PROJECT REPORT ON NOSOCOMIAL INFECTION AND ITS PREVENTION

IN SAFDARJUNG HOSPITAL

1. STUDENT DETAILS

NAME:- PRAMOD KUMAR SHARMA

ROLL NO:-1411005855

NAME OF PROGRAMME:-MBA IN HEALTH CARE MANAGEMENT

SESSION:-SUMMER

YEAR:-2014

SEMESTER:-4TH

SPECIALIZATION:-MBA IN HEALTHCARE MANGEMENT

2. PROJECT DETAILS

TITLE OF PROJECT:- A STUDY ON HOSPITAL ACQUIRED INFECTION & PREVENTION IN

SAFDARJUNG HOSPITAL
 INTRODUCTION AND OBJECTIVES OF PROJECT SYNOPSIS:- This is also known as
nosocomial infection. A 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. This
also includes infections acquired in the hospital but appearing after discharge, and also
occupational infections among staff .hospital acquired infection is an infection which a
patient receives during his visit to health care set-up . Nosocomial infection is contracted
from environment or staff of healthcare association. This infection can be spread by
various means like contaminated equipment, bed-linen, and air droplets and from
another infected patient.
 OBJECTIVES:-
 To identify causes of Nosocomial infection.
 To reduce chances of nosocomial infection.
 To educate vulnerable groups about preventive measures.
 To improve awareness of clinical staff and other hospital workers (including
administrators) about nosocomial infections.
 To identify possible areas for improvement in patient care, and for further
epidemiological studies (i.e. risk factor analysis).
 Methods of Hospital Acquired Infection Transmission:-
The first method by which a hospital acquired infection may be transmitted is direct
contact. Direct contact is physical or actual touching of the infected person, animal, or
other reservoir of infection. Infections are most commonly transferred through hands
 that come into contact with the infection. The second method of transmission is indirect
o ta t. The physi al prese e of the i fe ted host does ’t ha e to prese t for a
infection to spread. The bedding, clothing, toys, handkerchiefs, and surgical instruments
all can serve as vectors in the spread of infection. Another method of transmission is
through droplet spread. An infected patient sneezing, coughing, and sometimes even
talking can spread the infection. Although these droplets typi ally do ’t tra el ore tha
a few feet away from the source, they are still a method of infection transmission.
Although they are far less common, airborne infections can remain suspended in the air
for long periods of time. Inhalation of these infected particles can lead to a transmission.
The last method of transmission is through vehicles, such as water, food, or biological
products. This can occur through ingestion, inoculation, or by deposit on skin or of the
mucous membrane. Part of the reason hospital acquired infections are very difficult to
stop is because they have many mediums of being transferred. A hospital staff must be
very diligent in the sterilization process to avoid complications.
Common hospital acquired infection:
 1. Blood Streamline Infections (BSI)
 2. Surgical Site Infections (SSI)
 3. Urinary Tract Infections (UTI)
 4. Ventilated Associated Pneumonia (VAP)
These types of infection can be prevented by sterilization, isolation, hand-washing, gloves
and all other aseptic techniques.

PROBLEM STATEMENT AND LITERATURE REVIEW:- Safdarjung hospital is a government hospital has
an OPD of 5000-7000 patients and an IPD of 1000-1200 patients daily. Services provided in this hospital
are free of cost so number of patients are much higher than resources so the chances to get nosocomial
infection are comparatively high. Most of patients are immunocompromised so have increased chances
to get infection.

As per Weber and researchers in 2006 the patients hospitalized in ICUs are 5 to 10 times more likely to
acquire nosocomial infections than other hospital patients.

In 1999, Dancer depicts that many microorganisms associated with hospital-acquired infections display
two particular features; firstly, they are pathogens of well-established medical importance and secondly,
they can withstand the rigorous of the hospital environment .It benefits them to survive outside
temperature human tissues because an appropriate environment niche will provide shelter until some
timely mechanisms facilitates their transfer back to patients. Not all of them demonstrate this capacity;
so e origi ate fro the patie t’s o flora, espe ially those ho are i u o o pro ised a d others
can survive only in human tissues and thus rely upon person-to-to person spread in order to
disseminate.

In 2002 a study was conducted in US that shows that approximately 99K death just because of
nosocomial infection. Nosocomial infections still remain the most frequent complication in hospitalized
patients. They are the fourth most common cause of mortality in the hospital after the cardiovascular
system diseases, cancer and strokes. They are important contributors to morbidity and mortality. They
will become even more important as a public health problem with increasing economic and human
impact because of: Increasing numbers and crowding of people, impaired immunity (age, illness and
treatments), New microorganisms, Increasing bacterial resistance to antibiotics." .

