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Sana’s Guidelines for Hospital Infection Control
Mohd Samiullah Khan
1:
Microorganisms
STRUCTURE OF TYPICAL BACTERIAL CELL
The Cell Wall
Cytoplasmic Membrane
Cytoplasm
Ribosomes
Mesosomes
Intracytoplasmic Inclusions
Nucleus
CLASSIFICATION OF BACTERIA DEPENDING UPON THEIR MORPHOLOGY
Cocci
Diplococci
Staphylococcus
Streptococci
Bacilli
Streptobacilli
Diplobacilli
Vibrios
Spirilla
Spirochetes
CLASSIFICATION OF THE MEDICALLY IMPORTANT VIRUS GROUPS
VIRUSES
Introduction
Morphology of Viruses
Structure and Shape
MYCOLOGY: Study of Fungus
Introduction
Yeast
Yeast-like Fungi
Moulds or Filamentous Fungi
Dimorphic Fungi
MODE OF TRANSMISSION OF VARIOUS DISEASES
Airborne Infections
Water or Foodborne Infections
Sexually Transmitted Diseases
Transfer of Pathogens from Mother to Fetus During Pregnancy
FUNGAL INFECTIONS
Superficial Mycosis
Deep or Systemic Mycosis
Opportunistic Infections
2:
Infection
DEFINITION
STANDARDIZED CLASSIFICATION OF INFECTIONS
MODES OF TRANSMISSION
Routes of Entry of Organisms
Susceptible Patients
CAUSES FOR INCREASING INFECTION
Population at Risk
HEALTH CARE FACILITIES ARE SOURCE OF TRANSMISSION
SURVEILLANCE OF INFECTION
Microbiological Surveillance
BACTEREMIA
URINARY TRACT INFECTION
Asymptomatic Bacteriuria
Symptomatic Urinary Tract Infection
RESPIRATORY TRACT INFECTION
Surgical Wound Infection
OTHER SITE OF INFECTION
The Site of Intravenous Catheters and Needles
Other Cutaneous and Subcutaneous Infection
Female Genital Tract
Umbilicus
Conjunctiva
TYPES OF OPERATION WOUND
Clean Wound
Clean Contaminated Wound
Contaminated Wound
Dirty and Infected Wound
HIV AND HEPATITIS B
Prevention and Control of Hospital Acquired HIV Infection and AIDS
PREVENTION OF INFECTION BY SIMPLE CARE
STANDARD PRECAUTIONS
Summary of Standard Precautions
3:
Isolation Policies and Procedures
CATEGORIES OF ISOLATION
STRICT ISOLATION
Indications
Requirements
RESPIRATORY ISOLATION
Indications
Requirements
ENTERIC PRECAUTIONS
Indications
Requirements
WOUND AND SKIN PRECAUTIONS
Indications
Requirements
BLOOD PRECAUTIONS
Indications
Requirements
PROTECTIVE ISOLATION
4:
Hospital Infection Control Committee
MEMBERS FOR INFECTION CONTROL COMMITTEE
FUNCTIONS OF THE INFECTION CONTROL COMMITTEE
AUTHORITY OF THE COMMITTEE
FUNCTIONS OF THE INFECTION CONTROL TEAM
FUNCTIONS OF THE INFECTION CONTROL NURSE
5:
Sterile Field
TO MAINTAIN THE STERILE FIELD
RECOMMENDED PRECAUTIONS FOR ANTISEPTICS AND DISINFECTANTS
HIGH-LEVEL DISINFECTION (HLD)
SOME SAFE SURGICAL TECHNIQUE
ENVIRONMENT CONTROL
6:
Hand Washing
GUIDELINES IN KEEPING HANDS HYGIENIC
Objectives
PREVENTION OF INFECTION BY HAND WASHING
Staff
PROCEDURE FOR HAND WASH
THE STEPS OF ROUTINE HAND WASHING
GENERAL WARDS AND DEPARTMENTS
INTENSIVE AND SPECIAL UNITS
HIGH-RISK OPERATIONS
7:
Gloving
GLOVES AS INFECTION BARRIER
TYPES OF GLOVES
Surgical Gloves
Single-use Examination Gloves
Utility or Heavy-duty Household Gloves
General Properties
DOUBLE GLOVING
Advantages
Disadvantages
8:
Aseptic Techniques
ASEPTIC PRACTICES
MOST COMMON ASEPTIC PROCEDURES
