INFECTION PREVENTION AND SAFETY MEASURES

Introduction

Health care-associated infection remains a major issue of patient safety. It complicates

a significant proportion of patient care deliveries, adds to the burden of resource use, and
contributes to unexpected deaths. Early infection control pioneers showed that surveillance
and prevention programs can be successful and have set the scene for today’s infection
control activities. Parameters for success include those to recognize and explain healthcare-
associated infections and implement interventions to decrease infection rates and limit
antimicrobial resistance spread.

Healthcare associated infections (HAIs) are increasingly recognized as one of the

main issues affecting the mortality and morbidity of hospitalized patients. In developed
countries, it is estimated that between 5 and 10% of the hospitalized patients will develop a
HAI. In developing countries, this proportion has been estimated around 25%. The risk of
serious complications due to HAIs is particularly high for patients requiring intensive care. A
number of factors likely contribute to this problem, including increasing rates of
antimicrobial resistance, the development of progressively more-complex medical procedures
and invasive medical technology that place patients at risk for procedure-or device-related
infections, and an increasingly elderly and immunocompromised patient population. Many of
these factors are already happening in the Georgetown Public Hospital Corporation (GPHC)
in Guyana.

Definition of Infection

An infection is the entry and multiplication of an infectious agent in the tissue of host.
If infectious agent fail to cause injury to cell or tissue, then infection is asymptomatic.
Chain Of Infection

The presence of pathogen dose not mean that an infection will being. Development of
an infection occurs in a cycle that depends on the presence of all the following events.

1) An infectious agent or pathogen

2) A reservoir or source for pathogen growth.
3) A portal of exit from the reservoir
4) A mode of transmission
5) A portal of entry to host
6) A susceptible host

Causative
agent

Suseptible
Reservoir
Host

Poratal of Portal of
enrey Exit

Mode of
transmissi
on
 1) Infectious agent:-

Microorganisms include bacteria, viruses, fungi and protozoa, Microorganisms on the

skin may and be resident or transient flora. Resident organisms are considered permanent
residents of the skin, where they survive and multiply.

2) Reservoir

A reservoir is a place where a pathogen can survive but may or may not multiply for
E.g.: Hepatitis A virus survives in shellfish but does not multiply. But the pseudomonas
organisms may survive and multiply in the care of clients with respiratory alterations. The
most common reservoir is human body. A variety of microorganism lives on the skin and
within body cavities, fluids and discharges. For e.g. A person. can be carrier by hepatitis B
virus without having signs or symptoms infection. Animals, food, water, insects and
inanimate objects can also be reservoir for infectious organisms.

There are some reservoir are as follow

 Food

Microorganisms require nourishment. Some such as clostridium perfringens,

the microbe causes gas gangrene, thrive on organic matter. Other such as E.cherichia
coli, consumes undigested food stuff in the bowel. Carbon dioxide and inorganic
material such as soil provide nourishment for other microorganisms.

 Oxygen

Aerobic bacteria require oxygen for survival and for multiplication sufficient
to cause disease. Aerobic organism are more commonly the cause of infection
inhuman as compared with anaerobic organisms e.g. of aerobic organisms are
staphylococcus aurous and streptococcus organisms...

 Water
 Most organisms require water or moisture for survival. for e.g. A favourite
place of microorganisms is the moist drainage from a surgical wound The spore
forming bacteria such as that cause anthrax, botulism and tetanus, can live without
water.

 Temperature

Microorganisms can live only in certain temp ranges. The ideal temp for most
humans is 35 degree. However, some microbes can survive temp extremes that would
be fatal to human. Cold temperature tends to prevent growth and reproduction of
bacteria (bacteriostasis). A temperature that destroys bacteria is bactericidal.

3) Portal of Exit

After Micro-organisms find a site to grow and multiply, they must find a portal of exit
if they are to enter another host and cause disease. Micro-organisms can exit through a
variety of sites such as the skin and mucous membranes, respiratory tract, urinary tract,
gastrointestinal treat, reproductive tract and blood.

4) Modes of Transmission

They are many modes for transmission of micro organisms from the reservoir to the
host. Certain infectious discuses tend to be transmitted more commonly by specific mode
However, the same micro-organisms may be transmitted by more than one route. For e.g.
herpes zoster by droplet nuclei or by direct contact.

