INFECTION PREVENTION

AND CONTROL
DR RAHUL KAMBLE 
MBBS, MD Microbiology
Diploma Infectious Diseases(UNSW, Australia)
 Six Sigma Black Belt(GOI Certified)
 CC infection Control (Harvard Medical School)
 CIA-JCI,NABH,NABL,RBNQA
  PGDBA,PGDHA,PGDSR,PGDCR,PGDOM,PGDMLS
 Consultant Microbiologist & Infection control
  Lilavati hospital & Research centre, Mumbai
 Objectives

❖ Understanding of healthcare associated infections

❖ Infection prevention and control measures

❖ Implementation of Infection control in organization

❖ Management of Occupational exposure to blood and body fluids

❖ Antimicrobial stewardship

❖ Biomedical waste management

2
 Health care-associated infection (HCAI)

“An infection occurring in a patient during the process of care in a hospital or other
health-care facility which was not present or incubating at the time of admission.

This includes infections acquired in the health-care facility but appearing after
discharge, and also occupational infections among health-care workers of the facility”

https://www.cdc.gov/hai

3
 Estimated rates of HCAI worldwide

❖ HCAI affects hundreds of millions of people worldwide and is a major global issue for
patient safety

❖ In modern health-care facilities in the developed world:

5–10% of patients acquire one or more infections

❖ In developing countries the risk of HCAI is 2–20 times higher than in developed
countries and the proportion of patients affected by HCAI can exceed 25%

❖ In intensive care units, HCAI affects about 30% of patients and the attributable mortality
may reach 44%

https://www.who.int/gpsc/country_work/burden_hcai

4
 Impact of HCAI

HCAI can cause:

❖ Impact on patient
Mortality, Morbidity, hospital stay, stress, cost ,etc

❖ Impact on community
Increasing antimicrobial resistance, community spread, etc

❖ Impact on hospital
Reputation, litigation, Accreditation, etc

https://www.who.int/gpsc/country_work/burden_hcai

5
 Efficacy of Infection Control
>30% of HCAI are preventable

Relative change in HCAI in a 5 year period (1970–1975)

30 26%
20 19% 18%
14%
9% Without
10
infection
% 0 LRTI SSI UTI BSI Total control

-10 With infection

control
-20

-30
-27%
-40 -31% -32%
-35% -35%

Haley RW et al. Am J Epidemiol 1985

 What is Infection control?

Infection control is

❖ A scientific approach with

❖ practical solutions designed to prevent harm, caused by infections, to patients, health

care workers, visitors and families

❖ grounded in principles of infectious disease, epidemiology, social science and health

system strengthening, and

❖ rooted in patient safety and health service quality

https://www.who.int/infection-prevention

7
 Who is at risk of infection?

Everyone

https://www.who.int/infection-prevention

8
 Infection control plan

SMART plan

❖ Surveillance

❖ Monitoring and auditing

❖ Antimicrobial stewardship

❖ Reporting & Isolation diseases

❖ Training and staff health

WHO2015 Safe & Quality Health Services Package

9
 Infection Control Committee
Representatives

❖ Infection Control Practitioners

❖ Microbiologist

❖ Pharmacist

❖ Administrator

❖ Ward, ICU and Operating room Nurses

❖ Medicine/Surgery/Obstetrics/Pediatrics

❖ Central Sterilization

❖ Hospital Engineer
10
11
 INDICATORS
❖ Overall HAI

❖ Surgical site infections

❖ Ventilator associated pneumoniae

❖ Ventilator associated event

❖ Central line associated blood stream infections

❖ Catheter associated urinary tract infections

❖ Occupational exposure to blood/body fluids

❖ Hand hygiene compliance

❖ MRSA & VRE attack rate

https://nabh.co 12
 Monitoring and Auditing
❖ Hand hygiene compliance

❖ Safe injection practices

❖ Personal protective equipment usage

❖ Biomedical waste management

❖ Sterilization and Disinfection methods

❖ Device associated infection control compliance

13
 Implementation of IPC
❖ Awareness

❖ Innovations

❖ Encouragement

❖ Celebrations

❖ Awards

❖ Team spirit

❖ Patient involvement

14
 Standard precautions

• Apply to all patients receiving care in hospitals regardless of their

diagnosis or presumed infection status.

