TOOLS FOR DATA COLLECTION

Part-I: Socio-demographic data.

Code No________

1. Age in year ________

2. Gender
a. Male
b. Female

3. Religion
a. Hindu
b. Muslim
c. Christian
d. Others

4. Education qualification
a. GNM
b. B.Sc.(N)
c. P.B B.Sc. (N)
d. MSc(N)

5. Area of work
o General wards
o PICU
o NICU
o OPD

6. Year of work experience

a. Less than 5 years
b. 6-10 years
c. 11-15 years
d. More than 15 years
7. Undergone training on infection control
a. Yes
b. No

8. Source of information on infection control

a. Academic education
b. Magazine/Journals
c. Workshops/Conference
d. Others specify _____________
 Part-II: Structured knowledge questionnaire on infection control
protocol

1. The leading cause for increased preventable death in hospital is

a. Chronic diseases
b. Increased population
c. Infection
d. Quality of care

2. The group most vulnerable of infection

a. Pediatric
b. Adolescents
c. Young Adults
d. Older Adults

3. Infection means
a. The invasion and multiplication of microorganisms
b. The removal of microorganisms from the body tissues
c. Multiplication of cells in the body
d. Absence of micro-organisms in the body

4. Hospital Acquired infection means

a. infection that is contracted from the environment or staff of a healthcare facility
b. Infection that affect all the members in the healthcare facility
c. Infection that does not occur among health care staffs
d. Admission of an infectious patient to the hospital

5. The commonest infection in health care setting

a. Septicaemia
b. Fever
c. Malaria
d. Jaundice
6. The common means of spread of infection in the health care facility is
a. By health care staffs
b. By Contaminated equipments
c. By Bed linens
d. By All the above

7. The estimation of nosocomial infection in paediatric intensive care unit is

a. Less than 1%
b. 4-6%
c. 8-10%
d. More than 15%

8. The infection control means measures taken to

a. Prevent the spread, transmission and acquisition of infection
b. Control the admission of patients with infectious disease
c. Observe of patient with infectious disease
d. Understand the needs of an infectious patients

9. The most effective way to prevent the spread of infection

a. Avoid touching the patient
b. Wash Hands frequently
c. Avoid physical examination
d. Handle the baby carefully

10. Hand washing should be done for at least

a. 5 sec
b. 10 sec
c. 30 sec
d. 5 min
11. Hand washing should be done by using
a. Cold water
b. Hot water
c. Soap and water
d. None of the above

12. Solution used as hand rub include

a. alcohol-based hand sanitizer that contains at least 20% alcohol
b. alcohol-based hand sanitizer that contains at least 60% alcohol
c. hand sanitizer that does not contain alcohol
d. Non alcoholic solutions

13. The equipment used for all new born infants should be
a. Sterilized
b. Washed
c. Used without washing
d. Thrown away

14. Laryngoscope should be cleaned with

a. Sterilization
b. Washing
c. Autoclave
d. Alcohol wipes

15. Environmental surfaces like door knobs, table tops, carts should be cleaned with
a. 70% IP alcohol
b. Water
c. None
d. Cloth
16. The PPE means
a. Patient people evaluation
b. Personal people escape
c. Personal protective equipment
d. People population explore

17. Personal protective equipment is

a. Gloves, gown, mask, goggles, head cap
b. Shirts, shoes, pants, socks, trouser
c. Uniform with shoe
d. Apron

18. The gloves should be used

a. While giving medications
b. During vein puncture
c. While in contact with body fluid
d. All the above

19. Sterile gloves should be worn for

a. Invasive procedures
b. Every time
c. While touching patients
d. After every hand wash

20. Reason for wearing goggles in hospitals

a. to prevent blood splash on eyes
b. to protect from sun light
c. to protect ears
d. to prevent bleeding
21. Sterilization is a process intended to
a. kill all microorganisms on any equipment or objects
b. produce the micro-organisms for culture
c. protect the micro-organisms on the equipments
d. enhance the microbial activity

