Chapter- 7 Infection

Prevention and Control

(IPC)

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Chapter Objective

At the end of this module, participants will be able to:

• Identify health center Infection prevention and control activities

• Explain how to organize IPC committee and its responsibilities

• Analyze health center standard precaution requirements

• Assess the IPC infrastructure and supplies of health center

 Discuss Worker safety and environmental hygiene in a health

center.

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Chapter Outline

 Goal of IPC

 WHO Core components of IPC

 The infection chain/cycle

 standard precaution

 Transmission based precautions

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Definition of Basic Terms

 Microorganisms: causative agents of infection

 Infectious Microorganisms: microorganism capable of producing disease in

appropriate hosts.

 Colonization: presence and multiplication of a microorganisms without tissue

invasion or damage

 Infection: colonizing organisms are now causing cellular response

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Definition cont’d …

 Infection prevention and control: a systemic effort or process of placing

protective barriers (physical, chemical, or mechanical) between susceptible host
& microorganism

• “used interchangeably with Infection Prevention in this training.”

 Nosocomial infections: Infection arising > 48 hours after admission.

Used interchangeably with “healthcare facility acquired infection” or

“healthcare associated infections (HAIs)”.

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Why IPC?

 To protect patients from nosocomial infections

 To protect the healthcare providers and support staff from

occupational hazard
 To protect visitors

 To protect students practicing in the healthcare facilities

 To protect communities and environment

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Goal of Infection Prevention and Control

 To make healthcare facilities safe place for all, including

o Patients,
o Clinical and
o Non-clinical staff of healthcare facilities, and
o The community

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 The 8 WHO’s Core components are:-

1. IPC programs 6. Monitoring and audit of IPC

2. Evidence-based guidelines practices and feedback

3. Education and training 7. Workload, staffing and bed

occupancy ( facility level)
4. Health care-associated infection
surveillance 8. Built environment, materials and
equipment for IPC (facility level)
5. Multimodal strategies

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Chain of Infection

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 Healthcare associated infections

 Infections acquired while a patients is under health center (or any other health facility) care
which are not present or incubating at time of admission.

 Infections occurring more than 48 hours after admission

 HAIs may also occur;

 Up to 48 hours after the episode of care

 Up to 3 days after discharge
 Up to 30 days after an operation
 Up to 1 year after an operation with an implant
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Healthcare associated infections Cont’d …

 Some of the most common HAIs are;

 Surgical Site Infections
 Urinary Tract Infections,
 Blood Stream Infections,
 Pneumonia
 Diarrhea

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Infection Prevention and Control Practices

 Infection prevention and control practices include:

 Standard precaution and
 Transmission-based Precautions.

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Activity 7.2. Group discussion on IPC
Instruction:
 Be in group of 5-6 people discuss the topics below in your group and report the
work in the plenary (Reflect group response to the larger groups):
• Group-1 What is Standard precautions and types of SP
• Group-2 Hand hygiene/Types/
• Group-3 PPE/Types/
• Group-4 Sharps and injection safety
• Group-5 Linen/textile processing
• Group-6 Safe practice in the OR
• Group-7 Health care waste mgt
• Group-8 Environmental Cleaning
• Group-9 Instrument processing
• Group-10 What is Transmission based precautions and describe types of
TBP
Time: 15 min for discussion and 30 min for presentation

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1.Standard Precaution

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Standard Precautions

 These practices are designed for use in caring for all people-both clients and

patients attending healthcare facilities (first level precautions).

 These apply to blood, all body fluids, secretions and excretions (except sweat),
non-intact skin and mucous membranes.

 Since no one really knows what organisms do clients or patients have, it is

necessary that standard precautions be used all the time.