Despite advances in infection control, the emergence and introduction into clinical practice of new
antimicrobial drugs, improved diagnostic methods, improving the overall level of care, the issue of
prevention and control of nosocomial infections is still a challenging factor. it is necessary to mention
that infections occurring more than 48 or 72 hours after hospitalization are often considered
nosocomial. It is generally accepted position that there must be clinical signs of infection in the first
place of diagnosing nosocomial infections, which are identified either by direct observations of the
patient, or when analyzing the primary documentation about the patient ex.- diagram of body
temperature.

Observing sources of infection appearance we see that the most important are still endogenous sources.
First of all, it is normal flora of the patient (skin, gastrointestinal tract, etc.),and foci of chronic infection.
Describing exogenous sources we see among them hands of medical personnel, medical equipment,
tools, household articles, unsterile catheters, syringes, etc., aero genic contamination, water and foods.
It is frequently observed the combination of exogenous and endogenous factors in their interaction. In
addition to previously stated information. All health care providers are sources of nosocomial infection
but nurses are maximum because they spend more time with patient and they are real care provider
during hospitalization. Nosocomial infection can cause mortality, morbidity &have a high cost for
hospitals. This topic has been chosen because in crowded hospital nosocomial infection is a big issue
because of lack of resources and crowd more than resources.

Healthcare employees must understand specific guidelines in prevention of infection transmission

through isolation and other good healthcare habits. Much of this information in disseminated through
training and educational programs given by the infection control departments. An example of guidelines
that are essential for the healthcare worker are :

 Hand washing:- Wash hands with soap and water when they are soiled or visibly dirty with
blood or other body fluids (IB). Wet your hands, apply soap and then scrub them
vigorously for at least 15 s. Cover all surfaces of the hands and fingers, wash with water
and then dry thoroughly using a disposable towel
 Use an alcohol-based hand rub (IA) e.g. 0.5% chlorhexidine with 70% w/v ethanol,
if hands are not visibly dirty. A combination of chlorhexidine and alcohol is ideal
as they cover Gram-positive and Gram-negative organisms, viruses, mycobacteria
and fungi. Chlorhexidine also has residual activity.
 During surgical hand preparation, all hand jewelries (e.g. rings, watches and
bracelets) must be removed (2A)
 Finger nails should be trimmed to <0.5 cm (2A) with no nail polish or artificial nails
(2A)
  Avoid wearing long sleeves, ties should be tucked in, house coats are discouraged
and wearing scrubs is encouraged.
 Hygiene and uniform:- Healthcare workers must also be conscious of their personal
hygiene and what they wear to work as it could help spread infection within the hospital.
For example, employees must have good personal hygiene, maintain short and clean
nails, and keep hair worn short or pinned up. Also, employees should utilize proper
protective equipment, such as head covers, marks, PPE and must obey special uniform
rules. Clothing must also be easy to decontaminate and cleaned daily to keep at optimum
conditions. It is important that with any exposure to a possible pathogen, clothing should
be changed and decontaminated as soon as possible. Shoes are another measure of
safety in the healthcare system. Another important group of precautions to prevent the
spread of infection is the use of barriers such as caps, masks, and gloves. In general, caps
are suggested when in aseptic units, operating rooms, or when performing other invasive
procedures. Masks that are made of synthetic material that can filter the air are
considered good barriers against microorganisms. Masks made of other material such as
wool, gauze, or paper are not considered effective. The use of masks is indicated for many
situations and is present for both the protection of the patient and the healthcare worker.
Gloves are another set of necessary barrier when working with patients with a
communicable disease. Staff should wear non-sterile gloves when caring for this type of
patient while when working in surgery or immuno-compromised patients, gloves used
should be sterile. Again, gloves are used for protection of both the patient and healthcare
provider.
 Barriers:- caps, masks, gloves etc: important one is wearing gloves which includes

Sterile gloves should be worn after hand hygiene procedure while touching mucous
membrane and non-intact skin and performing sterile procedures e.g. arterial, central line
and Foley catheter insertion.

