HOSPITAL INFECTION CONTROL
POLICY AND PROCEDURE FOR HANDWASH
1.0. Aim:
To guide the staff how and when to wash hands in a proper technique.
2.0. Rationale:
2.1. Hand hygiene refers to removing or killing microorganisms (germs) on the
hands.
2.2. The purpose of a hand-washing policy and procedure in the workplace is to
promote hygiene and prevent the spread of germs and infectious diseases.
3.0. Applicable to:
3.1. Doctors
3.2. Nurses
3.3. Technicians
3.4. Patient Care Assistants
3.5. Housekeeping staff
3.6. Pantry boys
4.0. When should hand hygiene be performed:
4.1. Before and after contact with any patient their body substances or items
contaminated by them.
4.2. Between different procedures on the same patient.
4.3. Before and after performing invasive procedures.
4.4. Before preparing, handling, serving or eating food or feeding a patient.
4.5. After assisting patients with personal care (e.g., assisting patient, to blow nose,
in toilet or doing wound care)
4.6. Before putting on and after taking off gloves.
4.7. After performing personal functions (e.g., using the toilet, blowing your nose)
4.8. When hands come into contact with secretions, excretions, blood and body
fluids of patients. 5.0. Hand washing Instructions: -
5.1. To wash hands properly, always running water should be used.
5.2. Rub all parts of the hands and wrists with soap and water or an alcohol-based
hand rub.
5.3. Wash hands for at least 15 seconds or more.
5.4. Pay special attention to fingertips, between fingers, backs of hands and base of
the thumbs.
5.5. Keep nails short.
5.6. Wash wrists and forearms if they are likely to have been contaminated.
5.7. Remove watches, rings and bracelets.
5.8. Do not use artificial nails.
5.9. Make sure that sleeves are rolled up and do not get wet.
5.10. Use of a clean towel is an important part of effective hand washing.
6.0. Handwashing with soap and water-Steps.
6.1. Wet hands with water.
6.2. Apply enough soap to cover all hand surfaces
6.3. Rub hands together, palm to palm.
6.4. Right palm over left dorsum with interlaced fi ngers and vice versa
6.5. Palm to palm with fingers interlacedbacks of fi ngers to opposing
6.6. Palms with fi ngers interlocked
6.7. Rotational rubbing of left thumb clasped in right palm and vice versa
6.8. Rotational rubbing, backwards and forwards with clasped fi ngers of right
hand in left palm and vice versa
6.9. Rinse hands with water
6.10. Dry thoroughly with a single use towel
7.0. Cleaning with alcohol-based hand rub-Steps
7.1. Apply a palmful of the product in a cupped hand and cover all surfaces.
7.2. Rub hands together, palm to palm.
7.3. Right palm over left dorsum with interlaced fingers and vice versa.
7.4. Palm to palm with fingers interlaced backs of fingers to opposing.
7.5. Palms with fingers interlocked.
7.6. Rotational rubbing of left thumb clasped in right palm and vice versa.
7.7. Rotational rubbing, backwards and forwards with clasped fingers of right hand
in left palm and vice versa.
7.8. Dry it properly.
POLICY AND PROCEDURE FOR BIOMEDICAL WASTE MANAGEMENT
1.0. Aim:
This policy will provide guidance to the staff about segregation, treatment and
disposal of medical waste, based upon current best practice.
2.0. Rationale:
2.1. To protect the environment.
2.2. To prevent Hospital Acquired Infections.
3.0. Applicable to:
3.1. Doctors
3.2. Nurses
3.3. Technicians
3.4. Patient Care Assistants
3.5. Housekeeping staff
3.6. Pantry boys
4.0. Colour coding for Categories of waste
4.1. Yellow –
Human Anatomical Waste: Human tissues, organs, body parts, bleeding parts,
body fluid, blood.
Microbiology & Biotechnology Waste: Wastes from laboratory cultures,
stocks or specimens of micro-organisms, live or attenuated vaccines.
