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16II.

INTENSIVE TREATMENT UNITS 1.

No bystanders allowed.2.

Restrict entry of visitors to 2hrs per day.3.

Floors and shelves to be cleaned as for wards.4.

Staff should wear masks and aprons while working in the unit.5.

Humidity 40 60%. Temperature 18-25 o C.III. Number of staff and movement inside the operating theater to be minimum.5.8. High Efficiency Particulate Air filtration (HEPA)filtered air with at least 20 air exchanges per hour. nebulisers and humidifiers to be cleaned.7.< 30cfu/m33. walls and the lights above the operating table is essential B. .2. Staff from outside should not enter the unit. Environment:1.4. OPERATION THEATRESA. Ventilators. Bacterial count of air(using slitsamplers) .Staff from the unit should not be sent outside for any purpose. Proper cleaning of the floor.6. Environmental samples to be taken and Fumigation to be done only after anyrenovation work and during outbreak investigation. Positive pressure ventilation. sterilized/disinfected asrecommended above. Air-conditioning Monitoring and servicing by accredited technicians. Routine fumigation or swabbingis not required.

Pre-operative stay in hospital to be kept to a minimum . PATIENT 1.3. The surgeon. Pre-existing skin lesion diabetes and other immunosuppressive condition to becorrected.4. All articles used for surgical procedures must be STERILE. Staff working in the theatre should on no account be sent outside for any errandduring working hours.STAFF & INSTRUMENTS1. anesthetist and assisting nurse should scrub thoroughly before theprocedure. All staff should change to theatre dress before entering. 17 C. 3. .2. 2. No other staff working inother parts of the hospital should be allowed inside.

In addition. ENVIRONMENT:1.3. Always keep the doors closed with a self-closing device. Surfaces: All ledges and fixtures should be cleaned by wet mopping with detergent oncedaily. Clip the hair or usedepilatory creams. Keep all medicines.Pre-operative shaving using razors & brushes to be avoided. where sourceisolation precautions are to be followed. as theymay be subject to heavy contamination during routine use. Operative site . Use 0.5% Chlorhexidine / 10% PovidoneIodine followed by 70% Ethyl alcohol/Iso propanol. Wet mopping with detergent and 1%phenol/0. work surfaces.IV. .2. NEONATAL UNITSA. and similar horizontal areas should be cleanedonce a day and between patient use with a disinfectant/detergent and clean cloths. 5.5. Brooms are NOT recommended inside the unit. Sinks should be scrubbed clean at least daily with a detergent. First incision to be put only afterthe alcohol has dried. Friction cleaning is important toensure physical removal of dirt and contaminating microorganisms. wipe surfaces where medicines and equipment are kept with 70% ethylalcohol.to be disinfected properly. vials and other minor equipment in closed shelves if not in use. Mop heads should be machine laundered and thoroughly dried daily.6. There should be a separate isolation room for babies with suspected sepsis. 4. In the cleaningprocedure. Antibiotic prophylaxis not to exceed 24 hrs.4.5% Hypochlorite should be performed twice daily and at the time of anycontamination. storage shelves and similar non-critical surfaces should be scrubbedperiodically with a disinfectant/detergent solution as part of the general housekeepingprogram. windows. Walls. Cabinet counters. dust should not be dispersed into the air. Floors: Cleaning should be performed in the following order patient areas. accessoryareas and then adjacent halls.

disinfected unit so that the originally occupied unit can becleaned. is required before and after handling each neonateand after touching . Chlorhexidine 4 %or 70% alcohol ) should be used for scrubbing before entering the nursery.g.When the incubators / open care units are being cleaned and disinfected after the baby isdischarged. watches. before performing invasive procedures. 19III. The air filter should be maintained asrecommended by the manufacturer. The following steps are recommended bythe CDC. EQUIPMENT:1. it should be cleaned and disinfected. before providingcare for neonates. Suction catheters: Catheter tips should be sterile. BABY CARE: 1. Flush catheter with sterile distilled water after each use. 2. Before handling neonates for the first time. all detachable parts should be removed and scrubbed meticulously. disposable. Antiseptic preparations (e. If theincubator has a fan. because such a break precludes effective disinfection or sterilization. C. the manufacturer s instructionsshould be followed to avoid equipment damage.II. After vigorous washing. Hand washing: Medical and hospital personnel must follow careful hand-washingtechniques to minimize transmission of disease. and bracelets before washing their hands andentering the neonatal nursery. Mattresses should be replaced when the surface coveringis broken. personnel should scrub their hands and arms toa point above the elbow thoroughly with an antiseptic soap. Fingernails should be trimmed short and no nail polish shouldbe permitted. Personnel should remove rings. Keep the bottles and rubbertubes clean and dry when not in use. daily andbetween patients. Infants who remain in the nursery for an extended period should be transferredperiodically to a different. A 10-second wash without a brush. Wash the bottles with detergent and dry. and after providing care forneonates. The mattresses may be cleaned between babies with detergent and wiped with70%alcohol. Cradles / incubators/baby warmers: Surface clean once daily with detergent and 70% ethylalcohol.18 B. Change sheets daily and use laundered linen from the hospital supply. Incubatorsnot in use should be thoroughly dried by running the incubator hot without water in thereservoir for 24 hours after disinfection. Atlanta:I. but with soap and vigorous rubbing followed bythorough rinsing under a stream of water. thehands should be rinsed thoroughly and dried.