Clean, non-sterile gloves are safe for touching blood, other body fluids, contaminated
items and any other potentially infectious materials.
Change gloves between tasks and procedures in the same patient especially when moving
from a contaminated body area to a clean body area.
Never wear the same pair of gloves for the care of more than one patient.
Remove gloves after caring for a patient
Practice hand hygiene whenever gloves are removed.
The sterile gown is required only for aseptic procedures and for the rest, a clean, non-
sterile gown is sufficient.
Remove the soiled gown as soon as possible, with care to avoid contamination.
Mask, eye protection/face shield
 Wear a mask and adequate eye protection (eyeglasses are not enough), or a face shield to
protect mucous membranes of the eyes, nose and mouth during procedures and patient
care activities that are likely to generate splashes/sprays of blood and body fluids, etc.,
Patients, relatives and health care workers (HCWs) presenting with respiratory symptoms
should also use masks (e.g. cough) .
 Injection practices
 Equipment safety:- Used patient-care equipment soiled with blood, body fluids,
secretions, or excretions should be handled carefully to prevent skin and mucous
membrane exposures, contamination of clothing and transfer of microorganisms to
HCWs, other patients or the environment. Ensure that reusable equipment is not used for
the care of another patient until it has been cleaned and sterilized appropriately.
 Isolation of highly communicable patients:- Non-critical patient-care equipment should
preferably be of single use. If unavoidable, then clean and disinfect them adequately
before using to another patient. Respiratory protection must be employed when entering
the isolation room or within 6-10 ft of the patient. Use the disposable N-95 respirator
mask, which fits tightly around the nose and mouth to protect against both large and
small droplets. This should be worn by all persons entering the room, including visitors
 Use of aseptic techniques

"Most of these infections can be prevented with readily available, relatively inexpensive strategies by:
adhering to recommended infection prevention practices, especially hand hygiene and wearing gloves;
paying attention to well-established processes for decontamination and cleaning of soiled instruments
and other items, followed by either sterilization or high level disinfection; and improving safety in
operating rooms and other high-risk areas where the most serious and frequent injuries and exposures
to infectious agents occur." nosocomial infection with strains of microorganisms and colonization of
them can be prevented through the use of modern sterilization, disinfecting and antiseptic agents by
disinfection and sterilization. These activities are not only important from a medical point of view but
also considered economically viable steps in medical treatment. We should remember that medical
housekeeping of environment, sterilization of medical instruments, which are in contact with skin or
mucous membranes of patient adherence to aseptic technique during any invasive manipulation, and
currently remain the corner stone in the prevention of nosocomial infections. Discussing this side of the
problem it becomes understandable that in terms of effectiveness of prevention of nosocomial
infections is most advisable to use disposable instruments, gloves, catheters, equipment, factory-
sterilized. However, this is not always possible. Thus, the question of decontamination of reuse medical
devices consists of the following steps: disinfection, cleaning and sterilization.

Infection control (IC) is a quality standard and is essential for the well-being and safety of patients, staff
and visitors. It affects most departments of the hospital and involves issues of quality, risk management,
clinical governance and health and safety.
HOSPITAL INFECTION CONTROL . 1.The organization has a well-designed, comprensive and coordinated
infection control programme aimed at reducing/eliminating risks to patients, visitors and providers of
care:

a) Currently there is a working committee on infection control. They meet once in two months. This
meeting can be made once in a month so that measures on infection controls can be made effective.

b) There is a documented infection control programme.

c) There is an infection control team. They are involved in surveillance activities.

d) There is designated infection control nurse.

2. The organization has an infection control manual which is periodically updated:

a) There is infection control manual. It has all policies and procedures related to infection control
activities in the hospital and identify high risk areas in the same.

b) Even though surveillance activities like swab culture is done in various areas like OT & ICU there is a
need of strengthening the surveillance activities by including rounds, air and water quality checks in high
risk areas like CSSD & kitchen. So there must be policies and procedures on surveillance activities in the
hospital.

c) Policies and procedures related to CSSD activities must be prepared and included in the manual.

d) Policies and procedures on engineering controls to prevent infection are not documented.

3. The infection control team is responsible for surveillance activities in identified areas of the hospital
a) There is data collected on surveillance activities. The infection control nurse maintains the
surveillance data on infection control.

b) This is being uniformly done.

c) Information is sent to appropriate authorities.

d) Monitoring the effectiveness of housekeeping services (infection control) is being done.

