ADMINISTRATOR’S ROLE IN INFECTION CONTROL IN

THE HOSPITALBY:Dharmendra Raval

RN, Bsc(N),EMT,PGDHHM.Nursing Tutor.

Jamnagar

ADMINISTRATOR’S ROLE

Hospital’s physical environment

Healthcare workers

Patients & relatives

Community

To implement infection control measures for

To reduce nosocomial infections to a

minimum

To provide a safe environment for our

hospital patients, employees and

visitors through prevention, control and

surveillance.

Identification of hospital and

community acquired infections

GOAL

The Hospital Infection control program must:

Set relevant objectives

Develop guidelines for surveillance, prevention & practice

System to monitor infections-assess effectiveness

Continuous training programs for healthcare workers

Facilitate access to materials for hygiene & safety

Monitor nosocomial infections & give feedback to the professionals

INFECTION CONTROL PROGRAM

The important components are :1) Basic measures i.e. standard and additional

precautions

2) Education and training of healthcare workers

3) Protection of healthcare workers e.g. immunization

4) Identification of hazards and minimizing risks

5) Routine practices such as aseptic techniques, handling and use of blood and blood products, waste management, use of single use devices

6) Surveillance

7) Incident monitoring

8) Research

INFECTION CONTROL PROGRAMRole of administrator1. Formation of infection control

committee

2. Provide adequate resources for effective functioning

Infection Control Committee1. Review and approve surveillance and

prevention program

2. Identify areas for intervention

3. To assess and promote improved practice at all levels of health facility.

4. To ensure appropriate staff training

5. Safety management

6. Development of policies for the prevention and control of infection

7. To develop its own infection control manual

8. Monitor and evaluate the performance of program

FUNCTIONS1. Responsible for day to day activities

2. Carry out the surveillance program

3. Monitor and manage critical incidence

4. Coordinate training activities

5. Overseeing the sterilization and disinfections

INFECTION CONTROL COMMITTEE

Hospital Administrator

Representative from Nursing Dept.

Hospital Physicians

Clinical Microbiologists

Pharmacist

Representative from CSSD

Representative from Maintenance

Representative from Housekeeping

Representative from Training dept.

THE HOSPITAL SHOULD DEVELOP ITS OWN INFECTION CONTROL

MANUAL CONTAINING INSTRUCTIONS AND PRACTICES

FOR PATIENT CARE

EDUCATION AND TRAINING OF HEALTHCARE STAFF

PHYSICAL ENVIRONMENT

AIR

WATER

FOOD

HEATING, VENTILATION & AIR

CONDITIONING SYSTEM (HVAC)

Temperature

Humidity

Pressure

Flowers & Plants

Pests

ENVIROMENTAL SAMPLING

ENVIROMENTAL SERVICES

Healthcare environment have diverse population of micro-organisms --

Out of which only few are pathogenic

Mostly they grow in moist and organic

environment

Common organism – Myco tuberculosis,

Varicella zoster virus, measles – occurs due to

inappropriate air handling.

Aspergillus, enterococus facium, clostridium

• Location of sinks and dispensers for handwashing products and hand hygiene products

• Types of faucets (e.g., aerated vs. non-aerated)

• Air-handling systems engineered for optimal performance, easy maintenance, and repair

• ACH and pressure differentials to accommodate special patient-care areas

• Location of fixed sharps containers

• Types of surface finishes (e.g., porous vs. non-porous)

• Well-caulked walls with minimal seams

Construction Design And Function Considerations For Environmental Infection Control

• Location of adequate storage and supply areas

• Appropriate location of medicine preparations areas (e.g., >3 ft. from a sink)

• Appropriate materials for sinks and wall coverings

• Appropriate traffic flow (e.g., no “dirty” movement through “clean” areas)

• Isolation rooms with anterooms as appropriate

• Appropriate flooring (e.g., seamless floors in dialysis units)

• Sensible use carpeting (e.g., avoiding use of carpeting in special care areas or areas likely to become wet)*

• Convenient location of soiled utility areas

• Properly engineered areas for linen services and solid waste management

• Location of main generator to minimize the risk of system failure from flooding or other emergency

AIRAIR

Droplets to droplets under direct contact transmission through cough & sneeze

Influenza virus, rhino virus, adenovirus.

Quality of air very important

Ventilation – air volume per minute per occupant

Room AIR CHANGES PER HOUR – 12 – 15 ACH Comfortable

Room ACH > 12 at the time of construction or renovation

If the patient room is equipped with an individual through the wall fan coil unit, the room should not be used as AII or PE.

