Introduction to Infection Prevention

INTEGRATED HEALTH SYSTEMS STRENGTHENING-

SERVICE DELIVERY ACTIVITY
Let’s take a look at other risks outside of the healthcare
environment... 1. Lightning

2
Let’s take a look at other risks outside of the healthcare
environment... 2. Plane crash

3
Let’s take a look at other risks outside of the healthcare
environment... 3. Car accident

4
Death rate associated with various incidents

1. Lightning 1 : 10,000,000

2. Plane crash
1 : 3,000,000
3. Car accident 1 : 10,000

5
Now, let’s take a look at risks
within the healthcare
environment...
Q: What is the most
common or frequent
risk healthcare
workers encounter
while caring for
patients?

A: Direct contact
with blood and
other body fluids

6
Risk of acquiring infectious diseases through
occupational exposure
• Risk of acquiring HIV after being stuck with a
needle from an HIV+ client:
4:1000
• Risk of acquiring HBV after being stuck with a
needle from an HBV+ client:
27–37:100
• Risk of acquiring HCV after being stuck with a
needle from an HCV+ client:
3–10:10

7
 HIV/AIDS, Hepatitis B and C

• WHO estimates that of the 12 billion injections administered

each year for vaccination and curative purposes, unsafe
injections lead to*:
• 8 -16 million new cases of HBV infection
• 2 - 4.5 million new cases of HCV infection
• 75,000-150,000 new cases of HIV infection

– Hepatitis prevalence in Pakistan

– HBV: 2.5%
– HCV: 5%

– All healthcare providers be vaccinated for HBV!

8
 Purpose of Infection Prevention

Dual Role:

• To reduce the risk of disease transmission to

clients, caregivers, and communities.

• To protect healthcare workers at all

levels - from physicians and nurses to
cleaning, housekeeping, and laboratory staff.
9
Important Infection Prevention Concepts

• Microorganisms are the causative agents of infection:

– Bacteria (vegetative, mycobacteria, and endospores)
– Viruses
– Fungi
– Parasites
• Colonization - disease-causing microorganisms are present in a
person but not causing symptoms.
• Infection - colonizing organisms are now causing infection or
disease.
• Infection prevention depends on placing protective barriers
(physical, chemical, or mechanical) between a susceptible host
(person lacking immunity) and the organisms.

10
 Understanding the Disease
Transmission Cycle
• All microorganisms can cause
infection.
• All humans are susceptible to most
infectious agents unless immune
(naturally or by vaccination).
• Infection risk is related to number and
virulence of organisms.
• Number of organisms needed to
cause infection varies:
– blood stream—least number of
organisms needed to cause infection
– intact skin—greatest number of
organisms needed to cause infection

11
 Standard Precautions

Definition
• Standard precaution guidelines are designed to create a physical, mechanical, or
chemical barrier between microorganisms and a person to prevent the spread
of infection:
1. Consider every person infectious
2. Wash hands!
3. Wear gloves
4. Use physical barriers (PPE)
5. Use antiseptic agents when appropriate
6. Use safe work practices (no recapping/ bending needles, safely pass sharps, etc.)
7. Safely dispose of infectious waste
8. Process instruments properly

12
 Standard Precautions (cont.)

Examples of Barriers
• Physical: Personal protective equipment
(gloves, face masks, goggles, gowns, plastic or
rubber aprons, and drapes
• Mechanical: High-level disinfection (HLD) by
boiling or steaming and sterilization by
autoclaving or dry heat ovens
• Chemical: Antiseptics (iodophors, alcohol-
based antiseptic agents such as Iodine,
Pyodine) and high-level disinfectants
(chlorine, glutaraldehydes). 13
 Standard Precautions (cont.)

• Treat all clients and patients with caution, using standard

precaution measures
Why? Most people with HIV or other life- threatening
blood-borne diseases do not have symptoms.

• Use standard precautions when handling all blood, body

fluids, secretions, excretions, non-intact skin, and mucous
membranes
Why? Increased risk of exposure by touching, injury
(needle stick), or contact (splashing or spraying of
potentially contaminated blood or body fluids)

14
What are standard precautions designed to
do?
Purpose:
• To prevent facility-acquired infections in all
hospitalized patients and clients
• To reduce the risk of transmitting
microorganisms from known or unknown
sources
• To provide a rationale for the appropriate use
of limited infection prevention resources in
caring for all clients and patients

15
 Consistent and proper hand washing

• Is the most important infection prevention

measure!
• Wash hands before and after touching blood or
body fluids, before gloving and after removing
gloves, before and after every physical exam,
before and after every invasive procedure, and
between patient contacts!
• Use an antiseptic hand rub/ hand sanitizer when
hands are visibly clean.

