Hospital Infection Control Manual
Hospital Infection Control Manual
Hospital Infection Control Manual
No. of Pages : 59
Prepared By : Name :
Signature :
Approved By : Name :
Signature :
Signature :
AMENDMENT SHEET
The holder of the copy of this manual is responsible for maintaining it in good and safe condition and in a
readily identifiable and retrievable manner.
The holder of the copy of this Manual shall maintain it in current status by inserting latest amendments as and
when the amended versions are received.
Infection Control Nurse responsible for issuing the amended copies to the copyholders and the copyholder
should acknowledge the same and he /she should return the obsolete copies to the Infection Control Nurse.
The amendment sheet, to be updated (as and when amendments received) and referred for details of
amendments issued.
The manual is reviewed once a year and is updated as relevant to the hospital policies and procedures. Review
and amendment can happen also as corrective actions to the non-conformities raised during the self-assessment
or assessment audits by NABH.
The procedure manual with original signatures of the above on the title page is considered as ‘Master Copy’,
and the photocopies of the master copy for the distribution are considered as ‘Controlled Copy’.
SL.NO Designation
1 Managing Director
3 Accreditation Coordinator
CONTENTS
SGH recognizes the control of healthcare associated infections (HAI) as an important issue and is committed to
fulfilling its responsibility by ensuring that proper safeguards are instituted to identify and prevent HAI .All
aspects of hospital function are included in this activity.
"Any clinically recognizable microbiological disease that affects the patient as a consequence as being
admitted to hospital, or attending for treatment, or the hospital staff as a consequence of their work, whether or
not the symptoms of a disease appear while the infected person is in the hospital.
Purpose
To maintain standards in infection control measures and minimize hospital acquired infections in patients
and employees.
To define policy and procedure regarding healthcare associated infections in the hospital
a) Sigma Hospital has documented infection prevention and control program which aims at preventing
and reducing risk of health care associated infections.
b) The infection prevention and control program is a continuous process and updated in every year.
SGH have an Infection Control Committee which coordinates all infection prevention control activities
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Activities of IC Team
1. The hospital has an infection control team, which coordinates implementation of all infection
prevention and control activities. The team is responsible for day-to-day functioning of infection
control program.
2. Periodical training of all category staff about Infection Control Protocols and Policies.
3. Establish standard operational procedures for Infection Control practices.
4. Introduce new policies and protocols on the method of disinfection and sterilization.
5. Maintain and implement biomedical waste management protocols.
6. Regular monitoring of Engineering department and water supply system.
7. Supervision of biomedical waste management activities.
Responsibility of IC Nurse
1. Maintaining records and statistics regarding IC activities and maintains HAI incidents record.
2. Checking by inspection that Infection Control and prescribed disinfectant procedures are being carried out
in accordance with hospital policy.
3. Checking of housekeeping activities like the use of Personal Protective Equipments usage of proper
disinfectant, mopping plan, and biomedical waste management.
4. Training of all category staff.
5. Liaison between laboratory and ward staff: Informing head of department and giving advice on infection
control problems.
6. Notification of communicable diseases and other Notifiable disease through telephone and as well as
through email.
7. Arrangements taken to provide hand washing solutions and alcohol based hand rubs.
8. Work as a clinical supervisor by ensuring all the established policies and protocols are practiced like hand
washing procedures, use of hand rubs, isolation policies, care of IV and vascular access, urinary
catheters, universal precautions, housekeeping, cleaning and disinfection, PPE, equipment cleaning, etc.
9. Ensure health checkup of all employees.
10. Monitoring engineering activities like maintenance of aqua guard registers and cleaning register of Water
tanks etc.
11. Immediate attentions in NSI & Post exposure prophylaxis.
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SGH Hospital identified various high risk areas and procedures, and has policies to prevent infection in
these areas.
High risk areas of the hospital are identified as
1. Operation Theatres
2. Intensive care units
3. Causality
4. Endoscopy Room
There are a number of precautions designed to protect health care workers from exposure to blood borne
pathogens. While majority of patients infected with HIV/HBsAg/ HCV are asymptomatic at the time of
presentation, all patients are considered as having potentially infectious blood and body fluids. Precautions may
vary based on anticipated exposure.
