MEDICAL SURGICAL NURSING

CLASS PRESENTATION ON,

INFECTION CONTROL AND STANDARD SAFETY

MEASURES.

SUBMITTED BY SUBMITTED TO

ALMA SUSAN PROF MAYA P JOSPEH

MSC NURSING MTCON

MTCON
INTRODUCTION.

“It may seem a strange principle to enunciate as the very first requirement of a hospital that it do the
sick no harm”

(Florence Nightingale, Notes on Hospitals, 1863)

Controlling the spread of disease and minimizing the number of healthcare-associated

infections are primary concerns for any healthcare facility. There are elements in the environment of
a healthcare facility that could actually facilitate the development and spread of infectious disease.
Everything from the air in the building to the people who work there can be potential carriers of
contamination.

Due to the invasive nature of many modern medical procedures, the opportunity for unrelated
infections to develop in hospitals and other healthcare facilities is high. The number of surgeries
performed in recent decades has increased, opening patients up to infections at incision sites. There
are also a number of diagnostic instruments and other medical devices used in the treatment of
disease. It is more critical than ever for hospitals to ensure that infectious diseases do not spread.

Infection control is a scientific approach and practical solution designed to prevent harm
caused by infection to patients and health workers. It is grounded in infectious diseases,
epidemiology, social science and health system strengthening. Infection control occupies a unique
position in the field of patient safety and quality universal health coverage since it is relevant to
health workers and patients at every single health-care encounter.

Infection is the one of the leading causes of the preventable death in hospitals Every year.
The center of disease control and prevention estimated that there are approximately 2 million
preventable infections in the hospital every year, leading to 90000 unnecessary deaths.

DEFINITION OF AN INFECTION

• The entry and development or multiplication of an agent in the body of man or animals.
(Park, 2015)

• Entry of a harmful microbe into the body and its multiplication in the tissues / bloodstream.
(Wilson, 2001)

• Invasion of the body by a pathogenic microorganism

 (Bergquist and Pogosian, 2000)

• The presence of viable multiplying microorganisms in the tissues of a host, or in body cavities in
which such organisms are not usually found in normal course. The term implies the presence of a
host response (in contrast to colonization where there is no host response), which may actually be
responsible for many unwanted effect of infection

(Thomas, 2007)

•An infection the entry and multiplication of an infectious agent in tissues of host.

TYPES OF INFECTION

1. Generalized or systemic infection

2. Localized infection

CHAIN OF INFECTION.

Transmission occurs when the agent leaves its reservoir or host through a portal of exit, is
conveyed by some mode of transmission, and enters through an appropriate portal of entry to
infect a susceptible host.
Causative Agent Microorganisms Infectious agent

Microorganisms (bacteria, viruses, fungus, parasite)

• Resident:- normally reside on the skin in stable numbers

• Transient:- attach loosely to the skin by contact with another easily removed by hand washing.

Reservoir

The reservoir of an infectious agent is the habitat in which the agent normally lives, grows,
and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may
not be the source from which an agent is transferred to a host.

A reservoir is defined as “any person, animal, arthropod, plant, soil or substance (or combination of
these) in which as infectious agent lives and multiplies, on which it depends primary for survival and
where it reproduces itself in such manner that it can be transmitted to a susceptible host.”

Three types of reservoir are;

1) Human reservoir

Many common infectious diseases have human reservoirs. Diseases that are transmitted from
person to person without intermediaries include the sexually transmitted diseases, measles, mumps,
streptococcal infection, and many respiratory pathogens. Because humans were the only reservoir for
the smallpox virus, naturally occurring smallpox was eradicated after the last human case was
identified and isolated.