introducinga cannula or withdrawing blood for any investigation. overthe area. Do not use ordinary plastic bags or formula-bottle bags.Isolation procedures can be divided into two main categories: Protective isolation . This includes STERILE gloves and wipe with povidone iodine and 70% alcohol. Alcohol-containing foams kill bacteria satisfactorily when applied to cleanhands and with sufficient contact. The mother may be givenappropriate instructions regarding personal hygiene. has publishedguidelines regarding isolation practices in hospitals. Invasive procedures: For all invasive procedures.2. Try to use screw-cap bottles or hard plastic cups with tight caps. But they are not sufficient in cleaning physically soiled hands. Hand washing should immediately follow removal of gloves. However as the knowledge about the different modes of transmission increased the strategies involved have become more evidence based andtargeted. before touchinganother infant. The child should be put directlyto the breast as soon as possible. They can be used in areas where no sinks are available orduring emergency. including lumbar puncture.Milk should not be kept for long periods in open containers. Though the Centres for Disease Control (CDC). Use chilled milk (keptat 0-4 o C) within 24 hours.3. becausetransient organisms are not removed.b) Be sure to use only clean containers to store expressed milk. care must be taken to ensure no breach of confidentiality and not to stigmatise the patient .objects or surfaces likely to be contaminated with virulent microorganismsor hospital pathogens. Atlanta. USA. Do not store milk for more than 1 hr at room temperature.Hand washing is necessary even when gloves have been worn in direct contact withthe infant. (IAP recommendation). which should include hand washingtechniques: a) Always wash your hands before expressing or handling your milk. 20CHAPTER 4 ISOLATION POLICY AND OUTBREAKMANAGEMENT 1. each health care facility should devise itsown strategies based on the local needs. Though appropriate door signs may be necessary.ISOLATION STRATEGIES In order to prevent the spread of infectious diseases the patients with communicablediseases were often segregated. ALL aseptic precautions have to betaken. Theborderline term and growth retarded low birth weight babies can suckle fairly well at thebreast and should be given expressed breast milk in preference to formula feeds byappropriate techniques such as clean cup and spoon or cleaned and sterilized gokarnam . Feeding of babiesMother's milk is the best food for both normal and low birth weight babies.

gloves for body substances. It reduces the risk of transmission of microbes from both known and unknown sourcesof infection. Droplet precautions Spread is by large droplets. mask and gown for all those who enter.This is to prevent infection in immunocompromised patientswho are at increased risk of infection both from other patients and from the environment. pneumonic plague. Diseases for which this is neededare Viral haemorrhagic fevers. May cohort with similar patients. Source isolation A two.MRSA). Strict isolation . Single room. pertussis. Single room with door shut. Single room. These include: hand washing. 212. Gloves and gown if soiling is likely. Gloves and gown if there is likelihood of contact.Isolation measures are usually maximal for those undergoing transplantation. mumps. May cohort with patients withsame infection. Under this there are six categories of isolation or precaution:1.but at least 1 m separation between patients. rabies and rubella.measles.g. infection of wounds or burns with multiply resistant organisms(e. primaryVaricella and disseminated zoster. Diseases are: Meningococcal meningitis. The additional precautions are dependent on the differentmodes of transmission.tier approach is recommended by the CDC. A specializedroom with positive pressure ventilation and HEPA filtration is required. Requires close contact with theperson and occurs when the particles come into contact with eyes or mucousmembranes of a susceptible person. The Standard precautions are for all patients admitted in the health care facility regardless of their diseasestatus. Diseases include:Scabies.Gloves. .3. gown if soiling islikely.Spread is by contact or airborne.Masks only for those in close contact. and mask if splash is likely. Contact isolation Spread is by contact. pharyngeal diphtheria.

before the actual outbreak occurs.H. No need of separate room.At least six changesof air / hour . outbreak situation. Masks usedshould be particulate respirator type with filter.g. SURVEILLANCE & OUTBREAK MANAGEMENT Surveillance of nosocomial infection is the foundation for organizing and maintainingan infection control programme. pulmonary tuberculosis. Airborne precautions Spread is by small droplets. This information obtained should reach those who mayinfluence practice.Toilet facilities may be shared if patient is hygienic. The patient is kept here till at leastthree consecutive sputum samples become negative for AFB. When there is an ongoing surveillance programme. The process of surveillance incorporatesfour key stages: Data collection. The data also provides a baseline to compare after certain new infection controlmeasures are implemented. Single room with a negative pressure .e. Notneeded for atypical mycobacterial infection. One month forseverely ill patients and those with multi-drug resistant tuberculosis. 2. e. can be noted and infection control actionimplemented. This is alsorecommended for HIV infected patients with undiagnosed respiratory infection. any suddenchange in the infection rates i. Enteric precautions Diseases spread by faeco oral route.5.4. implement change or provide financial resources necessary to improveoutcome. Small droplets remain suspended for longerperiods and travel farther. Hospital Infection Control Manual Download this Document for FreePrintMobileCollectionsReport Document Info and Rating Follow avinash200 .The air has to be exhausted well away from any air intakes.where patient is sputum positive .influenzae epiglottitis. analysis. interpretation and dissemination.

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