Hand Washing
Hand washing means vigorous rubbing of hand with soap and water or with any antiseptic agents
Types
1. Social hand wash
2. Procedure hand wash
3. Surgical hand wash
Purpose
1. To remove dirt and debris
2. To decontaminate the hands
3. To prevent cross infection
4. To break the chain of infection
Most common mode of transmission of pathogens is via HANDS
“Hand washing is the single most important means of preventing the spread of infection”
When?
Before and after duty
Before each invasive procedures.
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1. Palm to Palm
2. Right palm over left dorsum and left over right dorsum.
3. Palm to palm finger interlocked.
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Hand Rub
In Chlorhexidine /alcohol 70% hand rub in all areas
When?
i. Before touching invasive devices
ii. After touching the patient
iii. Before handling the patient
iv. Before preparing any injections
Purpose:
The purpose of SAFE I is to promote implementation of safe practices associated with thefollowingmedical
procedures:
Intradermal, subcutaneous and intramuscular needle injections
Intravenous infusions and injections
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B. Staff at SGH, who are in direct contact with patients, shall wear non-sterile, well-fitting latex or
latex-free gloves when coming into contact with blood or blood product. Indications for glove use in
injection practice are
Masks, eye protection and other protective clothing ARE NOT indicated for the injection
procedures unless exposure to blood splashes is expected.
When using single-use personal protective equipment, dispose of the equipment immediately after use.
F. Injection Devices
The management of SGH shall ensure that an adequate supply of single- use devices is available, to allow
providers to use a new device for each procedure.
H. Medication
I. When giving medication:
a) NOT use a single loaded syringe to administer medication to several patients (i.e.ensure one needle, one
syringe, one patient!)
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clean the preparation surfaces with 70% alcohol (isopropyl alcohol or ethanol) and allow to dry
Assemble all equipment needed for the injection
Sterile single- use needles and syringes;
Reconstitution solution such as sterile water or specific dilutent
Alcohol swab or cotton wool;
Sharps container.
Labeling
After reconstitution of a multi dose vial, label the final medication container with
Date and time of preparation
Final concentration
Expiry date and time after reconstitution
Name and signature of the person reconstituting the drug.
For multi dose medications that DO NOT requires reconstitution, add a label with:
Date and time of first piercing the vial
Name and signature of the person first piercing the vial.
Administering Injections
Anaseptic technique should be followed for all injections.
Practical guidance on administering injections
General
When administering an injection:
c h e c k the drug chart or prescription for the medication and the corresponding patient’s name and
dosage
p e r f o r m hand hygiene
w i p e the top of the vial with 60–70% alcohol using a swab or cotton-wool ball
o p e n the package in front of the patient to reassure them that the syringe and needle have not been
used previously
U s i n g a sterile syringe and needle, withdraw the medication from the ampule or vial.
Reconstitution
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If reconstitution using a sterile syringe and needle is necessary, withdraw the reconstitution
solution from the ampule or vial, insert the needle into the rubber septum in the single or multi
dose vial and inject the necessary amount of reconstitution fluid.
Mix the contents of the vial thoroughly until all visible particles have dissolved.
After reconstituting the contents of a multi dose vial, remove the needle and syringe and discard
them immediately as a single unit into a sharps container.
Delay in administration
If the dose cannot be administered immediately for any reason, cover the needle with the capusing a one-
hand scoop technique.
Store the device safely in a dry kidney dish or similar container.
Important points
DO NOT allow the needle to touch any contaminated surface.
DO NOT reuse a syringe, even if the needle is changed.
DO NOT touch the diaphragm after disinfection with the 60–70% alcohol (isopropyl alcohol or ethanol).
DO NOT enter several multi dose vials with the same needle and syringe.
