CHAPTERX:

INFECTION PREVENTION
AND PATIENT SAFETY
MANAGEMENT

Dece 2018
CHAPTER CONTENTS
 Section 1:introduction
 Section 2:operational standards
 Section 3:Iplementation Guidance
 INTRODUCTION
 Health care facilities should provide safe, effective, patient-
centered, timely, efficient and equitable quality of service.
 HCAI is the most frequent harmful event in health-care
delivery and occurs worldwide in both developed and
developing countries
 The prevalence of infectious diseases such as TB, HIV, HBV
and HCV and etc..in Ethiopia enhance the urgency for health
facilities to CASH/IPPS program
INTRODUCTION CONT..
 Implementing clean and safe hospital
initiative in complement to infection
prevention and patient safety with the aim
of stopping the transmission of infectious
agents is the only way to reduce the
occurrence of HCAIs
 OPERATIONAL STANDARDS
1.The hospital has strategies and operational plan for IPPS as
well as a management system to monitor and evaluate the
activities

2.Hand hygiene practice is implemented and facilities are

provided at all service points at all time

3.All the necessary commodities and supplies of IPPS are

routinely available and utilized at the designated service
areas
OPERATIONAL STAND….CONT.

4.The hospital has ensured that safe surgical procedures and

practices are in place to minimize risks to clients and
providers

5.Safe injection practices are implemented to minimize risk to

all surrounding community and management of adverse
event related to injection are in place

6.The hospital practices health care waste management

following the national IPPS guidelines
OPERATIONAL STAN….CONT.
7.The hospital ensures the cleanliness and housekeeping
activities based on schedule

8.The hospital ensures the availability of adequate and

functional toilets, hand washing sinks and showers

9.The hospital ensures Adequate and functional laundry

service

10.All reusable medical equipments are processed according to

the national IPPS guidelines

11.The hospital has a procedure in place to regulate traffic flow

 OPERATIONAL STANS….CONT….
12.The hospital has a mechanism in place to minimize harm to
clients due to errors in medications management

13. The hospital has a monitoring system to ensure safety of food

and water served in the premises

14. The hospital has a clients’ education system for maintenance of

a clean and safe health care facility (CASH)

15. The hospital ensures all the post exposure and preventive
interventions and procedures are in place in case of occurrence of
occupational risks

16.The hospital develops hospital acquired infections tracking and

 SECTION 3
IMPLEMENTATION GUIDANCE
 1.EFFECTIVE MANAGEMENT OF IPPS
o Effective management is essential to create an effective
IPPS program:
o Hospitals should have a designated person or persons to
oversee day to day CASH / IPPS activities
o The hospital should also have an Infection Prevention and
patient safety Committee
o Senior level management should support the CASH and IPPS
committee’s efforts
o The successful implementation of IPPS program requires an
operational plan
o The hospital has also strategies to create clean and safe
health care environment
 2. HAND HYGIENE
Basic principles of hand hygiene are followed consistently
o Guidelines on hand hygiene have to be properly disseminated , promoted
and followed
o Best practices on hand hygiene have to benchmarked
o The culture of providing positive feedbacks has to be developed
o There has to be a culture of rewarding role models of proper hand washing

Necessary infrastructures for proper hand hygiene

o Functional hand washing sinks
o Water tanker for reserve water during water supply interruptions
o Functional drainage system
 HAND HYGIENE CONT….
Necessary supplies for proper hand hygiene
o Continuous supply of water
o Detergents
o Antiseptic soaps , Alcohol ,glycerin