5) Portal of Entry

Portal of Entry Organisms can enter the body through the same routes they use for
exit for e.g.-a when a contaminated needle pierces à client skin organisms enter the body.
Any obstruction to the flow of urine from a urinary catheter allows organisms to travel up the
urethra. A factor that reduces the body's defences enhances the chances of pathogens entering
the body.

6) Susceptible Host

Whether a person acquires an infection depends on susceptibility to an infectious

agent, Susceptibility depends on the individual degree of resistance to a pathogen. The more
virulent an organism is the greater the likelihood of a person's susceptibility, Organisms with
greater virulence and resistance to antibiotics are becoming more common in acute care
setting. A person's resistance to an infectious agent is enhanced by vaccines or by actually
contracting the disease.

Potential modes of transmission of infection

1. Hands:
The hands of practice staff are the most important vehicles of cross- infection. The hands of
patients can also carry microbes to other body sites, equipment and staff.

2. Equipment:
Items of equipment can become contaminated with an infective organism, which can
subsequently be transmitted to another person, either directly, or via the hands of healthcare
workers.

3. Inhalation:
Pathogens exhaled into the atmosphere by an infected person can be inhaled by and
infect another person e.g., influenza.

4. Ingestion:
Infection can occur when organisms capable of infecting the gastrointestinal tract are
ingested. This most commonly occurs by ingestion of contaminated food and water, or by
faecal-oral spread e.g., Hepatitis A, Salmonella, and Campylobacter.

Standard Precautions

The purpose of Standard Precautions is to break the chain of infection. Standard Precautions
are a set of practices that should be used in the care and treatment of all patients, regardless
of whether they are known or suspected to be infected with a transmissible organism.
Standard Precautions apply when there is the potential for contact with:

 Blood (including dried blood)

 Body fluids and secretions (except sweat)
  Non-intact skin
 Mucous membranes
Implementation of Standard Precautions is vital in the prevention of transmission of
infection to patients and staff.

Standard Precautions
 Hand hygiene
 Use of personal protective equipment (PPE)
 Respiratory hygiene and cough etiquette
 Appropriate patient placement
 Safe injection practices
 Management of sharps
 Management of needle stick injuries/contamination incident
 Decontamination of reusable medical equipment
 Decontamination of the environment
 Management of spillages of blood and body fluids
 Management of laundry
 Management of waste

Transmission Based Precautions are Contact, Droplet and Airborne

Precautions.
1. Contact Precautions:
Should be used for infections that can be transmitted by direct contact with the patient
e.g. Clostridium difficile, norovirus (winter vomiting bug). Patients who present with diarrhea
may have an infectious origin. When examining such patients Contact Precautions should be
adhered to, to prevent you and your clothes, equipment getting contaminated.
 Wear a disposable plastic apron and gloves for all interactions that may involve direct
contact with the patient.
 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or
excretions.
 Perform hand hygiene after patient contact/removal of gloves.

Droplet Precautions:
  Should be used for infections such as influenza and meningococcal meningitis which
can be transmitted by droplets that are generated by the patient during coughing,
sneezing, talking, or while performing cough-inducing procedures, e.g., sputum
induction, administration of aerosolized medications, airway suctioning and during
treatment of lesions/abscesses when aerosolization of drainage fluid is anticipated.
 Wear a disposable plastic apron, gloves and surgical facemask for all interactions that
may involve direct contact with the patient and within close proximity (i.e 3 feet/1
meter) from the patient wear surgical face mask.
 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or
excretions.
 Perform hand hygiene after patient contact/removal of gloves.
 Respirator masks (FFP2/3) masks maybe required for specific suspected or confirmed
infections during aerosol generating procedures such as above procedures for
influenza.

Airborne Precautions:

Should be used for infections that can be transmitted by very small respiratory particles that
remain suspended in the air e.g. infective pulmonary or laryngeal TB.

 Wear a disposable plastic apron, gloves and respirator mask (FFP2/3) for all
interactions with the patient.