Wounds
Fresh Wound or Incised Wound
Wounds with Minimal Contamination or Lacerated Wound
Dirt Ingrained Broken Skin or Crushed Wound
PREPARATION FOR CLINICAL PROCEDURES
METHOD OF PREPARATION OF PATIENT
Preoperative Skin Preparation
Removal of Hair
Heavily Contaminated Skin
OPERATING SITE
RECORD OF THE WOUND
PREPARATION FOR THE VAGINA, CERVIX AND OTHER MUCOUS MEMBRANES
Before Giving an Injection
TWO URINARY CATHETERS TECHNIQUE
MULTIDOSE VIALS
MAINTENANCE OF IN-USE RESPIRATORY THERAPY EQUIPMENT
Hand Washing
Fluids and Medication
Reusable Equipment
LABORATORY INVESTIGATION
PATIENTS WITH TRACHEOSTOMY
SUCTION OF RESPIRATORY TRACT
INEFFECTIVE METHODS
COLLECTION OF MIDSTREAM URINE SPECIMEN
LABORATORY SPECIMENS
All Specimens
Containers
Urine
Blood
Swabs
INTRAVENOUS INJECTION AND CANNULATION
URINARY CATHETER CARE
HEMODIALYSIS
Emergency Surgery
Routine Surgery
INSTRUMENT PROCESSING
Special Steps for Instrument Processing
Precautions
THE STEPS OF PROCESSING
Sorting and Identification
Decontamination
Cleaning
Sterilization
High-level Disinfections (HLD)
Use or Storage
STEPS OF DECONTAMINATION
Step 1
Step 2
ITEMS THAT REQUIRE SPECIAL ATTENTION
Reusable Needles and Syringes
Gloves
Linens (Caps, Gowns, Masks, and Surgical Drapes)
Storage Containers
Laparoscopes
Instruments Used During MVA
CLEANING
Importance of Detergents in Cleaning
STEPS OF CLEANING
Step 1
Step 2
Step 3
ITEMS THAT REQUIRE SPECIAL ATTENTION
Reusable Needles and Syringes
Surgical Gloves
Linens (Caps, Gowns, Masks, and Surgical Drapes)
Environmental Surfaces
Instruments Used During MVA
9:
Sterilization and Disinfection
FEATURES FOR IDEAL STERILIZATION DEPARTMENT
Methods of Sterilization
1. Steam Sterilization (Autoclaving)
Steps of Steam Sterilization
CENTRAL STERILIZATION SUPPLY DEPARTMENT FLOW CHART
AUTOCLAVE MAINTENANCE: PROPER MAINTENANCE OF AUTOCLAVE IS MUST
Some Important Points for Autoclaving
Testing Sterilizing Equipment
DRY-HEAT STERILIZATION (ELECTRIC OVEN)
Steps of Dry-heat Sterilization
Maintenance of Ovens
CHEMICAL (COLD) STERILIZATION
Formaldehyde—“Formalin”
Isopropyl Alcohol Preparation
Povidone-iodine, e.g. Chloros, Domestos
Hypochlorites, e.g. Chloros, Domestos
Formalin Disinfection
Appropriate Use of Disinfection and Antiseptics
High-efficiency Used Disinfectants
Common Disinfectant and Their Uses
Chlorhexidine “Hibitane”
Phenolics
Glutaraldehyde
Steps of Chemical Sterilization
SPECIAL CONSIDERATIONS DURING STERILIZATION
Liquids
Method for Liquid Sterilization
Surgical Gloves
Reusable Needles and Syringes
Linens (Caps, Gowns, Masks, and Surgical Drapes)
Instruments Used During MVA
HLD
Methods of HLD
Boiling
Chemical HLD
Steaming
Special Considerations During HLD
Reusable Needles and Syringes
Linens (Caps, Gowns, Masks, and Surgical Drapes)
STORAGE
Marking of Packs
Storage of Sterile Goods
Storage of Wrapped Items
CONTAMINATION OF A “CLEAN” AREA CAN BE MINIMIZED BY
Disinfection
Disinfections by Cleaning
Disinfections by Heat
Disinfection by Chemical Agents
Formalin Disinfection
Appropriate Use of Disinfectants and Antiseptics