DO NOT re-enter a vial with a needle or syringe used on a patient if that vial will be used to
Withdraw medication again (whether it is for the same patient or for another patient)
Prevention of s harps injuries to health workers
Use of best practices can help to prevent sharps injuries to health workers
of sharps
6. Seal and replace sharps container when the container is three quarters full.
Define Infection
SGH adheres to transmission based precautions at all times. Infection is the invasion and multiplication of
microorganisms. Hospital infection control is important for patients, health care workers and public .The
Infection control Team plays a major role in the prevention and control of nosocomial infections.
Infection acquired during or as a result of hospitalization generally after 48 hrs of admission. It can manifest
even after discharge.
Cleaning Protocols
1. Moping plan - clean to unclean area
2. Mopping plan means cleaning done from clean area to unclean area.
3. It gives special information to cleaning staff about priority of cleaning.
4. Mopping plan contains four categories
The order of cleaning is
a) Immuno compromised patient’s room
b) Room of the patient with clean case -Clean room
c) General
d) Infected
If there is a patient with communicable disease that room should be cleaned in the last, irrespective of
plan (Direction will be given by the Head nurse/ Sr. Staff Nurse on duty
Housekeeping supervisor/ HIC Nurse)
2. Environment:-
Clean the floors with a disinfectant thrice a day.
Clean with soap solution first and then with Super Shine Solution 3 times a day
Wash the floors with soap & water and disinfecting solution using scrubbing machine once in a week.
Do not carry out any cleaning activities while
1. Sterile supplies are being handled.
2. Sterile procedures are in progress.
a. Use 1 % Sodium Hypochloride solution to clean environment surfaces if contamination with
blood and body fluids occur.
b. Use 1 % Sodium Hypochlorite solution for 30 min for disinfecting mops used for cleaning
blood.
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c. Detach the pads and brushes of scrubbing machine after each use, clean thoroughly and
dry.
d. Clean the walls and ceilings weekly and on transfer / discharge/ death of a patient.
3. High Risk Areas:-
a. Floors are cleaned with prescribed disinfectant five times a day with Super Shine 2%
b. Ventilator parts are cleaned with prescribed disinfectant.
c. All equipment including monitor are cleaned with prescribed disinfectant spray.
d. Some plastic items like ambu bag, ventilator tubing,O2 mask, Nebulization set are sterilized
by formalin gas ( generally ETO sterilization recommended - implement the same)
e. Change the HEPA filter (ventilator) every 72 hours.
f. Keep a disinfectant hand rub solution in each bed side.
g. Keep separate stethoscope, BP always ready to use with a standby.
h. Damp dust bed frames, railings, I/V stands, lockers etc daily with prescribed disinfectant.
i. Floor cleaning done four times in a day with prescribed disinfectant.
j. Cover the mattresses and pillows with water proof covers.
k. Use disposable plastic sheets / Mackintosh to protect the bed linen.
l. Disinfect the patient’s unit with prescribed disinfectant solution after the transfer / discharge /
death.
m. Check the expiry date of CSSD items every day.
4. Wards:-
a. Damp dust the bed frames, railings, I/V stands, lockers etc. daily with prescribed
disinfectant.( Name the disinfectant)
b. Floor cleaning done three times a day from clean area to unclean area
c. Cover the mattresses and pillows with water proof cover.
d. Use disposable plastic sheets or mackintosh to protect the bed linen.
e. Disinfect the unit with prescribed disinfectant after the discharge/ death of a patient.
Fumigate the room after the transfer/ discharge/ death of an infected patient with Super
Shine.
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Fogging (Fumigation)
This method of disinfection is used after discharge of a patient with communicable diseases or
before admitting a patient after high risk operation.
action time 45 minutes to 1 hr.
Mode of use:11% Hydrogen Peroxide+0.01 Silver Nitrate in water(800 ml water and 200 ml
solution)
Room should be kept closed for two hours.
Digital Clean properly with Sprit/Ethanol 70% Daily - After the use of
3
Thermometer every patient
Laundry And Linen Management :All used linen shall be considered contaminated and shall be bagged at the
location of use before being taken to laundry.
A. Soiled linen:
Soiled linen shall be collected in the designated container and taken to laundry
Designated container shall be covered during transport of soiled linen.