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 Key Components of Standard Precautions
Cont’d…
 Hand Hygiene
 After touching blood, body fluids,
secretions, excretions and
contaminated items;
 Immediately after removing gloves;

 Between patient contacts

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18
Kinds of Hand Hygiene Practices

 Hand washing

 Antiseptic Hand-rub

 Hand Antisepsis

 Surgical Hand scrub

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19 5 Moments of Hand Hygiene

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 PPE use
Types of PPE Area of protection
Cap Hair and Scalp
Google Eyes
Face Masks Nose, Mouth and Lower Jaw
Face Shield Face
Gloves Hand
Gowns Upper body, skin and cloth
Apron Front of the body
Boots Lower legs and feet
Shoe cover Shoe MOH-ETH
PPE use….
 Wearing Gloves For contact with blood, body fluids,
secretions/excretions or contaminated
items

For contact with mucous membranes

and non-intact skin

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PPE use….
 Protect skin from blood or body fluid
 Gowns/Aprons contact
 Prevent soiling of clothing during
procedures that may involve contact
with blood or any body fluids
(secretions/excretions)

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PPE use….

Protect mucous membranes of

 Masks, Google's and Face shields
eyes, nose and mouth when
contact with blood and body
fluids is likely or possible

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Sharps and Injection Safety
 Avoid recapping, bending, breaking, or hand
manipulate used needles

 Use a one-handed scoop technique only if

needed

  Avoid removing used needles from

disposable syringes

 Place used sharps in puncture-resistant

container at point of use

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 Best Practices in Injection Safety
1. Elimination of unnecessary Injection
 Promoting Rational Prescribing
 Educating the patients

2. Administer Injections Safely

1. Right Patient
2. Right Drug 6. Right Time

3. Right Formulation 7. Right Route

4. Right Injection Equipment 8. Right Storage

5. Right Dosage 9. Right Method of Disposal

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Procedure for Pop-Open Ampoules

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Processing textile and Laundry

 Handle soiled linen to prevent

touching of skin or mucous
membranes
 Do not pre-rinse soiled linens in
patient care areas

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Components of reprocessing contaminated textiles

1. Collecting

2. Transporting

3. Sorting

4. Washing

5. Storing

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 Washing linen Sorting linen
2
9

Drying linen
Storing linen

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Health care waste Management
 Safely dispose of infectious waste materials to protect
those who handle them and prevent injury or spread of
infection to the community.

 HCWM is a key issue to control and reduce HAIs in

healthcare facilities and to ensure that the environment is
well protected.

 Approximately 75–90% of the general waste produced by

health care facilities is non-contaminated and poses no risk
of infection for those who handle it
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Steps of health care waste management
 Waste minimization

 Segregation

 Collection and transport

 Storage

 Disposal

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 Segregation of Waste at Point of Generation
3
2
Type of Waste Color of Container and Type of Container
Markings
Highly infectious waste Yellow, marked “highly Strong, leak-proof plastic bag
(includes all pathological infectious” with biohazard or container capable of being
waste) symbol autoclaved
Other infectious waste Yellow with biohazard symbol Leak-proof plastic bag or
container
Sharps Yellow, marked “SHARPS” Puncture-proof container
with biohazard symbol
Chemical and pharmaceutical Brown, labeled with Plastic bag or rigid container
waste appropriate hazard symbol

Radioactive waste Labeled with radiation symbol Lead box

General health care waste Black Plastic bag or container
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3
3 Disposal of Healthcare Waste Cont’d…

Healthcare Waste

Hazardous Non Hazardous

Biodegradable Other
Inorganic
(Kitchen, Landscape)

Recyclable
To Compost
To Market

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34
Disposal of Healthcare Waste Cont’d…

Hazardous

Hazardous Clinical Waste

Cytotoxic drug, toxic (Infectious Waste)
chemicals,
radioactive waste
stored in cement Sharps Non-Sharp
tanks until half life
Steam Sterilize, Shred deep
Burial Encapsulation

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Disposal of Healthcare Waste Cont’d…

Non Sharp

Clinical Waste – from Patient care Laboratory

Plastics Non Plastics

Disposable Syringes, IV Cotton, Gauze Dressing Contaminated
Sets, Catheters ET Tubes With Blood, Purulent Exudate,
Secretions and Excretions
Steam Sterilize and Shared Steam Sterilize and Shred or
Incineration
Landfill
Landfill
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3
6 Disposal of Healthcare Waste Cont’d…
Laboratory

Microbiology Anatomical Parts,

Specimens
Lab. Waste Animal Carcasses

Blood, Body Fluids, Steam Sterilization Incineration/

Secretions and Excretions and Shred Cremation

Ash to
Steam Sterilize Sewer or Landfill
Landfill

Landfill

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Key Components of Standard Precautions
Cont’d…
 Routinely clean noncritical care
 Environmental Cleaning equipment, instruments, devices, and
environmental surfaces.

