PRO1ECT REPORT

ON
'Io .vv, 1o.iv /.qvicv 1n{c.ion:
^vnvcncn, Tc.cnion (ono v (/)1
1o.iv"



Submitted by
^i...Ti,vn[v ). +vnvnc
^/ 11, (111 cn)

vivcv ,
^..)o.cinc Ivn.i.
(1/1(( )v.c )v.in vc.i.io)






I.Tvn]vvo Ic.nnv[n 1n.ivc o{ ^vnvcncn Ic.nnoo, vnv
)c.cv.n






(1)I1I1(/I1

Ini. i. o .ci{, nv ^.. Ti,vn[v ). +vnvnc .vvcn o{ I.Tvn]vvo Ic.nnv[nn
1n.ivc o{ ^vnvcncn Ic.nnoo, vnv )c.cv.n .onccv nc o]c. on 'Io vv,
1o.iv /.qvicv 1n{c.ion: ^vnvcncn, Tc.cnion (ono v (/)1 1o.iv",
)vv vnvc n, .vc.i.ion.

Io nc c. o{ n, [no.cvc, ni. o]c. co i. nc oiinv .o[ o{ nc .vnvivvc. 1
vn {v, .vi.{icv .in nc o]c. .o[ vnv c.onncnv i. v..cvn.c.

1 .i.n nc v nc c. in nc cnic {vvc cnvcv.o.





^.. )o.cinc Ivn.i.

(1/1(( )v.c )v.in vc.i.io)
Ivc:

Tv.c: )vv









I1(/)/I1O)

1 Ti,vn[v ). +vnvnc ncc,, vc.vc nv nc o]c. on 'Io .vv,
1o.iv /.qvicv 1n{c.ion: ^vnvcncn, Tc.cnion vnv (ono v
(/)1 1o.iv", )vv .v. vnvcv[cn , nc i. v c.v o{ n, o.n
c{{o vnvc .oninov. vnv in.iin vivvn.c o{ ^.. )o.cinc Ivn.i..

1 v.o vc.vc nv ni. o]c. .o[ i. n, o.n vnv nv. no ccn .vnicv
o vnonc in.ivc o vni.c.i,.

1 vc.vc nv v nc vo.c in{onvion i. cv {v. o c. o{ n, [no.cvc.



^i... Ti,vn[v ). +vnvnc
^/11, (111 cn)
T.I.1.^.I.) (occ,
)vv
Ivc:

Tv.c:











Acknowledgement

It is a great sense oI privilege to have this opportunity to acknowledge a
Ieeling oI deep gratitude to all those who in a direct or indirect way helped
me in this work.
It is my proIound concern to thank , Dr. Varun Bhargav (M.D.),
Mr. Rajeev Chourey, ChieI Hospital Administrator and Mr. Ravi
Mannadiyar, HR Head, Care Hospital, Nagpur who paved the path Ior
oIIering me this opportunity and avenues oI inIinite possibilities oI
kowledge.
I would like to express my deep sense oI gratitude to Mrs. Roseline Francis,
(HAICC Nurse and Nursing Supervisior) under the Noble`s thumb oI whose
my project has been carried out. She helped me and motivated me through
out my project.
I am grateIul to Dr. Yagnesh Thakar M.D. (Microbiologist), Ior his
invaluable advice, support and encouragement.
I also acknowledge and convey my thanks to entire staII oI CARE Hospital,
Nagpur, whose kind cooperation and timely assistance made this project
complete.
Last but not the least I am always grateIul to my parents and Iriends Ior
their perpetual support and encouragement throughout the period oI my
work.
Above all, I express my true grateIulness to Almighty, who has given me
strength and will power to complete my work.




(Miss. Priyanka R. Wandhe)






Introduction to the CARE Hospital, Nagpur

Care hospital is a part oI a movement called CARE` which took birth in the
year 1997, when Dr. B. Soma Raju led a team oI medical proIessionals to set
up the Iirst care hospital in Hyderabad. It opened a new chapter in history oI
Indian healthcare. Within a span oI 13 years, CARE has emerged as top
sixth healthcare provider in the country.
CARE hospital, Nagpur is a 105 bedded multispecialty hospital equipped
with advance medical technology and highly skilled healthcare
proIessionals. The hospital has emerged as a leading healthcare provider in
the region through dedication towards quality medical care.
The hospital is an ISO 9001:2000 certiIied multi-specialty Hospital
Doctors oI international acclaim, well qualiIied and competent medical,
nursing, paramedical and other staII, unite with the superior technology and
state-oI-the-art Iacilities to provide the best and the purest Iorm oI care to its
patients. We strive to achieve perIection in serving our patients by providing
quality healthcare built on values oI Compassion, Care and concern.
Highlights:
O Highly sophisticated technology
O Round the clock medical care
O 5 critical beds
O Practicing medicine the way it should be practiced 'patient Iirst
O Well equipped casualty centre with 2 hour service Iacility.

CARE hospitals is established in 12 cities in India & they are;

CARE Banjara- Hyderabad
CARE Nampally
CARE Secunderabad
CARE Musheerabad
CARE Raipur
CARE Nagpur
CARE Surat
CARE Pune
CARE Vishakhapatnam
CARE Bhuvaneshwar
CARE Vijayawada
CARE East Godavari
ajor areas of specialization:
O Cardiology
O Critical Care
O Dietetics
O E.N.T.
O Gastroenterology
O General Medicine
O General Surgery
O Plastic Surgery
O Gynecology
O Nephrology
O Neurology & Neuro surgery
O Ophthalmology
O Orthopedics
O Pediatrics & Neonatology
O Physiotherapy
O &rology















ISSION

'To provide the best and cost-eIIective care, accessible to every patient,
through integrated clinical practice, education and research, delivered with
compassion, care and concern through team spirit and transparency.


'ISION

O To evolve as unique university based-health-center where the quest
Ior new knowledge would continuously yield more eIIective and
more compassionate care Ior all.
O To nurture a new generation oI proIessionals oI liIe-long
commitment, dedication, knowledge, skill wisdom and value.
O To strive Ior public trust and maintain medicine`s humane and noble
place among proIessions.
O To be globally competitive in healthcare and related businesses
O Integrating local culture and ethos.

'alues

O Practice-practise medicine as an integrated team oI compassionate
physicians, scientists and allied health proIesssionals.
O Education- learn to serve through training and education oI
physicians, nurses and allied health proIessionals.
O Research- conduct basic and clinical research programmes to improve
patient care and to beneIit society.
O Mutual respect- treat everyone with respect and dignity.

O Commitment to quality countinusouly improve all processes that
support patient care education and celebrate success..
O Societal commitment- support the society we live and assist patient
with limited Iinancial resources.
O Finances allocate resources within the context oI the system rather
than its individual entities.


Quality policy of the hospital

M/S Care hospital is committed to provide quality patient/ client care
through continual improvement oI our processes and systems.
We shall comply with applicable regulatory and statutory requirements and
train our associates to the matters related to saIety and potential risk to all
concerned.
We shall strive towards eIIective implementation oI quality management
systems to enhance customer satisIaction.

The CARE multi-specialty services include Anesthesiology and pain
management, Cardiology, Cardio-thoracic surgery, Dermatology, ENT,
Endocrinology, gastroenterology and Hepatology, Internal medicine and
Critical care, Laboratory medicine, Oncology, Nephrology, Neurology,
Nuclear medicine, Orthopedics and Traumatology, Plastic and cosmetic
surgery, Pulmonology, Psychiatry, Physiotherapy, General surgery,
&rology and vascular surgery and Occupational and wellness department.






