Infection Prevention

1. SBA - Presentation 1 (b) Infection Prevention Maternal Health Division Ministry of Health & Family Welfare Government of India

2. Session Objectives To know • Sources of infection • Importance of infection prevention • Principles of infection prevention • Standard precautions • Preparation of 0.5% chlorine solution • Preparation of clean and disinfected instruments/gloves • Disposal of biomedical waste • Proper handling of contaminated waste Infection Prevention

3. Sources of Infection What are the common sources of infection? • Environment : Blood, body fluids, secretions, excretions, placenta, contaminated sharps and other equipments. • Other clients & Attendants • People in the community • Health care delivery personnel Infection Prevention

4. Why is infection prevention important? To prevent the occurrence of infections and to minimize the risk of transmitting any infections including hepatitis B, C and HIV to clients, health care staff and community. Infection Prevention

5. Principles of Infection Prevention • All objects in contact with the client: Potentially contaminated • Every person: Potentially infectious • If an object is disposable: Discard as waste. • If reusable: Prevent infection by decontamination cleaning, disinfecting or sterilizing Infection Prevention

6. Standard Precautions • Hand washing • Use of protective attire • Processing of used items • Proper handling and disposal of sharps • Maintaining a clean environment • Biomedical waste disposal Infection Prevention

7. 1. Standard Precautions: Hand Washing Technique Main Purpose Agents Residual effect Routine hand washing Cleansing Non medicated soap Short Careful hand washing Cleansing after client contact Non medicated soap Short Hygienic hand rub Disinfection after contamination Alcohol Disinfection Surgical hand disinfection Pre-operative disinfection Antibacterial soap , Alcoholic solutions Long Infection Prevention

8. Steps of hand washing Step 1 Wet the hands and wrists. Apply soap. Step 2 Right palm over left, left over right. Step 3 Palm to palm, Fingers interlaced. Step 4 Back fingers to opposing Fingers interlocked. Step 5 Rotational rubbing of right Thumb clasped in left palm and vice versa. Step 6 Rotational rubbing backwards and forwards with top of fingers and thumb of right Hand in left and vice versa. Infection Prevention

9. 2. Standard Precautions: Protective attire • Gloves • Masks • Eye-covers • Gowns • Caps • Footwear Infection Prevention

10. 3. Standard Precautions: Processing of used items A. Decontamination B. Cleaning C. Sterilization or high level disinfection (HLD) D. Storage Infection Prevention

11. Processing of used items A. Decontamination: Preparation of Bleaching solution (0.5%) • Wear utility gloves and plastic apron. • Take 1 litre of water in plastic bucket. • Make thick paste with 3 levelled tea spoons of bleaching powder and water in a plastic mug. • Mix paste in the bucket of water to make 0.5 % chlorine solution. Infection Prevention

12. Processing of used items B. Cleaning: • Involves - scrubbing with a brush, detergent and water. • Detergent is important for effective cleaning because water alone does not remove proteins, oils and grease. Infection Prevention

13. Processing of used items C. Sterilization: Sterilization ensures that items are free of all microorganisms (bacteria, viruses, fungi and parasite) including endospores. Three methods of sterilisation: • Steam sterilisation / Autoclaving / Pressure cooker autoclaving • Dry heat sterilisation • Chemical / cold sterilisation Infection Prevention

14. Processing of used items Pressure cooker type autoclave C. Sterilization: Geared steam gauge Excess pressure relief valve Control Valve Top Handle Air exhaust tube Infection Prevention

15. Processing of used items High level Disinfection • HLD eliminates bacteria, viruses, fungi and parasites, but does not kill all endospores which cause diseases such as tetanus and gas gangrene. • HLD only acceptable alternative to sterilisation. • There are 3 methods of HLD: • Boiling • Chemical HLD • Steaming C. Sterilization: Infection Prevention

16. Processing of used items D. Storage: • To prevent contamination after processing • Do not store instruments or other items such as scalpel blades and suture needles in solution, always store them dry Infection Prevention

17. 4. Standard Precautions: Proper Handling and Disposal of sharps Needles and syringes • Use disposable needle and syringe ONLY ONCE. • Always wear utility gloves while handling sharps • Do not disassemble the needle and syringe after use. • Do not recap, bend or break needles before disposal. • Make needles unusable after single use by burning them in a needle destroyer • Never burn syringes Infection Prevention

18. 4. Standard Precautions: Proper Handling and Disposal of sharps • Dispose off needles and syringes in a puncture-proof container such as metal box, cardboard box or an empty plastic box. • Finally dispose as follows: • Dispose the needles and broken vials in pit / tank, • Send the syringes and unbroken vials for recycling or landfill Needles and syringes Infection Prevention

19. 5. Standard Precautions: Maintaining clean environment Type of cleaning solution Uses Plain detergent and water To remove dirt & organic material such as grease, oil Disinfectant 0.5 % chlorine solution To clean up spills of blood or other body fluids Disinfectant cleaning solution For cleaning areas – operation theatres, procedure rooms , latrines Infection Prevention

20. 6. Standard Precautions:Biomedical Waste Disposal It is the waste that is generated during diagnosis, treatment or immunization of human beings Purpose of waste disposal • Minimize/Prevent the spread of infection to hospital personnel who handle waste • Prevent the spread of infection to the local community Infection Prevention

21. 6. Standard Precautions:Biomedical Waste Disposal Steps of waste disposal A. Segregation B. Collection and Storage C. Transportation D. Treatment and disposal Infection Prevention

22. Biomedical Waste Disposal: A. Segregation Yellow Bag Colour coded bins Puncture Proof Container Black Bag Red Bag All Needles and Sharps I.V. Cannulas Broken Ampoules All Blades Human tissue Placenta and PoCs Waste swabs / bandage Other items (surgical waste) contaminated with blood Kitchen waste Paper bags Waste paper / thermocol Disposable glasses & plates Left over food Disinfected catheters I.V. bottles and tubes Disinfected plastic gloves Other plastic material Infection Prevention

23. Biomedical Waste Disposal: B. Collection and Storage Wrong Correct Infection Prevention

24. Biomedical Waste Disposal: C. Transportation Wrong Correct Infection Prevention

25. Biomedical Waste Disposal:D. Treatment and Disposal Do’s • Disinfect and destroy the waste before its final disposal. • Remember • Biological waste to be buried deep at the sub- centre • Syringes to be cut with hub cutters and chemically disinfected at source of generation before final disposal into sharps pit located at the PHC Infection Prevention

26. Key Messages • Hand-washingis essential for preventing infections • Always wear gloves especially where there is a risk of touching blood, body fluids, secretions, excretions or contaminated items • Decontamination : 0.5% bleach solution is the least expensive and the most rapid acting and effective agent to use for decontamination • Proper handling of contaminated waste minimizes the spread of infection to healthcare personnel and to the local community Infection Prevention

27. Key Messages Proper handling means: • Wearing utility gloves • Transporting solid contaminated waste to the disposal site in covered containers • Disposing of all sharp items in puncture-resistant containers • Carefully pouring liquid waste down a drain or flushable toilet • Burning or burying contaminated solid waste • Washing containers, gloves and hands after disposal of infectious waste Infection Prevention

28. Thank you Infection Prevention