Cloth liners /containers shall be washed daily
Dirty utility room shall be swept daily and washed /Mopped with a detergent/Disinfectant weekly and
whenever visibly soiled
Soiled linen shall be handled as little as possible and with minimum agitation, in order to prevent gross
microbial contamination of the air and of persons handling the linen
All soiled linen shall be bagged at the location of use. Soiled linen shall not be sorted in-patient care
areas.
Bags containing soiled linen shall be tied before being taken to laundry in order prevent spillage
All linen that is contaminated with blood, excreta or other body fluids shall be placed in designated
laundry bags
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Used instruments are cleaned immediately by the scrub nurse and the attender. Reusable sharps are
decontaminated in Lysol / hypochloride and then washed in the room adjacent to the respective OT by scrubbing
with a brush, liquid soap and vim. They are then sent for sterilization in the CSSD. After septic cases the
instruments are sent in the instrument for autoclaving. Once disinfected, they are taken back to the same
instrument cleaning area for a manual wash described earlier. They are then packed and re-
autoclaved before use.
c. Environment
Wipe used equipment, furniture or table etc., with detergent and water. If there is a blood spill, disinfect with
sodium hypochloride before wiping.
Empty and clean suction bottles and tubing with disinfectant.
d. After the last case
The same procedures as mentioned above are followed and in addition the following are carried out.
Wipe over head lights, cabinets, waste receptacles, equipment, furniture with disinfectant like rapid incidur,
foam incidur etc…
Wash floor and wet mop with liquid soap and then remove water and wet mop with Super Shine solution.
Clean the storage shelves, scrub & clean room.
Weekly cleaning procedure
Remove all portable equipment.
Damp wipe lights and other fixtures with detergent.
Clean doors, hinges, facings, glass inserts and rinse with a cloth moistened with detergent.
Wipe down walls with clean cloth mop with detergent.
Scrub floor using detergent and water or Super shine.
Stainless steel surfaces - clean with detergent, rinse & clean with warm water.
Replace portable equipment: Clean wheel castors by rolling across toweling saturated with detergent.
Wash (clean) and dry all furniture and equipment (OT table, suction holders, foot & sitting stools, Mayo
stands, IV poles, basin stands, X-ray view boxes, hamper stands, all tables in the room, holes to oxygen tank,
kick buckets and holder, and wall cupboards)
After washing floors, allow disinfectant solution to remain on the floor for 5 minutes to ensure destruction of
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bacteria.
Methods of Surveillance
Fumigation and Random Culture from High Risk Areas
HICC decided that culture swab to be taken from critical areas once in two months or when an infection is
suspected. Take the swabs according to the table shown below. The request of sample to be approved by the
Infection Control Nurse. The original copy of the culture report to be filed in the infection control
department and a copy of the report to be filed in the concerned department as well.
Period for
Period for Weekly
S.NO Department Duration surveillance Air culture
Fumigation cleaning
culture
Every Sundays,
day before any Every
Monthly twice Every
1 ALL OT MONTHLY major surgeries Sunday&
(Sunday) 6months
&any infected SOS
cases notified
Twice a Month
MONTHLY Every Once in
2 NICU Every month & SOS
Sunday a Year
Casualty
Every 3rd Every Once in a
5 Procedure Every month
month Sunday Year
room
6. Encephalitis
7. Plague
8. Hepatitis-viral
9. Leptospirosis
10. Malaria
11. Measles
12. Meningitis – Pyogenic/ Prescribed disinfectant
13. Rabies
14. Tetanus
15. Enteric fever
16. Pertussis
17. Dengue
18. Chickenpox
19. Chikungunya
20. H1N1(Swine flu )
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There are predominately four types of hospital acquired infections. They can be recorded on the basis of
clinical and /microbiological data
Post-Operative Infections
Any surgical wound which results in a purulent discharge must be regarded as a hospital acquired infections
whether the bacteria are of endogenous or exogenous origin is not taken in to the account.
indicated.
Hand wash:
Hand washing should be done immediately before and after any manipulation of the catheter site or
apparatus.
Catheter Insertion
Catheters should be inserted using aseptic technique and sterile equipment. Use an appropriate antiseptic
solution for periurethral cleaning.