HOSPITAL LAYOUT


Care Hospital is classified in three respective wings and five respective floors:
FLOOR WINGS
A B C
GROUND MAIN ENTRANCE CMO ROOM
DIETCIAN
CONS&LTANT
PASSENGER LIFT CAS&ALTY/ACCIDENT
CONS&LTANT
CHAMBER
HELP DESK MINOR O.T.
CONS&LTANT
CHAMBER
I.P. RECEPTION EEG/EMG
CASHIER PHYSIOTHERAPY
I.P. BILLING X-RAY DEPT.
PTS. GRIEVANCE DESK OP PHARMACY

PTS. CO&NSELLING
DESK EMERGENCY EXIT
PRAYER AREA/TEMPLE PT. LIFT
PT. WAITING ROOM

EZZANINE GENERAL STORES
CANTEEN

FIRST OP RECEPTION CT SCAN

REPORT DISPATCH
DESK TMT ROOM

SAMPLE
COLLECTION ROOM PFT ROOM ICC&
OPD CHAMBERS ECG ROOM
MD CHAMBERS

CONS&LTANT
CHAMBER
PT. WAITING AREA
DATA ENTRY DESK
MD RECEPTIONIST
2-D ECHO
&SG ROOM



SECOND GEN. WARD GYNAEC. OPD ENDOSCOPY ROOM

TWIN SHARING
ROOM GEN WARD PIC&
DIALYSIS ROOM NIC&
FEMALE GEN WARD LINEN ROOM
LABO&R ROOM

THIRD GEN WARD
HOSPITAL
INFORMATION DEPT. SINGLE ROOM
DEL&XE ROOM TWIN SHARING ROOM
TWIN SHARING
ROOM

S&PER DEL&XE
ROOM SINGLE ROOM GEN WARD

COMM&NICATION
DEPT.

FOURTH CT OT CATH LAB GEN OT 1
CT RECOVERY CATH RECOVERY GEN OT 2
NE&RO OT
NE&RO RECOVERY
ROOM
S&RGICAL
RECOVERY ROOM

FIFTH TERRACE CSSD/ETO DEPT. IP MEDICINE STORE

PATHOLOGY
LABORATORY
BLOOD STORAGE
CENTRE

MICROBIOLOGY
LABORATORY &PS ROOM

PATIENT
LO&NGE(DISCHARGE) GEN WARD

CENTRAL DR&G
STORE.








1)I)OI+(I1O) IO I11 IOT1(
Hospital inIection, also called nosocomial inIection, is the single
largest Iactor that adversely aIIects both the patient and the
hospital. Patients are Iorced to stay long in the hospital because oI
hospital inIection, which is Iurther compounded by instituting all
types oI antibiotics to combat the original and hospital acquired
inIection. The resultant increase in the length oI stay and number
oI laboratory tests in turn result in increased hospital costs Ior the
patient. Studies in various countries have proved that a tremendous
cost borne by the patient with nosocomial inIection, as he has to
undergo a large number oI laboratory tests, prolonged length oI
stay, and loss oI working stays. The hospital suIIers because oI the
loss oI eIIectiveness in terms oI qualitative oI hospital beds. This
loss in hospital`s productivity is capable oI being brought down
with appropriate measures.
Nosocomial comes Irom
the Greek word nosokomeion (voookociov) meaning hospital
(nosos disease, komeo to take care oI). This type oI inIection is
also known as a hospital-acquired inIection (or, in generic
terms, healthcare-associated inIection).

Nosocomial inIections (pronounced, nos-uh-KOH-
mee-uhl), are inIections that are a result oI treatment in a hospital
or a healthcare service unit. InIections are considered nosocomial
iI they appear hours or more aIter hospital admission or within
30 days aIter discharge. It is usually an inIection occurring in a
patient in a hospital or other health care Iacility in whom the
inIection was not present or incubating at the time oI admission.
This includes inIection acquired in hospital but appearing aIter
discharge, and also occupational inIection among staII oI the
Iacility. Thus, HAIs represent a signiIicant part oI communicable
diseases and are a Irequent source oI morbidity and mortality.

Virulent pathogens are brought in constantly by new
patients admitted with inIections, in addition to those already
existing in the hospitals` patient population. Hospitalised patient
can be expected to be more suspectible to inIection due to their
underlying disease, or by injuries acquired outside or inIlicted
upon them by surgical procedures and instrumentations in the
hospital.

There is an increasing trend oI bacterial resistance to drugs
and emergence oI new strains, with harmless bacteria becoming
pathogenic under certain circumstances. Complicated and lengthy
surgical procedures and use oI extracorporeal circulation provide
microorganisms an increased opportunity oI access. Further, the
increasing use cytotoxic and immunosuppressive drugs which
result in lowered patient resistance, coupled with overcrowding in
hospitals, shortage oI eIIicient nursing and paramedical staII, and ,
in general, overutilization oI Iacilities all add to the complexity oI
the problem.

HAI is one oI the most prominent reasons Ior Iailure oI
advanced medical treatment, increased health care costs, increased
death rate in the hospital, increased antibiotic resistance and
adversely aIIects the image oI the hospital.

The Centres Ior Disease Control and Prevention estimates
that roughly 1.7 million hospital-associated inIections, Irom all
types oI bacteria combined, cause or contribute to 99,000 deaths
each year. Hospital acquired inIection occurs in every hospital, the
diIIerence being oI degree only. But only occasionally does it
becomes alarming. Estimates vary Irom 10-30 , the least being
about 3 in the best oI hospitals. One percent oI nosocomial
inIections results directly in the death oI the patient, and indirectly
contribute to mortality in additional 3 oI the cases. Although not
all such inIections can be prevented, data accumulated so Iar
indicate that under Iavourable conditions almost halI oI all
nosocomial inIections are prevented. In Europe, where hospital
surveys have been conducted, the category oI Gram-
negative inIections are estimated to account Ior two-thirds oI the
25,000 deaths each year. Nosocomial inIections can cause
severe pneumonia and inIections oI the urinary
tract, bloodstream and other parts oI the body. Many types are
diIIicult to attack with antibiotics, and antibiotic resistance is
spreading to Gram-negative bacteria that can inIect people outside
the hospital. Nosocomial inIections are commonly transmitted
when hospital oIIicials become complacent and personnel do not
practice correct hygiene regularly. Also, increased use oI
outpatient treatment means that people who are hospitalized are
more ill and have more weakened immune systems than may have
been true in the past. Moreover, some medical procedures bypass
the body's natural protective barriers. Since medical staII move
Irom patient to patient, the staII themselves serve as a means Ior
spreading pathogens.

Hospitals have sanitation protocols regarding uniIorms
equipment sterilization, washing, and other preventative measures.
Thorough hand washing and/or use oI alcohol rubs by all medical
personnel beIore and aIter each patient contact is one oI the most
eIIective ways to combat nosocomial inIections.More careIul use
oI antimicrobial agents, such as antibiotics, is also considered vital.
Despite sanitation protocol, patients cannot be entirely isolated
Irom inIectious agents. Furthermore, patients are oIten
prescribed antibiotics and other antimicrobial drugs to help treat
illness; this may increase the selection pressure Ior the emergence
oI resistant strains.

NABH laid down the standards regarding patient saIety, staII
saIety and patient rights and education. Iirst 5 chapters which are
patient centric & next 5

chapters are management centric. These
must be IulIilled Ior providing quality care.
The NABH standards guide the provision oI an eIIective
inIection control program in the organization. The program is
documented and aims at reducing/ eliminating inIection risks to
patients, visitors and providers oI care.