Hand Hygiene Promotion

o Prepare and post sign
o Develop posters
o Celebrate Hand Washing Days
o Prepare audiovisual materials
HAND HYGIENE CONT…
Monitoring hand washing practices in the hospital
o Checklist ( in interview and observation form)
o Conducts quarterly assessments
o Identify strengths and gaps
o Disseminate the identified strengths and challenges
o Prepare improvement plan and share
o Properly document all monitoring activities
 3.COMMODIITIES AND SUPPLIES
Commodities and supplies of IPPS includes
o Personal protective equipments
o consumables,
o cleaning materials and equipments: detergents ,etc..
SUPPLY
o Hospitals should make certain that there is a sufficient supply
of all commodities and supplies
o Regular supply should be provided when there is increased
demand or need for replacement of worn out items
o Different sizes of PPE’s should be procured and distributed
COMMODITIES AND SUPPLIES CONT..
Utilization
o The hospital should monitor staff use of all personal
protective equipment
o All re-useable personal protective equipment should be
cleaned or washed
o All fluid resistant long sleeve apron, goggles and face
shield should be routinely used when in procedure rooms
and where splash of fluid is anticipated.
o All staff should adhere to recommendations of when to
use each PPE and when not to use
4.SAFE SURGERY AND SAFE PRACTICES
IN THE OR
o The surgical unit is inherently a high risk area
o Providers are exposed to blood and injuries from the use of sharp
instruments used to perform surgeries.
o Patients are also at risk of acquiring infections as a result of the
procedures performed.
o Organization of the Surgical Unit

 unrestricted area

 transition zone

 semi restricted area


 SAFE SURGERY CONT….
 There should be appropriate facilities for surgical hand scrub:
antiseptic soap, clean water, soft brush
 The hospital should have a regular supply of antiseptics for
surgical hand scrub and skin preparation for surgery
 Hospital staff should be monitored for the proper use of each
antiseptic solution to ensure patient safety
 To protect staffs the surgical team performing the surgery
should review how sharps will be handled during the
operation
 5 SAFE INJECTION PRACTICE
o Medication by injection form is of huge magnitude in
hospitals
o Most of medications given by injection are unnecessary and
can be reasonably avoided
o The risk burden from unsafe injections is also huge
o Hospitals have to adhere to some basic principles to ensure
injection safety at their injection and medication rooms.
o Hospitals ensure the availability of inputs and supplies to
make injections in their medication rooms safe
 6 HEALTH CARE WASTE
MANAGEMENT
o Healthcare facilities produce waste that is potentially
harmful to public health and the environment
o Improper disposal of HCW increases the risk of spreading
infections and of exposure to toxic emissions from
incomplete combustion
o Proper management of HCW through an integrated,
effective waste management system can minimize the risks
both within and outside healthcare facilities
HEALTH CARE WASTE
MANAGEMENT CONT….
o The management of health care multi-step
process involving
 Waste Minimization
 Segregation
 Handling
 Collection
 Storage
 Transportation
 Treatment and Disposal
 HEALTH CARE WASTE MAGT…..
o Waste Minimization: In a proper HCW management
system, the first step is waste reduction or minimization
o Segregation :Segregation denotes the separation of waste
into a range of classes according to its character
o In the absence of color coded bins, it is possible to place
waste segregation system using labeled waste bins
o Handling: When handling waste, waste management staff
should wear protective clothing at all times.
 HEALTH CARE WASTE MGT CONT…
o Collection :At a minimum, the infectious waste bins should be
collected each day
o Storage: Each facility should have a specially designated
room for waste storage
o Transport :Carts should be used for transporting bags of
infectious waste within the facility
o Disposal :final disposal methods can be by burring, burning
and incinerator
o Incineration may still be seen as an appropriate final disposal
 7 HOSPITAL CLEANLINESS AND
HOUSE KEEPING
o Maintain a clean and safe health facility (CASH) is essential to
provide quality care for patients
o Hospitals may provide the housekeeping service through its
own staff or, or may contract out services to an outside vendor
o The housekeeping department should develop operating
procedures or work plan on the cleaning process and schedule
for each unit
o The hospital should have a regular supply of all necessary
cleaning materials
 HOUSE KEEPING CONT…
 Non clinical (Administrative) areas with no patient contact
require normal domestic cleaning
 All patient care areas should be cleaned based on the CASH
audit tool schedule
 The hospital compound should be visibly tidy and free from
none functional items
 Unpleasant odor that can be occurred in all clinical service
areas including toilets and placental pits should be avoided
 8 TOILET, HAND WASHING FACILITY
AND SHOWER FACILITIES
 The CASH/IPPS Committee should conduct a needs
assessment to identify and ensure
 Availability and functionality of hand wash sinks, toilets and
showers
 Availability of adequate water supply at all clinical service
units
 Availability of adequate light at all clinical service areas
 The assessment should be done periodically (at a minimum
quarterly) to ensure that any new needs are identified
 9.LAUNDRY SERVICE