4.2 Red - Solid Waste (Items contaminated with blood and body fluids including
cotton, dressings, soiled plaster casts, line beddings, other material contaminated
with blood)
4.3 Black- Discarded Medicines and Cytotoxic drugs ,wastes comprising of outdated,
contaminated and discarded medicines. Chemical Waste , chemicals used in
disinfection, as insecticides, etc
4.4 White - General waste, stationary, paper,non infectious plastic,etc.
4.5 Puncture Proof Container(PPC) - Waste Sharps (needles, syringes, scalpels blades,
glass etc. that may cause puncture and cuts. This includes both used & unused sharps)
4.6 Green-Kitchen waste and food.
5. Staff responsibility
• All the staff follow the colour coding systems for different wastes, ensure before
discarding anything that you are using the right bin.
• The syringes should be cut and the needle should be burned before discarding.
• Training of a new staff will be responsibility of the incharge sister.
• The biomedical waste management chart should always be displayed on the wall of
every nursing station.
• There should be a display on the bin also.
• The infection control nurse will supervise all the staff for following biomedical waste
management policy.
• Guiding the patient and the relatives will be duty of the ward staff.
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POLICY AND PROCEDURE FOR ISOLATION
1. Aim:
1.1 To guide the staff for procedure to be followed when a patient requires isolation /
barrier
nursing.
1.2 To prevent the transmission of pathogenic microorganisms within the hospital.
1.3 To recognize the importance of all body fluids, secretions and excretions in the
transmission of
nosocomial pathogens.
1.4 To practice adequate precautions for infections transmitted bu airborne droplet and
contact.
2. Rationale:
2.1 Isolation / barrier nursing is the use of infection control practices aimed at
controlling the spread
of and eradicating pathogenic organisms from the patient to others or another
susceptible
person.
2.2 To review the provision and use of the necessary resources and facilities to ensure
appropriate
management of isolation facilities.
3 . Personnel Responsible
Doctor
Nurses
Patient assistants
Technicians
4 . Isolation / Barrier Nursing Considerations
4.1Advice should be sought from the Infection Control Team on the appropriateness
of isolating /
barrier nursing patients
4.2 Before deciding to isolate / barrier nurse a patient, careful consideration must
be given to
4.3 Emotional well-being of the patient e.g. mental health or patient safety
4.4 Mode of transmission of the infection e.g. air-borne, faecal-oral route etc
4.5 The availability of facilities
4.6 Assess the risk of spread to other service users / healthcare worker
4.7 Consider the implementation of protective isolation / Universal precautions for
immunocompromised patients. Please contact the Infection Control team for advice and
risk assessment
4.8The application of Standard Infection Control Precautions is all that is required for the
majority of
infections.
5. Application of Standard Infection Control Precautions when Isolating / Barrier
Nursing a
Patient:
5.1.Hand Hygiene: (please refer to Hand washing policy)
· Regular, thorough, hand hygiene is essential to prevent the spread of microorganisms
· Hand wash with liquid soap and running water when hands are visibly soiled / dirty
· Alcohol handrub is used for routine hand decontamination when hands are visibly
clean
· Alcohol handrub should not be used when caring for patients experiencing vomiting
and / or any diarrhoeal illnesses e.g Norovirus and not recommended in outbreak situations
· For patients with Clostridium-difficile and any other type of diarrhoea (confirmed or
suspected infection) hands should be washed with warm water and liquid soap. Alcohol hand
rub should not be relied on solely in place of hand washing with liquid soap and water, as
alcohol hand rub does not kill Clostridium-difficile spores.
5.2. Protective Clothing - Protective clothing (also known as personal protective equipment
or PPE) is designed to provide a barrier between the patient and HCW to protect against
transmission of infectious agents. In the community setting, PPE comprises gloves, aprons
and face protection.
