INFECTION CONTROL

DR.RAMMISH.R,
CHIEF CIVIL SURGEON,
DISTRICT QUALITY NODAL OFFICER,
NATIONAL ASSESSOR,
O/O JDHS, RAMNAD
Assessment of Infection
Control Practices
AREA OF CONCERN F
Standards: 6
Measurable Elements: 21
 Infection Control
Program

Hand Personal Instrument Environment Biomedical

Hygiene Protection Processing Control Waste Mgt.
Standard
F1 The facility has infection control Program and procedures in place
(ME:6) for prevention and measurement of hospital associated infection.

ME F1.1
Infection
The facility has functional infection control
Control General/ Administration
committee.
Committee

Sample Collection in Infection Prone

ME F1.2 Department e.g. OT, Labour Room ICU,
Infection The facility has provision for Passive and Active SNCU, Emergency
Surveillance Administrative & Policy Issue in General
culture surveillance of critical & high risk areas.
Administration

ME F1.3 Data & Sample Collection in Indoor

The facility measures hospital associated
Hospital Departments & OT Analysis &
Acquired infection rates. feedback
Infections In General Administration
Standard The facility has infection control Program and procedures in place
F1
for prevention and measurement of hospital associated infection.

ME F1.4 There is Provision of Periodic Medical Check-up

Staff All Departments
Immunization and immunization of staff.

ME F1.5
Infection
The facility has established procedures for regular
Control All Departments
monitoring of infection control practices.
Monitoring

Policy level in
ME F1.6 The facility has defined and established antibiotic
Antibiotic
General/Admin.
Policy policy. Practices all patient
care departments
Standard The facility has infection control Program and procedures in place
F1
for prevention and measurement of hospital associated infection.

Ask Hospital Administration about Policy & program

Level Issues like
 Whether infection control committee has been formed
 How frequent ICC Meets and who coordinates it
 Whether Facility Measures HAI
 Linkage/in-house microbiological lab
 Whether Facility has an established Antibiotic Policy
Ask Staff
 Whether they collect data pertaining to HAI and aware
of case definition of different types nosocomial infections
 Whether their immunization has been done
 Whether they are aware of antibiotic policy of the hospital
Standard The facility has infection control Program and procedures in place
F1
for prevention and measurement of hospital associated infection.

Review Records –
 Attendance & Minutes of meetings of ICC to known
frequency and agenda
 Records of microbial surveillance and HAI
 Immunization and Medical Checkup Records of Staff
 Infection control practice monitoring Records
 Documented Antibiotic Policy & Records of
Antimicrobial Resistance if Any
CRITERIA FOR SURVEILLANCE OF HAI
Standard The facility has defined and Implemented procedures for ensuring
F2
ME-3 hand hygiene practices and antisepsis

ME F2.1 Hand washing facilities are provided at point of

Hand Washing All Departments
Facility use

The facility staff is trained in hand washing

ME F2.2
Hand Washing practices and they adhere to standard hand All Departments
Practices
washing practices

The facility ensures standard practices and

ME F2.3 All Clinical
Antisepsis materials for antisepsis. Departments
 The facility has defined and Implemented procedures for ensuring
Standard
F2 hand hygiene practices and antisepsis

Check for
 Washbasins are available at the at/nearby service areas. Staff do not
have to walk much for hand washing facility
 Running water is available at the wash basin
 Availability of elbow operated taps(OT,LR, SNCU)
 Soap is available with washbasin
 A poster depicting steps of hand washing and when to hand wash is
displayed at hand washing area
 Alcohol base hand rub is available for the staff
 Availability of antiseptics Betadine, Sevlon etc.
Standard The facility has defined and Implemented procedures for ensuring
F2 hand hygiene practices and antisepsis

Ask Staff
 Whether supply of water ,soap & Hand rub is regular and they having
no difficulty in availing hand washing facilities
 Ask any staff to demonstrate the Six Steps of Hand washing
 Ask staff about when they hand wash
 Ask staff about practices of antisepsis and Asepsis eg. Cleaning of skin
with antiseptic before procedure like insertion of cannula or catheter
Area commonly missed during Hand washing
Standard The facility ensures standard practices and materials for Personal
F3
protection.
(ME:2)

ME F3.1
The facility ensures adequate personal protection
Personal
Protection
All Departments
Equipment as per requirements
Equipment

ME F3.2
Personal The facility staff adheres to standard personal
Protection All Departments
Practices protection practices.
 The facility ensures standard practices and materials for Personal
Standard
F3 protection.

Check for
 Availability of personal protective equipment like Gloves,
Gown, Mask, head cap, shoes , lab coat etc.
 Check staff is using these PPE when required
 Check there is no reuse of disposable items happening

 Ask Staff About regular supply of Personal Protective

Equipment- Gloves , Masks etc.
 Ask staff to demonstrate how they wear and remove sterile
gloves
Standard
F4 The facility has standard procedures for processing of equipment
(ME:2) and instruments

The facility ensures standard practices and

ME F4.1
Decontaminatio materials for decontamination and cleaning of
n & Cleaning All Clinical Area
instruments and procedures areas.