Thus, organization is responsible Ior ensuring the saIety oI
patients & staII. Thus, it should provide proper Iacilities and
adequate resources to support the InIection Control Program.
Thus, protecting them Irom inIection is an important element oI
this responsibility.

The primary purpose oI the project is the evaluation oI the
awareness among the staII about Hospital Acquired InIection &
education, and Iinding the training need assessment. Majority staII
will be the healthcare workers.

The inIerences drawn by this project are intended to be used
as a basis Ior planning & Ior stimulating new ideas & techniques to
serve the purpose oI this project.

I hope this project will contribute in some measure oI the
growing need Ior the eIIiciency in evaluating the services oI the
hospital concerned with the topic oI the project and Ior creating
something new that is more comIortable Ior all those who are
involved in the process Ior evaluation oI hospitals.

Also it is hoped that this project will be a source oI
inIormation & enlightenment to all who are interested in this
subject.


/1^ OI I11 I+I

To study the current rate and know the prevalence oI HAI in
hospital and to promote Iaster recovery Irom illness.

IdentiIying HAI in the region, analysis and interpretation oI
data, observation and evaluation oI patient care practices,
monitoring equipments and the environment in order to
generate inIection surveillance data.

Application oI control measure and provide the highest
possible standards oI inIection control within the limitations
oI available resources, prospective study to monitor the
problem, evaluate the control measure and detect Iuture
recurrences and provide education.

Recommendation and suggestions Ior prevention oI HAI.

















I,c. o{ 1/1., ^vin ovc. o{ vn.ni..ion

1here are eight main types/routes of transmission of Hospital
acquired infections:-

O Contact 1ransmission : The most important and Irequent
mode oI transmission oI nosocomial inIections.
Contact transmission is divided into two subgroups:
- Direct Contact 1ransmission: It involves a direct body
surIace-to-body surIace contact and physical transIer oI
microorganisms between a susceptible host and an inIected or
colonized person, such as occurs when a person turns a patient,
gives a patient a bath, or perIorms other patient-care activities that
require direct personal contact. Direct-contact transmission also
can occur between two patients, with one serving as the source oI
the inIectious microorganisms and the other as a susceptible host.

- Indirect Contact 1ransmission: involves contact oI a
susceptible host with a contaminated intermediate object, usually
inanimate, such as contaminated instruments, needles, or dressings,
or contaminated gloves that are not changed between patients. In
addition, the improper use oI saline Ilush syringes, vials, and bags
has been implicated in disease transmission in the &S, even when
healthcare workers had access to gloves, disposable needles,
intravenous devices, and Ilushes.

O Droplet 1ransmission: It occurs when droplets are generated
Irom the source person mainly during coughing, sneezing,
and talking, and during the perIormance oI certain procedures
such as bronchoscopy. Transmission occurs when droplets
containing germs Irom the inIected person are propelled a
short distance through the air and deposited on the host's
body.

O Airborne 1ransmission: It occurs by dissemination oI either
airborne droplet nuclei (small-particle residue
5 micrometer or smaller in size} oI evaporated droplets
containing microorganisms that remain suspended in the air
Ior long periods oI time) or dust particles containing the
inIectious agent. Microorganisms carried in this manner can
be dispersed widely by air currents and may become inhaled
by a susceptible host within the same room or over a longer
distance Irom the source patient, depending on environmental
Iactors; thereIore, special air handling and ventilation are
required to prevent airborne transmission. Microorganisms
transmitted by airborne transmission include Legionella,
Mycobacterium tuberculosis and the rubeola and varicella
viruses.

O Common vehicle 1ransmission: Applies to microorganisms
transmitted to the host by contaminated items such as Iood,
water, medications, devices, and equipment.

O Jector borne 1ransmission: Occurs when vectors such as
mosquitoes, Ilies, rats, and other vermin transmit
microorganisms.

O Blood borne spread : The accidental transmission oI
inIections as HIV, HBV, and HCV by needle stick injuries is
documented Syphilis and malaria a concern in high
prevalence areas.

O Self Infections and Cross infections : SelI inIection Irom
patient`s own Ilora Irom Bowel can be major contributor oI
inIections in bowel surgery. SelI inIection may occur due to
Ilora Irom nose, Staphylococcus may be introduced into
wounds. In Cross InIection many diIIerent bacteria, viruses,
Iungi and parasites may cause Nosocomial inIections.
InIections may be caused by micro organism acquired Irom
another person in the hospital. It occurs due to spread oI
Staphylococcus or coli Iorms.

O Other Source of Hospital Infections : Hospital environment,
includes deIective constructions, People their behaviour has
great impact. Objects, Iood, water, Air in the hospital too
contribute to inIections.













INTERRELATIONSHIP OF SO&RCES OF INFECTION








Other Patients
Endogenous
StaII
AIR
Apparatus/Instrument
s
Formites
Ri.[ Iv.o. {o .vv.in 1/1.

All hospitalized patients are susceptible to contracting a
nosocomial inIection. Some patients are at greater risk than others-
young children, the elderly and persons with compromised
immune system are more likely to get an inIectionThe Iactors
which contribute to the development oI HAI are the relationship
between the agent, the host (patient), and the relationship Ior the
success oI any HAI control programme. The methods, process,
policies and procedures adopted in day-to-day patient care have a
very signiIicant relationship to these Iactors.

Other risk factors are:-

Greater exposure to hospital atmosphere, long stay.
Inadequate ventilation, Iaulty design oI wards and Ots.
Non availability oI isolation rooms Ior higher inIected cases
and clear utility room.
The use oI indwelling catheters.
Crowding in hospital wards, Iloor beds and rush in O.P.D.
Intimate contact between staII, patient, relatives, No Iixed
time schedule Ior visitors.
Inadequate and substandard aseptic procedures.
Failure oI healthcare workers to wash their hands.
Poor sterilization, laundry, and kitchen services.
Overuse oI antibiotics.







I/(IO) 1)I+1)(1) I11
I1(1OT^1)I OI 1/1

O 1HE ACEA1-1HE MICROBIAL ACEA1:
The agent includes diIIerent bacteria, viruses, Iungi and parasites.
Large number oI all hospital inIection are due to gram negative
organisms.
Some oI the inIection are contributed by coagulase positive
staphylococci.
InIections depends partly on the characteristics oI the
microorganism, resistance to antimicrobial agents, intrinsic
virulence and amount oI inIection material.

Organisms responsible for human infection

Organisms Percentage
E.coli 20
Staphylococcus aureus 11
Other staphylococci 11
Pseudomonas 9
Klebsiella 9
Proteus
Others/Mixed 32



O 1HE HOS1:PA1IEA1 SUSEP1IBILI1Y:
Important patient Iactors inIluencing acquisition oI inIection
include:-
Extreme oI age
Immunosuppressant
&nderlying disease like:-
Tuberculosis
Diabetes
Severe anemia
Malignancy
Renal Iailure etc
Aids, diagnostic and therapeutic intervention.


O 1HE EAJIROAMEA1:
Everything that surrounds a patient in the hospital is his
environment. The inIection can be acquired Irom:-
Other patient, hospital staII or visitors, Iood, water, dust
and other contaminated inanimate articles.
Drug resistance microorganisms and change Irom non-
pathogenic strain to pathogenic are Iound commonly.


O BAC1ERIAL RESIS1AACE :
Emergence oI multi drug resistant strains, many strains
oI Pneumococci, Staphylococci, Enterococci and Tuberculosis are
currently resistant to most oI all antimicrobials which where once
eIIective.