5.2.1 Gloves
· Disposable gloves should be worn when in contact with body fluids, e.g. blood, urine,
faeces, vomit. They should be disposed of in clinical waste stream as per Waste Management
Policy
· Gloves should be worn as single use for one procedure and then be disposed of into
the appropriate waste stream
· Gloves should be changed between procedures
· Hands should be washed before wearing and following glove removal
· Gloves should not be washed
· Gloves should not be worn unnecessarily
5.2.3 Removal of gloves
· When removing gloves, the following technique limits the risk of exposure to
potentially infected material: -
· Grasp the palm of the first glove just below the wrist
· Roll the glove towards the fingertips so that it turns inside out
· Place two fingers of the bare hand inside the cuff of the remaining glove
· Roll the second glove towards the fingertips with the bare hand until the first glove
is inside the
second glove
· Continue to remove until both gloves are inside out
· Dispose of used gloves in the appropriate healthcare waste bin
· Wash and dry hands.
5.2.4 Disposable Plastic Aprons
· These should be worn wherever there is a possibility of contamination of the clothing
with body fluids or from direct contact with the patient’s clothing or bedding.
· They should be single use and be disposed of after each procedure, in the
appropriate healthcare waste bin
· Aprons should not be used again on the same patient.
5.2.5 Masks, Visors and Eye Protection
· These should be worn for procedures where there is a likelihood of splashing of body
fluids or substances into the eyes, face or mouth
· Disposable equipment should be disposed of after use
· Re-usable equipment should be appropriately decontaminated
6.PATIENT ISOLATION:
Patients are isolated when,
a) Suffering from highly transmissible disease eg: chickenpox, patient is placed in a separate
room, visitors are restricted.
b) Viral Hepatitic, Tubercolosis etc.
7.CONCEPT OF STANDARD PRECAUTIONS:
They are a set of precautions designed to protect health care workers from exposure to blood
borne pathogens.Since the majority of patients infected with HIV/HBsAg/ HCV are
asymptomatic at the time of presentation,all patients are approached as having potentially
infectious blood and body fluids.
8.FEATURES OF UNIVERSAL PRECAUTIONS:
i) Use of PPE
ii) Prevention of injury with sharps.
iii) Handwashing (as mentioned above)
9.DISINFECTION OF EQUIPMENT
Re-use instruments, tubings etc,only after decontaminationand sterilization of
decontamination,as appropriate.
Do not touch equipment with soiled gloves or gloves used for patient care.
Spill clean up: Cover spills of blood or body fluids with 1% of freshly prepared sodium
hypochlorite for 10 minutes. Then mop dry. A second decontamination may be done ,if
required.Wash the area with detergent and water. Gloves must be worn during clean up and
decontamination process.
10.PRECAUTIONS AGAINST BLOOD BORNE TRANSMISSION:
Admission:
Patients with HIV/HBV/HCV disease but presenting with unrelated illnesses may
be admitted in any ward .Confidentially shall be maintained with appropriate precautions to
prevent nosocomial transmission
Preparation of patients:
In case of patient testing positive, attending physician should ensure that patient
and/or significant others are informed about result and receive counseling.
The nursing staff will explain to patients, attendants and visitors (when necessary),
the purpose and methods of handwashing, body substance precautions, etc.
Specimens:
Adequate precautions are to be taken while collecting specimens. The specimens
are to be transported in leak-proof containers.Attach a bio hazard label.
11.PRECAUTIONS AGAINST AIRBORNE TRANSMISSION:
These precautions are designed to reduce the risk of airborne and droplet transmission of
infectious agents, and apply to patients known or suspected to be infected.
Components of respiratory isolation:
*Place the patient in a single\private room with closed doors.Patients with same illness (but
no other infection) can be cohorted in one room.
* Masks to be worn by those who enter the patient's room.
* Gloves are necessary when handling the patient.
* Hands must be washed after touching the patient or potentially contaminated articles and
before taking care of another patient.
* Articles contaminated with infective material must be discared or bagged and labeled
before being sent for decontamination.
12.PRECAUTIONS AGAINST CONTACT TRANSMISSION
Contact isolation precautions are recommended for specified patients known or suspected to
be infected with microraganisms that can be transmitted by direct contact with the patient
(hand or skin-to-skin contact that occurs when performing patient care) or indirect contact
(touching) with contaminated surfaces or patient-care items.