Apply to

❖ blood;

❖ all body fluids, secretions, and excretions

❖ nonintact skin; and

❖ mucous membranes.

15
 Fundamental principles of Standard precautions
❖ Hand Hygiene

❖ Gloving

❖ Personal protective equipment:

• Masks, respiratory protection, eye protection, face shields, gowns and protective apparel

❖ Patient-care equipment and articles

❖ Safe injection practices

❖ Linen and laundry

❖ Environmental cleaning

❖ Biomedical waste management

❖ Placement & transport of patients

16
17
 5 stages of hand transmission

one two three four five

Germs present Germ transfer Germs survive Suboptimal or Contaminated

on patient skin onto health-care on hands for omitted hand hands transmit
and immediate worker’s hands several minutes cleansing results germs via direct
environment in hands contact with
surfaces remaining patient or
contaminated patient’s
immediate
environment

https://www.who.int/
18
 “My 5 Moments for Hand Hygiene”

https://www.who.int/infection-prevention/tools/hand-hygiene/en/ 19
 Situations illustrating direct contact:

▪ shaking hands, stroking a child’s forehead

▪ helping a patient to move around, get washed

▪ applying oxygen mask, giving physiotherapy

▪ taking pulse, blood pressure, chest

auscultation, abdominal palpation, recording
ECG

https://www.who.int/infection-prevention/tools/hand-hygiene/en/ 20
 Situations illustrating clean/aseptic procedures:

▪ brushing the patient's teeth,

instilling eye drops

▪ skin lesion care, wound dressing, subcutaneous

injection

▪ catheter insertion, opening a vascular access

system or a draining system, secretion
aspiration

▪ preparation of food, medication,

pharmaceutical products, sterile material.

https://www.who.int/infection-prevention/tools/hand-hygiene/en/ 21
 Situations illustrating body fluid exposure risk:
▪ brushing the patient's teeth, instilling
eye drops, secretion aspiration

▪ skin lesion care, wound dressing, subcutaneous

injection

▪ drawing and manipulating any fluid sample,

opening a draining system, endotracheal tube
insertion and removal

▪ clearing up urines, feces, vomit, handling waste

(bandages, napkin, incontinence pads), cleaning
of contaminated and visibly soiled material or
areas (soiled bed linen lavatories, urinal,
bedpan, medical instruments)

https://www.who.int/infection-prevention/tools/hand-hygiene/en/ 22
 Situations illustrating direct contact:
▪ shaking hands, stroking
a child forehead

▪ helping a patient to move around, get

washed

▪ applying oxygen mask,

giving physiotherapy

▪ taking pulse, blood pressure, chest

auscultation,

▪ abdominal palpation,
recording ECG

https://www.who.int/infection-prevention/tools/hand-hygiene/en/
 Situation illustrating contacts with patient
surroundings:

▪ changing bed linen, with the patient

out of the bed

▪ perfusion speed adjustment

▪ monitoring alarm

▪ holding a bed rail, leaning against

a bed, a night table

▪ clearing the bedside table

https://www.who.int/infection-prevention/tools/hand-hygiene/en/ 24
https://www.cdc.gov/handwashing/why-handwashing.html 25
 TYPES OF HANDWASH

Routine Hand wash

Procedural Hand wash

Surgical Hand wash

https://www.cdc.gov/handwashing
26
 ROUTINE HAND WASH
⮚ The aim of routine handwashing is to remove the transient bacterial
flora.

⮚ These organisms may be acquired from another person’s skin or from

objects in the environment.