o The laundry plays a key role in the function of the hospital

and in preventing the spread of infection and ensuring patient
o Each hospital laundry should develop an operating procedure
or work plan for laundry services.
o The laundry space should be adequate with separated rooms
for soiled and clean linens and has to have at least three
machines
o The laundry should ensure that there is always an available
supply of detergent and bleach
 10.INSTRUMENT PROCESSING
o Every item, whether a soiled metal instruments or pair of
surgical gloves, requires special handling and processing
o There are four main Instrument processing steps:
 Decontamination
 Cleaning
 Sterilization and
 High level disinfection
 INSTRUMENT PROCESSING CONT…
Decontamination :
o Is the process of making inanimate objects safer
o Fully immersing in 0.5% chlorine for 10 minutes must be
done to inactivate HIV, HCV and HBV and vegetative
organisms

Cleaning:

Physical removing and mechanical reduction of the number of

microorganisms
o Is an essential pre- requisite to ensure effective disinfection or
sterilization
 INSTRUMENT PROCESSING CONT…
Sterilization:
o Destroys all microorganisms including endospores
o Used for instruments and other items that come in direct
contact with the blood stream or tissue under the skin

High level disinfection :

o can only be used when there is No sterilization system
o Steaming, Boiling and chemical HLD can be applied
 11 TRAFFIC FLOW
 Proper management of patient care areas – flow of patients
and visitors– in the hospital is integral to maintaining high
standards of infection prevention
 Each hospital should strive to control the organization of all
patient areas and public spaces
 Hospitals should ensure that waiting areas have ample
space and provide a secure, shaded area
 The hospital should establish a system to regulate the
number of visitors and caregivers allotted for each patient
 12 FOOD AND WATERY SAFETY
o The kitchen should have adequate space, well ventilated,
visibly clean and free from debris, dusts, spillages, etc
o Food safety shall be monitored by Head of Kitchen or other
senior manager
o Kitchen staffs maintain personal hygiene and health
o kitchen staff should regularly be tested for communicable
diseases
o The hospital should have a continuous clean water supply
 13. CLIENT EDUCATION
o Hospital clients have stake in ensuring the cleanliness,
tidiness and safeness of hospitals
o Hospitals implement client education by using different
education materials and methods.
o Hospitals have client education materials contextualized to
their settings and their clients
o Hospitals monitor and evaluate their client education
activities
14 OCCUPATIONAL SAFETY
o Hospital staff members may exposed to different health
risks merely due to their work place.
o Hospitals organize post exposure prophylaxis services to
their staff members
o The hospital monitors and evaluates the program on
regular bases
o Hospitals utilize all preventive measures to the
maximum to minimize health risks from exposure to
HBV and HCV
 SURVEILLANCE OF HCAI’S AND
OCCUPATIONAL EXPOSURES
o Monitoring and measuring HCAI can provide valuable
information on the effectiveness of the hospital’s infection
prevention program
o Tracking the number of HCAIs allows hospitals to assess
quality of care and patient safety
o Risk assessment must be done on regular bases to see the
trend of the occurrence of bad outcomes related to poor IPPS
practices
o The results of the research and surveillance studies should be
compiled
THANK YOU