infection control program at elmch

1. INFECTION CONTOL PROGRAM
AT ELMCH
DR.ANJALATCHI
M.SC(N)MD(AM)MBA(HA)

2. OVERVIEW ABOUT ICP
This program is directed at infection prevention
and control professionals and other health
care professionals who require training in
infection prevention and control (IP&C).

3. ICP &M
• Infection prevention and control (IPC) is a practical,
evidence-based approach preventing patients and health
workers from being harmed by avoidable infections.
• Effective IPC requires constant action at all levels of the
health system, including policymakers, facility managers,
health workers and those who access health services.
• IPC is unique in the field of patient safety and quality of
care, as it is universally relevant to every health worker and
patient, at every health care interaction.
• Defective IPC causes harm and can kill. Without effective
IPC it is impossible to achieve quality health care delivery.

4. AIM OF ICP
• The primary Aim of an IPC
programme are:
• To prevent susceptible patients
acquiring pathogenic (disease-
causing) micro-organisms.
• To limit the spread of antimicrobial
resistant infections.

5. GOAL OF ICP
• To provide knowledge with basic principles
and practices of infection prevention and
control guidelines

6. Objectives:
• At the completion of this course the learner will be able to:
• Define how pathogenic organisms may be spread in healthcare setting
and factors that influence the outcome of an exposure.
• Implement strategies for Standard and Transmission-Based Precautions in
healthcare settings.
• Recognize the role of Antimicrobial Stewardship in reducing the
emergence of antimicrobial resistance.
• Describe applied practices for prevention of procedure/device related
infections.
• Explain Infection Control policy for the control of multi-drug resistant
organisms.
• Describe measures to prevent transmission of Occupational Blood borne
pathogens.

7. Continued
 To identify microorganisms and communicable disease in a timely fashion in
environment .
 To reduce the risks for transmission of infectious agents among and between
patients and health care personnel,
 To reduce the risk of infections developing in patients related to the use of devices
and procedures required in their care,
 To provide the standards and enforcement required to maintain a sanitary
environment,
 To ensure the reporting of results to the appropriate authorities.

8. Important ICP
Strategies to prevent and control infections are important to reduce the
spread of infection. They:
 Stop the chain of infection
 Reduce the need for antimicrobials, such as antibiotics
 Reduce resistance developing.
Standard ways to prevent and control infection include:
 Hand hygiene
 Using personal protective equipment
 Handling and disposing of sharps appropriately
 Cleaning and disinfecting equipment
 Environmental cleaning
 Vaccination.

9. The purpose of the Infection Control
Policy and Procedure Manual
• The purpose of the Infection Control Policy and Procedure Manual is three-fold as
follows:
• 1. To provide a standard of ‘best practice’ as it pertains to the prevention and
control of communicable disease and to serve as a reference source for health
care personnel.
• 2. To abide by the mandatory standards set forth by government regulatory
agencies (i.e. OSHA, CDC, etc.) and to meet the guidelines and expectations of
accrediting/certifying agencies within the industry.
• 3. To serve as a preparedness guideline for responsive action to a communicable
disease outbreak on campus or in the hospital, society and community etc.

10. Learning Methods
• Academic activities: Lectures and Discussion
for two days in Infection Control Directorate.
• Field activities :Practical Round in one of
Generalٍ /Specialized hospital for three days .

11. Method of assessment
1- Attendance of the academic and field
activities.
2-Multiple choice questions(Pre /Post-test) with
a single best answer format, the duration is 20
minutes.In this exam Infection control
objectives will be covered.
3.Practical Aspect In Clinical Area And Hospital

12. Certificate
• At the end of the course the trainee will be
given an attendance Cum completion of
infection control and prevention certificate

13. Course outline :
• Its is an offline course, with duration of
130hrs(approx.22weeks/5.5 months).
• 3 days a week and 2 hrs day has been dedicated for this
course.(1 hr for theory and 1 hrs clinical posting
accordingly )
• At the end of every month the clinical training given to
the participants assessed by
OSCE/checklist/demonstration of indicators etc
• providing certificate on completion of course a final
written exam will be conducted followed by practical
exam and area allotted for auditing process.

14. Training packages
• This includes printed course materials (lecture
hand out) PPT/log book /manual by
experienced resources person.
• Field visit will be conducted by the resources
person as well to provide practical overview.

15. Eligibility for admission
• Diploma in GNM/P.B.SC/B.sc/M.sc nursing degree.
• Has an active license from any recognized state nursing
council of India.
• Nursing staff currently working in a hospital where
training related activities can enroll this
course.(infection control audits/surveillance etc)

16. List of basic program for ICP
 Hand Washing Technique
 Standard Precautions And Its Significance In Health Care Services
 Personnal Protective Equipments (PPE)
 Cleaning And Disinfection Of Environmental Surfaces
 Cleaning And Disinfection Of Equipments Used In Hospital Services
 Housekeeping Services
 Linen Management And Its Significance In Hospital Services
 BMW Managements Guidelines
 General Waste Management
 Spillage Management Guidelines
 Post Prophylaxis Guidelines (NSI)
 Occupational Health Safety And Practice In Health Care Services

17. List of advance practice of ICP:
Health Care Associated Infections
 Epidemiology In HAIS
Blood Stream Infections(CLBSI)
Ventilator Associated Pneumonia(VAP)
Catheter Associated Urinary Tract Infection (CAUTI)
 Surgical Site Infections(SSI)
Multi Drug Resistance Organism(MRSA)
Guidelines Of Single Used Instruments And Devices
Audit In Infection Control
Notifiable Diseases In India With Precautions

18. Infection Control Committee (ICC)
• 1. At least one member of the Infection Control Committee is a member of
the Quality Management Committee and is responsible for reporting the ICC
concerns, recommendations, actions, statistics, etc. to the Quality
Management Committee.
• 2. The Infection Control Committee will report directly to the Governing
Body of the head of the Hospital Services via the Medical Director and/or the
Committee Chairperson.
• 3. The infection control department is responsible for reporting Infection
Control activities, concerns, and recommendations to the ICO of patient
services and Success for reduce the rate of infection control .