PROCEDURAL HANDWASH
⮚Alcohol hand rub solution are only effective for use when hands are
physically clean there fore routine handwashing is recommended in
addition in hygienic handwashing.

https://www.cdc.gov/handwashing
27
 SURGICAL HANDWASHING

Scope
❖ Prior to all surgical procedures

❖ Prior to other invasive or diagnostic procedure

e.g. Insertion of a central venous catheter or lumbar puncture

Purpose:
❖ Removing soil & transient microorganisms from hands & forearms

❖ Reducing the resident microbial count to as low a level as possible

❖ Inhibiting the rapid rebound growth of microorganism

https://www.cdc.gov/handwashing
28
 PROPER WAYS OF USING HAND SANITIZER

ELBOW HEEL OF YOUR PALM

29
 HAND WASHING TECHNIQUE

https://www.who.int/infection-prevention/tools/hand-hygiene/en 30
 Surgical Hand Wash
⮚Surgical hand wash or surgical hand rub must be performed preoperatively by surgical
personnel to eliminate transient and to reduce resident hand flora.

⮚Perform a preoperative surgical scrub for 3 minutes for 5 times using an antiseptic
based scrub - either 4% chlorhexidine or 7.5 % povidone- iodine based scrub .
Scrub the hands and forearms up to the elbows.

31
⮚ As per the 6 steps shown above, lather palm, back of hand, heel of hand, and space between
thumb and index finger ,washing each surface. Move up the forearm, lather, then wash to the
elbow.

⮚ After performing the surgical scrub, keep hands up and away from the body (elbows in flexed
position) so that water runs from the tips of the fingers toward the elbows. Do not retrace or
shake the hands and arms, let the water drip from them.

32
⮚ Slightly bend forward, pick up a hand towel and step back from the table Grasp the towel
and open it - do not allow the towel to touch any un-sterile object or un-sterile parts of the body.

⮚ Hold hands and arms higher than the elbows, and keep arms away from the body.

⮚ Holding one end of the towel with one hand, dry the other hand and arm with a blotting,
rotating motion .Work from fingertips to the elbow; DO NOT retrace any area. Dry all sides of the
fingers, the forearm, and the arms thoroughly .

⮚ Grasp the other end of the towel and dry the other hand and arm in the same manner as
above.

⮚ Discard the towel into the appropriate receptacle.

33
 THE GLOVE PYRAMID

https://www.who.int/gpsc/5may/Glove_Use_Information 34
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
35 35
 Major patterns of transmission
of health care-associated germs (1)
Mode of
transmission Reservoir / source Transmission dynamics Examples of germs
Direct contact Patients, Direct physical contact between Staphylococcus
health-care the source aureus, Gram
workers and the patient negative rods,
(person-to-person contact); respiratory viruses,
HAV, HBV, HIV
e.g. transmission by shaking
hands, giving the patient a bath,
abdominal palpation, blood and
other body fluids from a patient
to the
health-care worker through skin
lesions

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
36
 Major patterns of transmission
of health care-associated germs (2)

Mode of
transmission Reservoir / source Transmission dynamics Examples of germs
Indirect contact Medical devices, Transmission of the infectious Salmonella spp,
equipment, agent from the source to the Pseudomonas spp,
endoscopes, patient occurs passively via an Acinetobacter spp,
objects intermediate object S. maltophilia,
(shared toys in (usually inanimate); Respiratory
paediatric wards) Syncytial Virus
e.g. transmission by not changing
gloves between patients, sharing
stethoscope

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
37
 Major patterns of transmission
of health care-associated germs (3)
Mode of
transmission Reservoir / source Transmission dynamics Examples of germs
Droplet Patients, Transmission via large particle Influenza virus,
health-care droplets (> 5 µm) transferring the Staphylococcus
workers germ through the air when the aureus, Neisseria
source and patient are within meningitidis, SARS-
close proximity; associated
coronavirus
e.g. transmission by sneezing,
talking, coughing, suctioning

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
38
 Major patterns of transmission
of health care-associated germs (4)