22. Following is the method of Sterilization Except

a. Autoclave
b. Dry Heat (in an oven)
c. Chemical Sterilants
d. Cleaning

23. Disinfection helps to kill microorganisms on the surface by using

a. Liquid Chemicals
b. Soap and water
c. Dry Heat
d. All the above

24. The spread of infection in the play room can be prevented by

a. Close down the play room
b. Allow the children to play one after the other
c. Avoid the communication between children
d. Disinfect the play room and toys frequently

25. Biomedical waste means the waste generated

a. In the hospital
b. During the treatment of human beings
c. During the cleaning of the hospital
d. By the equipments
26. Biomedical waste management helps to
a. reduce hazardous nature of waste
b. prevent the spread of infection
c. prevent misuse or abuse of waste
d. All the above

27. The process of waste management includes the following except

a. Collection of waste
b. segregation of waste
c. Processing of waste
d. Generation of waste

28. While disposing the solid biomedical waste it should be

a. Disinfected before final disposal
b. disposed as it is
c. washed with clean water
d. wiped with wet cloths

29. The best method to dispose infected biomedical waste is

a. Microwave irradiation
b. Burning
c. burying
d. mix with other wastes

30. All workers involved in the waste management must be immunized against
a. tetanus & hepatitis B
b. Diphtheria and pertusis
c. Measles and Mumps
d. BCG and Rota Vaccine
 INFECTION CONTROL PROTOCOL

Introduction:
Childhood morbidity consumes a substantial portion of health care resources in a
hospital. Nosocomial infections or healthcare associated infections occur in patients under
medical care. These infections occur worldwide both in developed and developing
countries. Nosocomial infections accounts for 7% in developed and 10% in developing
countries. As these infections occur during hospital stay, they cause prolonged stay,
disability, and economic burden. Frequently prevalent infections include central line-
associated bloodstream infections, catheter-associated urinary tract infections, surgical site
infections and ventilator-associated pneumonia.

Young children readily acquire and transmit infections. They frequently harbour
infectious organisms and may shed pathogens, especially respiratory and gastrointestinal
viruses, even when asymptomatic. Preventing transmission of infection in the paediatric
health care setting is an important component of patient care and is of concern to health
care providers, patients and parents.

Infection is one of the leading causes of preventable death in hospitals every year.
The centre of Disease Control and Prevention estimated that there are approximately 2
million preventable infections in hospital every year, leading to 90,000 unnecessary deaths.
The most vulnerable group for the infectious disease is the paediatric group.
Regardless of the work area, preventing the transmission of organism is concern of all
nurses.

Definition of Infection
 The invasion and multiplication of microorganisms such as bacteria, viruses, and
parasites that are not normally present within the body. 

Nosocomial infection:
Also known as Hospital-acquired infection (HAI) — is an infection that is
contracted from the environment or staff of a healthcare facility. The common infection
that occur in the health care facility is septicaemia
 It can be spread in the hospital environment, nursing home environment,
rehabilitation facility, clinic, or other clinical settings. Infection is spread to the susceptible
patient in the clinical setting by a number of means. Health care staff can spread infection,
in addition to contaminated equipment, bed linens, or air droplets. The infection can
originate from the outside environment, another infected patient, staff that may be infected,
or in some cases, the source of the infection cannot be determined.

Epidemiology of nosocomial infection

Nosocomial infections accounts for 7% in developed and 10% in developing
countries. 

According to WHO estimates, approximately 15% of all hospitalized patients suffer

from these infections. During hospitalization, patient is exposed to pathogens through
different sources environment, healthcare staff, and other infected patients. Transmission
of these infections should be restricted for prevention. Hospital waste serves as potential
source of pathogens and about 20%–25% of hospital waste is termed as hazardous. 

According to an estimate in the paediatric intensive care unit, 16% of children

develop a nosocomial infection. 

Definition infection control:

Measures practiced by health care personnel to prevent spread, transmission &
acquisition of infection between clients, from health care providers to clients and from
clients to health care provider.
Infection control in a health care facility is the prevention of spread of micro-
organisms from:
Patient to patient
Patient to staff member
Staff member to patient
Staff member to staff member
MEASURES TO CONTROL INFECTION IN THE PAEDIATRIC HEALTH CARE
SETTING
1. Practice Good Hand Hygiene 
The most effective way to reduce the spread of infection is Hand washing. The
benefits of proper hand hygiene throughout any hospital environment are well established.
In pediatric settings, standards like making hand washing stations and hand sanitizers
available are equally as important. Beyond that, having kid-friendly signage encouraging
children of reading age- and the parents of those too young to read - to wash their hands,
can also be helpful. 