Human reservoirs may or may not show the effects of illness. As noted earlier, a carrier is a
person with in apparent infection who is capable of transmitting the pathogen to others.
Asymptomatic or passive or healthy carriers are those who never experience symptoms despite being
infected. Incubatory carriers are those who can transmit the agent during the incubation period before
clinical illness begins. Convalescent carriers are those who have recovered from their illness but
remain capable of transmitting to others. Chronic carriers are those who continue to harbor a
pathogen such as hepatitis B virus or Salmonella Typhi, the causative agent of typhoid fever, for
months or even years after their initial infection. One notorious carrier is Mary Mallon, or Typhoid
Mary, who was an asymptomatic chronic carrier of Salmonella Typhi. As a cook in New York City
and New Jersey in the early 1900s, she unintentionally infected dozens of people until she was
placed in isolation on an island in the East River, where she died 23 years later.
2) Animal reservoir

Humans are also subject to diseases that have animal reservoirs. Many of these diseases are
transmitted from animal to animal, with humans as incidental hosts. The term zoonosis refers to an
infectious disease that is transmissible under natural conditions from vertebrate animals to humans.
Long recognized zoonotic diseases include brucellosis (cows and pigs), anthrax (sheep), plague
(rodents), trichinellosis/trichinosis (swine), tularemia (rabbits), and rabies (bats, raccoons, dogs, and
other mammals). Zoonoses newly emergent in North America include West Nile encephalitis (birds),
and monkeypox (prairie dogs). Many newly recognized infectious diseases in humans, including
HIV/AIDS, Ebola infection and SARS, are thought to have emerged from animal hosts, although
those hosts have not yet been identified.

3) Reservoir in non-living things

Plants, soil, and water in the environment are also reservoirs for some infectious agents.
Many fungal agents, such as those that cause histoplasmosis, live and multiply in the soil. Outbreaks
of Legionnaires disease are often traced to water supplies in cooling towers and evaporative
condensers, reservoirs for the causative organism Legionella pneumophila.

Portal of Exit

As part of the chain of infection, the path by which the causative agent gets out of the
reservoir. In a person, this is often by a body fluid (Park, 2015).

Portal of exit is the path by which a pathogen leaves its host. The portal of exit usually corresponds
to the site where the pathogen is localized. For example, influenza viruses and Mycobacterium
tuberculosis exit the respiratory tract, schistosomes through urine, cholera vibrios in feces, Sarcoptes
scabiei in scabies skin lesions, and enterovirus 70, a cause of hemorrhagic conjunctivitis, in
conjunctival secretions. Some bloodborne agents can exit by crossing the placenta from mother to
fetus (rubella, syphilis, toxoplasmosis), while others exit through cuts or needles in the skin (hepatitis
B) or blood-sucking arthropods (malaria).

Mode of Transmission

Communicable diseases may be transmitted from the reservoir or source of infection to a

susceptible individual in many different ways, depending upon the infectious agent, portal of entry
and the local ecological conditions (Park, 2015). 
An infectious agent may be transmitted from its natural reservoir to a susceptible host in different
ways. There are different classifications for modes of transmission. Here is one classification:

 Direct

o Direct contact

o Droplet spread

 Indirect

o Airborne

o Vehicle borne

o Vector borne (mechanical or biologic)

In direct transmission, an infectious agent is transferred from a reservoir to a susceptible host by

direct contact or droplet spread.

Direct contact occurs through skin-to-skin contact, kissing, and sexual intercourse. Direct contact
also refers to contact with soil or vegetation harboring infectious organisms. Thus, infectious
mononucleosis (“kissing disease”) and gonorrhea are spread from person to person by direct contact.
Hookworm is spread by direct contact with contaminated soil.

Droplet spread refers to spray with relatively large, short-range aerosols produced by sneezing,
coughing, or even talking. Droplet spread is classified as direct because transmission is by direct
spray over a few feet, before the droplets fall to the ground. Pertussis and meningococcal infection
are examples of diseases transmitted from an infectious patient to a susceptible host by droplet
spread.

Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by

suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

Airborne transmission occurs when infectious agents are carried by dust or droplet nuclei
suspended in air. Airborne dust includes material that has settled on surfaces and become
resuspended by air currents as well as infectious particles blown from the soil by the wind. Droplet
nuclei are dried residue of less than 5 microns in size. In contrast to droplets that fall to the ground
within a few feet, droplet nuclei may remain suspended in the air for long periods of time and may be
blown over great distances. Measles, for example, has occurred in children who came into a
physician’s office after a child with measles had left, because the measles virus remained suspended
in the air.

