Best Practices in Infection Prevention

Best Practices in Maternal and Newborn Care

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Session Objectives

By end of session, participants will be able to:• Describe disease transmission cycle • Outline key IP principles• Discuss appropriate handwashing and antisepsis• Discuss appropriate gloving and personal protective

equipment• Outline safe handling of sharps• Discuss proper instrument processing and waste disposal

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The Six Components of the Disease Transmission Cycle

1. Agent: Disease-producing microorganisms

2. Reservoir: Place where agent lives, such as in or on humans, animals, plants, soil, air, or water

3. Place of exit: Where agent leaves host

4. Mode of transmission: How agent travels from place to place (or person to person)

5. Place of entry: Where agent enters next host

6. Susceptible host: Person who can become infected

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Question ??

• How can we prevent the spread of infection?

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How can we prevent the spread of infection?

• Break disease-transmission cycle• Inhibit or kill infectious agent (applying antiseptic to skin

prior to surgery) • Block agent’s means of getting from infected person to

susceptible person (handwashing or using alcohol-based hand rub)

• Ensuring that people, especially healthcare workers, are immune or vaccinated

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How can we prevent the spread of infection? (cont.)

• Providing health care workers with proper protective equipment to prevent contact with infectious agents

• Give some examples of ways to break transmission cycle

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Why is infection prevention important?

• Protects patients/clients—helps provide quality care that is also safe

• Lowers health care costs—prevention is less expensive than treatment

• Prevents infection among health care staff and community

• Limits number and spread of infectious agents that can become antibiotic-resistant

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Question ??

• What is the most important infection prevention practice?

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Handwashing

• When to wash hands:– Before and after examining client– After contact with blood, body fluids or soiled

instruments, even if gloves are worn– Before and after removing gloves– Upon arriving at and before leaving workplace

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The single most practical procedure for preventing infection: Handwashing

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Handwashing: How to Wash Hands

• Steps:– Use a plain or antiseptic soap.– Vigorously rub lathered hands – together for 10–15 seconds.– Rinse with clean running water

from a tap or bucket. – Dry hands with a clean towel or

air dry them.

10

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Alcohol-Based Handrub

• More effective than handwashing unless hands are visibly soiled

• 2 mL emollient (e.g., glycerin) + 100 mL ethyl or isopropyl alcohol 60–90%

• Use 3 to 5 ml for each application and continue rubbing the solution over the hands until dry.

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Antisepsis

• Antisepsis for mucous membranes:– Ask about allergic reactions – Use water-based product (e.g., iodophor or

chlorhexidine), as alcohols may burn or irritate mucous membranes

• Skin preparation for injections:– If skin is clean, antisepsis is not necessary– If skin appears dirty, wash with soap and water– Before giving injection, dry with clean towel

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When to Glove

• When there is reasonable chance of contact with broken skin, mucous membranes, blood, or other body fluids

• When performing invasive procedure

• When handling:– Soiled instruments– Medical, or contaminated, waste– When touching contaminated

surfaces

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Guidelines for Gloving

• Wear separate pair of gloves for each woman/ newborn to prevent spreading infection from client to client

• What kind of gloves do you wear for:– Procedures involving contact with broken skin or tissue under skin?– Starting IV, drawing blood, or handling blood or body fluid?– Cleaning instruments, handling waste and cleaning up blood and body

fluids?– Never wear gloves that are cracked, peeling or have holes.

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Personal Protective Equipment

• Gloves: utility, examination, HLD/sterile • Eyewear: face shields, goggles, glasses• Aprons – Should be fluid-resistant – Should be decontaminated after use

• Protective footwear

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What’s wrong with this picture?

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Global Statistics onOccupational Exposure

• 3 million health care workers (HCWs) per year report needlestick injuries per year

• 2.5% HIV infections among HCWs are transmitted by needlestick injuries

• 40% of Hepatitis C and Hepatitis B infections among HCWs are transmitted by needlestick injuries

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(WHO, 2002)

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Safe Handling of Sharps

• Never pass sharp instrument from one hand directly to another person’s hand

• After use, decontaminate syringes and needles by flushing three times with chlorine solution

• Immediately dispose of sharps in puncture-proof container• Which is greatest, the risk of acquiring Hepatitis B or HIV from

a needlestick injury?

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Safe Handling of Sharps (cont.)

• Do not recap, bend, break, or disassemble needles before disposal

• Always use needle holder when suturing• Never hold or guide needle with fingers

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Instrument Processing

• Decontamination: – Should be done immediately after use– Makes objects safer to handle– How do you make a 0.5% chlorine solution for

decontamination?

• Cleaning:– Most effective way to reduce number of

organisms– Removes visible dirt and debris

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Instrument Processing (cont.)

• Sterilization: – Destroys all microorganisms– Includes autoclave, dry heat, chemicals

• High-level disinfection (HLD):– Destroys all microorganisms

except bacterial endospores– Includes boiling, steaming,

soaking

• Storage:– After processing, must remain dry and clean

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DECONTAMINATIONSoak in 0.5% Chlorine solution for 10 minutes

THOROUGHLY WASH AND RINSE Wear glove and other protective barriers

(glasses, visors or goggles)

HIGH-LEVELDISINFECTION (HLD)STERILIZATION

Acceptable MethodsPreferred Method

ChemicalSoak10-24 hours

Autoclave106 k Pa pressure(15 lbs./in2)1210C (2500F)

20 min. unwrapped30 min. wrapped

Dry Heat1700C60 minutes

Boil or SteamLid on

20 minutes

ChemicalSoak

20 minutes

COOL(Use immediately or store)

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What’s wrong with this picture?

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Housekeeping

• Each site should follow housekeeping schedule

• Always wear utility gloves when cleaning• Clean from top to bottom• Ensure that fresh bucket of disinfectant

solution is available at all times

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Housekeeping (cont.)

• Immediately clean up spills of blood or body fluids

• After each use, wipe off beds, tables and procedure trolleys using disinfectant solution

• Decontaminate cleaning equipment with chlorine solution

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Waste Disposal

• Separate contaminated waste from noncontaminated waste

• Use puncture-proof container for sharps and destroy when two-thirds full

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Contaminated waste includes blood and other body fluids, and items that come into contact with them,

such as dressings.

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Waste Disposal (cont.)

• Follow these steps to destroy contaminated waste and sharps:– Add small amount of kerosene to burn – Burn contaminated waste in open area downwind

from care site– Dispose of waste at least 50 meters away from

water sources

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Summary

• Everyone (staff and patients) is at risk for infection

• This risk can be reduced through rigorous adherence to IP practices:– Handwashing or using alcohol-based handrub– Antisepsis– Personal protective equipment, including gloving– Safe handling of sharps and needles– Instrument processing– Housekeeping and waste disposal

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ReferencesClark A. Grab bag of questions adapted from grab bag developed by A. Clark/ACNM.

Ganges F. 2006. Infection Prevention, a presentation in Accra, Ghana in Maternal and Newborn Care Technical Update. (April)

Tietjen L, Bossemeyer D and McIntosh N. 2003. Infection Prevention Guidelines for Healthcare Facilities with Limited Resources. Jhpiego: Baltimore, MD. Accessed at: http://www.reproline.jhu.edu/english/4morerh/4ip/IP_manual/ipmanual.htm.

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