Components of contact isolation
Gowns are indicated if soiling is likely
Gloves are indicated for touching infected material/area
Hands must be washed after touching the patient or potentially contaminated articles and
before taking care of another patient.
Adequately clean and disinfect equipment and patient's articles.
13.ISOLATION FOR PATIENTS HIGHLY SUSCEPTIBLE TO INFECTION
Patients with certain disease or on certain treatment (immuno comprosised) are highly
susceptible to infection and hence have to be protected with isolatory methods
Employees who are ill (eg:common cold) must not be assigned to the care of such patients
Hand washing , use of gloves ,masks must be emphasized ,so as to protect the patient
5. Uniform / Clothing worn for work:)
· Staff should wear a clean laundered uniform clothing every shift.
· Staff uniforms should be washed separately from other items at 60 degrees.
· Clothing worn for work should be washed separate to other items on the highest
temperature.
· Using the appropriate personal protective equipment when undertaking clinical
procedures protects the uniform / clothing from potential contamination.
· Where changing facilities are provided, staff should not travel to and from
work in uniform.
5.4 Daily Clean –The housekeeping staff will undertake cleaning of affected patient’s
room/s, surfaces, flush handles, door handles etc on a daily basis with a mild
detergent/antiseptic solutions in a following strengths.
5.4.1Appropriate strength of
Floor-
Bed/trolly/ Wheelchairs-
Toiltet-
Door/door handle-
Curtains-
Urinals / bedpans/ commode buckets-
5.5 Movement of Staff:
Allocate one staff nurse for affected patients only. This is to reduce the risk of transmission /
further spread of infection.
5.6 Food handling:
Staff who have nursed the affected patient should not give out food.
5.7 Separate Room Isolation
· Wherever possible the patient should be cared for in a single room with en-suite
facilities. A risk assessment should be undertaken to determine the appropriate isolation /
barrier nursing precautions required, for the suspected or confirmed organism / infection.
· An appropriate colour-coded isolation precaution sign (according to the suspected or
confirmed infection) must be displayed outside the room on the door.
· Gloves and aprons should be available in the room and used to provide care to the
patient. Please take care not to over stock the affected resident’s rooms with Personal
Protective Equipment
· Alcohol hand rub should be available at the ‘point of care’
· Patients requiring therapy in their rooms should be seen last where possible and the
equipment cleaned in-between patient use
· On transfer or discharge to another Health Care Facility or to the services of a Health
Care Professional the Inter HealthCare Infection Control Transfer Form should be used.
5.8 Visitors-
· Visitors of the patients should be encouraged to practice hand hygiene when entering
and leaving the room.
· Visitors who wish to participate in personal care, should be instructed to use gloves &
aprons, and be given advice on how to correctly dispose of such items
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POLICIES AND PROCEDURES FOR LINEN AND LAUNDRY MANAGEMENT.
1.AIM:
To reduce the risk to Patients, health care workers, laundry staff that may be associated
with the use and handling of laundry that is potentially or actually contaminated with an
infectious agent.
2.RATIONALE:
3.Routine Handling of Soiled Linen:
Soiled linen should be bagged or put into carts at the location where it is used; it should not
be sorted or pre-rinsed in patient-care areas.
Linen used by patients diagnosed to have HIV, HBV, HCV and MRSA is to be
decontaminated by soaking in bleaching solution for an hour.
Transportation and Storage of Clean Linen:
Clean Linen should be transported and stored by methods that will ensure its cleanliness
4.LAUNDERING OF LINEN
Used linen must be placed into white plastic bags.
Care must be taken to prevent seepage of blood-body fluidsfrom laundry bags.
The Laundry service is responsible for providing an adequate, clean and constant supply of
linento all users.
ALL registers in the linen services must be maintained and up to date.
Approriate cleaning agents should be used.
Time schedule to be prepared for collection of soiled linen, delivery of clean linen etc.