 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or

excretions

 Perform hand hygiene after patient contact/removal of gloves

Practice Staff Immunisation

Immunisation is one of the most effective health-care interventions. Under the Safety, Health
and Welfare at Work (Biological Agents) (Amendment) Regulations, 1998 74, any employer
of employees who are in contact with, or at risk of being exposed to, a biological agent as a
result of work must complete a risk assessment to determine which, if any, vaccinations are
 recommended for workers. A biological agent is a bacterium, virus, prion or fungus that has
the ability to adversely affect human health.

Schedule 5 of the Biological agent’s regulations states:

 If the risk assessment reveals that there is a risk to the health and safety of employees
due to their exposure to a biological agent for which effective vaccines are available,
the employer should offer them vaccination.

 Vaccination should be carried out in accordance with guidelines issued by the

employing authority and employees should be informed of the benefits and drawbacks
of both vaccination and non-vaccination.

 A vaccination certificate may be drawn up which should be made available to the

employee in question and, on request, to the authority.

Recommended immunization for staff whose work may expose them to

blood borne virus infection and other infectious diseases.

Infectious disease Recommendations

 Staff should be offered Hepatitis B vaccination if not

Hepatitis B previously vaccinated.
 Staff should have anti-HBs levels checked if
previously vaccinated against Hepatitis B and
response not known
 Staff should have pre-employment base line Mantoux
tuberculin testing performed if there is no BCG scar present,
or no documented evidence of having received BCG
BCG vaccination.
(Bacillus Calmette  If there is an inadequate Mantoux response (defined as skin
Guerin) induration less than 5mm in diameter) then the staff member
should be referred to their public health clinic or
occupational health department, where BCG should be
offered.
  Any staff member who has been in close contact with a case
of smear-positive tuberculosis should be
assessed by an occupational health department.
 Staff without a definite history of chickenpox, proof of
immunity or vaccination status, should be routinely screened
for VZV IgG.
Varicella  In addition HCWs from outside Ireland and Western Europe
are less likely to be immune. Vaccination should be offered
to all non immune staff.
 Post-vaccination serological testing is not
recommended. Where exposure occurs in a susceptible
member of staff, advice should be sought.

 Staff members should be offered vaccination against

Influenza
influenza on an annual basis each autumn.
 Health-care workers should have serological proof of
immunity or evidence of having received two doses of MMR.
Those who are non-immune should receive two doses of
Measles, mumps,
MMR. Post-vaccination testing is not recommended.
rubella
 Where exposure occurs in a susceptible staff member, advice
should be sought from Occupational Health on
further management and possible exclusion from the
workplace 71.

Hand Hygiene

Hand Hygiene Preparation

 Nails should be kept short and cut smoothly.

 Nail varnish, and/or false nails should not be worn.

 All wrist and hand jewellery/watches (except plain wedding bands) should be
removed.
  Sleeves should be rolled up to the elbow.

 Cover any abrasions with a waterproof dressing.

 Healthcare workers with damaged skin on the hands eg. Weeping dermatitis
should not carry out direct patient care and should seek occupational health
advice.

General Care of Hands

 Cover cuts with an impermeable waterproof dressing.

 Wet hands before applying soap

 Use preparations containing emollients

 Always rinse hands and pat dry thoroughly

 Apply emollient hand cream or barrier cream regularly

 Communal jars/tubes of hand cream should not be used as the contents may
become contaminated.

 Seek professional advice for sensitivity/allergy to disposable gloves and skin

problems.

Safe Injection Practices

Preparation of Injections

 All injections should be prepared in a clean area.

 This area must not be used for disposing of used needles and syringes,
handling blood samples, or any material contaminated with blood or
body fluids

 An aseptic technique must be used when drawing up injections.

 Needles, syringes and cannulise are sterile, single use items; they must
not be reused for another patient, or to access a medication or solution
that might be used for a subsequent patient.
Single Dose Vials

 Use single dose vials wherever possible.

 Do not use single dose vials for multiple patients.

 Do not combine leftover medication from different vials for later use.

Multiple Dose Vials

 Multiple dose vials should only be used when absolutely necessary

(i.e., where there is no alternative).

 Restrict wherever possible the use of multiple dose vials to a single

patient. Label vial with patient name and date opened.

 Discard if sterility is compromised or questionable.

