10. Definition of Terms
Hand hygiene – A general term that
applies to either handwashing, antiseptic
hand wash, antiseptic hand rub, or
surgical hand antisepsis.
Hand washing – Washing hands with
plain soap and water.
Plain soap – Refers to detergents that
do not contain antimicrobial agents or
contain low concentrations.
Antimicrobial soap – Soap containing an
antiseptic agent.
11. Definition of Terms
Antiseptic agents – Antimicrobial
substances that are applied to the skin to
reduce the number of microbial flora. e.g.
alcohols, chlorhexidine, iodine etc.
Antiseptic hand wash – Washing hands with
water and soap containing an antiseptic
agent.
Alcohol-based hand rub – An alcoholcontaining preparation designed for
application to the hands for reducing the
number of viable micro-organisms on the
hands.
12. Five parts of asepsis
Practices that prevent entry of microbes
into the nursery environment
II. Practices that prevent proliferation of
microbes in nursery.
III. Practices that prevent spread of
microbes between babies.
IV. Practices that protect that newborn
from developing infections.
V. Practices that enable better asepsis &
administration.
I.
15. I- Practices that prevent entry of
microbes into the nursery environment
Maintain a clean environment outside the
nursery.
Entry restrictions
Hand washing
- Single most important intervention
Gowns/masks/slippers
Air changes :
- 12 air changes
- 0.5 µ bacterial filters
- ? Roll of exhaust fans
Contd….
16. I- Practices that prevent entry of
microbes in to the nursery environment
Entry restrictions
- Only Mothers Allowed
- No Entry of infected infants
Regulated entry
- Personnel of nursery
- Personnel of allied services
17. II – Practices that prevent proliferation
of microbes in nursery
Good house – keeping practices
- Floors
- Refrigerators
- Bins
18. II – Practices that prevent
proliferation of microbes in nursery
Decontamination of equipments : Imp
- Incubators & open care systems
- Ventilators (change tubing daily)
- Resuscitation bags & kits
(have sufficient Nos.)
- Laryngoscopes
- Disposable Procedure sets
(LP /Taps/ ExTx)
Develop “ Disposable Culture”
19. III – Practices that prevent spread
of microbes between babies
In addition to Hand washing & “Disposable culture“
Prevention of overcrowding
- At least 4-6 ft. space in between
- Avoid overcrowding
Adequate Staffing :
- Tertiary care, 1:1 ratio
- 1:2 for cohorted babies
- 1:3 for noninfectious, treated babies.
- 1:4 for stable babies
Prohibit stock solutions
Fomites – Files/stethoscope/Exam.tools/pens/cups/
telephone
Laminar flow – for mixing / reconst. Drugs / TPN
20. IV – Practices that protect
newborn from developing infections
Breast milk
Involvement of mother
Early discharge
Eye and cord care
Skin care
( position / probes / emollients )
* Handling IV fluids & drugs
*
*
*
*
*
Contd…
21. IV – Practices that protect
newborn from developing infections
* Handling invasive lines & tubes
- Peripheral IV lines
(Change every 72 hrs.)
- Central lines (surgical scrub must)
* Do not keep, if not necessary
- Peripheral IV lines a minute more
- IV infusion for an hour more
- Central line a day more
22.
23. IV – Practices that protect newborn
from developing infections
Minimize handling & breach of barriers
- Noninvasive monitoring
- Clubbing together rounds
Aseptic precautions during procedures
- Universal precautions
- IV lines ( assess frequently)
- Endotracheal intubation & suctioning
- Chest tube insertion/LP/Ex transfusion.
- Central lines insertions ( maintain sanctity)
25. V – Practices that enable better
asepsis
Environmental surveillance
- At least every month.
Record of positive cultures
- Analyze data regularly
- Develop antibiotic policy
Motivating staff- Most Important
- Sweeper to consultant / In-charge
- Regular meetings
26. Hand Hygiene
Historical perspective :
oUse of antiseptics – 19th century
oLiquid chloride solution, 1825
oIgnaz Semmelweis, 1846
Use of chlorine solution –
Decreased mortality
(First evidence)
In 1961, US Public Health services
recommended hand washing for
health personnel
27. Normal Bacterial Skin Flora
» Normal human skin – colonized with
bacteria.
Total bacterial count – 3.9x104 to 4.6x106
Transient Vs Resident flora’
» Transient flora –
Superficial layers
Easily removed with washing
Usually acquired through patient contact /
infected source
Usual cause of nosocomial infection
» Resident flora :
- More deeper
- Not easily removed
- May be pathogenic
28.