 Clean patient care equipment between

each use on patients to prevent cross-
contamination between patients.

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 Rooms level of risk & how to clean
Areas Level of risk Cleaned using
• waiting rooms and administrative low-risk soap and water
offices

• Toilets High-risk (heavy Disinfectants like

• Patient rooms items touched bare contamination) 0.5% Chlorine or
handedly by patients and staff 1% Phenol
• Operating rooms, pre- and
postoperative recovery areas,
dressing areas and intensive care
units (ICUs).
• Blood or body fluid spills areas

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Key Components of Standard Precautions
Cont’d…
• Use proper handling of sharps

• Safe practice in the OR • Use safe zone ( hand free techniques to

pass and receive sharps in the OR)

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40
2. The Safe Surgery Guidelines
2.1. The implementation of the safe surgery checklist.
 “Sign In” prior to induction of anesthesia
 “Time Out” prior to skin incision
 “Sign Out” before the team leaves the operating room.
2.2. The monitoring and evaluation of surgical outcomes
The monthly facility report:
 Death on the day of surgery
 Postoperative in-hospital deaths
 The frequency of compliance

09/02/2025 Vol.2 Sec.4 Chap. 6 : SAFE SURGERY AND SAFE P MOH-ETH

RACTICE IN THE OPERATION ROOM
 4
1 Instrument processing
Spaulding’s Risk Classification and Level
of Processing
Risk category Level of Examples
disinfection/
sterilization

Critical Sterilization Reusable surgical instruments

Semi-critical High-level Respiratory instruments, specula used

disinfection for vaginal examination ,endoscopes

Non-critical Cleaning Blood pressure cuffs, stethoscopes

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Instrument processing…

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Instrument processing…

 Medical devices Decontamination

 Special attention should be given to proper handling of

the instruments and other items to minimize the risk of
accidental injury or exposure to blood and other body
fluids of the sterile processing staff and to attain high
quality end result.

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4
4 Effectiveness of Methods of Processing Instruments

METHOD EFFECTIVENESS (kill or END POINT

remove microorganisms)

Cleaning (soap and Up to 80% Until visibly clean

rinsing with water)
95% (does not inactivate Boiling or chemical for 20
High-Level Disinfection endospores) minutes
High-pressure steam, dry
Sterilization 100% heat or chemical for the
recommended time

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2.Transmission Based Precaution

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 Transmission Based Precaution

 Are guidelines designed to reduce the risk of transmitting infections that are
spread wholly or partly by airborne, droplet, or contact routes between
hospitalized patients and health providers.
 Transmission-Based Precautions are applied for patients who are known or
suspected to be infected or colonized with infectious agents

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 Transmission Based Precaution cont’d…

Since the infective agent is not often known at the time of admission
to a healthcare facility, Transmission-Based Precautions are used
empirically according to the clinical syndrome and the likely
etiologic agents at the time.

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 Key Components of Transmission-Based
Precaution
Key components of transmission based precaution are
 Airborne precaution
 Droplet precaution
 Contact precaution
Examples
 Airborne: Chicken pox , measles, and tuberculosis
 Droplet: Mumps, rubella, and meningitis (N. meningitides) ,COVID-19
 Contact: Enteric pathogens (hepatitis A, echo viruses) and herpes
simplex
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 IPC/CASH program structure
 The team members are:
• Health center head ----------------------------chair
• CASH/IPC focal-----------------------------------secretary
• Pharmacy, laboratory, MCH, OPD, emergency department
heads------member
• Janitor head------------------member
• Laundry head---------------------------member
• Finance head------------------member

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Roles and responsibilities of the committee

 Develop CASH/IPC specific action plan and cascade to department/Case team level

 Support the implementation of the facility CASH/IPC performance improvement plan

 Conduct ongoing CASH/IPC assessment, prepare improvement plan, and give feedback
to case teams

 Conduct regular team meetings (monthly), set action points and document minutes

 Organize facility wide cleaning campaign on monthly basis

 Establish surveillance and report system for Health Care Acquired Infection

 Monitor and support health posts and HEW

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 Operational standards with their respective verifications
P-187
SD# Standard Method of Evaluation √/× Met Unmet Remark

1. Health center  Check member assignment letter

established functional
 Focal person assignment letter
IPC/CASH committee.

