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

Hand Hygiene

The hands can get contaminated when performing various procedures. The correct technique of hand hygiene is important since microorganisms could be concentrated in the skin folds between fingers and around the thumb.

Practicing hand hygiene is one of the most important procedures to prevent cross-infection (infection spread from one person to another).

A healthcare provider must be able to perform hand hygiene at the following times:

• Immediately after arriving at work
• Before and after examining each patient
• After contact with blood, secretions, excretions or articles that have been used for patients
• After handling specimens
• Before putting on and after removing gloves
• Before leaving work

Preparing for hand hygiene

1. Remove jewellery (rings, bracelets) and watches before washing hands.
2. See that the nails are clipped short.
3. Roll the sleeves up to the elbow.

Hand hygiene technique

• Wet the hands and wrists, keeping hands and wrists lower than the elbows (permit the water to flow to the fingertips, avoiding arm contamination)

• Apply soap and lather thoroughly

• Use firm, circular motions to wash the hands and arms up to the wrists.

• Cover all areas including palms, back of the hands, fingers, between fingers and lateral side of the fifth finger, knuckles, thumbs, nails and wrists (see Figure 8)

• Rub for minimum of 10-15 seconds

• Repeat the process if the hands are very soiled

• Rinse hands thoroughly, keeping the hands lower than the fore arms

• Dry hands thoroughly with disposable paper towel or napkins, clean dry towel, or air-dry them

• Discard the towel used, in an appropriate container without touching the bin lids with hand

• Use a paper towel, clean towel or your elbow / foot to turn off the tap to prevent contamination

If there is no running water available:

• Collect water in a bucket daily
• Ask someone for help to pour water on your hands using a mug 
• Follow the same steps as given.
• Collect used water in a basin and discard in a sink, drain or toilet
• DO NOT dip your hands in to the bucket as this will contaminate the water.
• DO NOT keep a basin with a disinfectant solution in the ward to use for cleaning hands. This will not disinfect the hands. It will only contaminate them further.

Use of Personal Protective Equipment (PPE)

PPE is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of healthcare providers from exposure to blood or other potentially infectious material (amniotic fluid, vaginal secretions, urine, stool etc.).

This includes the use of gloves, mask, apron or gown, goggles, footwear etc. The use of these will depend on what the chance of contact with infectious body fluids would be. If the risk is very high then all PPE must be used (see Table 10).

How to wear surgical gloves

After a thorough hand washing by maintaining the principles of hand washing, sterile gloves should be worn.

Step 1: Prepare a large, clean, dry area for opening the package of gloves and open the first cover if the gloves are reprocessed put them on a sterile or HLD surface

Step 2: Perform surgical scrub or thorough hand wash and dry your hand completely, either air dry or with single use towel or sterile gauze pieces

Step 3: Open the inner cover of gloves, exposing the cuffed gloves with the palms up

Step 4: Pick up the first glove by the cuff, touching only the inner side (the side which will touch your skin when gloves is on)

Step 5: While holding the cuff, slip your other hand into the glove (pointing the fingers towards floor will keep the fingers open by gravity). Be sure not to touch anything and hold the glove above waist level. Note: if the first glove is not fitted correctly, leave that like that until you put on the second glove. Then you use your sterile or HLD fingers to make adjustment in first glove.

Step 6: Pick up the other glove by sliding the fingers on the gloved hand between the cuff and the sterile or HLD portion of the second glove

Step 7: Put the second glove on the ungloved hand by maintaining a steady pull without trying to adjust the glove

Step 8: Adjust the position of gloved fingers to fit it comfortably

How to remove gloves see fegure below