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INFECTION CONTROL PROTOCOL IN ICU
Presenter
Anjani Walia
MSc Nursing 1st year
Objectives
INTRODUCTION
• “The very first requirement in a hospital that it
should do the sick no harm" - Florence Nightingale
• Health care associated infections(HCAI)- economic
loss, prolonged hospital stay & adverse patient
outcomes.
• In most health care facilities the average
incidence of HCAI is around 5-10 %
Measures practiced by health care personnel to
prevent spread, transmission & acquisition of
infection between clients, from health care
providers to clients & from clients to HCP.
Based on
INFECTION CONTROL - DEFINITION
Standard precaution
Additional
precaution
COMMON ORGANISMS
BACTERIA
 Staphylococcus aureus
 Enterococcus
 Pseudomonas aeruginosa
 Klebsiella
 E- coli
VIRUS
 HIV
 HBV
 HCV
 CMV
FUNGAL
 Candida albicans
 Aspergillus
PARASITES
 Giardia lambia
• Low resistance of patient to infections.
• Invasive procedures/interventions.
• Inappropriate anti-microbial usage.
• Drug resistance of endemic microbes.
• Contaminated environment.
RISK DUE TO
STANDARD SAFETY
MEASURES
STANDARD PRECAUTION
• Set of infection control practices used to prevent
transmission of diseases that can be acquired by
contact with blood, body fluids, non- intact skin &
mucus membrane
• STANDARD PRECAUTION STEPS
– Hand washing
– PPE
– Decontamination
– Waste disposal
HAND HYGIENE
Hand washing is the single most effective measure
in infection control.
80% of the diseases are spread through hands.
How to Handwash?
HOW TO HAND RUB?
POINTS TO BE REMEMBERED
• Covering cuts & wounds
• Gloves is not a substitute for hand washing
• When a bar soap is used, it should be kept dry
in soap case
• When liquid soaps are used, avoid topping off
of the solution , dispenser should be kept clean
PERSONAL PROTECTIVE EQUIPMENT
• Gloves
• Gown
• Mask
• Protective eye wear
• Face shield
• Apron
SEQUENCE FOR DONNING PPE
GOGGLES OR
FACE SHIELD
GLOVES
GOWN
MASK
SEQUENCE FOR REMOVING
PPE
SAFE HANDLING OF SHARPS
 Never pass sharps from one person to
another.
 Always dispose your own sharps.
 DO NOT RECAP needles.
 Dispose sharps in puncture proof container.
DISINFECTION
Reduce the number of microorganisms on
an object or surface but not the complete
destruction of all microorganisms or spores.
TYPE OF DISINFECTANTS
• High level disinfectants
2% glutaraldehyde (cidex)
stabilised hydrogen peroxide
1% sodium hypochlorite
• Intermediate level disinfectants
0.1% sodium hypochlorite
Iodophores & phenolic solutions
• Low level disinfectants
Quateranary ammonium compounds
STERILIZATION
 Procedures, which would remove all
microorganisms, including spores, from an object.
Sterilization Methods
• Dry heat sterilization
• Moist heat sterilization
• Chemical sterilization
• Radiation sterilization
Safety bundles
• A “bundle” is a group of evidence based care
components for a given disease that, when
executed together, may result in better
outcomes than if implemented individually.
CAUTIs Bundle
• Avoid unnecessay urinary catheters
• Insert using aseptic technique
• Maintain catheter using recommended
guidelines (daily care)
• Review catheter necessity daily & remove
promptly.
CLABSIs
• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Optimal catheter site selection
• Daily review of line necessity with prompt removal
of unnecessary lines
• Line secure with clean & intact dressing
SSI Bundle
• Appropriate use of antibiotics
• Appropriate hair removal
• Post operative glucose control
• Peri & postoperative normothermia
VAP Bundle
• DVT prophylaxis
• GI prophylaxis
• Head of bed elevated to 30-45º
• Daily sedation vacation
• Daily spontaneous breathing trail
BIO MEDICAL WASTE
MANAGEMENT
DEFINITION
Waste generated during the diagnosis, testing,
treatment, research or production of biological
products for humans or animals (WHO)
Waste management is the collection, transport,
processing or disposal, managing & monitoring of
waste material.
PURPOSES OF WASTE DISPOSAL
To reduce hazardous nature of waste.
 To reduce volume of waste.
 To prevent misuse or abuse of waste.
 To ensure occupational safety & health.
 To consider aesthetics.
LEGISLATION
• Ministry of environment & forests (MOEF) issued
guidelines to the hospitals to ensure proper &
safe disposal of bio medical waste.