^1()OO)/)1^ /)I I11/1

Staphylococcus aureus
Methicillin resistant Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
Acinetobacter baumannii
Stenotrophomonas maltophilia
Clostridium diIIicile
Mycobacterium tuberculosis
Vancomycin-resistant Enterococcus
Legionella

)OO(O^1/ 1)I1(I1O) 1I1:

O Urinary infection:Most oI the hospital acquired &TI (0)
is catheter associated. Even the single passage oI catheter is
associated with a deIinite though usually low inIection risk
(kunim 197). Even with adequate precautions,
catheterization in hospitals leads to &TI in about 2; with
indwelling catheters the rate goes upto 50 or more. Mixed
inIection is common. InIection can be prevented by strict
asepsis during catheterization. Indwelling catheters are to be
used only when unavoidable, and only with proper closed
drainage.


O Surgical site infection:InIection oI surgical wounds is
important numerically and as a cause oI morbidity and
prolonged hospital stay. In a prevalence survey it is
accounted Ior 12.3-2 oI HAI. Several Iactors inIluence the
occurrence oI surgical wound inIections, such as the site,
duration oI surgery, health oI patient and skill oI the operator.

O Respiratory tract infections: These represent signiIicant
proportion oI hospital acquired inIections. About 15-20 oI
all hospital acquired inIections are oI the lower respiratory
tract which are the leading causes oI mortality. Aspiration in
unconscious patients and pulmonary ventilation or
instrumentation may lead to nosocomial pneumonia. Gram
negative bacilli and Staphylococcus aureus are the common
pathogens.

O Aosocomial Pneumonia: It occurs in patients on ventilators
in IC&s. Rate oI pneumonia is 30 at these places.There is
high mortality rate in patients with ventilator associated
pneumonia.


O Aosocomial Bacteraemia & septicemia: Although
bacteraemia is not the most common hospital acquired
inIection or the most signiIicant in adding to costs, it is oI
greatest importance as it is a cause oI serious illness and
death. These may be consequences oI inIections at any site
but are commonly caused by inIected intravenous cannula. It
has been reported that hospital acquired bacteremia in 0.2-
0. oI hospital admissions but Iatality rates are high-
greater than 50 Ior some micro organisms.

. Much higher rates have been reported Ior tertiary care
reIerral centres than Ior general hospitals.





O Other nosocomial infection:
Skin & soIt tissue inIection
Gastroenteritis
InIection oI eye
Other inIection oI reproductive organs Iollowing child
birth.



1in i.[ vcv. in no.iv

In every hospital, some areas carry a greater risk oI HAI than
others. The host-Iactors (extreme age, primary ailments
complicated by other associated disease, diminished body
resistance due to immunosuppressive drugs, indiscriminate use oI
antibiotics and steroids, and longer patient exposure through
complicated and lengthy operative procedures) contribute to the
greater risk oI HAI. Such areas are as Iollows:
Nurseries
Intensive care unit
Dialysis unit
Organ transplant unit
Burn unit
Isolation ward
Cancer ward
Operation theatres
Delivery rooms
Post-operative ward




(/+1 OI 1/1

&rinary bladder catheterization ,

Surgery and wound ,

Intravenous (IV) procedures,

Biomedical waste,

Lack oI Awareness.























^TIO^ OI 1OT1I/ /(Q+1)1I
1)I1(I1O)

Increased TLC count (High white blood cell count),

Fever,

Rapid Breathing,

Mental ConIusion,

Hypotension,

Reduced urine output,

Swelling,

Redness,

Tenderness at the site oI InIection,

Coughing,

Dyspnoea,

Haematurea and Skin inIections etc.








I1/)O1

Diagnosis of a hospital acquired infection is based on:-

Symptoms and signs oI inIection,

Examination oI wounds and catheter entry sites,

Review oI procedures that might have led to inIection,

Laboratory test results (WBC count High).























^/)/1^1)I OI 1OT1I/ /(Q+1)1I
1)I1(I1O)

The basic responsibility oI any good hospital remain with
establishment oI good inIection control policies and proper
management which can always be achieved with:-

IAFEC1IOA COA1ROL COMMI11EE/1EAM:
Provides a Iorum Ior multidisciplinary input and co-operation and
inIormation sharing:

Composition:

Administrator Anesthetist
Microbiologist Nursing matron
Surgeon Pharmacist
Physician House keeping staII
Pediatrician Engineering service
representative
Gynecologist Dietitian etc

IAFEC1IOA COA1ROL COMMI11EE A1 CARE
HOSPI1AL:-

Chairperson: Dr.Varun Bhargav

Microbiologist: Dr.Yagnesh Thakar

InIection Control Comittee Doctor: Dr.Rishi

InIection Control Comittee Nurse: Mrs.Roseline Francis

Other Members: Consultants
Incharges
Matrons

It has following tasks:-

Committee should meet regularly to Iormulate and update
policies Ior the whole hospital on all matter which have
bearing on inIection control and to mange outbreaks oI
Nosocomial inIection.
Review & approve a yearly programme oI activity Ior
surveillance & prevention.
Review epidemiological surveillance data and identiIy the
area Ior intervention.
Assess and promote improved practice at all level oI health
Iacility
Ensure appropriate staII training in inIection control and
saIety.
Review and provide input into investigation oI epidemics.
Communicate and co-operate with other committees oI the
hospital with common interest.



ROLE OF HOSPI1AL CHAIRPERSOA:
Establishing multi-disciplinary inIection control.
IdentiIying appropriate resources Ior a programme to monitor
inIections and apply the most appropriate methods Ior
preventing inIection.
Ensuring education and training oI all the staII through
support oI programme on the prevention oI inIection and
sterilization techniques.
Delegating technical aspects oI hospital hygiene to
appropriate staII.
Participating in outbreak investigation.
Reviewing, approving and implementing policies approved
by inIection control committee.


ROLE OF 1HE PHYSICIAA:
By Providing direct patient care using practices which
minimize inIections.
By Iollowing appropriate practice oI hygiene(e.g. hand
washing, isolation)
By protecting their own patients Irom other inIected patients
and Irom hospital staII who are inIected
Obtaining appropriate microbiological specimens when an
inIection is present or suspected.
Complying with the recommendation oI the antimicrobial use
committee regarding the use oI antibiotics.


ROLE OF MICROBIOLOCIS1:
Handling patients and staII specimens to maximize the
likelihood oI the microbiological diagnosis.
Developing the guidelines Ior appropriate collections,
transport and handling specimens.
Ensuring lab practice to meet appropriate standards.
Monitoring sterilization, disinIections and the environment
where necessary.
Timely communication oI results to the inIection control
committee.





ROLE OF AURSIAC S1AFF:
1he senior nursing administrator is responsible for:
Promoting the development and the improvement oI the
nursing technique and ongoing review oI aseptic nursing
policies.
Developing training programme Ior members oI the nursing
staII .
Supervising the implementation oI techniques Ior the
prevention oI the inIections in specialized areas such as
operating suite, IC&, maternity unit and newborns.
Monitoring oI nursing adherence to policies.
Participating in inIection control committee.


1he nurse in charge of a ward is responsible for:-
Maintaining hygiene, consistent with hospital policies and
good nursing practice in the ward.
Monitoring aseptic techniques including hand washing and
use oI isolation.
Reporting promptly to the attending physician any evidence
oI inIection in patient under the nursing care.
Maintaining a saIe and adequate supply oI ward equipment,
drugs and patient care supplies
Limiting patient exposure to inIections Irom visitors, hospital
staII, other patients or equipment used Ior diagnosis or
treatment.