 Use a sterile syringe and needle every time a medication vial is

accessed, even if it to obtain a second dose for the same patient.

Management of Sharps and Sharps Injury

Sharps Include:

 Needles

 Scalpels

 Stitch cutters

 Glass ampoules/vials

 Lancets

 Broken glass

Prevention of Sharps Injury

  Non-sterile disposable latex or nitrile (if allergic to latex) gloves should be worn.
 Consider needle free system when possible*.
 Get help if patient is uncooperative.
 Sharps must not be passed directly from hand to hand (a sharps tray with integral
sharps bin maybe used).
 Needles must not be bent, broken or recapped.
 Each person using a sharp must dispose of it him/herself
 as one unit into the appropriate puncture resistant sharps box, conforming to UN
number (UN3291 or UN2814).
 Sharps containers should not be filled above the mark indicating they are full- sealed
when at the fill line and dispose of in an appropriate manner.
 Do not attempt to retrieve items from a sharps box
 Temporary closures should be used when the sharps box is not in use.
 Sharps containers should be located in a safe position, stored out of reach of clients,
visitors and children.
 Sharps boxes should not be placed on the floor, windowsills or above shoulder height
(mobile stands and attachment brackets are available commercially).
 Sharps boxes should be signed at assembly, closure and disposal.
 Sharps boxes should be disposed of by a licensed authority in accordance with
national guidelines.
 All staff (both clinical and non clinical) must be educated about the safe use/disposal
of sharps.

STANDARD SAFETY MEASURES

DEFINITIONS

Standard

A standard is a predetermined level of excellence that serves a guide for practice.

Safety

Safety is the state of being "safe" (from French sauf), the condition of being protected against
physical, social, spiritual, financial, political, emotional, occupational, psychological,
educational or other types or consequences of failure, damage, error, accidents, harm or any
other event which could be considered non-desirable.

TYPES OF SAFETY

Normative safety

Normative safety is a term used to describe products or designs that meet applicable design
standards.

Substantive safety

Substantive or objective safety means that the real-world safety history is favorable, whether
or not standards are met.

Perceived safety

Perceived or subjective safety refers to the level of comfort of users. For example, traffic
signals are perceived as safe, yet under some circumstances, they can increase traffic crashes
at an intersection.

SAFETY MEASURES

Safety measuresare activities and precautions taken to improve safety, i.e. reduce risk related
to human health. Common safety measures include:

1. Root cause analysis

2. Visual examination for dangerous situations

3. Visual examination for flaws such as cracks, peeling, loose connections.

4. Safety margins/Safety factors

5. Implementation of standard protocols and procedures

6. Training of employees, vendors, product users

7. Instruction manuals

8. Instructional videos
9. Examination of activities by specialists

10.Government regulation

11.Industry regulation.

12.Self-imposed regulation of various types.

13.Statements of Ethics

14. Periodic evaluations of employees, departments, etc.

STANDARD SAFETY MEASURES IN HOSPITAL

Physical health

Bio medical waste management

Standard precautions"

PHYSICAL ENVIRONMENT

Aim: to provide an environment favourable to recovery

1. Promote comfort

2. Extermination and control of vermin and animal pets

3. Dangers

- Preventing mechanical injury

- Preventing shocks and burns from electrical fixtures

- Prevention of fire

- Protection from chemical injury

BIO MEDICAL WASTE MANAGEMENT

"any solid, fluid or liquid waste including its container and any intermediate product, which
is generated during the diagnosis, treatment or immunization of human beings or animals, in
research pertaining thereto,
CLASSIFICATION OF WASTE CATEGORY

Cat-1 Human Anatomical Wastes

Cat-2 Animal Anatomical Wastes

Cat-3 Microbiology and Biotechnology wastes

Cat-4 Waste Sharps

Cat-5 Discarded medicines and Cytotoxic drugs

Cat-6 Soiled wastes include items contaminated with blood, body fluids such as
cotton, dressings, linen, beddings etc.

