INFECTION CONTROL PROTOCOL IN ICU

Presenter
RAJAK SMD
MSc Nursing
 INTRODUCTION
• “The very first requirement in a hospital that it
should do the sick no harm" - Florence Nightingale

• Health care associated infections(HCAI)- economic

loss, prolonged hospital stay & adverse patient
outcomes.

• In most health care facilitiesthe

average incidence of HCAI is around 5-
10 %
INFECTION CONTROL - DEFINITION

Measures practiced by health care personnel

to prevent spread, transmission & acquisition
of infection between clients, from health care
providers to clients & from clients to HCP.

Standard precaution
Based on
Additional
precaution
 COMMON ORGANISMS
BACTERIA VIRUS
 Staphylococcus aureus  HIV
 Enterococcus  HBV
 Pseudomonas aeruginosa  HCV
 Klebsiella  CMV
 E- coli
FUNGAL
 Candida
albicans
 Aspergillus

PARASITES
 Giardia lambia
 RISK DUE TO
• Low resistance of patient to infections.

• Invasive procedures/interventions.

• Inappropriate anti-microbial usage.

• Drug resistance of endemic microbes.

• Contaminated environment.
STANDARD SAFETY
MEASURES
 STANDARD PRECAUTION
• Set of infection control practices used to prevent
transmission of diseases that can be acquired by
contact with blood, body fluids, non- intact skin
& mucus membrane
• STANDARD PRECAUTION STEPS
– Hand washing

– PPE

– Decontamination

– Waste disposal
 HAND HYGIENE

Hand washing is the single most effective measure

in infection control.

80% of the diseases are spread through hands.

How to Handwash?
HOW TO HAND RUB?
 POINTS TO BE REMEMBERED
• Covering cuts & wounds

• Gloves is not a substitute for hand washing

• When a bar soap is used, it should be kept dry

in soap case
• When liquid soaps are used, avoid topping off
of the solution , dispenser should be kept clean
PERSONAL PROTECTIVE EQUIPMENT

• Gloves
• Gown
• Mask
• Protective eye wear
• Face shield
• Apron
SEQUENCE FOR DONNING PPE
GOWN

MASK

GOGGLES OR
FACE
SHIELD

GLOVES
SEQUENCE FOR REMOVING
PPE
 SAFE HANDLING OF SHARPS

 Never pass sharps from one person to

another.
 Always dispose your own sharps.
 DO NOT RECAP needles.
 Dispose sharps in puncture proof
container.
 DISINFECTION

Reduce the number of microorganisms on

an object or surface but not the complete
destruction of all microorganisms or spores.
 TYPE OF DISINFECTANTS
• High level disinfectants
2% glutaraldehyde (cidex)
stabilised hydrogen peroxide
1% sodium hypochlorite
• Intermediate level disinfectants
0.1% sodium hypochlorite
Iodophores & phenolic solutions
• Low level disinfectants
Quateranary ammonium
compounds
 STERILIZATION
Procedures, which would remove all
microorganisms, including spores, from an object.
Sterilization Methods
• Dry heat sterilization

• Moist heat sterilization

• Chemical sterilization

• Radiation sterilization
 Safety bundles
• A “bundle” is a group of evidence based care
components for a given disease that, when
executed together, may result in better
outcomes than if implemented individually.
 CAUTIs Bundle
• Avoid unnecessay urinary catheters
• Insert using aseptic technique
• Maintain catheter using recommended
guidelines (daily care)
• Review catheter necessity daily & remove
promptly.
 CLABSIs
• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Optimal catheter site selection
• Daily review of line necessity with prompt removal
of unnecessary lines
• Line secure with clean & intact dressing
 SSI Bundle
• Appropriate use of antibiotics
• Appropriate hair removal
• Post operative glucose control
• Peri & postoperative normothermia
 VAP Bundle
• DVT prophylaxis
• GI prophylaxis
• Head of bed elevated to 30-45º
• Daily sedation vacation
• Daily spontaneous breathing trail
BIO MEDICAL WASTE
MANAGEMENT
DEFINITION
Waste generated during the diagnosis, testing,
treatment, research or production of
biological products for humans or animals
(WHO)

Waste management is the collection, transport,

processing or disposal, managing & monitoring
of waste material.
PURPOSES OF WASTE DISPOSAL

 To reduce hazardous nature of waste.

 To reduce volume of waste.

 To prevent misuse or abuse of waste.

 To ensure occupational safety & health.