29. Purpose of Handwashing
* Removal all dirt and debris
* Reduce cross contamination from microbes
* Interrupt the fecal – oral route of
infection.
* Reduce risk of hands acting as vectors
* Breaks a link in a chain of infections.
* Increase the image of cleanliness of
Health Care Personnel.
30. Indications for hand washing
Hands are visibly dirty or
contaminated
Before having direct contact with
patients
Before donning sterile gloves
Before doing procedures
After handling contaminated body
fluids
31. Types of hand wash
Routine / social
Procedural (antiseptic)
Surgical hand scrub
„Time‟ method / „stroke
count‟ method
Details must be followed
Recommended time
First - 2 min, then 30 sec.
32. Hand Rub
Selection of hand hygiene agents
Must provide efficacious hand
hygiene with low irritancy potential.
Maximize acceptance by HCWs
Should not be costly.
Must have adequate information from
manufacturers.
Friendly dispenser systems
33. Criteria for selection of disinfectant
Broad spectrum of action
Rapid action
Ability to suppress microbial re-growth
for a prolonged period of time.
Non-irritating to the skin
Non allergenic
Effective after the first use
Visually and aesthetically acceptable
Cost effective
34. Types of chemical disinfectants
* Phenolics (environmental disinfectants)
- Black and white fluids
- Active against a wide range of bacteria
- e.g. Cresol & LYSOL
* Chloroxylenols (non irritant)
- e.g. Dettol, Ibcol
- High concentrations are required (2.5 – 5.0%)
* Chlorine releasing agents (Cheap)
- Effective disinfectants
- Rapidly effective against viruses, fungi, bacteria & spores.
- Should be prepared daily
- e.g. Sterite, Chloros, Presept
Contd….
35. Types of chemical disinfectants
•
•
•
•
•
•
•
Iodine or Idophors
- For hand disinfection or surgical scrub
- e.g. tincture of iodine, povidone iodine (betadine)
Aldehydes
- e.g. Glutaraldehyde (Cidex), Formaldehyde (Formalin)
- Nondamaging to metal, plastics, or rubber
- Useful for heat sensitive items.
Alcohols
- e.g. ethyl alcohol 70% (ethanol), isopropranol
- Rapid disinfection
- Cheap
Chlorhexidine
- Skin antiseptic, used for procedures
- Costlier
Quaternary ammonium compounds
Hydrogen peroxide and related compounds
Ethylene oxide gas
36. Recommended disinfectants
* A chlorine releasing agent
(virus – contaminated material)
* Phenolic disinfectant (for routine use)
* Hypochlorides and other chlorine releasing
agents (baths, toilets, wash basins)
* Glutaraldehyde – immersible metal objects
37.
38. Performance Indicators for
Hand Hygiene
» Periodically monitor and record
adherence
» Provide feed back
» Monitor the volume of antiseptic use
/ soap / towels
» Monitor adherence to policies
» During outbreaks, total assessment.
39. Risk factors for poor hand
hygiene practices
Physician status
Higher work load
Handwashing agents cause irritation and dryness
Sinks are inconveniently located/shortage of sinks
Lack of soap, water and towels
Often too busy/ insufficient time
Overcrowding
Lack of guidelines / protocols
Needs - “ Behavioral Change “
40. Optimal NICU design
Adequate space (80-100
sq. ft. for Level III)
Minimum 6 ft. distance
between incubators /
warmers
Facilities for hand wash
Foot or elbow operated
taps
Air circulation facility
41. Fumigation
No additional benefit, provided
excellent house keeping and asepsis
Mostly done routinely
Periodically / following epidemic
During low occupancy
Spraying may be used
44. Isolation of neonates
* Open wounds or skin lesions
0r acute gastroenteritis
* Strict hand washing
* Use of individual equipment
* Use of disposable
* Maintain optimum distance
45. Nursery Outbreaks
Cluster of infection with
same pathogens
Common source
• Contaminated equipments
(Thermometers,Ventilators,Stetho)
• Environmental reservoirs
• Lapses in hand washing – Most IMP.
“neonatologist‟s nightmare”
46. Nursery Outbreaks Lessons
Be vigilant to detect an increased
incidence of common organisms
Adopt a systematic approach
Be prepared to be surprised
47. Infection control and prevention
“best practices.”
staffing,
spacing,
cohorting,
auditing cleaning effectiveness,
auditing hand hygiene,
frequent microbiologic screening
51. CONCLUSIONS
• Hand washing & common sense
are the best disinfectants.
• Mother is the best nurse of the baby.
• Breast milk is the best antidote.
• “MININMAL HANDLING” is the key.
• Conscious, determined efforts & health
education is our moral responsibility.