– Bio medical waste management & handling
rule came in to effect in 1998
Human
anatomical waste
Chemo drugs
Soiled waste
Expired or
Discarded
Medicines,
soiled linen
Contaminated
Plastic Waste
(Recyclable
) Waste
sharps
including
Metals
Glassware:
Broken or
discarded
&
contaminated
glass including
medicine vials
& ampoules
37
General
waste
3 BINS, 01 CONTAINER, O1 BOX
CATEGORY TYPE OF
WASTE
TREATMENT & DISPOSAL
YELLOW
(a)Human
anatomical
waste
(b)Animal
anatomical
waste
(c) Solied waste
Incineration or plasma pyrolysis or
deep burial
(d) Expired or
discarded
medicine
Incineration at tem. >12000C Or
Encapsulation or Plasma Pyrolysis
(e) Chemical liquid
waste
(f) Linen
Pre treatment before mixing with
waste water.
Non- chlorinated chemical
disinfection
BMW RULE 2016
CATEGORY TYPE OF
WASTE
TREATMENT &
DISPOSAL
RED
Contaminated
plastic waste
(Recyclable)
Autoclaving or micro-
waving followed by
shredding, sterilization &
then sent to registered
recyclers for energy
recovery or for road
making
BMW RULE 2016
CATEGORY TYPE OF
WASTE
TREATMENT & DISPOSAL
White
(Translucent
Puncture proof,
containers)
Waste sharps
including
Metals
Autoclaving & shredding &
sent for final disposal to iron
foundries.
consent to operate from the
State Pollution Control Boards
or concrete waste sharp pit.
BMW RULE 2016
CATEGORY TYPE OF WASTE TREATMENT &
DISPOSAL
Cardboard boxes
with blue
coloured marking
Glassware:Broken
or discarded &
contaminated glass
Metallic Body
Implants
Disinfection then
Sent for
recycling.
BMW RULE 2016
WASTE MANAGEMENT
3R’s
WASTE SEGREGATION
Done at the source of waste generation
Responsibility of generator of waste.
segregation as per categories applicable.
WASTE STORAGE
Storage facility should have sufficient
capacity.
 Location - within hospital premises.
Untreated biomedical waste not to be kept
beyond 48 hrs (Permission required for
>48 hrs).
WASTE TRANSPORTATION
Points to be remembered:
Before taking the bags it should be tied &
labeled.
 Waste handlers should not touch any other
articles.
 A covered cart with biohazard symbol to
carry the waste to the central area of
collection.
AIIMS-OUT SOURCING BY BIOTIC
TRAINING ON BIOMEDICAL WASTE
MANAGEMENT
Overall aim of training:
• To develop awareness of health, safety
& environmental issues relating to
health care waste.
• Roles & responsibilities of health care
personnel in overall management
program should be highlighted.
STAFF SAFETY CONSIDERATIONS
• Separate trolleys for transporting waste within
the hospital.
• All workers involved in the work are aware of
the hazardous nature of the work.
• Provided with all protective equipment.
• Immunized against tetanus & hepatitis B.
ROLE OF INFECTION CONTROL
NURSES
• Visits all wards & high risk units.
• Checking nursing supervisor’s register &
records for cases suggestive of infection.
• Collection of sample from different areas of
the hospitals & sending them to the lab.
ROLE OF INFECTION CONTROL
NURSES(CONTD..)
• Daily visit to microbiology lab to ascertain
results of sample collected.
• Monitoring & supervision of infection among
hospital staffs.
• Training of nursing & paramedical personnel
on correct hygiene practices & aseptic
technique.
SUMMARY
• Infection control
• Chain of infection
• Standard safety measures
• Safety bundles
• Staff safety
• Role of infection control nurses
CONCLUSION
•This is the time to understand that infection
control, standard precaution, hospital waste
management are of great concern.
•The human element is more important than
technology.
•Well trained, motivated staff can really work
wonders.
•Strict adherence to simple infection control
procedures go long way in controlling infection.
