‫بسم هللا الرحمن الرحيم‬

Infection Prevention & Control

(I.P.C)
Amer Osman Omer
(RN, BSN, MSN, NPCF, ACBPT, KUCAT,
ABCT, ANA, AACN)
 ABOUT THE TRAINER-1
 Master of Science in nursing-(M.S.N)- Khartoum University.
 Bachelor of Science in nursing – El emem El Mahdi University.
 Accreditable Trainer at Khartoum University Centre for Advanced
Training.
 Accreditable Trainer at American Canadian Board for Professional
Training.
 Accreditable Trainer at Arab Board for Consulting and Training.
 ABOUT THE TRAINER-2
 E-Teaching and Training Specialist at Arab Board for Consulting
and Training.
 Member of American Nursing Association.
 Member of American Association of Critical Care Nurses.
 RCN i Accredited Certified Provider – Royal College of Nursing
(U.K).
 Critical and Intensive Care Nurse.
 Emergency Nurse.
 Contents of the Lecture
 Introduction.
 Hand Hygiene.
 Personal Protective Equipment(P.P.E)
 Isolation Procedure.
 Aseptic Technique.
 Waste Disposal
 Single Used Items.
 Employee Health.
Introduction:
 Infection control in a health care setting requires a
multiple approaches (CDC, 2007) and is responsibility of
everyone coming in contact with the patient. The vital role
is performed by a committed Infection Control Team
usually comprising:
Infection control practitioner or doctor.
Administrator.
Infection control nurse.
 Definitions:
 Infection: Infection occurs when viruses, bacteria, or other
microbes enter your body and begin to multiply.
 Disease: happens in a small proportion of infected people,
occurs when the cells in your body are damaged as a result
of infection, and signs and symptoms of an illness appear.
 Infection Prevention & Control: is the discipline / process
by which health care facilities develop and implement
specific policies and procedures to prevent the spread of
infections among health care staff and patients.
 CHAIN OF INFECTION

Infection requires 6 vital links:

1. Causative Agent
2. Infectious Reservoir
3. Portal of Exit
4. Mode of Transmission
5. Portal of Entry
6. Susceptible Host
Hand hygiene
Hand hygiene

 Hand hygiene is a general term referring to hand

washing, antiseptic hand rub, or surgical hand antisepsis.
Types of hand hygiene:
 Hand washing – washing hands with plain or
antimicrobial soap and water.
 Hand rubbing – Applying an antiseptic hand rub to
reduce or inhibit the growth of microorganisms without the
need for an exogenous source of water and requiring no
rinsing or drying with towels or other devices.
 Surgical hand antisepsis – An antiseptic hand wash or
antiseptic hand rub performed preoperatively by surgical
personnel to eliminate transient and reduce resident flora.
Indications:
 Five moments of hand hygiene:
o Before touching a patient
o Before clean/aseptic procedures
o After body fluid exposure risk
o After touching a patient
o After touching patient’s surroundings.
NOTE:
 Waterless, alcohol-based hand rubs are now the
preferred products for routine hand hygiene in healthcare
settings, unless hands are visibly soiled.
 Artificial fingernails or nail extenders are prohibited for
those having direct contact with patients at high-risk areas
(e.g. Intensive care units, OR etc.)
Point to be Considered
1- Do not wear jewelry .
2- Keep fingernails short .
3- Cleans under running water .
4- Avoid touching the sink.
5- Avoid splashing dirty water on uniform .
6- Repeat procedure if there any cut .
7- Regulate running water .
Supplies
 Plain (non-antimicrobial) soap:
These soaps are detergent-based and will remove lipids,
adhering dirt, and organic matter, They have no
antimicrobial activity. Such soaps can remove transient flora
from the skin.
 Antimicrobial soap:
These soaps are detergent-based and will remove lipids,
adhering dirt, and organic matter. They have antimicrobial
activity, They can remove transient and resident flora from the skin.
 Alcohols
- Alcohol-based hand rub is a solution that contains 60% to
95% alcohol and is designed to be applied to hands to reduce
the number of viable microorganism on the hands.
Alcohol-based hand rub Anti Microbial Soap
Hand washing technique:
o Wet hands with water.
o Apply enough soap to cover all surfaces.
o Rub hands together vigorously for at least 15 seconds,
generating friction on all surfaces of the hands and fingers.
o Rub hands palm to palm.
o Right palm over left dorsum with interlaced finger and vice
versa.
o Palm to palm with finger interlaced.
o Backs of fingers to opposing palms with fingers
interlocked.
o Rotational rubbing of left thumb clasped in right palm and
vice versa.
o Rotational rubbing, backwards and forwards with clasped
fingers of right hand i left palm and vice versa, (to remove
debris from under the fingernails.
o Rinse hands with water.
o Dry thoroughly with a single-use towel.
o Use towel to turn off faucet/tap.
Hand rub technique:
 Steps:
o Apply a 3-5ml of the product in a cupped hand and cover
all surfaces.
o Rub hands palm to palm.
o Right palm over left dorsum with interlaced fingers and
vice versa.
o Palm to palm with fingers interlaced.
o Back of fingers to opposing palms with fingers interlocked
o Rotational rubbing of left thumb clasped in right palm and
vice versa.
o Rotational rubbing, backwards and forwards with clasped
fingers of right hand i left palm and vice versa.
o Duration of the entire procedure: 20-30 seconds once
dry, your hands are safe.
complication
1- cracking
2- dryness
3- irritation
Personal Protective
Equipment (PPE)
Personal Protective Equipment (PPE)
 is used to create a barrier between HCWs and
patients, body substances, or surfaces. Appropriate
PPE (gloves/gowns/plastic aprons/eye protection)
should be used to prevent skin, eyes, mucous
membrane, airways and clothing exposure.
 Components of PPE can be used alone or in
combination based on the degree and risk of
exposure in order to achieve desired level of
protection.
Types of PPE:
 Gloves:
Gloves should be worn when there is contact with blood or
body fluids, non-intact skin or mucous membrane, by
touching surfaces / equipment contaminated with body
fluids.
o Types of gloves:
a. Sterile gloves
b. Non-sterile gloves
c. Heavy duty gloves
 Gloves should be discarded:

Between each patient.

 If they become heavily soiled, or contaminated with
infection.
If torn during patient care.
 Gowns / Plastic Aprons:
Gowns / Aprons should be worn if more extensive blood or
body fluids splashing of clothing are likely and during
procedures that may generate splashes or aerosolization of
body substances and cause the soiling of clothes.
o Types of gowns:
a. Sterile gowns
b. Non-sterile gowns
 The sterile gown is pre-opened and placed on the sterile field.
 Lift the gown from the sterile field touching only the inside
surface just below the neck band.
 Step back from the sterile field while letting the gown unfold at
arm's length from the body. The outer surface of the gown must
remain sterile.
 Carefully work the arms into the sleeves of the gown while holding
the hands and arms up.
 Insert the hands only as far as the seam of the inside cuff.
 The assistant, or circulating nurse, reaches inside the gown at the
shoulder level and pulls the gown over the shoulders. The assistant
secures the neck and waist ties at the back.
 Removing gown

Place fingers of dominant hand With the gown-covered hand, pull fold the outside of the gown
inside the cuff of other hand and gown down over dominant hand. together and dispose of it.
pull gown down over other hand. As the gown is removed
 Mask & Respirators:
o Types of Masks:
a. Standard surgical masks (Protects mouth & nose)
b. PPE for respiratory Protection: (Respirators (N- 95
masks) protects respiratory tract form airborne
infectious agents e.g., mycobacterium Tuberculosis).
c. High-efficiency particulate respirators.
d. Powered Air Purifying Respirators (PAPRs).
e. Half Air Purifying Respirator
 Masks should fully cover the nose and mouth and prevent
fluid penetration.
 Change mask between patients and sooner if mask
becomes wet, moist or torn.
 Wear an N95 mask when indicated to enter an airborne
isolation room, and Remove it only when outside of the
room.
 Protective Eye / Face wear:
o Eye/face wear should be worn if required for combined
protection from eye/face contamination by aerosolized
body substances.
o Wash and disinfect visibly soiled reusable face shields or
protective eyewear prior to reuse, according to hospital
policy.
o Protective eyewear / face wear are not to be worn after
leaving the patient room or procedure area.
Indication of PPE Use:
PPE is indicated to be used based on risk assessment as part
of standard precautions & Transmission based precautions.

 Contact: Appropriate PPE is Gown & Gloves

 Droplet: Appropriate PPE is Surgical mask, Gloves, and
Gown.
 Airborne: N95 mask / respirator before entering the room.
Sequence of donning and doffing of PPEs:
 Donning: PPEs should be donned in this order.
Hand hygiene, gown, surgical mask, goggles/face
shield then gloves.
 Doffing: PPEs should be doffed in this order:
Gloves, hand hygiene, goggles/face shield, gown, hand
hygiene, surgical mask then hand hygiene.
Disposal of PPEs:
a) Single-use PPE disposal:
o All PPEs are doffed inside the patient’s room except N95
respirator which is removed outside AIIR after closure of
the door of patient’s room in a specified waste receptacle
as per hospital waste disposal policy.
b) Reusable PPE:
o Manufacturer’s instructions must be followed for safe
reuse of PPE. e.g. Reuse of eye goggles etc.
o Reusable heavy-duty gloves and boots (individual use)
should be cleaned & disinfected after use and allowed to
dry.
Isolation Procedure
Isolation Procedure
Isolation is defined as the voluntary or compulsory separation
and confinement of those known or suspected to be infected with
a contagious disease agent (whether ill or not) to prevent further
infections.
Isolation - Why?
 To stop transmissible infections spreading to other sick patients.
 To protect vulnerable patients from normal germs e.g.leukaemia
 To stop spread of infection to all others e.g. TB
 Effects of isolation
isolation can have the following negative effects on patients and
staff:
 Patient may not be able to receive visitors, and in turn, become lonely
 Patient may be anxious
 Small children may feel their isolation is a punishment.
 Staff may need to spend more time with patients
 Patients may not be able to receive certain types of care due to the
risk that other patients may become contaminated
TYPES OF ISOLATION