16
Hand Washing Technique

17
Gloves and Personal Protective Equipment

• Wear gloves (both hands) before touching anything wet—

broken skin, mucous membranes, blood or body fluids, soiled
instruments, or contaminated waste materials—and before
performing invasive procedures.

• Use physical barriers (protective goggles, face masks, and

aprons) if splashes and spills of blood or body fluids
(secretions and excretions) are likely.

18
Standard Precautions Include...
Hand Hygiene

Wearing Gloves
 Other Key Standard Precautions:

• Use antiseptic agents for cleansing the skin or

mucous membrane prior to surgery, cleaning
wounds, or making hand rubs or surgical hand
scrubs with an alcohol-based antiseptic
product.
• Use safe work practices such as not
recapping or bending needles, safely passing
sharp instruments, and suturing, when
appropriate, with blunt needles.
• Consider every person (patient or staff) as
potentially infectious and susceptible to 20
 Waste Disposal

• Safely dispose of infectious waste materials

to protect those who handle them and prevent
injury or spread of infection to the community.

21
Do you have proper waste management in
your facility?

22
 Types of Waste

Non-Contaminated Hazardous

Contaminated

23
 Segregation at point of use
Production of Segregation at point of
waste use

~ 85% regular waste ~ 15% contaminated

or hazardous waste

24
 Contaminated Waste Disposal

• How to dispose of sharps?

– Segregation at point of use
– Options for final disposal (sharps pits,incineration or
encapsulation). NEVER PLACE SHARPS IN A TRASH CONTAINER
OR PLASTIC BAG THAT MIGHT BE HANDLED BY CUSTODIAL STAFF
• Q: How to dispose of contaminated liquid waste?

A: Discharge into the Sewer System.

• Q: How to dispose of solid contaminated waste?

A: incineration, burial, or open burning

25
Use PPE during Waste Handling
and Disposal

26
 Instrument Processing

• Process instruments, gloves, and other items

after use by first decontaminating and
thoroughly cleaning and then either sterilizing
or high-level disinfecting them using
recommended procedures.

27
 Instrument Processing
Decontaminate

Sterilize: Clean High-Level Disinfect:

Chemical Boil
High-pressure steam Steam
Dry heat Chemical

Dry/Cool and Store

28
Use of PPE

29
Standard Precautions Include...

Handling and
Disposing of Sharps
 Methods of Sterilization

• Steam sterilization
• Dry heat sterilization
• Chemical sterilization

Thorough cleaning of instruments prior to

sterilization is critical
 IP: Sterilization continued
Practices:
– Steam sterilization (autoclave):
• 121oC (250BF); (15 lbs/in2) pressure: 20 minutes for
unwrapped items, 30 minutes for wrapped items
• Allow all items to dry before removing
– Dry-heat (oven):
• 1700C (340BF) for 1 hour, or 1600C (3200F) for 2
hours
– Chemical sterilization:
• Soak items in glutaraldehyde for 8 -10 hours or
formaldehyde for 24 hours
• Rinse with sterile water
IP : Autoclaves/Sterilizers

33
34
IP: Instructions for Preparing Dilute
Chlorine Solutions

Total parts (TP)  % Concentrate  -1

(H2O) =  % Dilute 

To make a 0.5% chlorine solution from 5% bleach mix 1 part bleach to 9

parts water

Total parts (TP)  5% Concentrate  = 9 Total parts

(H2O) =  .5% Dilute  -1
(TP) (H2O)
 

35
To convert in water in liters (L) and chlorine
in milliliters (ml):
• I liter (L) divided by the part of water:

ml of chlorine in 1L= 1000

Part of water

• ml of chlorine in 1 L = 1000 = 111 ml/L

9

36
 Summary

• Minimize and prevent exposure to

infection by:
– Using standard precautions with every patient
– Disposing of clinic waste properly
• Work together to make the workplace safer.
• Teach patients and their families how
to reduce risk of exposure in the home.

38
Thank You