Airborne Infection Isolation (AII)

Max. organisms spread via air, hence infected

Patients kept in isolation

Organism spread via airborne droplet

nuclei <5 µm.

Air changes per hour (ACH) - > 12 ACH

From outside adjacent space into the room.

Air exhausted outside, but may be

recirculated provided return air is filtered

through HEPA filter (High Efficiency

Particulate Air)

Direction of airflow

Protective environment (PE)

Specialized patient care area – Positive airflow related to the corridor (Airflow from room to the corridor)

HEPA filtration to be used

High number of ACH >12

Minimal Leakage of Air

“For patients who have undergone

allogenic hematopoetic stem cell

transplantation”

Laminar Air Flow

Move air in a single pass

One way direction – optimizes air flow. Delivery of air @ 0.5 meters per second

However there is no specific data that demonstrate a survival benefit for

patients in PE.

Heating, Ventilation and Air conditioning system HVAC

Includes outside air inlet or intakes, filters, humidity, modification mechanism, cooling equipments, fans, duct work, air exhaust and diffusers or grills.

Infections result due to:

Decreased performance of HVAC System

Filter inefficiencies

Improper installation

Poor Maintenance

A centralized HVAC system operates as follows

Outdoor air enters the system where low-efficiency or roughing filters, remove large particulate & microorganisms, enters the distribution syst for approp. temp & humidity, than again filtered, than circulated

HEPA filter efficiency monitored by Dioctylphthelate test (DOP Test)

Preventive filters and duct maintenance (cleaning Duct vents, replacing filters)

Dust and moisture increases risk of spread of infection

Stagnation should be avoided

infectious diseases outbreaks mainly due to Poor maintenance of HVAC systems

HVAC maintenance

FILTER MAINTENANCE

Efficiency depends on density of filters which creates a drop in pressure.

Pressure differential across filters measured by manometers

Poorly maintained filters implicated in outbreaks of aspergillosis

Ultra Violet Germicidal Irradiation – UVGI

For reducing transmission of airborne

bacteria and viral infections

No effect on fungal spore

Upper room air irradiation

Duct irradiation

WATER

Culprit in spreading infections due to pseudomonas, Asperigillus etc

Practice hand Hygiene

Point of use filtration equipments

Eliminate contaminated water or fluid environmental reservoirs (e.g., in equipment or solutions)

Clean and disinfect sinks

No fish tanks or decorative fountains

Dialysis water quality – endoxin testing on product water

Hot water range 40.6°C to 49°C, cold water range <20°C

FOOD PREPARATION AND STORAGE

The food handlers should wear Head Gear and gloves while serving the food

The quality of Water - to prepare food and clean fruits and vegetables.

Potentially hazardous food – maintain at 140 Fº or above or int. temp. of 41 Fº or below

ENVIRONMENT SERVICESENVIRONMENT SERVICES

Select good disinfectants

Keep housekeeping surfaces visibly clean

Detergent and water adequate for non-patient care areas. (E.g. Administrative Offices).

Clean and disinfect “HIGH TOUCH AREAS” like door knobs, bedrails, light switches, surfaces in & around toilets, on and more frequently schedule than minimal.

Do not perform disinfectant fogging in patient care areas

Temperature- range comfortable-70-75°F (21-24 ° C)

Humidity – Relative Humidity -- comfortable range 30-60%

Pressurization

AII rooms – Negative pressurePE Rooms – Positive pressure Neutropenic

patients

Self closing doors mandatory for both.

ENGINEERING SPECIFICATIONS FOR IC

Laundry & BeddingOne must ensure that Laundry workers personal protective garments are not contaminated with blood

Laundry facilities

Receiving area of contaminated textiles must have negative pressure compared to clean area.

Ensure Hand washing after handling contaminated clothes & before handling clean clothes

Do not leave damp textiles or fabrics in machines overnight.

Disinfection of washing and drying machines not needed, if properly maintained

Contaminated Laundry

No sorting in patient care areas.

Use leak resistant containers

Use Identity Labels for the contaminated bags

Laundry process

If hot –water laundry cycles use Detergent in water at >=160°F for >=25 minutes

Special Situations Dry cleaning not required for routine

laundering

No recommendations regarding disposable v/s durable goods – unresolved issue

Hygienically clean textiles – laundered not sterilized

Mattresses & Pillows – keep them dry

Maintain integrity of matress – discard when torn

Flowers & Plants in patient care areas

No restriction in immunocompetent patient care areas

No fresh or dried flowers or potted plants in patient care areas for immunosuppresed patients.