Vehicles that may indirectly transmit an infectious agent include food, water, biologic products
(blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels). A
vehicle may passively carry a pathogen — as food or water may carry hepatitis A virus.
Alternatively, the vehicle may provide an environment in which the agent grows, multiplies, or
produces toxin — as improperly canned foods provide an environment that supports production of
botulinum toxin by Clostridium botulinum.

Vectors such as mosquitoes, fleas, and ticks may carry an infectious agent through purely
mechanical means or may support growth or changes in the agent. Examples of mechanical
transmission are flies carrying Shigella on their appendages and fleas carrying Yersinia pestis, the
causative agent of plague, in their gut. In contrast, in biologic transmission, the causative agent of
malaria or guinea worm disease undergoes maturation in an intermediate host before it can be
transmitted to humans.

Portal of Entry:

The portal of entry refers to the manner in which a pathogen enters a susceptible host. The
portal of entry must provide access to tissues in which the pathogen can multiply or a toxin can act.
Often, infectious agents use the same portal to enter a new host that they used to exit the source host.
For example, influenza virus exits the respiratory tract of the source host and enters the respiratory
tract of the new host. In contrast, many pathogens that cause gastroenteritis follow a so-called “fecal-
oral” route because they exit the source host in feces, are carried on inadequately washed hands to a
vehicle such as food, water, or utensil, and enter a new host through the mouth. Other portals of entry
include the skin (hookworm), mucous membranes (syphilis), and blood (hepatitis B, human
immunodeficiency virus).

• As part of the chain of infection, the path by which the causative agent gets into a susceptible host.

• Nose, mouth, eyes, rectum, genitals and other mucous membranes, cuts, abrasions or breaks in the
skin

Susceptible Host
 Susceptibility of a host depends on genetic or constitutional factors, specific immunity, and
nonspecific factors that affect an individual’s ability to resist infection or to limit pathogenicity. An
individual’s genetic makeup may either increase or decrease susceptibility. For example, persons
with sickle cell trait seem to be at least partially protected from a particular type of malaria. Specific
immunity refers to protective antibodies that are directed against a specific agent. Such antibodies
may develop in response to infection, vaccine, or toxoid (toxin that has been deactivated but retains
its capacity to stimulate production of toxin antibodies) or may be acquired by transplacental transfer
from mother to fetus or by injection of antitoxin or immune globulin. Nonspecific factors that defend
against infection include the skin, mucous membranes, gastric acidity, cilia in the respiratory tract,
the cough reflex, and nonspecific immune response. Factors that may increase susceptibility to
infection by disrupting host defenses include malnutrition, alcoholism, and disease or therapy that
impairs the nonspecific immune response.

• Anyone whose resistance to disease decreases

• Reasons for lowered resistance: age, existing illnesses, fatigue and stress.

STAGES OF INFECTIOUS DISEASE:

INCUBATION;

Time from entrance of pathogen into the body to appearance of first symptoms; during this
time pathogens grow and multiply.

PRODROME:

Time from onset of nonspecific symptoms such as fever, malaise, and fatigue to move
specific symptoms. Person is more infectious and this stage lasts from several hours to days. A
patient often does not realize that he/ she is contagious as a result infection spreads.

FULL STAGE OF ILLNESS:

Time during which patient demonstrates signs and symptoms specific to an infection type

CONVALESCENCE:

Time when acute symptoms of illness disappear. It is the recovery period from the infection.

TYPES OF INFECTION
1. Community Acquired

2. Hospital Acquired

a. Nosocomial Infection

b. Opportunistic Infection

c. Iatrogenic Infection

d. Cross Infection

COMMUNITY ACQUIRED INFECTIONS.

Community Acquired An infection contracted outside of a health care setting or an infection

present on admission. Community acquired infections are often distinguished from nosocomial by
the types of organisms (Medical Dictionary, 2009).