1he nurse in charge of infection control responsible for:
IdentiIying Nosocomial inIection.
Participating in training oI personnel.
Surveillance oI hospital inIection.
Participating in outbreak investigation.
Ensuring with local and national regulation.
Development oI inIection control policy and review and
approval oI patent policies relevant to inIection control.



ROLE OF 1HE CEA1RAL S1ERLIZA1IOA SERJICE:
The responsibility oI CSSD are to clean, decontaminate all
instruments, sterilize them, test and prepare Ior use, also store
sterilized hospital equipments. It develop and monitor policies on
cleaning and decontamination oI Reusable equipments and
Contaminated equipments

1he director of this service must:
Oversee the use oI diIIerent methods physical, chemical and
bacteriological method Ior sterilization process.
Ensure technical maintenance oI the equipment according to
national standards and manuIacture recommendation.
Maintain complete records oI each autoclave.


ROLE OF 1HE LAUADRY SERJICES:
Selecting Iabrics Ior using in diIIerent hospital areas,
developing policies Ior working cloths in each areas and
group oI staII and maintaining appropriate supplies.
Distribution oI working cloths and iI necessary managing
changing room.
Developing policies Ior the collection and transport oI dirty
linen, protection oI clean linen Irom contamination during
transport Irom the laundry area to the area oI use.
Ensuring appropriate separation oI clean and dirty area.
Ensuring saIety oI laundry staII through prevention oI
inIections to sharp or laundry contaminated with potential
pathogens.


ROLE OF 1HE FOOD SERJICE:
1he head of catering service is responsible for:
DeIining criteria Ior purchase and storage oI Iood stuII.
&se and cleaning procedure to maintain high level oI Iood
saIety.
Issuing return policies and instruction Ior hand washing,
clothing, staII responsibilities, daily disinIections duties and
cleaning oI dishes aIter use, including special consideration
Ior inIected or isolated patients.
Establishing programmes Ior training staII.

ROLE OF HOUSE KEEPIAC SERJICE:
Regular & routine cleaning oI all hospital surIaces and
maintaining the high level hygiene.
ClassiIying the diIIerent hospital areas by varying need Ior
cleaning.
Developing policies Ior appropriate cleaning techniques,
collection transport and disposal oI diIIerent type oI waste.
Ensuring that liquid soap and paper towel dispensers
replenished regularly.
Pest control.
Establishing method Ior cleaning and disinIections oI
bedding.











T)1(1)I1O) OI 1OT1I/ /(Q+1)1I
1)I1(I1O)

The Prevention oI Hospital Acquired InIection is necessary
because it provides saIe environment to patients and health care
workers, reIlects good quality care, cost eIIective , eg Adherence
to hand hygiene practices is cheaper than the use oI high end
antimicrobials in the IC&.
Since,Nosocomial inIections are caused by organisms with
antibiotics resistance, these inIection are diIIicult to treat and
result in high morbidity and mortality. Thus, in order to prevent
this:
It usually involves the following:
Extensive inIection control programmes,
Aseptic (sterile) techniques,
Frequent Hand washing,
Early signs oI inIection are to be identiIied,
Antibiotics should be used only when necessary,
Frequent changing oI dressings,
Isolation oI InIected patients,
Awareness Programmes Ior StaII.


^1I1OIOO

S1AADARD CUIDELIAES BY WHO:-
Frequent Hand Wash aIter contact with inIective material
and aIter removing gloves.
Wear gloves.
All sharps should be handled with extreme care.
Disposal and Segregation oI biomedical waste.


IAFEC1IOA PREJEA1IOA IA DE1AIL:

A. HAAD HYCIEAE:-
A general term that applies to either hand washing, antiseptic
handwash, antiseptic hand rub, or surgical hand antiseptic.
Hand hygiene would include two steps:-
Hand washing: Washing hands with plain (i.e., non-
antimicrobial) soap and water, when hands are visibly dirty,
contaminated or soiled with blood or other body Iluids.
Hand DisinIection :Washing hands with disinIectant
e.g. sterillium, when hands are not visibly soiled or
contaminated with blood or body Iluids, usually alcohol-
based hand rub Ior routinely decontaminating hands.
Wash hands aIter touching blood, secretions, excretions and
contaminated items, whether or not gloves are worn. Wash hands
immediately aIter gloves are removed, between patient contacts.
&se a plain soap Ior routine hand washing. &se an antimicrobial
agent Ior speciIic circumstances.

















ROU1IAE HAAD WASH:-
Its main purpose is to remove or reduce transient microorganisms.
Wash hands thoroughly using the Iollowing steps about 5
strokes/steps Ior atleast 15 secs.


FLUORESCEA1 MAPPIAC FOR 1HE DE1EC1IOA
OF HIDDEA AREAS










B. Cloves :-
Wear gloves when touching blood, body Iluids, secretions,
excretions, and contaminated items. Put on clean gloves just
beIore touching mucous membranes and non-intact skin.

C. Mask, eye protection, face shield:-
Wear a mask and eye protection or a Iace shield during
procedures and patient-care activities that are likely to
generate splashes or sprays oI blood, body Iluids, secretions,
and excretions.

D. Cown :-
Wear a gown during procedures and patient-care activities
that are likely to generate splashes or sprays oI blood, body
Iluids, secretions, or excretions.

E. Patient-care equipment :-
Ensure that reusable equipment is not used Ior the care oI
another patient until it has been cleaned and reprocessed
appropriately.

F.

Environmental control:-
Ensure that the hospital has adequate procedures Ior the
routine care, cleaning, and disinIection oI environmental
surIaces.

G Linen:-
Handle used linen, soiled with blood, body Iluids, secretions,
and excretions in a manner that prevents skin and mucous
membrane exposures, and that avoids transIer oI
microorganisms to other patients and environments.




H. Occupational health and blood borne pathogens:
Take care to prevent injuries when using needles, scalpels,
and other sharp instruments or devices.
Accidental exposure to blood caused by needle injuries or
injuries Iollowing , cutting, bitingor splashing incidents
carries the risk oI inIection by blood-borne viruses such as
the hepatitis B(HBV),hepatitis C(HCV) and Human
DeIiciency virus(HIV).
HBV risk10-30
HCV risk3-10
HIV risk0.03-0.3
&se ventilation devices as an alternative to mouth-to-mouth
resuscitation methods.

PREJEA1IOA OF AEEDLE S1ICK IA1URY:-
Do not put the needle back in its cover, instead, the needle
should be put in a specially designed/ rigid puncture prooI
needle container. Make sure the container is always at hand.

JACCIAA1IOA:-
Health care personnel at risk Irom accidental exposure to
blood should be vaccinated against HBV, there are no
preventive vaccines available yet Ior HCV and HIV.

REPOR1IAC 1HE IACIDEA1:-
Report the incident immediately to the inIection control nurse
or nursing supervisior. This will allow proper registration and
subsequent management oI the event.



IMMEDIA1E AC1IOA (IA1URED PERSOA):-
A blood sample should be taken to the pathology laboratory as
soon as possible aIter the injury to test Ior HBV, HCV and HIV.

I. Place of care of the patient :-
Place a patient who contaminates the environment or who
does not assist in maintaining appropriate hygiene in an
isolated (or separate) room.

J. AA1IBIO1IC POLICY:-
The major problem is involvement oI organisms showing
multidrug resistance. &se oI antibiotics must be monitored
and controlled. IdentiIication oI bacterial isolates and
antibiotics sensitivity testing should be done adopting
standard techniques. The Iactors that inIluence antibiotic
resistance in the hospital are as Iollows:-
1).Volume oI antibiotics use.
2).Extensive use oI certain antibiotics.
3).Proportion oI prophylactic to therapeutic antibiotic usage
in monotherapy. The medical audit committee must
speciIically look Ior this.