As small a catheter as possible, consistent with good drainage, should be used to minimize urethral trauma.
Indwelling catheters should be properly secured after insertion to prevent movement and urethral traction.
permits. Heat and moisture exchanging filter (HMEF) is to be changed every 24- 48 hours. It should
not be removed from circuit except at the time of changing.
Oxygen masks, venture devices and nebulizer chambers are cleaned carefully and then sterilized by
ETO.
Humidifier domes are ETO sterilized. Ambu bags are cleaned thoroughly and are then sent for ETO
sterilization.
Microbiological surveillance of respiratory therapy equipment is practiced in our hospital.
2. Tracheostomy Care / Endotracheal Tube
Careful attention to post-operative wound care is mandatory.
The patient should receive aerosol therapy to prevent desiccation of the tracheal and bronchial
mucosa or the formation of crusts. The skin around the tracheostomy tube should be cleaned with
betadine (Povidone-iodine 5%) every four hours or more frequently, if necessary.
In case of metal tracheostomy tubes, the inner cannula should be cleaned every four hours and more
often if necessary to prevent the formation of crusts. The inner cannula is cleaned with water,
immersed in hydrogen peroxide for 15 minutes and then rinsed with fresh & sterile normal saline. The
plastic tracheostomy tubes are removed, another plastic tube is inserted, and the tube is cleaned, with
hydrogen peroxide, and rinsed well before reuse.
The tracheostomy tube should be changed every 24 hours. This tube must be tied securely at all times.
The first complete tube change should be performed not earlier than 4-5 days to allow time for the tract
to be formed. Subsequent changes should be done weekly or as necessary.
Clean technique should be used to change the tracheostomy tube unless there is a medical indication
for sterile technique.
The obturator should be at the bedside (preferably taped to the head of the bed) to be used if the
tracheostomy tube accidently is dislodged or is removed for any reason.
3. Suctioning of endotracheal / tracheostomy tube :
Employees should be instructed and supervised by trained personnel in proper technique before performing this
procedure on their own. Assess the patient using auscultation, ECG, (if available) and vital signs prior to
suctioning.
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a. Sterile Suctioning
1. Wash your hands.
2. Use a catheter with a blunt tip.
3. The wall suction should be set no higher than 120 mm Hg for adults and between 60 and 80 mm Hg for
children.
4. Attach the suction catheter to the suction tubing; do not touch the catheter with bare hands (leave it in its
protective covering).
5. Put on sterile gloves. The wearing of a mask is also strongly recommended.
6. However, if saline does need to be instilled, '1/2 cc of sterile saline is put into the tracheostomy tube on
inspiration only.
7. If on a respirator, pre-oxygenate the patient by connecting the resuscitation bag to the artificial airway and
ventilating the patient with three or four deep breaths. A mechanical ventilator on 100% oxygen may also be
used by depressing the manual ventilation button three or four times.
8. Insert the catheter gently through the inner cannula until resistance is met. Do not apply suction during insertion.
9. Withdraw the catheter approximately 1 cm and institute suctioning.
10. Carefully withdraw the catheter, rotating it gently between the thumb and forefinger applying intermittent
suctioning.
11. Continuous suctioning for longer than 10 seconds may create an unacceptable level of hypoxia.
12. The patient should be given time to rest between suctioning episodes. If possible, this time should be from
two to three minutes. If the patient is receiving oxygen or ventilator support, reapply the oxygen or ventilator
for at least two minutes before re-suctioning.
13. Observe for unfavorable reactions such as increased heart rate, hypoxia, arrhythmia, hypotension, cardiac
arrest, etc.
14. If oral suctioning is necessary, it should be done after the tracheostomy is suctioned.
15. When suctioning is completed, clear the catheter and tubing of mucous and debris with sterile water or saline.
16. Discard the catheter, water container, and gloves appropriately.
17. Wash hands.
18. The tubing and suction canister should be changed every 24 hours. The canister should be labeled with the
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date and time when they are changed. If debris adheres to the side of the tubing or the canister, either or both
should be changed. The tubing should be secured between suctioning periods so that it will not fall to the bed,
floor, etc.