REFERENCES
• Potter AP, Perry AG, Fundamentals of
nursing.6th ed .Mosby.St Louis.773-819
• Seema Sood.Microbiology for nurses.2nd ed.46-
70
• AIIMS infection control manual
• SOPP trauma centre, AIIMS
• http://www.wikipedia.org
• http:// www.cdc.gov
• www.who.int
• N95 mask required in
a) Airborne precautions
b) Droplet precautions
c) Contact precautions
Ans – a)
• Hands that are visibly dirty should be washed
with
a) Alcohol based hand product
b) Warm water
c) Soap & water
d) All of the above
Ans- c)
BIO HAZARD
RADIOACTIVE WASTE
CYTOTOXIC WASTE
Infection control protocol in icu
Infection control protocol in icu
Infection control protocol in icu
Infection control protocol in icu
Infection control protocol in icu
Infection control protocol in icu

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Infection control protocol in icu

  • 1. INFECTION CONTROL PROTOCOL IN ICU Presenter Anjani Walia MSc Nursing 1st year
  • 3. INTRODUCTION • “The very first requirement in a hospital that it should do the sick no harm" - Florence Nightingale • Health care associated infections(HCAI)- economic loss, prolonged hospital stay & adverse patient outcomes. • In most health care facilities the average incidence of HCAI is around 5-10 %
  • 4. Measures practiced by health care personnel to prevent spread, transmission & acquisition of infection between clients, from health care providers to clients & from clients to HCP. Based on INFECTION CONTROL - DEFINITION Standard precaution Additional precaution
  • 5.
  • 6. COMMON ORGANISMS BACTERIA  Staphylococcus aureus  Enterococcus  Pseudomonas aeruginosa  Klebsiella  E- coli VIRUS  HIV  HBV  HCV  CMV
  • 7. FUNGAL  Candida albicans  Aspergillus PARASITES  Giardia lambia
  • 8. • Low resistance of patient to infections. • Invasive procedures/interventions. • Inappropriate anti-microbial usage. • Drug resistance of endemic microbes. • Contaminated environment. RISK DUE TO
  • 9.
  • 11. STANDARD PRECAUTION • Set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non- intact skin & mucus membrane • STANDARD PRECAUTION STEPS – Hand washing – PPE – Decontamination – Waste disposal
  • 12. HAND HYGIENE Hand washing is the single most effective measure in infection control. 80% of the diseases are spread through hands.
  • 13.
  • 15. HOW TO HAND RUB?
  • 16. POINTS TO BE REMEMBERED • Covering cuts & wounds • Gloves is not a substitute for hand washing • When a bar soap is used, it should be kept dry in soap case • When liquid soaps are used, avoid topping off of the solution , dispenser should be kept clean
  • 17.
  • 18.
  • 19. PERSONAL PROTECTIVE EQUIPMENT • Gloves • Gown • Mask • Protective eye wear • Face shield • Apron
  • 20. SEQUENCE FOR DONNING PPE GOGGLES OR FACE SHIELD GLOVES GOWN MASK
  • 22. SAFE HANDLING OF SHARPS  Never pass sharps from one person to another.  Always dispose your own sharps.  DO NOT RECAP needles.  Dispose sharps in puncture proof container.
  • 23. DISINFECTION Reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms or spores.
  • 24. TYPE OF DISINFECTANTS • High level disinfectants 2% glutaraldehyde (cidex) stabilised hydrogen peroxide 1% sodium hypochlorite • Intermediate level disinfectants 0.1% sodium hypochlorite Iodophores & phenolic solutions • Low level disinfectants Quateranary ammonium compounds
  • 25. STERILIZATION  Procedures, which would remove all microorganisms, including spores, from an object. Sterilization Methods • Dry heat sterilization • Moist heat sterilization • Chemical sterilization • Radiation sterilization
  • 26.
  • 27.
  • 28. Safety bundles • A “bundle” is a group of evidence based care components for a given disease that, when executed together, may result in better outcomes than if implemented individually.
  • 29. CAUTIs Bundle • Avoid unnecessay urinary catheters • Insert using aseptic technique • Maintain catheter using recommended guidelines (daily care) • Review catheter necessity daily & remove promptly.
  • 30. CLABSIs • Hand hygiene • Maximal barrier precautions • Chlorhexidine skin antisepsis • Optimal catheter site selection • Daily review of line necessity with prompt removal of unnecessary lines • Line secure with clean & intact dressing
  • 31. SSI Bundle • Appropriate use of antibiotics • Appropriate hair removal • Post operative glucose control • Peri & postoperative normothermia
  • 32. VAP Bundle • DVT prophylaxis • GI prophylaxis • Head of bed elevated to 30-45º • Daily sedation vacation • Daily spontaneous breathing trail
  • 34. DEFINITION Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO) Waste management is the collection, transport, processing or disposal, managing & monitoring of waste material.
  • 35. PURPOSES OF WASTE DISPOSAL To reduce hazardous nature of waste.  To reduce volume of waste.  To prevent misuse or abuse of waste.  To ensure occupational safety & health.  To consider aesthetics.