Inappropriate Use of Disinfectants and Antiseptics
High-efficiency Use of Disinfectants
Common Disinfectants and Their Use
Chlorhexidine “Hibitane”
Phenolics
Glutaraldehyde
Formaldehyde “Formalin”
Isoprophyl Alcohol Preparation
Povidone – Iodine, e.g. Betadine
Hypochlorites, e.g. chloros, domestos
To Minimize Contamination
10:
Housekeeping
TASKS FOR HOUSEKEEPING
COMMON CLEANING SOLUTIONS
1. Plain Water and Detergent
2. Disinfectant Solution
3. Disinfectant Cleaning Solution
GENERAL PRINCIPLES OF CLEANING GENERAL AREAS
SPECIAL PROCEDURES FOR CLEANING
Cleaning Up Spills
When Cleaning up Spills
Note
CLEANING PROCEDURES FOR DIFFERENT CLINIC AREAS
Low-risk Areas (Waiting Rooms, Administrative Areas)
Showers, Sluices, Bathrooms, Urinals, Toilets
Basin/Shower Cleaning
Equipment Needed
Method
Toilet/Urinal Cleaning
Equipment Needed
Method
Patient-care Areas (Operating Theaters, Procedure Rooms, Laboratories and Critical Areas)
1. Each Morning
2. Between Patients
3. At the End of the Clinic Session or Day
PROCEDURES FOR SPECIAL CARE AREAS IE: OR/ICCU/L and D/NICU/PICU etc…)
Procedure for Cleaning
CLEANING DISCHARGE ROOM (TERMINAL CLEANING)
CLEANING OR/L AND D, ETC
General Cleaning Procedures
Daily Routine Cleaning
FREQUENCY OF CLEANING: CORRIDORS AND PUBLIC PLACES
GENERAL DAILY CLEANING ROUTINES
GENERAL WEEKLY CLEANING ROUTINES
GUIDELINES ON CLEANING PROCEDURES
Walls
Stainless Steel
Tables, Surfaces and Seating
Glass and Windows
FLOORING
Double Bucket Method
Advantages of Double Bucket Method
STRIPPING
WAXING
CARPETING
Spot Cleaning
Shampooing
Note
CLEANING PROCEDURES
Cleaning Floors
Daily Duties
Weekly Duties
Monthly Duties
Change to Duties
FREQUENCY OF CLEANING
Corridors and Public Places
General Patient Care Areas: (Wards and Clinics)
Patient High-Risk Areas
EXTRA DUTIES FOR HIGH-RISK AREAS
INFECTION CONTROL AT ICU CRITICAL CARE AREAS
INFECTIOUS DISEASE PATIENTS
Procedures
STRICT ISOLATION
Cleaning Procedure—Daily Cleaning
On Patients Discharge
Enteric Isolation
Cleaning Procedure—Daily Cleaning
Wound and Skin Isolation
Cleaning Procedure—Daily Cleaning
Protective Isolation
Cleaning Procedure
ENVIRONMENTAL INFECTION CONTROL
PEST CONTROL SUPPORTS INFECTION CONTROL
ROLE OF LAUNDRY IN INFECTION CONTROL
11:
Waste Disposal
STEPS FOR WASTE DISPOSAL
CLASSIFICATION OF HOSPITAL WASTE
Non-clinical
Special Waste
DISPOSALS COLOR CODES
1. Orange Bags
2. Yellow Sharps Box
3. Black Plastic Bag
4. Blue Plastic Bag
PROPER WASTE DISPOSAL CAN REDUCE INFECTIONS
WASTE-MANAGEMENT PLAN
1. Sorting
Sorting Sharps
Tips for Sorting Waste
Handling
Emptying Waste Containers
Interim Storage
Subdisposal and Final Disposal
Solid Medical Waste
Burning
A Drum Incinerator
When using Drum Incinerator
Burying
Transporting
SHARPS
ENVIRONMENTAL HYGIENE
Policy
General Rules
Staffing
Hospital Employees
Contract Employees
Conditions of Service
Training
Health
Uniform
Methods of Cleaning
Dust Control
Cleaning Routine
Frequencies of Cleaning
Care of Cleaning Equipment
Disposal of Waste or Infected Articles
What is contaminated waste?