Prevention Modalities

• Primordial Prevention: inhibit the emergence of risk factors

• Primary Prevention: the action taken prior to the onset of disease

• Secondary Prevention: action which halts the progress of a disease at its incipient stage and
prevents complications

• Tertiary Prevention: prevention are disability limitation, and rehabilitation

HOSPITAL-ACQUIRED INFECTION (HAI)

Hospital-acquired infection (HAI) is an infection that is contracted from the environment or

staff of a healthcare facility. Infection is spread to the susceptible patient in the clinical setting by a
number of means; health care staff, contaminated equipment, bed linens, or air droplets

(CDC, 2014)

• Exogenous:– from an outside source, staff, other patients, environment, equipment (Iatrogenic,
Nosocomial Infection)

• Endogenous:– self infection from the patient (Oppotunistic Infection)

Nosocomial Infections
  Nosocomial infection is an infection originated in a patient while in a hospital or other health
care facility. It denotes a new disorder associated with being in hospital. (Park, 2015).
 An infection occurring in a hospitalized patient, 72 hours or more after admission. Also
includes infections directly related to a previous hospitalization (Capital Health, 2010).
 At least 5% of hospitalized patients each year in the U.S. develop nosocomial infections
many are preventable (CDC, 2014a).
 About 5.6 million HCWs and related occupations are at risk of occupational exposure to
bloodborne pathogens, including HIV, HBV, HCV, and others (OSHA, 2014).

Iatrogenic Infection

Iatrogenic Infection resulting from the activity of a health care provider or institution or said
of any adverse condition in a patient resulting from treatment by a physician, nurse, allied health
professional or medical instruments and procedures (Park, 2015).

Opportunistic infection

Infection by an organism that does not ordinarily cause disease but becomes pathogenic
under certain circumstances, as when the patient is immunocompromised. An infection caused by
normally nonpathogenic organisms in a host whose resistance has been decreased (Perry, and Potter,
2007).

Cross Infection

Cross infection transmitted between one patient to another patients infected with different
pathogenic microorganisms (Perry, and Potter, 2007).

INFECTION PREVENTION

Measures practiced by healthcare personnel intended to prevent spread, transmission and

acquisition of infection between clients, health care professional to the client, from instrument, and
client to health care worker in the healthcare setting (Park, 2015).

Largely depends on placing barriers between a susceptible host (person lacking effective natural
or acquired protection) and the microorganisms. Protective barriers are physical, mechanical or
chemical processes that help prevent the spread of infectious microorganisms from (CDC, 2007).
FUNDAMENTAL PRINCIPLES OF INFECTION PREVENTION (CDC GUIDELINE 1996)

Guideline of infection prevention develop on 1996 and revised in 2007

1. Standard Precaution

2. Transmission Based Precaution

STANDARD PRECAUTION

Standard precautions used in health care of all hospitalized individuals regardless of their
diagnosis or possible infection status. These precautions apply to blood, all body fluids, secretions,
and excretions, except sweat, nonintact skin, and mucus membranes.

Definitions of Standard Precautions

• Placing a physical, mechanical or chemical barrier between microorganisms and an individual

• Consider every person (patient or staff) as potentially infectious and susceptible to infection.
• Wash hands the most important procedure for preventing cross- contamination (person to person or
contaminated object to person), (OSHA, 2011a.).

Standard Precautions

I. Hand Hygiene
II. Personal Protective Equipment
III. Respiratory Hygiene
IV. Safe Injection Practice
V. Cleaning and Disinfections
VI. Safe Handling Sharp
VII. Waste Management
VIII. Linen or Laundry Management
IX. Spill Management
X. Pre and Post Prophylaxis
XI. Immunization

Hand Hygiene

• Hand washing is the most important way to reduce the spread of infections in health care setting.

• Reduces the number of infectious microorganisms on hands

• Reduces client sickness and death caused by infections (Perry, and Potter, 2007). 

Three Kind of Hand Washing

Type 1 (with soap and running water) It removes transient microorganism and soil.