K.PRECAU1IOAS FOR S1AFF:-
StaII working in vulnerable areas should be immunized
against cholera, typhoid, or hepatitis-B iI indicated.

L. DIE1ARY SERJICES:-
Storage oI Iood,& temperatures in reIrigerators and deep
Ireezers must be checked, control oI rodents & insects is a
must to prevent contamination.




M.SECRECA1IOA OF COA1AMIAA1ED
IAS1RUMEA1S:-
Segregation oI contaminated instruments , linen ,sputum
cups, bedpans ,urinals Irom clean items.

CLEAAIAC, MOPPIAC AAD DISIAFEC1IAC 1HE
WARDS:-

Include the use oI disinIectants or the cleaning
Bacillocid special:- (2 and 0.5 dilution)
200ml Bacillocid Special to get 2 solution, OR
50ml Bacillocid Special to get 0.5 solution.
DisinIection procedure Ior instruments, Critical areas etc.
Fumigation :-e.g. Eco-shield solution in 1: ratio.

ISOLA1IOA OF IAFEC1ED PA1IEA1S:-
e.g. Sodium Hypochlorite

!BIOMEDICAL WAS1E:-
Biomedical waste is generated during the diagnosis, treatment or
immunization oI human beings and animals. It can also be
generated during research activities concerning the above or in
the production or testing oI biological materials.
Healthcare waste includes all waste generated by healthcare
establishments, research Iacilities and laboratories. Healthcare
waste is related to general waste as well as biomedical waste.
The aim oI Biomedical Waste is to 'To prevent environmental
pollution , transmission oI disease, outbreak oI epidemic, inIection
, prevent general exposure to the harmIul eIIects oI the cytotoxic
and chemical biomedical waste as much as possible, disaster due to
bmw.




CLASSIFICA1IOA OF HEAL1H CARE WAS1E:-

InIectious waste : Waste Irom lab. Cultures , isolation wards,
tissues, swabs, excreta.
Pathological waste : Human tissue or Iluids e.g. body parts,
blood and other body Iluids, Ietuses.
Pharmaceutical waste : e.g. expired ones.
Genotoxic waste : Waste containing cytotoxic drugs,
genotoxic chemicals.
Chemical waste : Chemical substances.
Wastes with high contents oI heavy metals: Batteries, broken
thermometers, blood pressure gauges, etc.
Pressurzed containers: Gas cylinders, gas cartridges, aerosol
cans.
Radioactive waste : unused liquids Irom radiotherapy or
lab.research, contaminated glassware, packages or absorbent
paper; urine and excreta Irom patient treated with unsealed
radionuclide's.

An inappropriate treatment and disposal oI Biomedical Waste
leads to inIection and it usually spreads Irom:-

Blood contaminated items : AIDS (HIV), Septicemia,
Hepatitis B and C Viruses, Hemorrhagic Ievers etc.
Faeces and/or vomit contaminated items : Gastroenteritis
inIectious (Salmonella, Hepatitis (Hepatitis A Virus Irom
Iaeces only) etc.
Saliva contaminated items: Respiratory inIections
(Mycobacterium Tuberculosis, Measles Virus) etc.
Pus contaminated items; Skin inIectious (streptococcus Sp.)
etc.




Treatment and disposal technologies Ior health care waste:-

Incineration
Chemical disinIection
Wet & dry thermal treatment
Microwave irradiation
Land disposal

Color Coding System Segregation

Color
Coding
Type oI
Container
Waste Category Treatment Options
Yellow Plastic Bag Human Anatomical
Waste, Discarded
medicines, cytotoxic
drugs. (Cat. 1,2,3 & 6)
Incineration / Deep Burial.
Red DisinIected
Container /
Plastic bag
Microbiology &
Biotechnology, toxins,
Soiled waste
(contaminated with
blood & body Iluids,
plaster, Cotton, dress),
Solid Wastes
(disposables) (Cat. 3, 6
& 7)
Autoclaving / Micro-
waving / Chemical
treatment.
Blue / White Puncture ProoI
Container / Plastic
Bag
Waste Sharps tubings &
Plastics (Cat. & 7)
Autoclaving / Micro-
waving/Chemical treatment
and destruction &
shredding.
Black Plastic Bag Bio
degrade
Incinerator ash (secure
landIill), chemical waste
(neutralize), Household/
kitchen waste, Non-
inIectious bio-degradable
(Cat. 5, 9 & 10)
Disposal In secured landIill
Biodegradable
composting.

































unici





























D&STBIN
Drugs,
incinerator
ash,
chemical
solid

Disposable
IV bottles,
tubes, solid
sharps.

Micro-
biology,
Soiled &
solid
waste
Black
polythene
bag
Yellow
polythene
bag
Blue
polythene
bag
Red
polythene
bag
TROLLEY
Municipal
landIill
Incinerator/deep
burial
Autoclaving/micro-
waving/disinIection/
shredding
Autoclaving/micro-
Waving/chemical
treatment
1n{c.ion (ono Ivinin Tovnnc.

Aational training programme:
Responsible health authority should:-
Develop a national/regional programme to support hospital in
reducing the risk to nosocomial inIection,
Designate an agency to oversee the programme,
Plan national activities with the help oI national committee,
Involve proIessional and academic organization.

Hospital programme:-
Yearly work plan to access and promote good health care,
appropriate isolation, sterilization and other practices, staII training
and epidemiological surveillance should be developed.

Essential to understand that transmission of a pathogen:-
Causative agent,
InIectious reservoir,
Portal oI exit Irom reservoir,
Mode oI transmission,
Portal oI entry in the host,
Susceptible host.

Sessions for the staff included:-
InIection control,
Biomedical Waste management,
Bed sores, its prevention and care,
Pre and post operative care,
IV Cannulation and sterilization,
Catheterization and Catheter care
Central line insertion and its care,
Needles stick injuries and its Prevention,
Bed bath and Wound care,
Patient care on ventilator,
Care and procedures related to isolated patients.

Sessions for the House keeping staff included:-
Personal Hygiene ,
DisinIection procedures,
DisinIectants used and the concentrations to be used,
Linen management,
Handling blood spills,
Special care Ior Isolated patients.

























+)(11/)(1

The inIection control nurse will collect data Ior prevalence study in
the speciIied Iormat.
SpeciIic attention will be paid to the high risk areas C.T.recovery,
IC&, PIC&, NIC& & Dialysis unit).
The surveillance will be done Irom the Microbiology laboratory
data.
The data will be presented to the HICC every month.

Dealing with outbreaks:-
A sudden increase in number oI cases oI particular inIection or
pathogen in a ward/ unit over a short period oI time will be
reported to the inIection control team. The problem may be
initially identiIied by nurses, physicians, microbiologist, any other
healthcare worker or inIection control nurse.
Appropriate investigation will be done by the inIection control
team to source oI outbreak and implement the control measures.

AIMS:-
To monitor the nosocomial inIection rate,
To identiIy local problems & priorities,
Evaluate the eIIectiveness oI inIection control activity.

Characteristics:-
Timeliness, simplicity, Ilexibility,
Acceptability, reasonable cost,
Representativeness (or exhaustiveness).

Quality of data provided:-
Sensitivity, speciIicity,
Predictive value,
&seIulness in relation to the goal oI the surveillance.


Immediate control measures for outbreak management:-

Type of transmission
suspected
Suggested action
Cross transmission Patient isolation and barrier
precaution determined by
inIectious agents.
Hand transmission Improvement in hand washing:
cohorting
Airborne agent Patient isolation with
appropriate ventilation.
Agent present in water Checking water supply and all
liquid containers.
Food borne agents Elimination oI Iood at risk.

