What Is Infection Prevention

 

INFECTION PREVENTION

This chapter explains the importance of infection control at facilities, different components of infection control specific to facilities and how a mentor can actually apply the PDCA approach to set up or strengthen the infection prevention practices in a facility.



Introduction and need for infection prevention practices

Any person in the facility including its providers and clients along with their family members can be a source of infection. All objects that come in contact with any of them in the facility should be considered to be potentially infected and capable of transmission of infection. The most neglected service in a health care setting in India has poor infection control that lead to transmission of infections in the facility and community.



The objectives of infection prevention practices are:

  • To provide services to clients with high quality and safety
  • To prevent post-procedure infections in clients
  • To prevent infections in service providers
  • To prevent cross-infection in the community from health care facilities


Infection prevention is to mainly necessary to prevent the occurrence and minimize the risk of transmitting infections including blood-borne infections such as Hepatitis B, C and HIV to and from patients and staff in the health facility. Risk for infection is high when the clients and the staff are exposed to body fluids.

The risk is even higher when health care providers are not careful enough to take adequate precautions. Hence infection prevention practices must be followed in the facility as infected person and objects are not being anticipated. These precautionary measures are called Standard Universal Precautions.


Components of Infection Control (Standard Universal Precautions)

A mentor should be aware of different components of infection control so that she can orient and encourage the facility staff to practice these effectively.


There are 6 components in infection prevention namely:

(1) Hand Hygiene

(2) Use of Personal Protective Equipment (PPE)

(3) Processing of instruments and other items

(4) Proper handling and disposal of sharps

(5) Maintain a clean environment

(6) Waste segregation and disposal

In this session, we are going to explain in detail about Processing of instruments and other items


Processing of Instruments and Other Items:

All instruments that are to be reused (e.g. episiotomy scissors, cord-cutting scissors, artery clamp etc.) must be decontaminated first, washed thoroughly and sterilised before using them again.

  • Decontamination is needed to kill the viruses and bacteria present on articles and make it safer for health care providers to handle articles for cleaning.
  • Cleaning reduces visible dirt, oils, grease, blood or any secretions that could be present on the instruments.
  • Sterilisation removes all the bacteria and viruses including endospores from the instruments and makes them safe for use again.

Steps to be followed for decontamination, cleaning, sterilization and storage are mentioned below:

Decontamination

  • Put on utility gloves or surgical gloves.
  • Place all instruments (forceps, scissors etc.) in 0.5% chlorine solution for 10 minutes immediately after completing the clinical procedure.
  • Dispose of waste material and put in a leak proof container.
  • Decontaminate labour room table or other surfaces contaminated during the procedure by wiping with 0.5% chlorine solution.
  • Remove instruments from 0.5% chlorine solution after 10 minutes and place them in water.
  • Remove reusable gloves by inverting and soaking in 0.5% chlorine solution for 10 minutes. If wearing utility gloves do not remove till cleaning instruments are finished.

How to prepare a 0.5% chlorine solution

A chlorine solution can be made from liquid household bleach (Sodium hypochloride) or from bleaching powder (calcium hypochlorite) or chlorine tablets (sodium dichloroisocyanurate). 
As liquid household bleach and bleaching powder are readily available and low cost, these two are mainly recommended for decontamination.

Active chlorine in different products varies but you can make 0.5% solution from any type of bleach by using the following formula:

(a). Using Liquid bleach :( % of active chlorine in liquid bleach + 0.5%) - 1 = parts of water for each part of bleach. e.g. to make a 0.5% chlorine solution from a 3.5% liquid bleach you must use 6 parts of water with 1 part of liquid bleach.

(b). Using bleaching Powder :( % of active chlorine in liquid bleach + 0.5%) * 1000 grams of powder/litre of water. e.g. to make a 0.5% chlorine solution from a 35% bleaching powder you must use 14.3 gm (approx. 15 gm) i.e. 3 tsp bleaching powder in one litre of water.

Take 3 teaspoon of bleaching powder (15 gm) and make thick paste using little water from one litre. Mix the paste with remaining water to make 0.5% chlorine solution. Resulting solution is likely to be cloudy (Milky). See figure below.

(C). Ensure availability of 2 tubs with lids/covers of bleaching solution: one for gloves and the other for instruments.

Figure of Mixing bleaching powder


Cleaning

  • Place the instruments in basin with clean water and mild detergent.
  • Completely disassemble instruments and or open jaws of joint items.
  • Wash all instrument surfaces with brush or cloth until visibly clean (hold instruments under water while cleaning to avoid splashing).
  • Thoroughly clean serrated edges (rough surfaces of artery forceps or thumb forceps) of instruments using a small brush.
  • Wash surgical gloves in soapy water, cleaning inside and out.
  • Towel dry instruments or allow them to air dry.
  • Hang surgical gloves up to allow them to air dry, and once first side is dry, reverse them to dry completely.
  • After cleaning all items, remove utility gloves and allow to air dry.
  • Wash hands thoroughly.

Sterilisation

  • Arrange instruments in tray or cloth wrapping using appropriately clean material
  • Wrap items using envelope or square wrap technique.
  • Place packs in drums or trays for autoclaving.
  • Arrange items in autoclave chamber to allow free circulation and penetration of steam to all surfaces.
  • Sterilise for 30 minutes for wrapped items; 20 minutes for unwrapped items at 121°C or (250°F) and (15lbs/in²).
  • Wait for 20-30 minutes (until the pressure gauge reads zero) before opening the lid or door to allow the steam to escape.
  • Allow packs to dry completely before removing.
  • Place sterilised drums or packs on a surface padded with paper or cloth to prevent condensation.
  • Allow them to reach room temperature before storing.
  • Record sterilisation condition (time, temperature and pressure) in log book.

Storage

  • Place sterilised instruments in the cupboards based on date of sterilisation (earlier dates to be used first).
  • See that the room is and the cupboard is cleaned regularly.
  • It is thus important to keep enough stock of these instruments so that there is always more than the required amount.
For example if in a day an average of 2 deliveries occurs, then it is important to keep an additional two sets of instruments so that what has been used could be processed before they are reused.


A word about gloves

Syringes, needles, gloves, and masks are for one-time use. Washing gloves with soap, and water can cause micro punctures and may allow liquids to penetrate through undetected holes in the gloves.

Therefore washing of gloves is generally not recommended. In case of the extreme shortage of glove supply at the facility, the gloves can be reused by processing the gloves as below:

  • Grab the cuff of one of the gloves to turn inside out and pull halfway off of the hand. Pull the other glove at the cuff to turn inside out and pull halfway off the hand.
  • When both gloves are halfway off the hands, pull both gloves off from the inside at the same time. Never touch the outer portion of the gloves with your skin.
  • Soak the gloves in 0.5% chlorine solution for at least 10 minutes.
  • Wash gloves in soapy water inside and out and rinse fully. Test for holes or tears by placing the gloves under water. If any air bubbles appear, throw the gloves away immediately. If no air bubbles appear, let the gloves air dry.
  • Turn the cuffs of the gloves inside out a few inches and place five to fifteen pairs of gloves onto each steamer pan and cover with the lid.
  • Steam the gloves for 20 minutes at a rolling boil.
  • Air dry the gloves in the steamer pan for four to six hours before use and remove with forceps into a disinfected container with a lid.

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