Infection Prevention and Control in Hospitals

Infection Prevention and Control in Hospitals

Introduction

·        Infection prevention and control (IPC) in hospitals is a critical aspect of healthcare management aimed at reducing hospital-acquired infections (HAIs), protecting patients and healthcare workers, and ensuring safe clinical environments.

·        Effective IPC involves systematic practices, proper sterilization of instruments, routine maintenance of equipment, adherence to hygiene standards, staff training, and coordinated actions by dedicated infection control teams.

·        HAIs can lead to prolonged hospital stays, increased treatment costs, and in severe cases, mortality.

·        Therefore, hospitals implement rigorous infection control programs guided by national and international recommendations such as those from WHO, CDC, and HIC (Hospital Infection Control) guidelines.

 Sterilization of Instruments

·        Sterilization is the process of eliminating all forms of microbial life, including spores, from surgical instruments and medical devices.

Methods of Sterilization

1. Autoclaving (Steam Sterilization)
• Uses high-pressure saturated steam at 121–134°C.
• Common for surgical instruments, glassware, and some textiles.
• Effective against all microorganisms and spores.
2. Dry Heat Sterilization
• Uses hot air at 160–180°C for 1–2 hours.
• Suitable for powders, oils, and metal instruments that can withstand high temperatures.
3. Chemical Sterilization
• Uses agents like glutaraldehyde, formaldehyde, hydrogen peroxide, and peracetic acid.
• Useful for heat-sensitive equipment like endoscopes and MVA (Manual Vacuum Aspiration) sets.
4. Radiation Sterilization
• Uses gamma or electron beams.
• Mostly used in industrial sterilization of disposable items like syringes and gloves.
5. Filtration
• Sterilization of heat-sensitive liquids and gases through membrane filters.

Monitoring Sterilization

• Physical indicators: Temperature and pressure gauges on autoclaves.
• Chemical indicators: Color-change strips to verify exposure to sterilizing conditions.
• Biological indicators: Spore tests to confirm sterilization efficacy.

MVA Equipment Maintenance

·        MVA (Manual Vacuum Aspiration) is a minor surgical procedure often used for uterine evacuation.

·        Proper maintenance of MVA equipment is essential to prevent infections:

·        Disassembly and cleaning: All parts must be separated and cleaned immediately after use.

·        Sterilization: Follow autoclave or chemical sterilization protocols.

·        Inspection: Check for cracks, wear, or malfunctioning parts.

·        Lubrication: Ensure movable parts work smoothly, if required.

·        Documentation: Maintain logs for sterilization and maintenance.

Components of an Effective Infection Control Program

1. Policy and Procedures: Standardized IPC protocols for all departments.
2. Education and Training: Regular staff training on infection control practices.
3. Surveillance: Monitoring infection rates and patterns.
4. Hand Hygiene: Promoting proper handwashing practices.
5. Antimicrobial Stewardship: Rational use of antibiotics to prevent resistance.
6. Environmental Sanitation: Regular cleaning and disinfection of hospital premises.
7. Safe Waste Management: Proper segregation, collection, and disposal of biomedical waste.
8. Outbreak Management: Preparedness for rapid response to infection outbreaks.

Predictors of Infection

• Patient-related: Age, immunity, comorbidities, nutritional status.
• Procedure-related: Duration of surgery, use of invasive devices (catheters, ventilators).
• Environmental: Hospital cleanliness, air and water quality.
• Staff-related: Adherence to hand hygiene, use of personal protective equipment (PPE).

HIC Guidelines & Recommendations

Hospital Infection Control (HIC) guidelines provide standards for:

• Sterilization and disinfection protocols.
• Hand hygiene compliance.
• Use of PPE and barrier nursing.
• Surveillance and reporting of infections.
• Staff vaccination (e.g., Hepatitis B, influenza).
• Environmental cleaning and biomedical waste management.

Hand Washing

Techniques

1. Handwashing with Soap and Water: 40–60 seconds, including all surfaces of hands.
2. Alcohol-based Hand Rub: 20–30 seconds; use if hands are not visibly soiled.

Indications

• Before and after patient contact.
• Before aseptic procedures.
• After contact with blood, body fluids, or contaminated surfaces.
• After removing gloves.

Facilities

• Handwashing sinks with running water, soap, and disposable towels.
• Alcohol-based dispensers at point-of-care.
• Posters demonstrating proper technique.

Standard Precautions

• Hand hygiene.
• Use of PPE (gloves, masks, gowns, eye protection).
• Safe injection practices.
• Respiratory hygiene/cough etiquette.
• Proper cleaning and disinfection of equipment and surfaces.
• Safe handling of contaminated laundry and waste.

Hospital Infection Control Committee (HICCOM)

·        HICCOM is responsible for overseeing infection control practices in the hospital.

Functions

• Develop and update IPC policies.
• Conduct infection surveillance and audits.
• Review infection outbreaks and implement corrective actions.
• Facilitate staff training programs.
• Ensure compliance with national and international IPC standards.

Duties of Infection Control Nurse

• Monitor hand hygiene compliance.
• Ensure sterilization and disinfection protocols are followed.
• Maintain infection surveillance data.
• Educate staff on infection prevention practices.
• Assist in outbreak investigation and control measures.
• Coordinate with housekeeping, laundry, dietary, and CSSD departments.

High-Risk Procedures

Procedures that have a higher risk of infection include:

• Surgeries, especially open and long-duration procedures.
• Catheterization (urinary, central venous, arterial).
• Invasive diagnostic procedures (endoscopy, lumbar puncture).
• Mechanical ventilation.
• MVA and other minor surgical procedures.

Role of Service Departments

Housekeeping

• Regular cleaning, disinfection, and maintenance of floors, surfaces, and patient areas.
• Proper management of spills and contaminated material.

Dietary

• Ensure food hygiene and safe handling practices.
• Prevent contamination during food preparation and distribution.

Laundry

• Proper segregation of linen (clean vs. contaminated).
• Sterilization/disinfection of hospital linen before reuse.

CSSD (Central Sterile Supply Department)

• Responsible for cleaning, sterilizing, and distributing medical instruments.
• Maintains inventory and ensures adherence to sterilization protocols.

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