Cat-7 Solid wastes i.e. waste generated from disposable items other than sharps
such as tubing, catheters, IV sets,

Cat-8 Liquid wastes (washing, cleaning)

Cat-9 Incineration ash

Cat-10 Chemical wastes ( Disinfectant, insecticides)

Principles of Control of Hazards of Biomedical Waste in Health

Care Establishment

 Each institution should develop its own bio waste management policy and ensure that
the health care workers are adequately trained to handle biological waste.
 Measures such as universal safety precautions, hand washing and proper segregation
of waste material should be encouraged.
 Rationale patient management policy should be followed and admissions restricted to
those for whom it is felt absolutely necessary.
  Proper house-keeping is essential and the hospital premises should be kept clean and
well-ventilated..
 Use of disinfectants should be rationalised.

Steps in the Management of Biomedical Waste

 Survey of waste generated.

 Segregation of hospital waste
 Collection & Categorization of waste.
 Storage of waste. (Not beyond 48 hrs.)
 Transportation of waste.
 Treatment of waste.

STANDARD PRECAUTIONS

Standard precautions are meant to reduce the risk of transmission of bloodborne and other
pathogens from both recognized and unrecognized sources. They are the basic level of
infection control precautions which are to be used, as a minimum, in the care of all patients.

Health policy

 Promote a safety climate.

 Develop policies which facilitate the implementation of infection control measures.

Hand hygiene

 Perform hand hygiene by means of hand rubbing or hand washing (see detailed
indications in table).
 Perform hand washing with soap and water if hands are visibly soiled, or exposure to
spore-forming organisms is proven or strongly suspected, or after using the restroom.
Otherwise, if resources permit, perform hand rubbing with an alcohol-based
preparation.
 Ensure availability of hand-washing facilities with clean running water.
 Ensure availability of hand hygiene products (clean water, soap, single use clean
towels, alcohol-based hand rub). Alcohol-based hand rubs should ideally be available
at the point of care.
Gloves

 Wear when touching blood, body fluids, secretions, excretions, mucous membranes,
nonintact skin.
 Change between tasks and procedures on the same patient after contact with
potentially infectious material.
 Remove after use, before touching non-contaminated items and surfaces, and before
going to another patient. Perform hand hygiene immediately after removal.

Facial protection (eyes, nose, and mouth)

 Wear

(1) a surgical or procedure mask and eye protection (eye visor, goggles) or

(2) a face shield to protect mucous membranes of the eyes, nose, and mouth during activities
that are likely to generate splashes or sprays of blood, body fluids. secretions, and excretions

 Gown
• Wear to protect skin and prevent soiling of clothing during activities that are
likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions
• Remove soiled gown as soon as possible, and perform hand hygiene

Prevention of needle stick and injuries from other sharp instruments

Use care when:

• Handling needles, scalpels, and other sharp instruments or devices

• Cleaning used instruments
• Disposing of used needles and other sharp instruments.

Respiratory hygiene and cough etiquette

Persons with respiratory symptoms should apply source control measures:

  Cover their nose and mouth when coughing/sneezing with tissue or mask. dispose of
used tissues and masks, and perform hand hygiene after contact with respiratory
secretions.

Health-care facilities should:

 Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet) away
from others in common waiting areas, if possible.
 Post visual alerts at the entrance to health care facilities instructing persons with
respiratory symptoms to practise respiratory hygiene/cough etiquette.
 Consider making hand hygiene resources, tissues and masks available in common
areas and areas used for the evaluation of patients with respiratory illnesses.

Environmental cleaning

 Use adequate procedures for the routine cleaning and disinfection of environmental
and other frequently touched surfaces.

Linens

Handle, transport, and process used linen in a manner which:

 Prevents skin and mucous membrane exposures and contamination of clothing

 Avoids transfer of pathogens to other patients and or the environment..

Waste disposal

Ensure safe waste management

 Treat waste contaminated with blood, body fluids, secretions and excretions as
clinical waste, in accordance with local regulations.
 Human tissues and laboratory waste that is directly associated with specimen
processing should also be treated as clinical waste.
 Discard single use items properly

Patient care equipment

 Handle equipment soiled with blood, body fluids, secretions, and excretions in a
manner that prevents skin and mucous membrane exposures. contamination of
clothing, and transfer of pathogens to other patients or the environment
 Clean, disinfect, and reprocess reusable equipment appropriately before use. With
another patient.