 To consider aesthetics.
 LEGISLATION
• Ministry of environment & forests (MOEF) issued
guidelines to the hospitals to ensure proper &
safe disposal of bio medical waste.

– Bio medical waste management & handling

rule came in to effect in 1998
 3 BINS, 01 CONTAINER, O1 BOX
Human Glassware
anatomical waste : Broken
Chemo drugs C) Waste or
Soiled waste discarded
General ontaminated sharps
Expired or &
Plastic Waste including
waste Discarded
(Recyclable Metals contaminated
Medicines, glass including
soiled linen
medicine vials
& ampoules

3
 BMW RULE 2016
CATEGORY TYPE OF TREATMENT & DISPOSAL
WASTE
(a) Human Incineration or plasma pyrolysis
anatomical or deep burial
waste
(b) Animal
YELLOW anatomical
waste
(c) Solied
(d) waste
Expired or Incineration at tem. >12000C Or
discarded Encapsulation or Plasma Pyrolysis
medicine

(e) Chemical liquid Pre treatment before mixing with

waste waste water.

(f) Linen Non- chlorinated chemical

disinfection
 BMW RULE 2016
CATEGORY TYPE OF TREATMENT &
WASTE DISPOSAL

Contaminated
plastic waste Autoclaving or micro-

RED (Recyclable) waving followed by

shredding, sterilization &
then sent to registered
recyclers for energy
recovery or for road
making
 BMW RULE 2016
CATEGORY TYPE OF TREATMENT & DISPOSAL
WASTE

White Waste sharps Autoclaving & shredding &

(Translucent including
sent for final disposal to iron
Puncture proof, Metals
containers) foundries.
consent to operate from the
State Pollution Control
Boards or concrete waste
sharp pit.
 BMW RULE 2016
CATEGORY TYPE OF WASTE TREATMENT &
DISPOSAL

Cardboard boxes Glassware:Broken Disinfection then

with blue or discarded & Sent for
contaminated glass recycling.
coloured marking
Metallic Body
Implants
 WASTE MANAGEMENT

3R’
s
 WASTE SEGREGATION

 Done at the source of waste generation

 Responsibility of generator of waste.

 segregation as per categories applicable.

 WASTE STORAGE

Storage facility should have sufficient

capacity.
 Location - within hospital premises.

Untreated biomedical waste not to be kept

beyond 48 hrs (Permission required for

>48 hrs).
 WASTE TRANSPORTATION

 Points to be remembered:
 Before taking the bags it should be tied &
labeled.
 Waste handlers should not touch any other
articles.
 A covered cart with biohazard symbol to
carry the waste to the central area of
collection.
AIIMS-OUT SOURCING BY BIOTIC
 TRAINING ON BIOMEDICAL WASTE
MANAGEMENT
Overall aim of training:
• To develop awareness of health, safety
& environmental issues relating to
health care waste.
• Roles & responsibilities of health care
personnel in overall management
program should be highlighted.
STAFF SAFETY CONSIDERATIONS
• Separate trolleys for transporting waste within

the hospital.

• All workers involved in the work are aware of

the hazardous nature of the work.

• Provided with all protective equipment.

• Immunized against tetanus & hepatitis B.

 ROLE OF INFECTION CONTROL
NURSES

• Visits all wards & high risk units.

• Checking nursing supervisor’s register &
records for cases suggestive of
infection.
• Collection of sample from different areas of
the hospitals & sending them to the lab.
 ROLE OF INFECTION CONTROL
NURSES(CONTD..)
• Daily visit to microbiology lab to ascertain
results of sample collected.
• Monitoring & supervision of infection among
hospital staffs.
• Training of nursing & paramedical personnel
on correct hygiene practices & aseptic
technique.
 SUMMARY
• Infection control
• Chain of infection
• Standard safety measures
• Safety bundles
• Staff safety
• Role of infection control nurses
 CONCLUSION
•This is the time to understand that infection
control, standard precaution, hospital
waste management are of great concern.
•The human element is more important than
technology.
•Well trained, motivated staff can really work
wonders.
•Strict adherence to simple infection control
procedures go long way in controlling infection.
• N95 mask required in
a) Airborne precautions
b) Droplet precautions
c) Contact precautions

Ans – a)
• Hands that are visibly dirty should be washed
with
a) Alcohol based hand product
b) Warm water
c) Soap & water
d) All of the above

Ans- c
BIO HAZARD
RADIOACTIVE WASTE
CYTOTOXIC WASTE
THANK YOU