The selection oI control measures will be determined by results oI
analysis oI investigation and in consultation with appropriate
proIessionals viz. inIection control staII, clinicians, microbiologist,
nursing incharge.
II needed, a separate outbreak committee will be constituted Ior its
control.
Communication: During the outbreak, timely, up-to-date
inIormation will be communicated to the hospital administration
and public health authorities (as and when required).

1ypes of surveillance:-
Prevalence surveillance: (cross sectional / transverse)
InIection in all patients hospitalized at a given point in time
are identiIied in entire hospital or in selected units.

Incidence surveillance: (continuous / longitudinal)
Prospective identiIication oI new inIections requires
monitoring oI all patients within a deIined population Ior a
speciIied time period. Patients are Iollowed throughout their stay
and sometimes oIten aIter discharge.

Alert organism surveillance:
Continuous monitoring oI the incidence oI speciIied
organisms isolated by the microbiology laboratory.

1argeted surveillance:
Monitor Irequent inIections with signiIicant impact in
mortality, morbidity, costs.

Unit oriented surveillance:
Focus on high-risk units such as IC&, surgical unit,
oncology /hematology, burns unit, neonatal IC& etc.

Priority oriented surveillance:
For a speciIic issue oI concern to the Iacility (i.e. urinary
tract inIection in patients with urinary catheter in long term care
Iacilities).















^1I1OIOO


DA1A COLLEC1IOA:-
PRIMARY DA1A COLLEC1IOA:
Primary data is that data which is collected Ior the Iirst time & are
Iresh. They are collected by the researcher itselI. The various methods Ior
collecting primary data are as Iollows:

"&ESTIONNAIRE
PERSONAL INTERVIEW
OBSERVATION
`

SECOADARY DA1A COLLEC1IOA:
Secondary data is that data which already exists & collected by some
one else. The researcher goes through the secondary data Ior getting some
previous inIormation related to the topic. The sources oI secondary data are:

Hospital inIormation system.
Collection data oI discharged patients on the basis oI non
inIected and inIected patients Irom inIection control nurse.
Internet
Books and Magazines
Journals


PRIMARY DA1A:
"&ESTIONNAIRE:
A questionnaire was prepared on the management,
prevention and control oI Hospital acquired inIection ,and was given
to the nurses, RMO`s and lab techicians to Iill. It contains objective as
well as subjective questions.

Number oI staII Iilled the questionnaire:-
N&RSES 0
RMO 10
LAB.TECHNICIANS 10


PERSONAL INTERVIEW:
Primary data collection method was through personal
interview & observation. It was collected by interviewing personally,
questions were asked to the various staII; Nurses, RMO`s, Lab.technicians
about the management, prevention and control oI Hospital acquired
inIection, and on the answers given in the questionnaire.


OBSERVATION:
Each procedures & processes related to the project was
observed. It also includes observations on the answers given in the
questionnaires.


SECOADARY DA1A:
Secondary data was collected Irom the inIection control nurse. .












Data collection Iorm Ior Hospital Acquired
InIection

I.P No: Date:
Name: Age/ Sex:
Ward/Bed No. Date oI Adm: Date oI discharge:

Noscomial/ Hospital Acquired InIection Yes No
If Yes:
Surgical site inIection &rinary tract inIection
Blood stream inIection Pneumonia
Line related inIection Other respiratory inIection
Other nosocomial inIection

Intrinsic risk factors:
Diabetes Smoker Hpertension Alcohol intake
Anaemia Malignancy Trauma Cirrhosis
Steroids Immuno-suppression

HIV: Reactive/Non-Reactive/Not tested
HBsAg: Reactive/Non-Reactive/Not tested

Invasive pracedures:
ET Tube Assisted Ventilation IV/CVP Catheter
Arterial line Drianage tube Lumber puncture
Biopsy Endoscopy Dialysis Airway catheter
Any other



Signs and Symptoms:
1.Fever 2.Chills 3. Local pain .Swelling
5.Redness 6.Pus/ Discharge 7.&rinary Irequency
.Dysuria 9.Suprapubic tenderness 10. Oliguria
11.Pyuria 12.Cough 13.Increased respiratory secretion
1.Vomiting 15.Diarrhoea 16.Any other signs oI pneumonia
17.Hypotension 1.Hypothermia(Temp37
0
C) 19. Apnoea
or Bradycardia

1otal Leucocyte count: /cumm
Differential Leucocyte count: P: L: E: M: B:
X-ray Chest:
Others(iI any):

Culture report:

Specimen Growth Sensitivity




















Data collection Iorm Ior Hospital Acquired InIection


I.P No: Date:
Name: Age/ Sex:
Ward/Bed No. Date oI Adm: Date oI discharge:

Surgical Site Infection

Date of operation:
1ype of operation:
1.Elective 2. Emergency

Wound class:
1.Clean 2.Contaminated 3.Clean- contaminated
.Dirty/InIected

ASA Score 1. 2. 3. . 5.

Date of Infection:
Infection Site: 1.SuperIicial 2.Deep 3.Organ/Spaces

Antimicrobial Prophylaxis: Yes/No
Starting date: Duration:

Antibiotics given:(name/s):


Culture Report:

Specimen Growth Sensitivity




HOSPITAL ACQUIRED INFECTION:

~ANAGENENT, PRE'ENTION AND CONTROL

QUESSTIONAIRE

Name:

Designation: Department:


1) Do the healthcare workers aware /educated about the HAI ?

a) Full aware b) Mod.aware c) Not aware

2) Do the healthcare workers regularly attend the HAI training session ?

a) Full aware b) Mod.aware c) Not aware
3) What are the main sources oI inIection?





) What are the causes oI inIection?






5) Diagnosis:-




6) Do the healthcare workers aware about the antibiotic protocol?

a) Full aware b) Mod.aware c) Not aware

7) Do the healthcare workers aware oI the 'HAND WASHING ACTIVITY?

a) Full aware b) Mod.aware c) Not aware

) Do the healthcare workers uses the disinIectants regularly?

a) Full aware b) Mod.aware c) Not aware

9) Do the healthcare workers properly Iollow the IV procedures?

a) Full aware b) Mod.aware c) Not aware

10) Do the healthcare workers properly Iollow the cannulation and sterilization
Procedures properly?

a) Full aware b) Mod.aware c) Not aware

11) Do the healthcare workers aware about the catherization and catheter care?

a) Full aware b) Mod.aware c) Not aware

12) Are the clothes and other materials washed regularly?

a) Full aware b) Mod. aware c) Not aware

13) Do the healthcare workers know about the measures taken Ior post operative
care?
a) Full aware b) Mod. aware c) Not aware

1) Are the biomedical waste segregated and disposed properly?

a) Full aware b) Mod.aware c) Not aware.

15) Do the healthcare workers aware about the preventive health check-up?

a) Full aware b) Mod.aware c) Not aware

16) Do the healthcare workers aware about the vaccination against Hepatitis-B?

a) Full aware b) Mod. aware c) Not aware

17 ) Do the healthcare workers aware about the prevention against the needle stick
injury?

a) Full aware b) Mod. aware c) Not aware

1) Do the healthcare workers aware about the prevention against HIV/AIDS?

a) Full aware b) Mod.aware c) Not aware


19) Do the healthcare workers aware about the Hospital Acquired InIection Control
Committee?

a) Full aware b) Mod.aware c) Not aware

20) What is &niversal Precaution?