Type 2( with antiseptic and running water) it removes transient microorganism and soil, kills or
inhibits resident microorganism and appropriate before invasive procedures

Type 3 ( alcohol handrub) it helps to kill or inhibit the transient and resident microorganism, but does
not remove microorganism and soil (Perry, and Potter, 2007).

STEPS OF HAND WASHING.

Personal Protective Equipment:

Face mask / eye protection: protect mucous membranes of the eyes, nose and mouth during
procedures

Gloves: Touching mucous membrane and non- intact skin and performing sterile procedures

Gown: Prevent soiling of clothing and skin during procedures that are likely to generate splashes of
blood, body fluids, secretions or excretions

Footwear: if exposure to blood and body fluids occur.

HOW TO WEAR PPE.

HOW TO REMOVE PPE

RESPIRATORY HYGIENE

Respiratory hygiene is a relatively new concept introduced after the SARS outbreak in 2003,
comprising vigilance and prompt implementation of infection control measures at the first point of
encounter within a healthcare setting. It is directed to patients and family members with signs of
respiratory illness such as cough, congestion, or increased respiratory secretion (CDC, 2007)

• Education regarding how respiratory illnesses spread and prevention practices including “cover
your cough”

• Availability and use of tissues and hand hygiene products

• Use of mask for person who is coughing

• Spatial separation of the person with a respiratory illness

• At least 1 metre (3 feet) away from others in common waiting areas (WHO, 2007)

S
AFE INJECTION PRACTICE

• Safe injection practices are intended to prevent transmission of infectious diseases between
individuals and to prevent injuries such as needle sticks

• In developing countries 16 thousand million injections used each year. 90%, for therapeutic
purposes while 5 to 10% are given for preventive services, including immunization and family
planning (WHO, 2014).
CDC Recommendations

The following recommendations apply to the use of needles, cannulas that replace needles, and,
where applicable intravenous delivery systems

1. Use aseptic technique to avoid contamination of sterile injection equipment

2. Do not administer medications from a syringe to multiple patients, even if the needle or
cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use
items; they should not be reused for another patient nor to access a medication or solution
that might be used for a subsequent patient
3. Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for
one patient only and dispose appropriately after use. Consider a syringe or needle/cannula
contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag
or administration set
4. Use single-dose vials for parenteral medications whenever possible
5. Do not administer medications from single-dose vials or ampules to multiple patients or
combine leftover contents for later use
6. If multidose vials must be used, both the needle or cannula and syringe used to access the
multidose vial must be sterile
7. Do not keep multidose vials in the immediate patient treatment area and store in accordance
with the manufacturer’s recommendations; discard if sterility is compromised or questionable
8. Do not use bags or bottles of intravenous solution as a common source of supply for multiple
patients
9. Infection control practices for special lumbar puncture procedures Wear a surgical mask
when placing a catheter or injecting material into the spinal canal or subdural space

CLEANING AND DISINFECTION.

Cleaning with warm water and detergent is a process that removes visual dirt and
contamination and in most cases is effective for decontaminating both equipment and the
environment.

Disinfectants are antimicrobial agents designed to inactivate or destroy

microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms,
especially resistant bacterial spores; it is less effective than sterilization, which is an extreme
physical and/or chemical process that kills all types of life. Disinfection is a process that reduces the
number of microorganisms to a level at which they do not present a risk to patients or clients.

Sterilization is the process by which all microorganisms including spores are

destroyed. The use of a physical, radiation or chemical process to destroy all microbial life, including
highly resistant bacterial spores.

Disinfection and sterilization are essential for ensuring that medical and surgical instruments do not
transmit infectious pathogens to patients. Because sterilization of all patient-care items is not
necessary, health-care policies must identify, primarily on the basis of the items’ intended use,
whether cleaning, disinfection, or sterilization is indicated.

SAFE HANDLING OF SHARP

A hypodermic needle, suture needle, blade, scissors, forceps can be a potentially

lethal instrument. Vein puncture for example, is one of the most dangerous procedures a health care
worker can perform if it results in a needle prick injury.