If used, Vase water to be changed frequently

PEST CONTROL

Cockroach, Flies, maggots, ants, mice act as vector for transmission of microorganisms

Pest control in Kitchen, Operating rooms, Laundries, CSSD & other infection prone areas

Place Lab specimens in covered containers

Advise families, visitors & patients regarding importance of hand hygiene.

Avoid shaking hands in the hospital – biggest source of infection

Avoid meeting patients in ICU’s, it can cause cross infection

Hospital equipments and grounds should be maintained in a clean and sanitary condition

OTHER PRECAUTIONS

Aspergillus spp. Improperly functioning ventilation systems Air filters*,+ Air filter frames Window air conditioners Backflow of contaminated air Air exhaust contamination+ False ceilings Fibrous insulation and perforated metal

ceilings Acoustic ceiling tiles, plasterboard Fireproofing material

IMPLICATED ENVIRONMENTAL VEHICLE FOR ENTRY OF PATHOGENS

Damp wood building materials Opening doors to construction site Construction Open windows Disposal conduit door Hospital vacuum cleaner Elevator Arm boards Walls Unit kitchen Food Ornamental plants

Mucorales / Rhizopus spp. Air filter False ceilings HeliportScedosporium spp. ConstructionPenicillium spp. Rotting cabinet wood, pipe leak Ventilation duct fiberglass insulation Air filters Topical anestheticAcremonium spp. Air filtersCladosporium spp. Air filtersSporothrix Construction (pseudoepidemic)

ENVIROMENTAL SAMPLING

For monitoring the sterilization process

Monthly cultures of water & dialysate in hemodialysis unit.

Cultures from Operation rooms and ICU’s

No random undirected sampling of Microorganisms

SPECIAL ISSUESSPECIAL ISSUES

Operation room

The operation of a TB patient should be scheduled last to have adequate ACH

OR personnel should use NIOSH N95 respirators

OR room to be closed after Intubation for adequate ACH to remove 99% airborne particles

Temporary use of portable, HEPA filter may eliminate air borne contaminants

Breathing circuit filters with 0.1-0.2 ųm pore size to be used

INFECTION CONTROL MEASURES DURING RENOVATION/ REPAIR

Identify the target population for relocation based on risk evaluation

At risk patient should wear protective masks outside the PE room

Do not transfer the patient in elevators where the construction material is transported

Keep the entry & exit for the construction workers separate

Clinical lab to be free from dust

The workers should not be allowed in the outside clothes in the hospitals

Shut off the return air vents in construction zone

Exhaust air/dust outside

Set the pressure differential to keep at –ve press.

The humidity to be <65%

Construction zone to be cleaned daily

TEAM INVOLVED Infection control Personnel

Lab Personnel

Hospital Administrator

Director Engineering

Risk management personnel

Director of specialized services

Employee safety personnel

Environment service personnel

Construction Administrator

Project manager, contractor, architect

HEALTH CARE WORKERS

Employee Health Program

Annual Health Examination

Interim Health Examination

Follow up Examination

In house training programs for the Medical & Paramedical staff

Ensuring that the staff have heavy meals before joining duty

Needle stick injury to be reported immediately

FOR PATIENTS

Daily bathing / sponging of patient

Daily changing of Patient linen, including Uniform, Bed sheets, Pillow covers.

Keeping the infected patients in Isolation rooms

Reducing visitor traffic in rooms

Restricted visiting hours for ICU patients

Use of respiratory protection indicated for persons entering their room.

FOR RELATIVES

Keeping fixed visit hours for the relatives

Disincentives to reduce the visitors

Restriction of Children entry in patient care areas

COMMUNITYCOMMUNITY

Maintaining records of all infected cases identified

Surveillance report of all the infection cases to be reported to the government authorities like WHO, and local authorities

SOME INFECTION CONTROL SOME INFECTION CONTROL MEASURES AT STERLING HOSPITALMEASURES AT STERLING HOSPITAL

Vaccination of Hepatitis B to employees

Regular stool examination of food handlers

Follow up Examination

Maintain Register to ensure the hand washing before and after going to the wash room

“UP” sign outside infected patient rooms

Regular checking of nail, hair, uniform of health care workers

THANK U !!!!