21) Any suggestion :-



























OBSERVATIONS

CARE is an ISO certiIied Multispecialty hospital, and it is going Ior
the NABH accreditation.
Observations were done on the answers given in the questionnaire.
It includes:---
Male & Female Nurses 0
Technicians 10
RMO 10

It is known Iact that "ualiIied, trained and experienced staII meant an asset
to the organization. And that is why, I came to know during the project.
Evaluating the HAI awareness level means nothing but to Iind out whether
they are aware oI HAI by theoretically & practically.

CARE Hospital has taken diIIerent measure Ior the awareness oI staII
regarding about the HAI. There are diIIerent training programs and exams
Ior staII.

There are pamphlets, posters at each nursing station and other prime
locations about hand washing, patient saIety, staII rights, ways to improve
patient saIety, patient rights and patient responsibilities.













DATA ANALYSIS AND GRAPHS

NURSING
STAFF



RATING

1

2

3
HHospital Acquired InIection (HAI) 0
HHAI Training Session 0
SSources oI InIection 03 37
Causes oI InIection 03 37
Diagnosis 15 25
Antibiotic Protocol 10 30
IV Procedures 0
Cannulation & Sterilization 0
Catherization & Catheter
Care

0
Post-Operative Care 0
Hand Washing Technique 0
DisinIectants 0
Linen Washing 0
Biomedical Waste 0
Preventive health check-up 10 30
Vaccination against
Hepatitis-B

09

31
Prevention against needle
stick injury

0
Prevention against
HIV/AIDS

0
&niversal Precaution 12 2
InIection Control Committee 0







Rating is given as:-
1-not aware
2-mod.aware
3-Iull aware
These ratings are applied Ior every object.

Nursing StaII-0



Nursing StaII aware about:-
O Hospital Acquired InIection-100 Iull aware.
O HAI Training Session-100 Iull aware.
O Sources oI InIection-93 Iull aware, 7 mod.aware.
O Causes oI InIection-93 Iull aware, 7 mod.aware.
O Diagnosis-63 Iull aware, 37 mod.aware.
O Antibiotic Protocol-75 aware, 25 mod.aware.
O IV procedures-100 Iull aware.
O Cannulation and Sterilization-100 Iull aware.
O Catheterization and catheter care-100 Iull aware.
O Post operative care-100 Iull aware.
O Hand Washing technique-100 Iull aware.
O DisinIectants-100 Iull aware.
O Linen washing-100 Iull aware.
O Biomedical Waste-100 Iull aware.
O Preventive health check-up-75 Iull aware,25 mod.aware.
O Vaccination against Hepatitis B-7 Iull aware,23 mod.aware.
O Prevention against needle stick injury-100 Iull aware.
O Prevention oI spread oI HIV/AIDS inIection-100 Iull aware.
O &niversal Precaution-70 Iull aware,30 mod.aware.
O InIection Control Committee-100 Iull aware.
























RO1



RATING

1

2

3
HHospital Acquired InIection (HAI) 10
HHAI Training Session 10
SSources oI InIection 10
Causes oI InIection 10
Diagnosis 10
Antibiotic Protocol 10
IV Procedures 10
Cannulation & Sterilization 10


Catheterization & Catheter
Care

10
Post-Operative Care 10
Hand Washing Technique 10
DisinIectants 10
Linen Washing 02 0
Biomedical Waste 10
Preventive health check-up 10
Vaccination against
Hepatitis-B

10
Prevention against needle
stick injury

02

0
Prevention against
HIV/AIDS

10
&niversal Precaution 10
InIection Control Committee 02 0








RMO-10



RMO`s aware about:-
O Hospital Acquired InIection-100 Iull aware.
O HAI Training Session-100 Iull aware.
O Sources oI InIection-100 Iull aware.
O Causes oI InIection-100 Iull aware.
O Diagnosis-100 Iull aware.
O Antibiotic Protocol-100 aware.
O IV procedures-100 Iull aware.
O Cannulation and Sterilization-100 Iull aware.
O Catheterization and catheter care-100 Iull aware.
O Post operative care-100 Iull aware.
O Hand Washing technique-100 Iull aware.
O DisinIectants-100 Iull aware.
O Linen washing-0 Iull aware,20 mod.aware.
O Biomedical Waste-100 Iull aware.
O Preventive health check-up-100 Iull aware.
O Vaccination against Hepatitis B-100 Iull aware.
O Prevention against needle stick injury-0 Iull aware,20 mod.aware.
O Prevention oI spread oI HIV/AIDS inIection-100 Iull aware.
O &niversal Precaution-100 Iull aware.
O InIection Control Committee-0 Iull aware, 20 mod.aware.































icro Lab
Technicians
1



RATING

1

2

3
HHospital Acquired InIection (HAI) 10
HHAI Training Session 10
SSources oI InIection 10
Causes oI InIection 10
Diagnosis 07 03
Antibiotic Protocol 06 02 02
IV Procedures 10
Cannulation & Sterilization 10


Catheterization & Catheter
Care
10
Post-Operative Care 0 01 01
Hand Washing Technique 10
DisinIectants 10
Linen Washing 10
Biomedical Waste 10
Preventive health check-up 10
Vaccination against
Hepatitis-B
10
Prevention against needle
stick injury
10
Prevention against
HIV/AIDS
10
&niversal Precaution 02 0
InIection Control Committee 10






Micro.Lab.Technicians-10




Micro.Lab.Technicians:-

O Hospital Acquired InIection-100 Iull aware.
O HAI Training Session-100 Iull aware.
O Sources oI InIection-100 Iull aware.
O Causes oI InIection-100 Iull aware.
O Diagnosis-30 Iull aware, 70 mod.aware.
O Antibiotic Protocol-20 Iull aware,20 mod.aware,60 not aware.
O IV procedures-100 Iull aware.
O Cannulation and Sterilization-100 Iull aware.
O Catheterization and catheter care-100 Iull aware.
O Post operative care-10 Iull aware, 10 mod.aware, 0 not aware.
O Hand Washing technique-100 Iull aware.
O DisinIectants-100 Iull aware.
O Linen washing-100 Iull aware.
O Biomedical Waste-100 Iull aware.
O Preventive health check-up-100 Iull aware.
O Vaccination against Hepatitis B-100 Iull aware.
O Prevention against needle stick injury-100 Iull aware.
O Prevention oI spread oI HIV/AIDS inIection-100 Iull aware.
O &niversal Precaution-0 Iull aware , 20 mod.aware.
O InIection Control Committee-0 Iull aware, 20 mod.aware.




























RECOENDATION

O Proper coordination
O On job training sessions should be interactive
O Increase awareness, monitoring, survillience and
participation regarding Hospital Acquired InIection
O Hand hygiene practices
O Isolation oI the patient with HIV, HBsAg
O Needles care
O Antibiotic protocols should be Iollowed properly
O An early sign oI symptoms should be detected Ior cultuers























11O)/T1

Report oI the Hospital Review Committee (Delhi Hospitals),
196.
Bennet JV Broachman AS: Hospital InIections. Little Brown
and Co.: Boston, 1979.
Rattan A, Bhujwala RA, Gupta AK: Role oI microbiology
laboratory in surveillance and control oI nosocomial
inIections. Journal oI the Academy oI Hospital
Administration 3(2): 1991.
Bacteremia in surgical patients with intravenous devices-a
European multicenter incidence. Journal oI Hospital InIection
193.
Francis C M, DeSouza, Mario C et al: Hospital
Administration Jaypee Brothers Medical Publishers: New
Delhi, 1993.
Panigrath D: Containment oI hospital inIections. In Goel SL,
Kumar R (Eds): Hospital Administration and Planning. Deep
and Deep Publications: New Delhi, 1990.