Hand washing, also known as hand hygiene, is the act of cleaning hands for the
purpose of removing soil, dirt and microorganisms. The duration of hand washing must not
be less than 30 seconds.
Using of soap and water for hand washing prevents the spread of infection to a
greater extent. If soap and water are not available, use an alcohol-based hand sanitizer that
contains at least 60% alcohol. 

 
2. Disinfect Equipment and Surfaces Thoroughly 
Dealing with young children means dealing with dirty diapers and occasional
diaper leaks - especially when the kids are sick with diarrhea. Excreta can easily spread
infection, so it’s important to be vigilant about sterilizing and disinfecting surfaces and
equipment that children come in contact with. Hence
 the equipments used in the pediatric set up should be sterilized every time without
fail to prevent the spread of infection.
 The laryngoscope should be cleaned with alcohol wipes.
 Environmental surfaces like door knobs, table tops, carts should be cleaned with
70% IP alcohol

Equipment/ Supplies: Monitoring

 Blood pressure cuffs: neonatal, infant, child, adult.
 ECG monitor/ defibrillator with pediatric and adult pads/ paddles.
 Hypothermia thermometer.
 Pulse oximeter with pediatric and adult probes.
 Continuous end-tidal CO2 monitoring device.
 
3. Take PPE Usage Seriously
The PPE means Personal Protective Equipment. Little kids can be infected with
grownup illnesses, so using PPE’s like surgical masks, gowns, and goggles in procedures
where there may be body fluids projected from a young patient is as important as with
patients of any age. 
 
Specialized clothing or equipment worn by an employee for protection against
infection materials.
 Gloves
 Gown
 Mask
 Protective eye wear
 Face shield
 Apron

 Wear Gloves as Appropriate

Gloves should be used when anticipating coming into contact with bodily fluids
and mucous membranes. If a caregiver happens to have broken skin on his or her
 hands, gloves are a must there too – to prevent the young patient’s immune system
from being compromised by an infection the caregiver is harboring. 
The sterile gloves should be used during any of the invasive procedures, wound
dressing, minor surgical procedures etc.

 Gown
- Fully covers torso from neck to knees, arms to end of wrists and wrap around
the back
- Fasten in back of neck and waist.

 Mask or Respirator
- Secure ties or elastic bands at middle of head and neck.
- Fit flexible based to Nose Bridge
- Fit snug to face and below chin.
- Fit check respirator

 Goggles or face shield

- Place over face and eyes and adjust to fit to prevent the splash of blood or body
fluids in the eyes.

 Gloves
- Extend to cover wrist of isolation gown.

4. Sterilization
Sterilization is a process intended to kill all microorganisms and is the highest level
of microbial kill that is possible.
There are four main ways in which such items can be sterilized:
 Autoclave (by using high pressure steam)’
- An autoclave is used to sterilize surgical equipment, laboratory instruments,
pharmaceutical items, and other materials.
  Dry heat (in an oven)
- Instruments used for dry heat sterilization include hot air oven, incineration
or burning, flaming, radiation, microwave, bunsen burner, and glass bead
sterilizer.

 Chemical sterilants such as glutaraldehydes or formaldehyde solutions.

- A sterilant is a chemical that is applied to inanimate objects to kill all
microorganisms as well as spores. Ethylene oxide, glutaraldehyde,
hydrogen peroxide gas, and peracetic acid are examples of sterilants.
 Radiation (with the help of physical agents).

Currently, an estimated 40-50% of all disposable medical products are sterilized

using radiation. For example, sutures, surgical gloves, gowns, face masks, syringes,
sticking plasters, dressings and other single use healthcare supplies are all processed
using gamma radiation.

5. Decontamination:
It is the reduction in the number of microorganisms or spores. Disinfection is less
effective than sterilization because it does not kill bacterial endospores.

Disinfection uses liquid chemicals on surface and at room temperature to kill

disease causing microorganisms.