19. ICP Structure and Meetings
1. An Infection Control Committee meeting is convened at the direction of the chairperson at
intervals as deemed necessary to conduct the business of the Committee. There are no less than
two (2) meetings per year.
2. The Committee consists of staff members who agree to an appointment by the AVC to serve for a
minimum of a one year term. There is no limitation to the number of terms a member may serve.
3. The Committee consists of staff representing laboratory, nursing, medicine, facilties, and
administration.
4. The Committee reviews and/or updates the Infection Control manual regularly and makes
recommendations for programmatic changes to the Governing Body based on new findings or
concerns.
5. The Committee minutes of these meeting are kept by the committee chairperson or designee and
are forwarded to the Health Center’s Administration for review and approval as well as to the
Quality Management Committee.

20. Infection Control Committee (ICC):
As a regulatory committee with the primary responsibility of Infection Control within the
ambulatory care clinic, the Committee:
a. Identifies possible risk of staff and/or patient exposure to biohazardous materials
(i.e. blood, vaginal secretions, urine, etc.).
b. Determines the types and methods of infection surveillance including signage,
labels, storage areas, containers, etc.
c. Determines the Infection Control standards for employee.
d. Has final authority in matters of isolation or infection prevention or control
measures where there is felt to be danger to patients, visitors, or personnel. In
situations of extreme urgency, the Medical Director may initiate action after
consultation with the AVC as appropriate or available (without a meeting or
consultation with members of the Committee).
e. Provides the standards, policies, and enforcement to ensure the consistency of safe
practice among SHC staff in regards to Infection Control.
f. Reviews and makes recommendations on any matter related to Infection Control,
such as procedures, products, equipment, construction, and related matters.

21. Introduction about ICC
Infection Control Committee:
This committee bears the responsibility
of infection control measures with
an objective of reducing the risk of
HAI in the hospital. The committee
discuss and decides on each matter
that can have an effect on infection
control.

22. Roles and responsibilities
 Develop and approve organization wide infection control programme,
policies, activities and manual
 Establish standard precaution practices to be followed across the hospital
 Establish definitions and criteria for identifying and reporting of all
infections among patients and personnel
 Guide departments on evidence based infection control practices
 Set benchmark HAI rates for monitoring the effectiveness of infection
control measures
 Validate methods for calculating HAI rates
 Review HAI rates periodically and recommend actions accordingly
 Develop antibiotic policy in conjunction with pharmaco-therapeutics
committee
 Develop protocol for handling of infection outbreak and manage such
situations
 Other similar matters related to infection control

23. ICC members
Chairperson – Someone from top management such as CEO, Vice president or director
Convenor/Co-ordinator – Infection Control Officer / Medical Microbiologist /
Infectious diseases specialist
Clinical members – One representative each from all clinical specialities and super-
specialities, including Anaesthesiology, Critical Care, Emergency Medicine,
Laboratory services, Blood Bank, Nursing Services and Allied health specialities
Non-clinical members – Person in-charge for administration of Operation theatre,
ICU, IPD, OPD, Emergency department, CSSD, Laundry, Bio-medical waste,
Maintenance, Medical Equipment and General Management,housekeeping
department, diet department etc

24. Surveillance, monitoring and
indicators
 Surveillance for infection control should be regularly carried out. The frequency of
surveillance in high risk areas should be higher
 Surveillance must include both, patient surveillance and environmental
surveillance
 The data of HAI should be collected through surveillance
 The data collected through surveillance must be verified
 During surveillance, monitoring of certain significant type of infections should be
done, such as occurrence of multi-drug resistant organisms
 Compliance of hand-hygiene guidelines by healthcare staff must be monitored
 Effectiveness of housekeeping services must be monitored
Following indicators must be used to determine effectiveness of infection control
measure
i. Catheter-associated urinary tract infection rates
ii. Ventilator associated pneumonia
iii. Catheter linked blood stream infections
iv. Surgical site infections

25. Summary
Still now we have discussed about the description about ICP , meaning,
aim, goal, purpose, objectives, importance , learning methods,
method of assessment, certificate , course outlines, training,
eligibility criteria, etc
List of basic subject related to ICP
List of advance subject related to ICP, infection control committee and
its role in health care services

26. Conclusion
• Healthcare Associated Infections (HAI) can easily qualify as the most important
patient safety concerns in hospitals. To address the menace of HAI, infection
control is kept as one of the main objectives, while designing any healthcare
delivery structure, policies and processes. Almost all activities that are done within
hospital has a bearing on infection control and there are a large number of studies
that has resulted in various good practices for controlling infections. NABH has also
dedicated a full chapter on Infection Control, while standards and objective
elements under various other chapters also incorporates infection control aspects
in it. A list of all infection control measures, grouped under appropriate heading is
given below for hospitals to keep a check on.

27. Thank you for listening