Presented by

Dr. Ramkishor
Pandey
What is Safety?
The condition of being protected from or
unlikely to cause danger, risk, or injury.
“Safety means first aid to the uninjured”
Why safety?
DANGEROUS ULTRA-SAFE
(>1/1000) (<1/100K)
1,00,000 HealthCare
Driving
Total lives lost per year

10,000

1,000
Scheduled
Airlines
100
Mountain Chemical European
10
Climbing Manufacturing Railroads
Bungee Chartered Nuclear
Jumping Flights Power
1
1 10 100 1,000 10,000 1,00,000 10,00,000 1,00,00,000

Number of encounters for each fatality

 When you should have safety
committee in your hospital?
OPTIONS:
1. According to policy and procedures?
2. When some safety problems arises?
3. After commissioning of hospital?
4. None of the above?

ANSWER: BEFORE COMMISSIONING OF THE HOSPITAL

 What are different safety hazards?
 Fire safety  Burglary- vehicles and facilities
 Electric safety  Kidnapping
 Infant abduction  Bomb threats and bombing
 Bio-medical hazard  Malicious destruction of property
 Assaults  Civil disobedience and disturbances
 on patients  strikes
 On employees  Terror attacks
 And visitors  Patient elopment
 Pilferage  Infection
 Homicide  Radiation hazard
 Accidents  Chemical hazard
 Safety Committee Team
• Chairman – Medical Superintendent / Director
Administration / Chief Operating Officer.
Members :-
• All Heads of Clinical & Administrative Departments.
• Chief Nursing Officer or equivalent
• Head of Biomedical Engineering Department or
representative.
• Head of Maintenance Department or representative.
• Head of Security
• Co-opted Members on as & when required basis.
 Composition: Hospital Safety
Committee
 Safety Officer  Home Health personnel

 HOD Biomedical  Patient Safety Officer

Engineering  Information Technology
 Laboratory HOD  Patient Accounts
 Nursing Supervision  Accounting personnel
 Maintenance HOD
 Environmental Services
 Nursing General personnel
 Occupational Health HOD  Staff Education Head
 Long Term Care Nursing
 Human Resources HOD
personnel
 Infection Control/Quality
Manager
Role of Safety Committee
 The Safety Committee has the following roles to
perform:
 Dedication and follow their
responsibilities.
1. Preparation of the Safety Manual
2. Monitoring of all Safety Activities
3. Evaluating all Safety Breaches & Accidents.
4. Implementing Corrective & Preventive Actions.
5. Training of employees & evaluating the effects of Training
on the overall safety environment of the hospital.
6. Conduct facility inspection rounds
7. Strict monitoring & reporting of adverse / sentinel
events.
8. The committee should meet once in a quarter &
whenever there are serious incidences related to
Security aspects.
9. The minutes of the meeting should be recorded
regularly & all action taken reports must be
documented.
10. Conduct mock drills
11. Root cause analysis
 Hospital Infection Control
Committee
Blood Transfusion Quality Committee
Committee