4. Sigma Hospital has taken action to prevent intra vascular device infection.
I. Hand washing
Wash hands before every attempted intravascular cannula insertion. Antimicrobial hand washing soaps are
desirable, and are preferred before attempted insertions of central intravenous catheters, catheters requiring cut
downs, and arterial catheters.
II. Preparation of skin
Povidine-iodine (PVP)or 70% alcohol may be used for cleaning the skin. Insertion sites should be
scrubbed with a generous amount of antiseptic. Beginning at the centre of the insertion site, use a circular
motion and move outward. Antiseptics should have a contact time of at least 30 seconds prior to catheter
insertion. Antiseptics should not be wiped off with alcohol prior to catheter insertion.
III. Applying dressings
Sterile dressings should be applied to cover catheter insertion sites. Unsterile adhesive tape should not be
placed in direct contact with the catheter-skin interface.
IV. Record Time and date of IV insertion.
V. Inspecting catheter insertion sites
Intravascular catheters should be inspected daily and whenever patients have unexplained fever or complaints
of pain, tenderness, or drainage at the site for evidence of catheter related complications.
VI. Inspect for signs of infection (redness, swelling, drainage, tenderness) or phlebitis and also palpate gently
through intact dressings.
VII. Manipulation of intravascular catheter systems
Strict aseptic technique should be maintained when manipulating intravascular catheter systems. Examples of
such manipulations include the following:
Placing a heparin lock
Starting and stopping an infusion
Changing an intravascular catheter site dressing
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All invasive procedure are recorded in a book.(please keep a register for this in nursing areas)
5. The organization takes action to prevent surgical site infections.
Surgical wounds
Surgical wounds after an elective surgery are inspected on the third post-operative day, or earlier.
All personnel doing dressings should wash their hands before the procedure. Ideally, a two member
technique is followed. One to open the wound, and one to do the dressing.
If two health care workers are not available, then, take off the dressing, wash hands again before
applying a new dressing.
A clean, dry wound may be left open without any dressing after inspection.
If there is any evidence of wound infection, or purulent discharge, then dressings are done daily, using
povidone-iodine to clean the wound and applying dry absorbent dressings.
If any Surgical site infection occur
Surgical site infection reporting format is filled up by surgeons.
Records maintained by registrar in charge. Data collected every quarterly by secretary HICC
and presented.
Special studies will be conducted as needed. These may include
The investigation of clusters of infections above expected levels.
The investigation of single cases of unusual or epidemiologically significant nosocomial infections.
Prevalence and incidence studies, collection of routine or special data as needed and sampling of personnel
or the environment as needed.
Injection abscess.
Sigma Hospital provides adequate and appropriate personal protective equipment for employees, soaps and
disinfectant at the point of use and adequate inventory is maintained at all time to ensure availability of these.
Personal protective equipments includes
Gloves
Protective eye wear
Mask
Apron
Gown
Boots/ shoe covers
Cap/ hair cover
The hospital have adequate and appropriate facilities for hand hygiene in all patient care area such as liquid hand
wash, large wash basin with elbow operated taps, tissue paper/ hand dry, hand rubs etc. are available to all health
care providers.
a. The hospital defines the conditions where isolation , barrier nursing or both isolation and barrier nursing is
required. The organization provides barrier nursing facilities such as clothing , mask , gloves…etc.
Isolation protocols
Definition: It is the separation of infected persons from the non- infected persons for the period of
communicability under conditions which will prevent the transmission of infection.
When a patient comes with any infectious disease/ Immuno compromised state, the concerned ward staff
will inform the ICN and she will arrange the room or if the patient is critically ill admit the patient in side
bed allocated for ISOLATAION PATIENTS of the concerned ICU. If the patient can’t afford the room
patient will be admitted in the isolation room, the patient and the family members will.
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Strict Isolation
Strict isolation is an isolation category designed to prevent transmission of highly contagious or virulent
infections that may be spread by both air and contact.