Mode of
transmission Reservoir / source Transmission dynamics Examples of germs
Airborne Patients, health- Propagation of germs contained Mycobacterium
care workers, hot within nuclei tuberculosis,
water, dust (< 5 µm) evaporated from droplets Legionella spp
or within dust particles, through
air, within the same room or over
a long distance;

e.g. breathing

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
39
 Major patterns of transmission
of health care-associated germs (5)
Mode of Reservoir / Examples of
transmission source Transmission dynamics germs
Common Food, water or A contaminated inanimate Salmonella
vehicle medication vehicle acts as a vector spp, HIV, HBV,
for transmission of the Gram negative
microbial agent to rods
multiple patients;

e.g. drinking
contaminated water,
unsafe injection

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
40
 Airborne vs Droplet
Airborne infections Droplet infections

Particles < 5um size Particles >5um size

Spread more than 3 feet distances Spread less than 3 feet distances

Suspended for longer duration Suspended for lesser duration

N95 respirator, mask, Mask

Negative ventilation

Tuberculosis, Measles,etc Diptheria, pertusis,etc

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
41
 Safe injection practices

www.southernnevadahealthdistrict.org
42
 Respiratory hygiene/etiquette
Reduces the spread of microorganisms (germs) that cause
respiratory infections (colds, flu).

• Turn head away from others when coughing/sneezing

• Cover the nose and mouth with a tissue.

• If tissues are used, discard immediately into the trash

• Cough/sneeze into your sleeve if no tissue is available

• Clean your hands with soap and water or alcohol based

products

Image source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public 43

 PERSONAL PROTECTIVE EQUIPMENT (PPE)
❖ Always clean your hands before and after wearing PPE

❖ PPE should be available where and when it is indicated

• in the correct size
• select according to risk or per transmission based precautions

❖ Always put on before contact with the patient

❖ Always remove immediately after completing the task and/or leaving the patient care area

❖ NEVER reuse disposable PPE

❖ Clean and disinfect reusable PPE between each use

44
PERSONAL PROTECTIVE EQUIPMENT (PPE)

45
OCCUPATIONAL EXPOSURE TO BLOOD/BODY FLUIDS
Blood-borne diseases that could be transmitted by such an exposure include “

❖ Human immunodeficiency virus (HIV)

❖ Hepatitis B (HBV)

❖ Hepatitis C (HCV)

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure

46
•Hollow-bore needles are the cause of injury in 68.5% of cases.

•Scissors.

•Surgical Blades (Knife).

•Sharp Instruments used for procedure.

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure

47
 WHICH TASKS INVOLVE THE MOST INJURIES?

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure

48
 WHAT FACTOR INFLUENCES THE RISK?

❖ Type of needle (hollow bore ).

❖ Device visibly contaminated with patient’s blood.

❖ Depth of injury.

❖ The amount of blood involved in the exposure.

❖ The amount of virus in patient’s blood at the time of exposure.

❖ Whether Post Exposure Prophylaxis (PEP) was taken within the recommended time.

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure

49
WHAT YOU CAN DO TO PROTECT YOURSELF AND OTHERS?
• Avoid the use of needles where safe and effective alternatives are
available.
• Avoid recapping needles.
• Plan for safe handling and disposal before beginning any procedure
using needles. Dispose of used needles promptly in appropriate
sharps disposal containers.
• Follow recommended infection prevention practices, including
hepatitis B vaccination.
• Report all needle stick and other sharps related injuries to ensure
that you receive appropriate follow-up care.
• Advocate for screening, post exposure counseling, prophylaxis.
• Use purchasing power to buy safe equipment.
• Promote safety awareness.

50
 IMMEDIATELY POST EXPOSURE

❖ Needle stick injuries and cuts should be washed with soap and water

❖ Pricked finger should not be put into mouth reflexly.

❖ Splashes to the nose, mouth or skin, should be flushed with plenty of water.

❖ Eyes should be irrigated with clean water, saline, or sterile irrigants.

