PATIENT RIGHT AND EDUCATION (PRE)

Including family members

Doctors, nurses, patient educator, admin staff to
explain/educate in language they understand
Rights and responsibilities
• Displayed
• Informed in a language they understand
• The organization’s leaders protect patient's and family rights
• Violation of patient and family rights recorded, reviewed –
corrective/preventive action

Interpreter List
Pastoral List
 PATIENT RIGHT AND EDUCATION (PRE)
RIGHTS
• Respect any special preferences, spiritual and cultural needs
• Dietary, Worship
• Respect for personal dignity and privacy during examination, procedures and
treatment
• w.r.t. photographs/recording procedures - informed consent is taken and patient‘s
identity is not revealed
• Confidentiality
• Protection from physical abuse and neglect
• Refusal of treatment
• Informed consent before transfusion of blood and blood products,
anaesthesia, surgery, initiation of any research protocol and any other
invasive/ high-risk procedures/ treatment
• To complain and information on how to voice a complaint
• Information on the expected cost of the treatment
• Access to his/ her clinical records
• Information on plan of care, progress and information on their health care
needs
 PATIENT RIGHT AND EDUCATION (PRE)
Education (compassionate, emphathetic)
• Explained about the proposed care including the risks,
alternatives and benefits
• Explained about the expected results, possible complications
• Care plan is prepared and modified in consultation with
patient and/or family members (concerns and requests)
• Informed about the results of diagnostic tests and the
diagnosis
• Explained about any change in the patient's condition
 PATIENT RIGHT AND EDUCATION (PRE)
Informed Consent
• General consent for treatment is obtained when the patient enters the
organisation (explain the scope)
• Before transfusion of blood and blood products, anaesthesia, surgery,
initiation of any research protocol and any other invasive/ high-risk
procedures/ treatment
• Includes information regarding the procedure, risks, benefits, alternatives
and as to who will perform the requisite procedure in a language that
they can understand
• Dialysis - repeat consent after 6 months (but endorse every time)
• Describe who can give consent when patient is incapable of independent
decision making
• Consent taken by staff doing the procedure
• Staff awareness about informed consent
• Policy for HIV testing should follow the national policy on HIV testing
(NACO)
 PATIENT RIGHT AND EDUCATION (PRE)

Health care needs (Patient educators)

• Safe and effective use of medication and the potential side
effects
• Food-drug interactions e.g. no alcohol when taking metronidazole
• Diet and nutrition
Health care needs (doctors)
• Immunizations -flu, Hep B,
• Organ donation
• Specific disease process, complications and prevention
strategies
• Preventing healthcare associated infections
 PATIENT RIGHT AND EDUCATION (PRE)
Expected cost
• Informed about the financial implications when there is a
change in the patient condition or treatment setting
• Tariff list is available to patients
Feedback
• doctors and nurses, pain management, hospital environment
(cleanliness and quietness), responsiveness of hospital staff,
discharge information, communication about medications and
overall rating of the hospitals
• redressal procedure
• review and analyse
• preventive, corrective action
 PATIENT RIGHT AND EDUCATION (PRE)
Enhanced Communication
• during challenging situations like breaking bad news, handling
adverse events, handling an aggressive patient/family, talking
to a family of a patient who has expired, counseling for a
complicated intervention etc.
 HOSPITAL INFECTION CONTROL (HIC)

Infection Control Program

WHO guidelines, CDC Guidelines and Manual for Control of
Hospital Associated Infections, Standard Operative Procedures
by NACO, Ministry of Health and Family Welfare, Govt. of India
• To reduce/eliminate risks to patients, visitors and providers of
care
• Standard Precautions/Universal Precautions
• Infection Control Manual
– Documented, a continuous process and updated at least
once in a year (reviewed monthly)
– organization adheres to standard precautions at all times
 HOSPITAL INFECTION CONTROL (HIC)
• Multi-disciplinary infection control committee
– Hospital Administrator
– Microbiologist
– Physician/Infection control specialist
– Surgeon
– Nursing Manager (Nursing Supervisor)
– staffs from CSSD and other support services
– hospital infection control nurse & officer
• Frequency and quorum of meetings
• Infection Control Cell
– designated infection control officer
– designated infection control nurse (ICN)
 HOSPITAL INFECTION CONTROL (HIC)