4. The organization takes actions to prevent/reduce the risk of Hospital Acquired Infections (HAI) in
patients and employees a) The infection control nurse collects the data and monitors the rate.

b) It is suggested to provide the feedback regarding rates to medical and nursing staffs (can be through
circulars, newsletters etc)

5.Proper facilities and adequate resources are provided to support the infection control programme
 a) Hand washing facility is adequate. Scrubs are provided with elbow/foot operating tap. Also
drier/tissue papers provided. Hand washing pictures are displayed. Also hand washing areas are kept
clean.

b) Hand washing should be monitored regularly.

c) Policies and procedures on isolation and barrier are available. Staffs are aware of isolation/barrier
activities, who are the patients to be admitted in isolation room. Isolation rooms are available in wards.
These rooms are more organized and cleaned. They are displayed „I“OLATED ROOM‟.

d) Adequate gloves, masks and disinfectants are available. The usage must be monitored by infection
control team.

6. The organization takes appropriate actions to control outbreaks of infections a) Hospital has
documented procedures on handling such outbreaks. It is prepared and implemented.

7. There are documented procedures for sterilization activities in the organization a) There is an
established documented procedure.

8. Statutory provisions with regard to Bio Medical Wastes (BMW) are complied with

a) The hospital is authorized by agencies for management and handling of bio-medical waste.

b) Biomedical waste segregation is done at the source unlike in OT. The color codes and instructions are
properly displayed in waste segregation areas. This is displayed uniformly throughout the hospital.

c) The waste is cleared at least twice in a day. Trolleys are used with covered bins of different color to
transport waste. Also the staffs are trained to use protective measures.

d) All the wastes must be weighed before handling over to the outsourcing service.

e) Bio-medical waste treatment is outsourced which is authorized to treat biomedical waste.

9. The infection control program is supported y the orga isatio ’s a age e t and includes training
of staffs and employee health

a) Designated infection control nurse is there.

b) Facilities like gloves, mask etc is available.

c) Elbow taps are provided in patient care services.

d) Soap solutions are provided in all hand washing areas instead of soap

e) There should be initial orientation for new staffs on infection control

 f) Proper system of pre and post exposure prophylaxis is implemented throughout the organization. This
must be applicable to all staffs working in the organization including outsourced services.

. SUGESSTIONS AND RECOMMENDATION

 The existing system of Infection Control measures in this Hospital, has been in practice for over
a long period of time. There is only two infection control nurse. Employing two more nurses for
infection control team will minimize the work load of IC nurse, so that work is made effective.
There is infection control manual. It has all policies and procedures related to infection control
activities in the hospital and identify high risk areas in the same.
 Quality check in air and water should be done regularly. Water sample should be sent for lab to
check the presence of micro organisms.
 Policies and procedures related to CSSD activities must be prepared and included in the
manual.
 Policies and procedures on engineering controls to prevent infection should also be added.
 The infection control nurse maintains the surveillance data on infection control. Each ward in-
charge should also maintain the same.
 It is suggested to provide the feedback regarding rates to medical and nursing staffs (can be
through circulars, newsletters etc)
 Hand washing should be monitored regularly.
 Experienced and well trained staffs only should be allowed to treat I“OLATED patie ts.
 Adequate gloves, masks and disinfectants are available. The usage must be monitored by
infection control team.
 Regular validation tests on validation carried out should be reported to the Infection Control
Team regularly.
 Employees should be well educated about color codes so that waste segregation is done
correctly.
 All the wastes must be weighed before handling over to the outsourcing service.
 Outsourcing staffs should also be educated about infection control so that development of
infection can be minimized to the least.
 There should be initial orientation for new staffs on infection control.
 Training and educating newly recruited staffs will minimize infections in and around hospital

RESEARCH METHODOLOGY :-

Research Design: The research design used in this study is descriptive and analytical in nature

Sampling Design: simple random sampling method used for my work. In which patients and healthcare
workers are target

Size: datas for this work is collected from 200 people which includes patients ,healthcare professionals
and patients’ attendants.
Sampling area: safdarjung hospital

Nature of respondents: Nurses, Hospital administrators and Patients

Data Collection: Primary data was collected from nurses, hospital administrators and patients of the
hospitals.

Secondary data was collected from hospital records, articles and journals.

Refrences:-

 Preventive and social medicine (2016) by k. park.

 Google


Various journels, papers on nosocomial infections.


International Journal of Innovative Research in Science, Engineering and Technology.


Website of safdarjung hospital


Journals of TNAI
A questionnaire from patients, relatives and healthcare personnnels.