The facility ensures standard practices and

ME F4.2
Disinfection & materials for disinfection and sterilization of All Clinical Area
Sterilization Sterilization/Autoclaving
instruments and equipment. covered in OT
Standard The facility has standard procedures for processing of equipment
F4
and instruments

Check whether
 Sterilization records being maintained.
 Autoclaving Indicators are beings used.
 Where sterilized items are kept?
 How linen is collected from wards and whether some processing of
infected linen done on patient care areas.

 Ask staff about how they do decontamination and Cleaning of used

instruments and procedure surface like Delivery & OT Tables
 Ask staff how they make chlorine solution
 Ask staff about process of High level disinfection (HLD)
 Ask OT staff about the processes of Autoclaving and Management of
Sterile Goods
Steps of processing instruments and other items
Decontamination
(Soak in 0.5% chlorine solution 10 minutes)

Cleaning with brush, detergent and water

Preferred Method Acceptable Method
Sterilization HLD

Autoclave
15lbs/In2 Chemical soak
pressure in Chemical
Boiling Soak in
121ºC, Glutaraldehyde Lid on 20
(2%) for 10-24 Glutaraldehyde
(250ºF) minutes
hrs, Rinse with (2%) for 20
20 min/30
sterile water min. Rinse with
min
Normal saline

Cool, dry and Store

 ARRANGEMENT OF INSTRUMENTS &
PACKING

 Arrange the instruments in trays.

 Place heavy instruments at the bottom of the tray.
 Place a signoloc indicator inside the tray.
 Double wrap the instruments set with linen.
 Apply a signoloc indicator with a dated label outside
the pack also.

Dr.Rammish
 FLASH STERILIZATION

 Immediate use steam sterilization or flash sterilization is a

modification of conventional steam sterilization intended
for emergency use.
 These sterilized instruments are not intended to be stored
for future use.
 It involves autoclaving in a flash autoclave at 132°C at 30
lbs of pressure for 3 minutes.

Dr.Rammish
 ETHYLENE OXIDE (ETO)

 ETO uses a combination of vacuum, humidity, temperature and

gas to sterilize at lower temperatures than steam sterilization.
 It is widely used for resterilizing packaged heat sensitive devices
like sharp knives and blades.
 Effective and safe for heat labile tubings, vitrectomy cutters,
cryoprobes, light pipes, laser probes, diathermy leads, etc.
 Exposure to the ETO is at 5psi for 12 hours or 10psi for 6 hours
at 45° to 55°C.

Dr.Rammish
GLUTERALDEHYDE (2%)

 It is suitable for instruments that are heat sensitive and cannot be

autoclaved.
 It is used in high level disinfection and chemical sterilization of sharp
cutting instruments, plastic and rubber items, endoscopes.
 Gluteraldehyde is effective against vegetative pathogens in 15 minutes
and spores in 3 hours.
 Instruments should be thoroughly rinsed 2 to 3 times in trays filled
with sterile water after sterilization.
 Immerse instruments in 2% gluteraldehyde for 20 min for HLD and 10
to 24 hrs for sterilization.

Dr.Rammish
 GAMMA IRRADIATION

 It is a method of cold sterilization (uses Cobalt 60

radiation).
 Has high penetrating power and is lethal to DNA.
 There is no appreciable rise in temperature.
 Most useful for disposable and rubber items.

Dr.Rammish
 VALIDATION OF STERILIZATION

CHEMICAL INDICATORS
 Signoloc tapes
 Bowie-Dick tapes
BIOLOGICAL INDICATORS
 Spore strips/vials impregnated with spores of bacillus
steriothermophillus.
 Strips are inserted in the cold compartment of autoclave, which is the
lowest part of the chamber.
TRACEABILITY OF STERILIZED PACK

• Technician/sister initials, Autoclave Number, Load number, No. of sets

BG010210
 Date and time of sterilization
 Date and time of expiry

 Sterilizer code: Separate Autoclaves

o A- linen
o B- instruments
o C- miscellaneous (gauze, bandage roll, sterile pad, etc,.)
Standard Physical layout and environmental control of the patient care areas
F5
ensures infection prevention
(ME: 5)

ME F5.1 All High risk area like

Layout of the department is conducive for the infection control
Layout for SNCU, ICU, OT,
Infection practices. Labour Room,
Prevention
Emergency Etc.

ME F5.2
Disinfectant The facility ensures availability of standard materials for cleaning All Departments
Materials
and disinfection of patient care areas.

