2021 JCIA preparation

training
“ ▪ “Tell me and I
forget, teach me
and I may
remember, involve
me and I learn.”
▪ – Benjamin Franklin
3
Hand Hygiene
5 Moments and 6 Steps
(1. before & 2. after touching the patient)
(3. before & 4. after exposure to blood and
body fluids)
(5. after touching patient environment)
▪ Timings
40-60 seconds or 1 minute (Soap & Water)
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20-30 seconds or ½ minute (Hand Rubs)
Standard Precautions

Patient Placement (Isolation Precautions)

▪ Airborne (Blue)
▪ Contact (Green)
▪ Droplet (Red)
▪ Protective (Yellow)

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Standard Precautions

PPE
Donning (GMGG)
Doffing (GGGM)
Donning COVID (GMGG)
Doffing COVID (GGGM-HH each step)
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Standard Precautions

Sterilization and Disinfection

Only in CSSD except endoscopy

Sterile Items – Time bound and Event

Related
Disinfected items – 3 months validity
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Standard Precautions
Sharp Disposal
▪ Label with date of use
▪ Dispose if ¾ full and/or 3months after first use
▪ Close upper lid (orange coloured cover) if not in
use
▪ Securely cover with TOP lid (yellow coloured
cover) if disposing and ensure to label with date
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and unit location
Standard Precautions

Safe Injection
▪ No recapping of needles
▪ Single use policy shall be applied

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Standard Precautions

Linen Management
▪ Cream – regularly soiled laundry items
▪ Red – Infectiously soiled laundry items (if wet ,
to be kept in yellow plastic bag for an additional
precautions)
▪ Water Soluble Bag – COVID19
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Standard Precautions

Waste management
▪ Black – General rubbish
▪ Yellow – Contaminated rubbish
▪ COVID19 garbage has different collection timings from
municipality
▪ 3rd party contractor is daily collecting CSH waste as per
municipality (Suez company previously Trashco)
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▪ Allow only ¾ full before disposal
Standard Precautions

Staff immunization
▪ Hepatitis B – Healthcare Providers
▪ Hepatitis A – Kitchen Staff
▪ Influenza – All Staff (Recommended)
▪ COVID19 Vaccine – All Staff (Recommended)

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Standard Precautions

Environment Sanitation
▪ Cleaning and Disinfection of surfaces using High
Level Disinfectant with active ingredient of
Hypochlorite Solution
▪ IC inspection control checklist
▪ HK Cleaning checklist for each unit/department
& WC
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Standard Precautions

Cough Etiquette
▪ Mouth Covering (sneezing/coughing)
▪ Wearing Mask at All times

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PPE Sequence

Donning (principle: from Cleanest to Clean): GMGG

▪ Gown
▪ Mask or Respirator (N95)
▪ Goggles/Face Shield
▪ Gloves
Note: Extra PPE of head cap and shoe cover must
done first before GMGG
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Doffing (principle: from Dirtiest to Clean): GGGM
▪ Gloves
▪ Goggles/Face Shield
▪ Gown
▪ Mask or Respirator (N95)
Note: Extra PPE of head cap and shoe cover must
be remove following the principle and with the
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use of gloves
Reporting of Communicable Disease

▪ Fill the disease notification from CSH Portal

under PCI issues and attach copy of emirates Id
then scan and send mail to ICN for follow up
and other logistic notes (see the form for
appropriate timings for each disease category)
▪ Clear copy of Emirates ID or Passport is
mandatory for the notification
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Needle Stick injury

▪ Wash the area affected and ‘ DO NOT BLEED

the area’ , cover with dry dressing /Inform
immediate supervisor/ICP
▪ Immediately visit staff clinic (ER) for assessment
(Policy applied)
▪ Staff shall fill the Incident Form
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Needle Stick injury

▪ Doctor/Nurses to fill the blood and exposure

form
▪ Treatment based on assessment and degree of
incident (per policy)
▪ IR review and action plan shall commence

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Needle Stick injury

▪ Eye splash – wash the affected area with

running water and/or use the portable wall
mounted eye wash then proceed to the nearest
eyewash station

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Risk Assessment

▪ IC Risk assessment is part of PCI program like

surveillance and immunization. TOP priority is
the potential for Exposure to Emerging & re-
emerging global communicable/infectious
diseases
▪ Done annually and/or as necessary
▪ Refer to PCI manual for other categories and
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risk management
Surveillance : HAI Guidelines

▪ An infection is considered an HAI if site-specific

infection criterion were not present during the
POA (Present on Admission) time period but
were all present on or after the 3rd calendar
day of admission to the facility (the day of
hospital admission is calendar day 1)