Preventing Sharps Injuries

• Preparation: – Assemble all equipment required for the procedure. – Minimize distractions.

• Equipment: – Equipment should be used strictly according to protocols and only for the purpose for
which it was designed. – Choose the safest equipment.

Technique:

– Perform the procedure slowly and carefully

– Minimize the handling of sharp instruments. The less they are handled the less chances of needle
prick injuries occurring

– The needle must be properly recapped; the sheath must not be held in the fingers; either a single-
handed technique, forceps or a suitable protective guard designed for the purpose, must be used if
needed. 

– Each health care worker who uses sharp instruments is responsible for their management and
disposal

– Dispose of all the sharp instruments used during the procedure immediately, carefully and
appropriately

– The sharps container never be overfilled and dispose after ¾ filled up the container.

– The sharp container must be securely sealed with a lid before disposal. Use utility glove during
disposing the sharps. 

WASTE MANAGEMENT

• Hospital waste is “Any waste which is generated in the diagnosis, treatment or immunization of
human beings or animals or in research” in a hospital.

• Hospital waste is a potential reservoir of pathogenic micro organisms and requires appropriate safe

Steps in the management of hospital waste :

Generation

Segregation/separation
Collection

Transportation

Storage

Treatment

Final disposal (WHO, 2007)

LINEN AND LAUNDRY MANAGEMENT

• Although soiled linen may harbor large numbers of pathogenic microorganisms, the risk of actual
disease transmission from soiled linen is negligible.
• Dirty linen often contains a significant number of microbes (104–108 bacteria per 100 cm2 of
soiled bed sheets), mostly Gram-negative rods and bacilli (Blaser, et al. 1984).

Soiled Linen and Laundry

• All soiled linen should be bagged or placed in containers at the location where it was used and
should not be sorted or rinsed in the location of use.

• Linen heavily contaminated with blood or other body fluids should be bagged and transported in a
manner that will prevent leakage.

• Soiled linen is generally sorted in the laundry before washing.

• Gloves and other appropriate protective apparel should be worn by laundry personnel while sorting
soiled linen.

Management of the Clean Linen

Storing Clean Linen

• Keep clean linen in clean, closed storage areas.

• Use physical barriers to separate folding and storage rooms from soiled areas.

• Keep shelves clean.

• Handle stored linen as little as possible. 

Transportation of Clean Linen

• Clean and soiled linen should be transported separately.

• Containers or carts used to transport soiled linen should be thoroughly cleaned before used to
transport clean linen.

• Clean linen must be wrapped or covered during transport to avoid contamination

Distribution of Clean Linen

• Protect clean linen until it is distributed for use.

• Do not leave extra linen in patients’ rooms.

• Handle clean linen as little as possible.

• Avoid shaking clean linen, it releases dust and lint into the room.

• Clean soiled mattresses before putting clean linen on them.

SPILL MANAGEMENT.

Spillages should be dealt with as quickly as possible. All laboratories (research, diagnostic, or other)
working with potential pathogens must have a written plan for dealing with spills or other releases of
such materials. All work locations where employees may be reasonably anticipated to come into
contact with blood or other potentially infectious material must have equipment available to safely
and effectively clean up these spills.

The basic principles of blood and body fluid/substance spills management are:

 standard precautions apply, including use of personal protective equipment (PPE), as

applicable

 spills should be cleared up before the area is cleaned (adding cleaning liquids to spills
increases the size of the spill and should be avoided)

 generation of aerosols from spilled material should be avoided.

Materials required

• Spill kits specifically designed for the clean up and decontamination of biological spills in
laboratories are commercially available. These kits contain items such as autoclave bag, latex gloves,
gloves for handling broken glass, dustpan/brush, shoe covers, disposable lab coat, paper towels,
disinfectant, safety glasses and ready made solutions to clean and decontaminate the spill.