Contact Isolation
a) Contact isolation is designed to prevent transmission of highly transmissible or epidemiologically
important infections (or colonization that do not warrant strict isolation.
b) All diseases or conditions included in this category are spread primarily by close direct contact.
Multiple resistant bacterial infection, or colonization (any site) with any of the following
Gram- negative bacilli resistant to all aminoglycosides that are tested. Staphylococcus aureus resistant
to penicillin.
Pneumococcus resistant to penicillin.
Haemophilus influenzae resistant to ampicillin (betalactamase –positive) and chloramphenicol.
Other resistant bacteria may be included if they are judged by the infection control team to be of
special clinical and epidemiological significance.
Pediculosis
Pharyngitis, infections, infectious, in infants and young children.
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1) Respiratory Isolation
Respiratory isolation is designed to prevent transmission of infectious diseases primarily over short
distances through the air (droplet transmission).
Specifications for Respiratory Isolation
1. Private room is indicated.
2. Masks are indicated for those who come close to the client.
3. Gowns are not indicated.
4. Gloves are indicated if contamination of hands is anticipated.
Requiring Respiratory Isolation
Epiglottitis, Haemophilusinfluenzae
Erythematic infections
Measles
Meningitis
Haemophilusinfluenzae, known
Meningococcal, known or suspected
Meningococcal pneumonia
Meningococcemia
Mumps
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
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HOSPITAL INFECTION
Date 01/4/2017
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3) Enteric Isolation
Enteric precautions are designed to prevent infections that are transmitted by direct or indirect contact with
faeces.
Specification for Enteric Precautions
1. Private room is indicated if client’s hygiene is poor. (A client with poor hygiene does not wash
hands after touching infective material, contaminates the environment with infective material, shares
contaminated articles with infective material, or shares contaminated articles with other clients.)
2. Masks are not indicated.
3. Gowns are indicated if soiling is likely.
4. Gloves are indicated for touching infective material.
Disease Requiring Enteric precautions
Amoebic dysentery, Typhoid, Hep A
Cholera
Coxsackievirus disease
Enterocolitis caused by Clostridium difficile or Staphylococcus aureus
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 49 of 59
Enteroviral infection
Tetanus
Gastroenteritis caused by
Campylobacter species
Cryptosporidium species
Dientamoebafragilis
Escherichia coli (enterotoxic, enteropathogenic, or enteroinvasive)
Giardia lambdia
Salmonella species.
Shigella species
Vibrio parahaemolyticus
Viruses – including Norwalk agent and rotavirus
Protocol for receiving patient with Dengue and Chikungunya, Lepto, Malaria
1. Receive the patient in isolation room. / ward.
2. Inform Infection Control Nurse.
3. Confirm report from laboratory.
4. Provide isolation measures with facilities of mosquito net, mosquito repellant.
5. Send notification card to Infection Control Nurse.
6. Infection Control Nurse will inform to DMO – Health by telephone and then send notification
through e-mail to DMO.
7. Instruct the relatives to protect themselves and others by keeping the environment free from
mosquito.
The following points are common for all the types of isolation.
a. Hands must be washed after touching the client or potentially contaminated articles and before
taking care of any other client.
b. Stick BIO-HAZARD symbol on the contaminated articles before sending to the CSSD.
c. Discard all infectious wastes- non-plastic in yellow plastic bag.
MRSA Protocol
1. Admission to an Isolation room
2. Single use Disposable plastic apron should be worn for patient contact
3. The gown/plastic apron & gloves should be removed before leaving the room
4. Single use disposable gloves should be worn for handling contaminated tissue, dressing or linen.
5. Hands must be decontaminated after removing the gloves
6. High efficiency filter type masks should be used for procedures that may generate aerosols
7. Bed linen / clothing should be changed daily
8. Linen bags must be sealed at the bed side and removed directly to the dir ty utility area or the collection
point
9. All instruments used for the patient care must be kept with the patient
10. Use dedicated equipments
11. Hand must be washed before andafter contact with the patient or their environment .Use Chlorhexidine or
alcoholic based hand rub.