Immediate Packaging of Infected Waste or Articles
NEEDLES AND OTHER SHARPS
What are “Sharps”?
Objectives
Handling Sharps
Safe Passing of Sharp Instruments
When Giving Injections
Postexposure Prophylaxis
Safe Disposal of Sharps
Sharp-disposal
Containers
Definition
Routine Operation
STERILIZATION AND DISINFECTION
Sterilization
Sterilization Procedure
Disinfection
Disinfection by Cleaning
Disinfection by Heat
Disinfection by Chemical Agents
WASTE FOR DISPOSAL
NEEDLES AND SYRINGES
12:
Operation Theater Infection Control
PROCEDURE IN STERILIZING OPERATING ROOM
1st Step
2nd Step
Daily Routine Procedure in OR
Procedure After Each Case or Operations
For Infected Cases
Objectives
SURGICAL SCRUB
Method for Surgical Scrub
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 1
Step 2
Step 3
High-volume Settings
SURGICAL GLOVES AND OTHER SURGICAL ATTIRE
Putting on Sterile Surgical Attire
If your gloves become contaminated
Steps of Putting on Sterile Gloves
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Tips for Removing Surgical Gloves
Step 1
Step 2
Step 3
Step 4
Step 5
Putting on Other Attire
Scrubsuits
Waterproof Aprons
Footwear
Masks
Gowns
13:
Employee Health
INTRODUCTION
CONTRACTING THE EMPLOYEE FOR HOSPITAL
STEPS TO FOLLOW IF NEW STAFF HAVE CURRENT INFECTIONS
Intestinal Infections and Infestation
Parasites:
Enteric Bacteria
Other Infections
DURING COURSE OF EMPLOYMENT AT THE HOSPITAL
Food Handling Staff
14:
Hospital Food Service Policy
BUILDING INFRASTRUCTURE
GENERAL PRINCIPLES IN FOOD PREPARATION
ROLE OF DOMESTIC WORKER IN FOOD SERVICE
STAFFING
Training
Health
Uniform
PREPARATION OF INFANTS MILK FEEDS
Feed Preparation Area
Milk
Water
Equipment
Staff
PREPARATION OF FEEDS
WARD
15:
Definitions for Terms Commonly Used
AIRBORNE INFECTION
ANTIBIOTIC (ANTIMICROBIAL)
ASEPTIC
AUTOGENOUS INFECTION
BARRIER NURSING
BLOOD PRECAUTIONS
CARRIER
COMMUNICABLE DISEASE
CONTACT
CONTAMINATION
CROSS INFECTION
DISINFECTANT
DISPENSER
ENDEMIC
ENDOGENOUS INFECTION
ENTERIC PRECAUTIONS
ENVIRONMENTAL INFECTION
EPIDEMIC
FOMITES
HOSPITAL INFECTION
HIGH-SECURITY INFECTION UNIT
HOST
IMMUNOSUPPRESSION
INFECTION
ISOLATION
ISOLATOR
NOSOCOMIAL INFECTION
PANDEMIC
PRECAUTIONS
PATHOGENS
PORTAL OF ENTRY
PROTECTIVE OR REVERSE ISOLATION
RESERVOIR
REVERSE ISOLATION
SAFE PROCEDURES
SELF INFECTION
SEPSIS
SOURCE
SOURCE ISOLATION
STERILIZATION
SURVEILLANCE
VECTOR
INCUBATION PERIOD
ANTIBIOSIS
ANTIBIOTICS
INDEX
TOC
Index
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