  • 36. LEGISLATION • Ministry of environment & forests (MOEF) issued guidelines to the hospitals to ensure proper & safe disposal of bio medical waste. – Bio medical waste management & handling rule came in to effect in 1998
  • 37. Human anatomical waste Chemo drugs Soiled waste Expired or Discarded Medicines, soiled linen Contaminated Plastic Waste (Recyclable ) Waste sharps including Metals Glassware: Broken or discarded & contaminated glass including medicine vials & ampoules 37 General waste 3 BINS, 01 CONTAINER, O1 BOX
  • 38. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL YELLOW (a)Human anatomical waste (b)Animal anatomical waste (c) Solied waste Incineration or plasma pyrolysis or deep burial (d) Expired or discarded medicine Incineration at tem. >12000C Or Encapsulation or Plasma Pyrolysis (e) Chemical liquid waste (f) Linen Pre treatment before mixing with waste water. Non- chlorinated chemical disinfection BMW RULE 2016
  • 39. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL RED Contaminated plastic waste (Recyclable) Autoclaving or micro- waving followed by shredding, sterilization & then sent to registered recyclers for energy recovery or for road making BMW RULE 2016
  • 40. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL White (Translucent Puncture proof, containers) Waste sharps including Metals Autoclaving & shredding & sent for final disposal to iron foundries. consent to operate from the State Pollution Control Boards or concrete waste sharp pit. BMW RULE 2016
  • 41. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL Cardboard boxes with blue coloured marking Glassware:Broken or discarded & contaminated glass Metallic Body Implants Disinfection then Sent for recycling. BMW RULE 2016
  • 43. WASTE SEGREGATION Done at the source of waste generation Responsibility of generator of waste. segregation as per categories applicable.
  • 44. WASTE STORAGE Storage facility should have sufficient capacity.  Location - within hospital premises. Untreated biomedical waste not to be kept beyond 48 hrs (Permission required for >48 hrs).
  • 45. WASTE TRANSPORTATION Points to be remembered: Before taking the bags it should be tied & labeled.  Waste handlers should not touch any other articles.  A covered cart with biohazard symbol to carry the waste to the central area of collection.
  • 47. TRAINING ON BIOMEDICAL WASTE MANAGEMENT Overall aim of training: • To develop awareness of health, safety & environmental issues relating to health care waste. • Roles & responsibilities of health care personnel in overall management program should be highlighted.
  • 48. STAFF SAFETY CONSIDERATIONS • Separate trolleys for transporting waste within the hospital. • All workers involved in the work are aware of the hazardous nature of the work. • Provided with all protective equipment. • Immunized against tetanus & hepatitis B.
  • 49. ROLE OF INFECTION CONTROL NURSES • Visits all wards & high risk units. • Checking nursing supervisor’s register & records for cases suggestive of infection. • Collection of sample from different areas of the hospitals & sending them to the lab.
  • 50. ROLE OF INFECTION CONTROL NURSES(CONTD..) • Daily visit to microbiology lab to ascertain results of sample collected. • Monitoring & supervision of infection among hospital staffs. • Training of nursing & paramedical personnel on correct hygiene practices & aseptic technique.
  • 51. SUMMARY • Infection control • Chain of infection • Standard safety measures • Safety bundles • Staff safety • Role of infection control nurses
  • 52. CONCLUSION •This is the time to understand that infection control, standard precaution, hospital waste management are of great concern. •The human element is more important than technology. •Well trained, motivated staff can really work wonders. •Strict adherence to simple infection control procedures go long way in controlling infection.
  • 53. REFERENCES • Potter AP, Perry AG, Fundamentals of nursing.6th ed .Mosby.St Louis.773-819 • Seema Sood.Microbiology for nurses.2nd ed.46- 70 • AIIMS infection control manual • SOPP trauma centre, AIIMS • http://www.wikipedia.org • http:// www.cdc.gov • www.who.int
  • 54.
  • 55. • N95 mask required in a) Airborne precautions b) Droplet precautions c) Contact precautions Ans – a)
  • 56. • Hands that are visibly dirty should be washed with a) Alcohol based hand product b) Warm water c) Soap & water d) All of the above Ans- c)

Hinweis der Redaktion

  1. Ethlene oxide, nitrogen dioxide, formaldehyde, hydrogenperoxide Xray, gamma ray
  2. To ensure the safety of personnel involved in bio medical waste treatment & disposal AIIMS follows certain policies & guidelines
  3. pause & ponder over the matter because evidence is there for us to