Safety Committee
Bioethics
Medical Records Committee
Committee

Waste Management Pharmacy & Therapeutic

Committee Committee

Coordination
 The safety manual should contain?
 Safety policy  Fire safety
 Safety objectives  Disaster management plans
 Top management  Bio medical equipment
responsibilities management
 Safety officer  Radiological safety
 Departmental head’s  Laboratory safety
responsibilities  Hazardous materials safety
 Patient safety  Adverse and sentinel event
 Electrical safety analysis
 Radiation Safety
 Warning signage
 Radioactive materials
handling, storage, and spillage
 Staff and patient safety
 Dosimeters
 Training
 Daily monitoring of
radioactive sources leakage
 Written procedures
Fire Safety and Security
 Properly sign posted
 Emergency no to call
 Equipments in good work
condition
 Fire exists
 Staff awareness and training
 Fire safety code – Red
Biological Safety
 Hand hygiene
 Antibiotic policy
 Swab reports
 Infection risks identified and
proper notices in place
 Using protective equipments
like gloves, mask, goggles.
Gown etc.
 Reporting and recording of
sentinel events.
Electrical safety
 Cords/plugs safe, not frayed
or broken
 Any cords present a tripping
hazard by running across
floors
 Power points overloaded
(No double adapters in use)
 Electrical equipment been
tested
Chemical and Drug Safety Biomedical hazards waste
 Written procedures for
 All chemical containers clearly
handling and disposing of waste
labelled
are in place
 Similar looking/sounding drugs
 Staff are aware of procedures
colour coded
 Appropriate waste containers
 Dangerous or harmful substances
are provided
stored appropriately
 Containers labelled
 Necessary protective equipment
appropriately
available and used
 Waste is segregated and stored
 Emergency spill procedures
appropriately away from drains
displayed
 Spill kits are available
 Medical Gases stored securely
and safety signs displayed  Waste is recycled where
possible
 Records of waste are kept
 Case studies
 A fire broke out at Annapurna Hospital at Dwarkanagar on
Monday, May 2011. The smoke that spread to all the floors of the
building. Reason: Negligence of Hospital maintenance
committee.
 Mumbai: Mother flung baby girl out of hospital window
The pediatric ward of KEM hospital in Parel, Mumbai became the
scene of a horrific crime when 26-year-old Deepika Parmar tried
to get rid of her infant daughter by throwing her out of window of
a toilet and then claiming that she had been stolen.
 Andra baby stolen, allegedly by burqa-clad woman.
 Problems with safety committee?
 Communication problems with the safety committee
members
 Ego
 Not attending the committee meetings by the members
 Insufficient funds
 Not knowing about the new technologies in the market,
which are related to safety and security.
 Training and education
 Updating of policies
 References?
 Minnesota hospital safety committee. www.mnhosptial.org
 Supportive Services Book – G.D Kunders Hospital planning
 www.hosptialsafetycenter.com
 Hindu paper
Infection control committee
Hospital acquired infections
(Nosocomial infection)
 An infection occurring in a patient in hospital or other health
care facility in whom the infection was not present or
incubating at the time of admission.
 An infection occurring as a result of treatment in a hospital,
but secondary to patients original condition.
 First appears 48 hours or more after hospital admission or
within 30 days after discharge.
 Common sites
 Urinary tract
 Surgical wounds
 Respiratory tract
 Skin
 Blood
 Gastrointestinal tract
 Central nervous system
Hospital based infections in west
Multicenter study
123 hospital, 38439 patients

Ward Prevalence

 General Medical ward 9.5%

 General surgical ward 9.9%
 Intensive care Units 26.1%
 Hospital based infections in USA
Incidence
NNIS (USA) - 3-5% of all
hospital admissions

 Urinary 40-45%
 Respiratory 15-20%
 Surgical wound 25-30%
 bacteremia from 5-7%
vascular devices
 Cost of infection
 Prolonged stay in hospital

 Additional resources

 Loss of man-hours - doctors and patients

 Mental agony

 Poor surgical results

Incidence of Surgical Infections

40
35
30
25
20
15
10
5
0
Clean Clean Contaminated Dirty
Contaminated

west our
Prevention and control

 Basic responsibility of any good hospital remain with

establishment of good infection control policies , which can
be achieved by
 An infection control committee
 An infection control team
 INFECTION CONTROL PROGRAM
 The important components are
1) Basic measures i.e. standard and additional
precautions
2) Education and training of healthcare workers
3) Protection of healthcare workers e.g.
immunization
4) Identification of hazards and minimizing risks
5) Routine practices such as aseptic techniques,
handling and use of blood and blood products,
waste management, use of single use devices
6) Surveillance
7) Incident monitoring
8) Research
 GOAL
 To reduce nosocomial infections to a minimum

 To provide a safe environment for our hospital

patients, employees and visitors through
prevention, control and surveillance.