SPILL MANAGEMENT

MINOR SPILLS Small volumes (few drops) of Spills

1. Wear workman’s gloves and other PPE appropriate to the task.

2. When sharps are involved use forceps to pick up sharps, and discard these items in a
puncture-resistant container.

3. Cover the spill with a newspaper, blotting paper / paper towel or dry mud.
 4. Wipe the spill with a newspaper moistened with hypochlorite solution (1% dilution
containing minimum 500ppm chlorine). Discard the paper as infected waste. Repeat until all
visible soiling is removed.

5. Wipe the area with a cloth mop moistened with 1% hypochlorite solution and allow drying
naturally.

6. All contaminated items used in the clean-up should be placed in a bio-hazardous bag for
disposal.

MAJOR SPILLS Large volumes (>10 ml) of Spills

1. Confine contaminated area

2. Wear workman’s gloves and other PPE appropriate to the task

3. Cover the spill with newspaper or appropriate absorbent material to prevent from spreading

4. Flood the spill with 10% hypochlorite solution. While flooding the spill with 10%
hypochlorite solution it is to be ensured that both the spill and absorbent material is
thoroughly wet

5. Alternatively, chlorine granules can be sprinkled on the spill first and then the paper put over
it

6. Wait for five minutes.

7. Remove and discard the paper as infected waste

8. Wipe the area with paper moistened with 10% hypochlorite again if required until all visible
soiling is cleaned

9. Wipe the area once with 10% hypochlorite and a cloth mop and allow drying naturally

10. All contaminated items used in the clean-up should be placed in a bio-hazardous bag for
disposal.

POST EXPOSURE PROPHYLAXIS

• Post exposure prophylaxis is intended to protect the health care workers from different infection
which could be acquired while performing medical procedures (e.g. needle stick injury, blood splash
on mucosa, blood and body fluid)

• Expose with HIV cases -PEP should be started as soon as possible within72 hours the course will
be for 28 days. 
IMMUNIZATION

• Health care workers may be exposed to certain infections in the course of their work.

• Vaccines are available to provide some protection to workers in a healthcare setting.

• Before exposure, first responders (health personnel) may receive vaccinations for different
diseases, e.g. hepatitis B, influenza, measles, mumps, rubella, tetanus, diphtheria and pertussis

TRANSMISSION BASED PRECAUTION

I. Contact precautions
II. Droplet precautions
III. Airborne precautions (CDC, 2007, Gardner, 1996 and Siegel et al., 2007). (Including
standard precautions)
IV. Isolation Precautions (CDC, 2007)

Isolation

• Isolation refers to various measures taken to prevent contagious diseases from being spread from a
patient to other patients, health care workers, and visitors, or from others to a particular patient.

• Isolation is most commonly used when a patient has a viral illness (CDC, 2007).

Types of Isolation CDC (Centers for Disease Control and prevention) isolation precaution. It
includes;

• Category specific Isolation precaution

 Strict isolation: - It includes strict hand washing, private room, gown, mask, proper disposal
of contaminated items.
 Contact isolation: - It includes private room, gown, mask as needed, gloves, proper disposal
of contaminated items and hand washing.
 Respiratory isolation: - It concludes private room, mask, gown and gloves as needed, proper
disposal of contaminated articles. 

• Disease specific Isolation precaution

 Tuberculosis isolation:- Same as respiratory isolation. It also includes cleaning and

disinfecting the articles.
 Enteric precaution:- It is maintained through private room if hygiene is poor, gown and
gloves as needed, hand washing, disposal of contaminated articles. Same as strict isolation.
 Drainage/Secretion precaution:- It concludes gown and gloves as necessary, hand washing,
disposal of contaminated articles. Same as enteric/strict isolation. 
• Universal blood and body fluid precaution 

 Blood and body fluid precaution:- Same as secretion precaution in puncture proof container
for disposal.
 Reverse Isolation (Protective Isolation):- Is used to prevent contact between potentially
pathogenic organisms and uninfected person who have seriously impaired resistance (CDC,
2007)

SAFETY.

Definition of safety

“The condition of being safe from undergoing or causing hurt, injury, or loss. ‘The avoidance,
prevention and amelioration of adverse outcomes or injuries stemming from the process of
healthcare.”