 Strictisolation
 Contact isolation
 Respiratory isolation
 Blood and body fluid -precautions
 Reverse isolation
Strict isolation is used for diseases spread through the air
and in some cases by contact, Patient is kept in a room
separate from other patients, health care staff contact is
minimal, and in some cases visitors are not allowed. Is used
for the most contagious diseases of all.
Contact isolation: is used to prevent the spread of
diseases that can be spread through contact with open
wounds. Health care workers making contact with a patient
on contact isolation are required to wear gloves, and in
some cases a gown.
Blood and body fluids precautions: Used when
there is concern about communicable diseases
found in a patient's body fluid. Health care workers
making contact with the patient when body fluids are
involved must wear gloves.
Body fluids May include:
Blood, Semen, C.S.F, Vaginal secretion, Amniotic
fluid, Pleural fluid, Peritoneal fluid, Pericardial fluid.
Asepsis & Aseptic Technique
 Aseptic Technique

Asepsis divided into :

1- Medical asepsis:
Is the practice of techniques and procedures designed to reduce
the number of microorganism in an area (clean technique)
2- Surgical asepsis:
Includes all the sterile procedures and techniques used exclude all
microorganism from an area (sterile technique) .
 Recommended Medical aseptic techniques and safe
practices for preparation and use of:

a) Single-dose medication vials or single-use ampules.

b) Multi-dose medication vials.
c) Single-use devices (e.g., syringes, needles …etc.).
d) Single-patient devices (e.g insulin pen).
e) Ventilation circuits.
f) IV solution bottles.
g) IV sets (including secondary sets and add-on devices).
Nosocomial infections
infections acquired in  C.A.U.T.I
the hospital or other  C.L.A.B.S.I
health care facilities
 V.A.P
that were not present
or incubating at the  Surgical Site
time of the client’s  Pneumonia.
admission.
Antiseptic :
1- Typically an antiseptic is a chemical agent that is applied to
living tissue to kill microbes .

2- Note that not all disinfectant are antiseptics because an

antiseptic additionally must not be so harsh that it damages living
tissue .
Purpose
are applied to skin surfaces or mucous membranes for their anti-
infective effects.
Their uses include:
1- cleansing of skin and wound surfaces after injury.
2- preparation of skin surfaces prior to injections or surgical
procedures.
3- routine disinfection of the oral cavity as part of a program of
oral clean.
Sterilization

Sterilizationis the killing of all microorganisms in a

material or on the surface of an object.
Factors affecting sterilization by heat are:
o Nature of heat: Moist heat is more effective than dry heat
o Temperature and time: temperature and time are inversely
proportional.As temperature increases the time taken decreases.
o Number of microorganisms: More the number of microorganisms,
higher the temperature or longer the duration required.
o Nature of microorganism: Depends on species and strain of
microorganism, sensitivity to heat may vary. Spores are highly
resistant to heat.
o Type of material, Presence of organic material: such as protein,
sugars, oils and fats increase the time required.
Autoclave
A modern front-
loading autoclave
stovetop
Color Change Sterilization Indicators
Waste Disposal
Waste Disposal

 The World Health Organization (WHO) categorizes waste

substances produced by hospitals according to their
density and constitution. Wastes are divided into the
following groups: infectious, sharps, pathological,
pharmaceuticals, radioactive, and others.
Medical Waste Containers
Single Use Devices (SUD)
Single Use Device (SUD).
Single Use Device: a medical device that is intended for
single use only, on an individual patient for a single
procedure, and then should be discarded. It should not be
reprocessed or reused again even on the same patient.
 A device labeled as ‘Single Use Device – SUD’ MUST
NOT be reused.
 SUD should only be used on an individual patient during a
single procedure and then discarded.
 Single-use devices should not be reprocessed or used
again, even on the same patient.
Employee Health
The Employee health program will perform
the following duties through (E.H.C)
 Record Keeping.
 Medical and Occupational History.
 Pre-employment Screening.
 Periodic Medical Examination.
 Vaccination according to updated international standard.
 Management of needle stick injuries and body fluid
exposure.
 Post exposure prophylaxis, followup.
 In case of incident with potential transmission of infectious
disease the case should be referred to infectious disease
department in the institution.
 Management of occupational illnesses and injuries.
 Training.
 Occupational health risk management.
 Treatment, Rehabilitation, and compensation services.