Ultraviolet light has also been used to disinfect the rooms of patients after
discharge.

Cleaning: The hospitals housekeeping departments is responsible for the regular

and routine cleaning of all surfaces and maintaining a high level of hygiene in the facility
in collaboration with the infection control committee.

6. Find the Right Balance Between Childcare and Infection Control

 Allowing kids to play together, share toys and socialize in a waiting room can
reduce patient anxiety (and parental stress). It also has its risks. Letting children play can
spread communicable diseases between them. At the end of the day, it’s up to the caregiver
to thoughtfully and carefully evaluate if the benefits of waiting room play outweigh the
risks. 
Hence disinfect the play room frequently and clean the equipments and toys by
using disinfectants.
 
Don’t Forget to Clean Toys
Sterilizing surfaces is an infection control strategy, but waiting room toys are easy
to overlook. Because toys come into direct contact with child after child, it’s critical that
they are properly and thoroughly cleaned.  
 
Schedule Patients to Minimize Waiting Room Crowding
Smart operational strategies can be as critical to infection control as is adherence to
proper hygiene and disinfection protocol. Thoughtful scheduling in a pediatric office is one
of these strategies. Fewer people, specifically kids, in a waiting room at one time means
fewer kids transmitting illnesses directly to one another, which is better for all patients and
caregivers.

7. Hospital/Bio Medical Waste Management:

According to bio-medical waste management and handling rule 1998 of India: Bio-
medical waste means any waste which is generated during the diagnosis, treatment or
immunization of human being o animals or in research activities.

Waste management is the collection, transport, processing or disposal, managing

and monitoring of waste material.

Purposes of waste management:

 To reduce hazardous nature of waste.
 To reduce volume of waste.
 To prevent misuse or abuse of waste.
 To ensure occupational safety and health.
  Additional (transmission based)precautions:
 Additional precautions/environmental precautions are taken while ensuring
standard precautions are maintained.

Sources of bio-medical waste: Hospital and health care canters:

Clinics/ office:
Medical research canter and laboratories:
Animal’s institute:
Blood bank and collection canters/ donation camp
Biotechnology institutes

Disposal of biomedical waste includes three stages:

Collection and segregation Transportation and storage Disposal techniques

DISPOSAL TECHNIQUES:
1. Chemical disinfection:
 Solid waste must be disinfected before they are sent for final disposal.
 Chemical disinfection is most appropriate method for to treat the liquid waste
such as blood, urine, and stool or hospital sewage.
2. Thermal measures:
 Autoclave (wet thermal treatment): It is effective method of sterilization for
microbiology and biotechnology waste.
 Hydroclave (dry thermal treatment): In this method shredded infectious waste is
exposed to high temperature, high pressure steam like autoclaving.
 It dries 80% liquid of waste and waste is reduced to 20-30% in weight.
 Adequately trained operators or technicians are needed for its operation.
3. Microwave irradiation:
 This technique is also effective like autoclave in sterilizing infected disposable
waste.
 Most of micro- organism destroyed by action of microwaves.
4. Incineration:
  It is a high temperature dry oxidation process that reduces organic, incombustible
matter.
 It also reduces the volume and weight of waste.
5. Inertization:
 In this process cement and other substance are mixed with waste before disposal.
 Mixing of cement etc. reduces risk of migrating toxic substance into surface water
or ground water.
 After making homogeneous mixture, cubes are prepared at site, and then
transported to final disposable site.

6. Landfill:
 It is quite effective, provided practiced appropriately a sanitary landfill observing
certain rues can be acceptable choice for disposal of biomedical waste, particularly
in developing countries like India.
 It is responsibility of nurse to keep patient in their care safe by modeling effective
and frequent hand washing practices and proper use of personal protective
equipment.
 Biomedical wastes are one of the major causes of infection in hospital settings. So
its responsibility of hospital authority along with health team to collect, segregates,
transport and store and dispose it off to safeguard the people from hospital acquired
infection.

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 Health care provider:

 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.
 Daily visit to microbiology lab to ascertain results of sample collected.
 Monitoring & supervision of infection among hospital staffs.
 Training of nursing