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Surveillance : HAI Guidelines

▪ If all elements of site-specific infection criterion

are present on the day of transfer or the next
day from one inpatient location to another in
the same facility or a new facility, the infection
is attributed to the transferring location or
facility

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Surveillance : HAI Guidelines

▪ If all elements of site-specific infection criterion

are present on the day of discharge or the next
day, the infection is attributed to the
discharging location

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Surveillance : HAI Guidelines

▪ Following infections are not considered

healthcare associated:
▪ Infections associated with complications or
extensions of infections already present on
admission (see POA definition), unless a change
in pathogen or symptoms strongly suggests the
acquisition of a new infection
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Surveillance : HAI Guidelines

▪ Infections in infants that have been acquired

transplacentally (e.g., herpes simplex,
toxoplasmosis, rubella, cytomegalovirus, or
syphilis) and become evident on the day of
birth or the next day
▪ Reactivation of a latent infection (e.g., herpes
zoster [shingles], herpes simplex, syphilis, or
tuberculosis) 26
Others : Management of nearly expired items

▪ 3months prior to the date of expiry, store and

end-user shall have coordination to replace
and/or keep the item
▪ Shelves/plastic boxes must be labelled
accordingly with expiry dates of all items kept
inside. FIRST IN FIRST OUT policy shall be
implemented
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Others : Management of nearly expired items

▪ Not allowed to use rubber band to keep all

items together
▪ Bar coding on all oncology consumables/item
as per guidelines
▪ Remove/Replace all sterile items if
compromise
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Others : Management of nearly expired items

▪ All Multidose vials and other medications (can

be use in 28 days or as per manufacturer’s
instruction which ever dates comes first) –
please refer to medication manual for further
details as required

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Storage

Open Storage:
▪ 8 inches from the floor
▪ 2 inched from the wall
▪ 18 inches from the ceiling fixtures
(sprinklers)
▪ AIR EXCHANGE of 15-16 per hour is
recommended / 12-15 air exchange is 30

acceptable
Outbreak policy and Influx of infectious
Diseases
▪ Outbreak-developed infection within the hospital
and transmitted to several staff within same
department (Example: Pink Eye, Chicken Pox)
▪ OCT (outbreak control committee will take over to
investigate and manage in accordance to the
degree of outbreak) – Member includes:
CEO/MD/CCO/QI/DON/ICD/ICP/Microbiologist/
Doctors/NS/other personnel 31
Outbreak policy and Influx of infectious
Diseases
▪ Influx- Increase number of cases exceeding the
maximum capacity
****Infectious disease disasters are events that
result in mass casualties, such as an outbreak of an
emerging or re-emerging infectious disease (i.e.,
MERS-CoV or Ebola). Infectious disease disasters
are different from other types of disasters because
they increase the risk of communicable disease
spread during and after the incident 32
Outbreak policy and Influx of infectious Diseases

AIIR (airborne infection isolation room): 15 rooms

▪ 08 rooms in ICU
▪ 01 room in NICU
▪ 01 room in LDR
▪ 02 rooms in 4th floor
▪ 01 room in ER
▪ 01 room in dialysis (exclusive)
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▪ 01 room oncology (exclusive)
Outbreak policy and Influx of infectious Diseases

▪ AIIR normal Range : -5.0 to -2.5 Pascal

▪ DMT (disaster management team) –
responsible for code black management based
on the local guidelines of DHA. Members:
▪ CEO/MD/CCO/QI/DON/FMSS/ICD/ICP/Others

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Emergent and Re-emerging infectious diseases

▪ Emergent Refers to are diseases that have

newly appeared in a population or have
existed but are rapidly increasing in
incidence or geographic range
▪ Re-Emerging Disease – are age-old diseases
that have increased its prevalence again

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Response to global communicable disease

▪ Use of syndromic triage in ER and in OPD

▪ Rapid identification of potential case of
communicable and infectious disease to
facilitate immediate patient
placement/isolation

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Infectious Disease Tag on top of patients files

▪ RED DOT STICKER – confirmed infectious

disease
▪ YELLOW DOT STICKER – confirmed case of
MDRO (multi drug resistant organism)

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Temperature and Humidity

▪ Medication/Treatment/General Room
Temperature: 20°c - 25°c
▪ Medical Refrigerator: 2°c - 8°c
▪ CSSD Sterile Room: 18°c - 22°c
▪ HUMIDITY in CSSD: 35% - 68%
▪ Mortuary Room: 15°c - 20°c
▪ Mortuary Freezer: - 1°c to - 5°c 38
Temperature and Humidity