Organizational compliance to
• Hand hygiene guidelines
• Safe injection and infusion practices
• Transmission-based precautions
• Cleaning, disinfection and sterilization practices
• Antibiotic policy - established, implemented
• Laundry and linen management processes (including blankets, curtains)
• Kitchen sanitation and food handling issues
• periodic screening of kitchen workers and food handlers for carriage of
parasites and Salmonella Typhi every six months or if the staff rejoins after
leave of 15 days or more
• nails, nose swabs
• Engineering controls
• Housekeeping procedures
 HOSPITAL INFECTION CONTROL (HIC)
Surveillance
• Identify high risk areas
– ICU, HDU, OT, post-operative ward, Blood bank, CSSD, mortuary and post mortem
area

• Identify high risk procedures

– cardiac catheterization, endoscopies, surgery lasting more than two hours, BMT
etc.

• Ongoing collection of data

– Hand hygiene
– UTI, VAP, SSI, Intra vascular device (CRBSI)
– A good reference is the CDC/WHO/SHEA guidelines
– Society for Healthcare Epidemiology of America (SHEA)
– tracking and analyzing of infection risks, rates and trends
 HOSPITAL INFECTION CONTROL (HIC)

Provisions
• Adequate and appropriate PPE, soaps and disinfectants
• Isolation/ barrier nursing facilities
• pre- and post-exposure prophylaxis (PEP) to concerned staff in
case of NSI

Notifiable diseases, information (in relevant format) is sent to

appropriate authorities
 HOSPITAL INFECTION CONTROL (HIC)

Outbreaks
• Documented procedure for identifying and handling
• Corrective actions are taken to prevent recurrence
 HOSPITAL INFECTION CONTROL (HIC)
Sterilization activities (CSSD)
– “CDC Guideline for Disinfection and Sterilization in Healthcare Facilities,
2008”
– A good reference is Hospital Infection Society India (HISI) and HTM guidelines
• Adequate space and appropriate zoning
• unidirectional flow, CU, DU
• Documented procedure guides the cleaning, packing, disinfection
and/or sterilization, storing and issue of items
• Identify disinfectants and dilution protocols
• Document Reprocessing of instruments and equipment
• Regular bacteriologic validation tests for sterilization carried out and
documented - Bowie-Dick tape test, leak rate test
• Established recall procedure when breakdown in sterilization system
is identified
 HOSPITAL INFECTION CONTROL (HIC)
Engineering Controls
• patient care areas (optimum spacing between beds is one-two
metres), operating rooms, air quality and water supply
• Issues such as air-conditioning plant and equipment
maintenance, cleaning of AC ducts/filters, AHUs, cleaning /
replacement of filters, seepage leading to fungal colonization,
replacement/repair of plumbing, sewer lines (in shafts) should be
included
• Water-supply sources and system of supply, testing for water
quality.
• ICRA guidelines - Any renovation work in hospital patient-care
areas should be planned with infection control team with regard
to architectural segregation, traffic flow, use of materials, etc.
Refer to NABH guidelines on OT air-conditioning
 HOSPITAL INFECTION CONTROL (HIC)

Bio Medical Waste (BMW)

• Proper segregation, collection, storage, transportation, to the
site of treatment and disposal in proper covered vehicles
within stipulated time limits in a secure manner (organization
to ensure)
• BMW treatment facility – follows statutory provisions (visit
atleast once in 6 months)
• Appropriate personal protective measures (PPE) are used by
all categories of staff handling Bio-medical Waste
 HOSPITAL INFECTION CONTROL (HIC)

Infection Control Program

• Annual budget
• Management makes available resources required for the
infection control program
• Trainings – record