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 52 of 59
12. All single use items must be disposed of as clinical waste. Clinical waste bags must be sealed before
leaving the room. All reusable items would be processed in accordance with the local disinfection
policy.
Steps – Protocol/Manual
1. Check status of the injured staff
2. Status of the source:
3. Inform the consultant
4. Inform patient – Check patient’s serology
Step-1
1. If patients serology – HepB+ve /Known case of HepB+ve
2. Check vaccination status of injured person.
If vaccinated Check HB3 A3 titer
If not vaccinated Provide Hepatitis B vaccine. If
patient is +ve case Check HbsAg titer
If HbsAg Titer value < 10 Provide immunoglobin within 24 hour
Step-2
If patient known case of HIV +ve / Unknown and staff is injured
1. Consult concerned physician
2. Start Anti Retro Viral Therapy (ART) as early as possible.
3. If patient is HCV positive: hand washing in running water with soap.
4. Consult concerned physician
After Post exposure of Known case of Hepatitis-B, HIV&HCV/Unknown
Follow up the serology of staff for 3months,6 months and 12 months
Infection control nurse to monitor, follow up and maintain documents.
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 54 of 59
SIGMA HOSPITAL documents the procedures for identifying and managing an outbreak.
Verification of the diagnosis. Each case should be reviewed to meet the definition.
Confirmation that an outbreak exists by comparing the present rate of occurrence with the endemic rate
should be made.
b. Step 2
The appropriate departments and personnel and the hospital administration should be notified and involved.
c. Step 3
Additional cases must be searched for by examining the clinical and microbiological records.
Line listings for every case, patient details, place and time of occurrence and infection details
should be developed.
An epidemic curve based on place and time of occurrence should be developed, the date analyzed,
the common features of the cases e.g age, sex, exposure to various risk factors, underlying
diseases etc. should be identified.
A hypothesis based on literature search and the features common to the cases; should be
formulated to arrive at a hypothesis about suspected causes of the outbreak.
Microbiological investigations depending upon the suspected epidemiology of the causative organism
should be carried out. This will include (a) microbial culture of cases, carriers and environments (b)
epidemiological typing of the isolates to identify clonal relatedness.
The hypothesis should be tested by reviewing additional cases in a case control study, cohort study, and
microbiological study.
d. Step 4
Specific control measures should be implemented as soon as the cause of outbreak is identified.
Monitoring for further cases and effectiveness of control measures should be done.
A report should be prepared for presentation to the HICC, departments involved in the outbreak and
administration
The hospital takes appropriate corrective action to prevent the recurrence
Immediate control measures
Control measures should be initiated during the process of investigation. An intensive review of infection control
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 56 of 59
measures should be made and general control measures initiated at once. General measures include:
• Strict hand washing;
• Intensification of environmental cleaning and hygiene.
• Adherence to aseptic protocols, and
• Strengthening of disinfection and sterilization.
Microbiological Study
Microbiological study is planned depending upon the known epidemiology of the infection problem. The study is
carried out to identify possible sources and routes of transmission. The investigation may include cultures from
other body sites of the patient, other patients, staff and environment. Careful selection of specimens to be cultured
is essential to obtain meaningful data.
Specific control measures
Specific control measures are instituted on the basis of nature of agent and characteristics of the high-risk group
and the possible sources. These measures may include:
• Identification and elimination of the contaminated product;
• Modification of nursing procedures;
• Identification and treatment of carriers, and
• Rectification of lapse in technique or procedure
Evaluation of efficacy of control measures
• The efficacy of control measures should be evaluated by a continued follow-up of cases after the outbreak
clinically as well as microbiologically. Control measures are effective if cases cease to occur or return to the
endemic level.
• The outbreak should be documented.
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 57 of 59
rules. Annual report of waste generated is maintained by administration and report submitted to Pollution Control
Board. All categories of staff handling bio medical waste are using appropriate personal protective measures.
SIGMA HOSPITAL Doc. No. E / NABH / SGH / HIC / 01 - 08
Issue No. 01
Rev. No. 00
HOSPITAL INFECTION
Date 01/4/2017
CONTROL MANUAL
Page Page 59 of 59