▪ Pharmaceutical Freezer Temperature: - 20°c to

- 30°c
▪ HUMIDITY Range (general): 35% - 68%
▪ HUMIDITY Range for OT: 45% - 60%
▪ Room Temperature for OT: 18°c - 22°c

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Temperature and Humidity

▪ HUMIDITY Range for NICU/NURSERY: 30%-60%

▪ Room Temperature for NICU/NURSERY: 22°c -
26°c
▪ Medical Freezer for NICU: - 10°c to -35°c

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Water Recommended for Oxygen humidifiers

▪ Distilled Water (must be change each and every

patient use)

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Suction filter (wall/suction attached)

▪ Replace if coloured is change and if wet

▪ Changing date must be written

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Blood Culture collection

Follow the following sequence:

▪ Blood Culture (orange & green for adult /
yellow for pediatric)
▪ BLUE – coagulation Profile Pt, PTT / D-dimer /
Fibrinogen

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Blood Culture collection

▪ Yellow/Red – Biochemistry/immunology/Blood
Bank (cross matching,ICT) / Cardiac Enzymes
▪ Lavander - Hematology
(CBC,G6PD,Malaria,Sickle Cell, peripheral
Smear) / blood bank (BG & RH, Cross matching,
Antibody Screen, DCT) / Biochemistry
(HbA1C,BNP)
▪ Black - ESR 44
Blood Culture collection

▪ Disinfect the bottle tops with 70% alcohol (let it

dry) then followed by chlorhexidine (GCH) and
allow to dry

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Blood Culture collection

▪ FOR ADULT : 2 Veni puncture areas are required:

(5-10 ml per bottle)
▪ 1st site – aerobic & anaerobic
▪ 2nd site - aerobic & anaerobic
▪ FOR ADULT : Patient with Central Lines: (5-10 ml
per bottle)
▪ 1st site – aerobic & anaerobic (CENTRAL LINE)
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▪ 2nd site - aerobic & anaerobic (PERIPHERAL HAND)
Blood Culture collection

▪ FOR PEDIATRIC & NEONATES: collect 1-3 of

blood ONLY
▪ Bottles shall be labelled according to the site of
collection

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Blood and Body Fluids Spillage

▪ Caution Board /Open the window and doors for

extra ventilation
▪ Hand hygiene
▪ PPE (Gown, Mask, Goggles/Face Shield, Gloves,
Extra PPE –Head cap/shoe covering)

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Blood and Body Fluids Spillage

▪ Open the Spill Wipes (1 big wipe inside & 2

extra wipes for cleaning)
▪ Big wipe has side A & B – Side A contacting the
spill(blood /body fluids) for seconds then
remove and properly dispose

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Blood and Body Fluids Spillage

▪ Take the 2 extra wipe and in as spiral motion (S-

motion) wipe the area and then dispose
accordingly
▪ Remove the PPE accordingly and Hand hygiene

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COVID 19 Guidelines

▪ Based on updated DHA guidelines and

mandates
▪ Rapid identification and ISOLATION of the
patient in AIIR and/or equipped with portable
Hepa Filters

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COVID 19 Guidelines

▪ Hand hygiene and standard precaution shall be

applied at all times
▪ COVID19 sample storage and transport to
laboratory
▪ COVID19 sample must be kept in biohazard
bag, properly labelled as per policy
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COVID 19 Guidelines

▪ Place the sample in an ice box monitored by

digital thermometer of temperature 2-8°c
and keep the box on the second bag
(DOUBLE PACKING SYSTEM)
▪ Sample should be dispatch immediately to
the laboratory

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COVID 19 Guidelines

▪ The specimen should be stored in a -20°c

freezer where there is a delay of over 12 hours
for specimen transport
▪ Collected Samples shall be transported to the
authorized laboratory testing for COVID19 in
TRIPLE PACKING SYSTEM

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COVID 19 Guidelines

▪ Posters of immediate notification are advice

▪ Social distancing (Reminders and Floor Stickers)
▪ Wearing of Mask at all times
▪ Vaccination Recommendations

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Protocol of Common tubes, Catheter & connection

Item Duration Change By: Remarks

1. Peripheral IV 72 hrs RN Date on dressing &
Cannula on the set/sign-initial
2. Plain IV 48 hrs RN Label with date
Administration set /sign-initial
3. 3 way stop cock 24 hours RN -

3. 3 way stop cock - 48 hours RN Label with date

Vygon /sign-initial
4. Combi Stopper Single use only RN -

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Other related IC concerns

▪ See departmental related policy and guidelines

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THANKS!
Any questions?
You can find me at:
icn@csh.ae
04-707-2374
055-569-6148
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