 Check IPC committee TOR

 Current annual plan

 Minutes of regular IPC meetings

 Used IPC/CASH audit tool in ensuring

IPC/CASH activities regularly

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 Operational standards with their respective
verifications
SD# Standard Method of Evaluation √/× Met Unmet Remark

2. The health  Check presence of audit plan

center conducts  Check assessment checklist/audit tool
quarterly
CASH/IPC audit  Action plan based on audit result
 Implementation of action plan
3. The health Check availability of:
center shall avail  disinfectant
the necessary  detergents supplies
equipment,  PPE
supplies  Sweeping & mopping tools
necessary for  trollies for waste transport
IPC/CASH.

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SD# Operational
Standard standards Method
withoftheir
Evaluationrespective √/× Met Unmet Remark
verifications
4 The Health center shall
 Check availability of the revised
ensure that all staff are
IPC guideline, 2019
trained using standard
infection prevention and  Training plan
control training manual.
 Check separate training materials are prepared for clinical
and supportive staffs

 Training Attendance, minute and photos

 Interview 5 sampled staff(3 providers & 2 support) on training

5 The health center  Adequate cleaners as per standard

ensures housekeeping
 Observe visibly cleanliness of sampled rooms(eg delivery,
activities.
toilet

 Compound cleanliness(inside and around)

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 Check rooms are well ventilated
 Operational standards with their respective
verifications
SD# Standard Method of Evaluation √/× Met Unmet Remark
6 The health center ensures  Observe presence and functionality of hand
hand hygiene facilities are hygiene stations in all service outlets
available at all service
points.  Hand hygiene job aids posted at all stations

 Observe hand hygiene practice of 3 staffs

 Check presence of sanitizers in all service outlets

7 The health center has a  Check presence of designated laundry room

functional laundry service.
 Check presence and functionality of laundry
machine

 Presence of water at all times

 Use of PPE during laundry machine operation MOH-ETH
SD# Operational
Standard standards Method withoftheirEvaluationrespective √/× Met Unmet Remark
8 verifications
The health center  Presence of SOPs based on revised IPC manual(2019)
ensures standardized
instrument processing  Check instruments are processed based on the revised
practice. IPC guideline

 Presence of sterilizer/high level disinfection setup

 Separate Storage area for sterilized and cleaned supplies

9 The health center  Annual plan HBV/COVID 19 vaccinations for staff

ensures all the post o Presence of PEP for HIV & HBV
exposure and preventive
 PPE including
interventions and
o Mask
procedures are in place
in case of occurrence of o Face shield
occupational risks. o Boots
o Heavy duty gloves
o Head cover
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o Goggles
SD# Operational
Standard standardsMethod
with their respective√/×
of Evaluation Met Unmet Remark
10 Theverifications
health center  Annual plan
provides health  Posted monthly schedule
education to  HE Logbook/report
patients/clients,  EPHCG included in all HE sessions
caregivers and visitors.  IPC HE topics included in monthly schedules

11 The health center shall  Check proper segregation of wastes

ensure proper health
 Fenced Placenta pit, Incinerator, ash pit and Burying pit
care waste
 Disposal is proper(check the right wastes are disposed in
management.
the right place and no wastes found/disposed outside
places mentioned above)
12 The Health center  Annual plan for support
provides IPC/CASH  Support checklist and feedback
support to its satellite  Training report
health posts  IPC/CASH supplies provided

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 Summary
 The goal of infection prevention and control is to make health care facilities a safer place and WHO’s components
of infection prevention and control is an integral part of this guideline.

 Infection prevention and control practices include:

 Standard precaution

- Hand Hygiene, Use of PPE, Safe Injection Practices, Environmental Cleaning, Instrument
Processing, Processing Textiles and Laundry, Healthcare Waste Management
 Transmission-based Precautions.

- Airborne precaution

- Droplet precaution

- Contact precaution

 IPC/CASH structure

 Infection prevention and Control activities are every body’s responsibility.

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 standards and verification points of the chapter
Thank you!
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