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure

51
 POST EXPOSURE MANAGEMENT
❖ The exposed HCW is tested for HIV immediately following exposure, at six weeks following
exposure and again at twelve weeks after the exposure.

❖ On all the occasions, HCW must be provided with a pre-test and post-test counseling.

❖ HIV testing should be carried out on three ERS (ELISA/Rapid/Simple) test kits or antigen
preparations.

❖ Along with HIV tests, exposed HCW is also tested for HBsAg and Anti HCV immediately
following exposure, at six weeks following exposure and again at twelve weeks after the
exposure.

❖ Hepatitis B antibody titer is checked and if the titer is less than 10 mIU/ml, then revaccination
is done against Hepatitis B

❖ If the source is known and if the source is known positive for HIV/HBV/HCV, then the HCW is
referred to ID physician for further post exposure management

https://www.cdc.gov/nhsn/PDFs/HPS-manual/exposure 52
 BIOMEDICAL WASTE
Any waste, that is produced during the diagnosis, treatment or immunization of human beings,
or animals or in research activities pertaining to those, or in production or testing of biological

53
 HEALTHCARE WASTE CHARACTERIZATION

Healthcare Waste

85% Non-infectious
10% Infectious
5% Hazardous

http://www.cpcbenvis.nic.in

54
 YELLOW

CATEGORY TYPE OF WASTE DESCRIPTION

Human Anatomical Waste

 
Soiled waste
 
Discarded or Expired Medicine (Only
Cytotoxic ) With cytotoxic label in
cardboard box with yellow
bag.
YELLOW Discarded Linen, mattresses, beddings
contaminated with blood or body fluid.

 
Microbiology, Biotechnology and other
clinical laboratory waste

http://www.cpcbenvis.nic.in 55
 RED

CATEGORY TYPE OF WASTE DESCRIPTION

Contaminated waste(Recyclables):
*Waste generated from disposable items, such as
Tubings, Plastic-I/Vbottles,
I/V sets, Catheters, Urine bags, Syringes (without
needles ) and gloves.
Contaminated Final Waste Treatment:
RED
waste (Recyclable) (Autoclaving and Shredding)

http://www.cpcbenvis.nic.in

56
 WHITE (PPC)
CATEGORY TYPE OF WASTE DESCRIPTION
Waste- Sharps including Metals:
Needles, Syringes with fixedneedles,
Vacutainer needles, glass slide, cover slips,
Scalpels, blades, ampoules or any other contaminated
sharp object that may cause puncture and cuts.
This includes both used ,discarded and contaminated
Waste sharps metal sharps.
WHITE
including metals
Final Waste Treatment:
(Autoclaving and Shredding and sent for final disposal to
iron foundries having consent to operate from MPCB.

http://www.cpcbenvis.nic.in

57
 BLUE

CATEGORY TYPE OF WASTE DESCRIPTION

Glassware:

Broken or discarded or expired medicine and contaminated glass

including medicine vials , except those contaminated with cytotoxic
wastes. ECG leads, disinfectant-bottles.
Glassware To be discarded in a cartoon box with blue bag.
Final Treatment:
(Autoclaving/ Microwaving and Re-cycling)
BLUE

Metallic Body Implants:

Metallic Final Waste treatment:
Body
Implants Cleaning and disinfection with multienzyme cleaner, only then to be
discarded in a cartoon box with Blue bag.

http://www.cpcbenvis.nic.in 58
 ANTIMICROBIAL STEWARDSHIP

http://www.bsac.org.uk/antimicrobialstewardshipebook

59
 SUMMARY

❖ Healthcare associated infections

❖ Infection prevention and control- Implementation & monitoring

❖ Fundamental principles of Standard precautions

❖ Transmission based precautions

❖ Biomedical waste management

❖ Occupational exposure to blood /body fluids

60
 THANK YOU

Please like, share, comment, subscribe for more videos

For more details and support, contact email:

doctorrahulkamble@gmail.com