b) Send the blood sample for HIV testing
c)
1st sample (baseline): immediately after exposure
d) 2nd sample: 6 weeks full exposure
e)
3rd sample: 12 weeks full exposure
f)
Last sample: 6 months
During follow-up period:
a)
Refrain from Donating blood, semen, organ
b)
Abstain from sexual intercourse/use condom
c)
Do not breast feed.
Recommendations for the management of potentially
exposed HCP
a)
Written
protocols are available with Administrator for prompt reporting, evaluation, counseling,
treatment and follow up of occupational exposures that may place HCP at risk of
acquiring any blood-borne infection including HIV
b)
Exposure
reporting is mandatory
c)
Clinician
responsible for providing care is available during duty hours.
d)
PEP
drugs are made available for timely administration for high risk patients
Drugs
for PEP
a)
Basic regimen: Zidovudine 300 mg b.d. + Lamivudine
150 mg b.d.
b) Expanded regimen: Zidovudine + Lamivudine + Indinavir 800mg t.d.s
or any other protease
inhibitor
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