(Vincent, 2010)

• S - Sense the error

• A - Act to prevent it

• F - Follow the safety guideline

• E - Enquire into accidents and death

• T - Take appropriate remedial measures

• Y - Your responsibility

Safety Measures:

Definition

 “Safety measures is a discipline in the health care sector that applies safety science methods
toward the goal of achieving a trustworthy system of health care delivery. Patient and HCWs
safety is also an attribute of health care systems, it minimizes the incidence and impact and
maximizes recovery from, hazardous and adverse events”
(Emanuel et al., 2008) .
 “The World Health Organization (WHO) Conceptual Framework for the International
Classification for Patient Safety (ICPS) activities or measures taken by an individual or a
 health care organization to prevent, remedy or mitigate the occurrence or reoccurrence of a
real or potential (patient) safety event”

(WHO, World Alliance for Patient Safety 2009)

Safety Issue

• Adverse Health Care Event: event arise from care

• Error: Failure to complete the plan

• Health Care Near Miss: failure to prevent injury and compensating

• Adverse Drug Reaction: noxious drug

• Medication Error: inappropriate medication, harm during medication

• Sentinel Error: surgery wrong body part, wrong patient patient receive wrong medication.

Safety measure
ICU INFECCTION CONTROL PROTOCOLS.

According to the IHI A "bundle" is a group of evidence-based care components for a given disease
that, when executed together, may result in better outcomes than if implemented individually.

-Institute for Health Care Improvement (IHI)

ROLE OF NURSE

Nurses as primary caregivers can intervene in and positively affect a patients

outcome. By assessing the person at risk, selecting appropriate nursing diagnosis, planning, and
intervening to maintain a safe environment, the nurse can reduce a patients potential for developing
an infection.

• Participating in the infection control committee

• Promoting the development and improvement of nursing techniques,

• Ongoing review of IP and safety measures nursing policies

• Developing training programs for members of the nursing staff

• Supervising the implementation of techniques for the prevention of infections and practice in
specialized areas

• Monitoring of nursing adherence to policies.  

• Monitoring aseptic techniques, including hand- washing and use of isolation

• Reporting promptly to the attending physician any evidence of infection in patients under the
nurse’s care

• Initiating patient isolation and ordering culture specimens

• Limiting exposure to infections, hazard and risk

• Maintaining a safe and adequate supply of ward equipment, drugs and patient care supplies. 

• Identifying nosocomial infections, type of infection and infecting organism

• Participating in training of personnel

• Surveillance of hospital infections

• Participating in outbreak investigation

• Ensuring compliance with local and national regulations

CONCLUSION.

Infection control is a scientific approach and practical solution designed to prevent

harm caused by infection to patients and health workers. It is grounded in infectious diseases,
epidemiology, social science and health system strengthening. Infection control occupies a unique
position in the field of patient safety and quality universal health coverage since it is relevant to
health workers and patients at every single health-care encounter.

Controlling the spread of disease and minimizing the number of healthcare-

associated infections are primary concerns for any healthcare facility. There are elements in the
environment of a healthcare facility that could actually facilitate the development and spread of
infectious disease.

BIBLIOGRAPHY.

 Taylor et al, fundamentals of nursing, 7th edition, LWW publications, 653-695

 Aiello, A.E., Coulborn, R.M., Perez, V., and Larson, E.L. (2008). Effect of Hand Hygiene on
Infectious Disease Risk in the Community Setting: A Meta-Analysis. Am J Public Health.
8(8): 1372–1381
 Infection control: A problem for patient safety. The New England Journal of Medicine, 348,
p. 651-656.
 Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations
of the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)
(Rep. No. MMWR 2003; 52 (No. RR-10)).
 https://vikaspedia.in/health/sanitation-and-
hygiene/swachhta_abhiyaan_guidelines/management-of-spills-body-fluid-chemicals-mercury
 https://www.niinfectioncontrolmanual.net/cleaning-disinfection
 https://www.cdc.gov/infectioncontrol/guidelines/disinfection/cleaning.html