HOSPITAL INFECTION CONTROL PROGRAMME

INTRODUCTION

Hospital infection control program is dedicated to assisting the Public Health Services, State and Local Health Departments, Hospitals and other professional organizations in the prevention and control of nosocomical infections.

The aim of the Hospital Infection Control Program is dissemination of information, surverllance activities, investigation, prevention and control of nosocomial infections in the hospitals.

Nosocomial infections affects approximately 2 million patients annually in acute care facilities in our country and their annual patient care costs several millions of rupees.

Studies shows that nearly one-third of nosocomial infections can be prevented by a well organised infection control programme. But only less than 10% are actually prevented.

To be effective the infections control programme should include the following.

1. Organised surveillance and control activities
2. One infection control practitioner for every major Health Facility.
3. A Trained Hospital Epidemiologist
4. A system for reporting surgical wound infection rates and other infection back to the practicing surgeons and physicians.

GUIDELINES AND RECOMMENDATIONS

* Handwashing and Hospital Environmental Control

* Immunization

* Infectious Diseases Control

* Intravascular Device-Related Infections and its control

* Isolation Precautions

* Long-Term Care Facilities

* Guidelines for Infection Control in Health Care Personnel

* Surgical Site Infections Control

* Urinary Tract and Respiratory Tract Infections Control

* Ordering and Preparing Guidelines appropriately

* Home care

* Hospital Construction

* Sterilization / Disinfection

1. HANDWASHING

INTRODUCTION

Handwashing is the single most important procedure for preventing nosocomial infections. Handwashing is defined as a vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water. Although various products are available, handwashing can be classified simply by the nature of the products used:

plain soap

detergents

antimicrobialcontaining products

Handwashing with plain soaps or detergents (in bar, granule, leaflet or liquid form) suspends microorganisms and allows them to be rinsed off; this process is often referred to as mechanical removal of microorganisms. In addition, handwashing with antimicrobial containing products kills or inhibits the growth of microorganisms; this process is often referred to as chemical removal of microorganisms.

RECOMMENDATIONS

Handwashing Indications

A). In the absence of a true emergency, personnel should always wash their hands.

* before performing invasive procedures;

* before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns;

* before and after touching wounds, whether surgcal, traumatic or associated with an invasive device;

* after situations during which microbial contamination of hands is likely to occur, especially those involving contact with cucous membranes, blood or body fluids, secretions or excretions;

* after touching inanimate sources that are likely to be contaminated with virulent or epidemiologically important microorganisms; these sources include urine-measuring devices or secretion collection apparatuses;

* after taking care of an inf ected patient or one who is likely to be colonized with microorganisms of special clinical or epidemiologic significance, for example, multiply-resistant bacteria;

* between contacts with different patients in high risk units.

B). Most routine, brief patient-care activities involving direct patient contact other than that discussed above, e.g., taking a blood pressure, do not require handwashing

C). Most routine hospital activities involving indirect patient contact, e.g., handing a patient medicatins, food or other objects, do not require handwashing.

* Handwashing Technique

For routine handwashing, a vigorous rubbing together of all surfaces of lathered hands for at least 10 seconds, followed by thorough rinsing under a stream of water, is recommended.

* Handwashing with Plain Soap

a. Plain soap should be used for handwashing unless otherwise indicated

b. If bar soap is used, it should be kept on racks that allow drainage of water.

c. If liquid soap is used, the dispenser should be replaced or cleaned and filled with fresh product when empty; liquids should not be added to a partially full dispenser.

* Handwashing with Antimicrobial-Containing Products

(Health Care Personnel Handwashes)

Antimicrobial handwashing products should be used for handwashing before personnel care for newborns and when otherwise indicated during their care, between patients in high-risk units and before personnel take care of severely immunocompromised patients.

* Handwashing Facilities

a. Handwashing facilities should be conveniently located throughout the hospital

b. A sink should be located in or just outside every patient room. More than one sink per room may be necessary if a large room is used for several patients.

c. Handwashing facilities should be located in or adjacent to rooms where diagnostic or invasive procedures that require handwashig are performed (e.g., cardiac catheterization, bronchoscopy, sigmoidoscopy, etc.).

Dr. S. Gopalakrishnan M.D., D.P.H.,