 Identification of hospital and community

acquired infections
 Infection control team
•Will function under the guidance of infection control officer.
 Functions
(a) Regular collection of data from wards, periodic analysis of data
to detect the incidence of HAI and recognition of any out-break of
infection.
(b) Microbiological sampling of affected areas e.g. ward, O.T., linen,
air.
(c) Determine the factors involved in the occurrence and spread of
infection.
(d) Random quality control sampling for bacteriology investigations
by swabs taken from sterile instruments, linen etc. in OT, CSSD,
labor room.
(e) Follow up of discharged patients.
(f) Educate hospital staff about hospital infections.
 Infection control committee
 Should meet regularly to formulate and update policies for the
whole hospital on all matter which have bearing on infection
control and to mange outbreaks of nosocomial infection.
 Functions:
• To do surveillance and infection monitoring of hygiene practices.
• Educate the medical and paramedical staff
in infection prevention and safe procedures.
• Identify areas for intervention
• Safety management.
Members of ICC

 Hospital Administrator

 Representative from Nursing Dept.

 Hospital Physicians

 Clinical Microbiologists

 Pharmacist

 Representative from CSSD

 Representative from Maintenance

 Representative from Housekeeping

 Representative from Training dept.

 Infection control officer
 He/she is the secretary of the ICC.
 Microbiologist seems to be most suitable.
 Works in association with a group of hospital staff including
physicians, surgeon, nursing and administrative staff.
 Role of the microbiologist

1. Developing guidelines for appropriate collection, transport, &

handling of specimens.
2. Ensuring standardization of laboratory practices
3. Ensuring safe laboratory practice to prevent infections in staff.
4. Performing antimicrobial susceptibility testing & providing
summary reports of prevalence of resistance.
5. Monitoring sterilization, disinfection & the environment where
necessary.
6. Timely communication of results to the Infection Control
Committee or the hygiene Officer.
7. Epidemiological typing of hospital microorganisms.
 Infection control nurse
 Is the key member of the team.
 Maintain the close working relations between microbiology,
laboratory, different clinical services and supportive services
like laundry, pharmacy and engineering.
 Reports to ICO(infection control officer)
Duties of infection control nurse

 Daily visits to wards and patient handling unit and checking

sister’s report register.
 Collection and tabulation of daily data of hospital infection.
 Ensuring the samples of blood, stool, sputum, urine etc are
collected and dispatched to the laboratory in time.
 Initiating the hospital infection control form while
documenting for HAI.
 Daily visit to laboratory to ascertain results of samples.
 Monitoring and supervision of infection among hospital staff.
 Training of nurses and paramedical personnel on correct use
of hygiene and aseptic techniques.
 Administrator’s role
 To implement infection control measures
for
 Hospital’s physical environment

 Healthcare workers

 Patients & relatives

 Community
 Effective control measures
Sanitation, asepsis and waste disposal as per standards
Practical surveillance system for reporting , evaluating & keeping
records
Isolation of infected patients
Microbiological service and Periodic review of antibiotic usage
Training program of medical / Para personnel
Careful handling of soiled linen
Good housekeeping
Air hygiene in OT- laminar air flow.
Special precautions for disinfection of instruments used for HIV
patients.
Strict supervision of the hygiene & sanitation level in dietary
services
 Washing of hands between patients to prevent cross infection.
 Strict adherence to aseptic techniques in invasive procedures.
 Segregation of contaminated instruments, linen, bedpans to
minimize mix up.
 Antibiotic policy, monitored and controlled.
 Every health care worker should follow the maxim-“Infection
control in this hospital is my job and responsibility and I shall do it in
good spirit”.
Precautions for staff:
1. Complete 3 doses of Hep B vaccine
2. Protection of all high risk groups by vaccination
3. Report needle sticks immediately
 Universal Precaution Guidelines

 Disposable latex gloves must be worn when contact with

blood or other bodily fluids is anticipated or possible.
 Hands must be washed thoroughly after removing the latex
gloves.
 Blood-soaked or contaminated materials, such as gloves, towels,
or bandages, must be disposed of in a wastebasket lined with a
plastic bag.
 Properly trained custodial personnel must be called if
cleanup or removal of contaminated waste is necessary
 Contaminated materials such as needles, syringes, swabs, and
catheters must be placed into red plastic containers labeled for
disposal of biohazardous materials. Proper institutional
procedures generally involve incineration.
 References
 Hospital planning – Kunders
 Hospital administration- Sathoskar