ME F5.3 The facility ensures standard practices are followed for the All departments with
Environment & Special focus on
Cleaning cleaning and disinfection of patient care areas.
High Risk Areas
Standard Physical layout and environmental control of the patient care areas
F5 ensures infection prevention

ME F5.5
The facility ensures segregation infectious patients All patient Care Area
Isolation

ME F5.6 The facility ensures air quality of high risk area SNCU, ICU,OT Unit,
Air Quality Lab & PP Unit
Standard Physical layout and environmental control of the patient care areas
F5 ensures infection prevention

Check whether
 Check layout of department and organization of processes ensures
unidirectional flow and no criss- cross between sterile and infected
items
 Check for availability of cleaning solutions/Disinfectants used for
cleaning purpose
 Observe infectious patients are not admitted with other patients
 There is provision of equipment for maintain positive/negative
pressure as per requirement
 External foot wears are not allowed in critical areas like Labour room ,
OT & SNCU
Standard Physical layout and environmental control of the patient care areas
F5 ensures infection prevention

 Ask staff how they clean and disinfect the area

 What materials they use for cleaning
 Ask staff how they manage spills specially of body fluids like blood

 Check for records of fumigation, carbolization and cleaning

activities
 Cleaning Of Patient Care Areas

• 3 BUCKET SYSTEM FOR MOPPING

• One bucket for cleaning solution like detergent
• Second bucket for plain water for rinsing the mop
• Third bucket for disinfectant - 0.5 % Sodium
Hypochlorite/ Lysol.
 Fumigation

• Routine fogging is not recommended if using a HVAC/HEPA

filter system, unless it is a new OT or after
repair/renovation, or if any infection is reported in the OT.

• The method of fogging is recommended mainly to ensure

uniform application of disinfectant to all surfaces in the
room.

• The age old tradition of formalin fumigation is not

recommended as it is difficult to perform, dangerous to use,
unreliable, and formalin is carcinogenic. Instead, a peroxide
based disinfectant can be used.
 Bacillocid Fumigation

• Bacillocid special is a commercially available

surface and environmental disinfectant
commonly used to sterilize the operating room.
• It has a very good cleansing property along with
bactericidal, virucidal, sporicidal and fungicidal
activity.
• To prepare 2% bacillocid, add 20ml of bacillocid
special in 1 litre of water.
• 5ml of 2% bacillocid is required per cubic metre
of the room volume for fumigation.
 Usage of Bacillocid

• Bacillocid can be used at 0.5%

concentration to spray or mop in non
critical areas, keeping a contact time of
20 to 30 min.
• In high risk areas, it can be used at 1%
dilution for daily fumigation, or 2% for
weekly.
• For regular disinfection, use at 2%
weekly, 1% alternate days, or 0.5% daily.
 Ultraviolet Light Disinfection

• UV light is an effective addition to manual

disinfection, and can kill harmful pathogens
quickly and efficiently.
• Daily UV irradiation for 12 to 16 hours is
required.
• The lights are to be switched off 2 hours before
surgery.
• Accidental exposure causes damage to
superficial tissues especially skin and eyes, and
has the potential to cause malignancies.
 SPILL MANAGEMENT

• Small volumes of spill (few drops):

– Wear the gloves and other PPE appropriate to the task.
– Wipe the spill with a newspaper moistened with hypochlorite solution (1% dilution)
– Discard the paper as infected waste.
– Repeat until all visible soiling is removed.
• Large spills (>10ml):
– Confine the contaminated area
– Wear the glove and other PPE appropriate to the task.
– Cover the spill with newspaper or appropriate absorbent material to prevent from spreading.
– Flood the spill with 1% chlorine solution .While flooding the spill with 1-2% chlorine solution it is to be ensured that
both the spill and absorbent material is thoroughly wet.
– Wait for 10-20 minutes.
– Remove and discard the paper as infected waste.
 Surface Cleaning

• Infant Bassinets and incubators, radiant warmers: Daily damp clean

cloth wiping and wiping with 1 % bacillocid weekly.
• Avoid using phenolics/carbolic acid in new born care units- leave
residue
• Avoid Chlorine solution- release gases
• Use bacillocid(Contains chemically bound formaldehyde,
glutaraldehyde and benzalkonium chloride) for floor cleaning in
SNCU.
Standard Facility has defined and established procedures for
F6 segregation, collection, treatment and disposal of biomedical
(ME: 3) and hazardous waste

ME F6.1 The facility ensures segregation of biomedical waste as per

Segregation All Departments
guidelines

ME F6.2
Sharps The facility ensures management of sharps as per guidelines All Departments
Management

ME F6.3
The facility ensures transportation and disposal of waste as
Transportation General
and disposal per guidelines administration
Bio Medical Waste Management
Rules 2016
(Amendment 2018 and 2019)
 YELLOW CATEGORY: Soiled waste

ED
P I R
EX
RED CATEGORY: Contaminated recyclable plastics
BLUE CATEGORY: Glass sharps
WHITE Category: Metal sharps