Hospital Infection control Committee

Infection control addresses factors related to the spread of infections within the healthcare setting (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff), including prevention (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance).

What is the need for HICC?

Incidence of Healthcare-associated infections are 10 per 100 admissions. These infections can cause

• Resistant bugs
• Increase in cost of treatment
• Prolonged hospital stays
• Morbidity & mortality increased

Goal: to reduce nosocomial infections

• Hospital Infection Control Committee (HICC) – formulates policies and guidelines regarding hospital infection control.
• Infection Control Team (ICT) – headed by Infection Control Officer – carries out daily activities of Infection control in the hospital

The main objectives of the Committee

• To develop and formulate Hospital infection control policy and procedure manual
• To continue surveillance of hospital acquired infections and high-risk areas
• To develop and monitor hospital antibiotic policy.
• To do training and education
• To segregate, monitor and to manage Bio-Medical Waste
• To manage any outbreaks in the hospital and community
• To manage and monitor accidental blood and body fluid exposure.
• To monitor sterilization and Disinfection.

Functions of HICC

Structure & Membership of HICC

Components of the Infection Prevention and Control Program

• Establishing and regular update of hospital infection control manual.
• Minimizing HAIs through continuous training and monitoring of healthcare associated infection.
• Surveillance of HAIs.
• Maintain good hand hygiene compliance.
• Investigation and control of outbreaks.
• Monitoring of emergence of antimicrobial resistance.
• To recommend antibiotic policy for the hospital based on local antibiograms and evidence based published national/international guidelines.
• Monitor and curb irrational use of antibiotics in hospital areas.
• Identification of high-risk activities and establish steps to mitigate risk of HAIs to patients, staff, and visitors.

Standard Precautions

• Standard Precautions are a set of infection control practice used to prevent transmission of diseases, that can be acquired by contact with blood and body fluids, non-intact skin & mucous membranes.
• These work practices are applied to all health care workers regardless of infectious status.

Components of standard precautions

• Hand hygiene
• Personal protective equipment
• Safe use and disposal of sharps
• Routine environmental cleaning
• Respiratory hygiene and cough etiquette
• Biomedical waste management
• Appropriate handling of linen.

HAND HYGIENE

WHO guidelines have simplified the recommended indications to perform hand hygiene: My Five Moments of hand hygiene

TECHNIQUE OF HAND HYGIENE

Duration of Hand hygiene

• Duration for hand rub should be performed for a minimum of 20 – 30 seconds
• Duration for hand wash should be performed for a minimum of 40 seconds
• Duration for surgical hand wash should be performed for a minimum of 3-5 minute

Personal protective equipment

Safe use and disposal of sharps

• Avoid unnecessary use
• Use of alternative -cutting diathermy and laser.
• Disposable needles should be used.
• Handle hollow bore needles with care
• Never recap needle or follow single hand-scoop
• Never break/bend needles by hand
• Never pass in hand directly (use kidney tray)
• Should not be left on trolleys and bed side
• Dispose – in sharp

Safe injection and perfusion practices

• Hand wash.
• PPE
• Rub the hub.
• One needle, One syringe, only one time.
• Disinfect the site with alcohol swab & wait for dry.
• Proper Bio Medical Waste management.

Respiratory hygiene and cough etiquette

If having signs and symptoms of a respiratory infection:

• Cover the nose/mouth with single use tissue paper or inner elbow rather than the hand
• Hand hygiene should be done

In high-risk areas:

• Provide mask to patients with cough and separate queue away from general queue
• Sputum collection should be done in an open space or a well-ventilated room

Bio medical waste management

• SEGREGATION
• TRANSPORTATION
• FINAL DISPOSAL

Common HCAI

• Gastroenteritis (rotavirus – chief pathogen) most common NI in children
• Bacteremia, Skin, and soft tissue infection – ulcer, bed sores, sinusitis
• Catheter associated UTI (CAUTI)
• Ventilator associated pneumonia (VAP)
• Central line associated blood stream infection (CLABSI)
• Surgical site infection (SSI)

VENTILATOR ASSOSCIATED PNEUMONIA (VAP)

CATHETER – RELATED blood stream infection (CRBSI)

SURGICAL SITE INFECTIONS

Surgical site infection is defined as development of an infection at an incision site after a surgical procedure within 30 days of surgery (or within 90 days for some surgeries such as breast, cardiac and joint surgeries including implants)

• WHO – a purulent discharge around the wound or the insertion site of the drain, or spreading cellulitis from the wound.
• Incidence varies 1% to 20%
• Pathogens involved:
  • Skin commensals – Staphylococci, CONS
  • Endogenous Faecal Flora – E coli, anaerobes
• Risk factors:
  • type of surgery (more in cardiothoracic, orthopaedic, GI and implants surgeries);
  • Clean or contaminated wound
  • Emergency or elective surgery, Infection control policy of hospital

CAUSES OF SSI :

Pre operative causes:

• Poor nutrition
• Improper surgical site preparation
• Improper bowel preparation for abdominal surgeries
• Inadequate Antibiotic prophylaxis prior to surgery
• Poor glycemic control
• Uncorrected anaemia prior to surgery
• Continuation of immunosuppressants prior to surgery

Per operative causes :

• Unsterile handling of OT equipment, OT setting
• Large incision
• Intra operative changing of gloves (not recommended)
• Improper ventilation system in OT

Post operative causes :

• Improper wound dressing
• Inadequate antibiotic support
• Inadequate correction of blood loss, anaemia, hyperglycaemia after surgery
• Improper handling of incision site
• Inadequate nutrition support

Dr. Narayanappa. D
Professor Dept. of Paediatrics
Chairman HICC