INTRODUCTION TO INFECTION PREVENTION AND CONTROL

Infection prevention and control: is a practical, evidence-based approach preventing patients and health
workers from being harmed/exposed by avoidable infections. Defective IPC causes harm and can kill. IPC
affects all aspects of health care including hand hygiene, surgical site infections, injection safety,
antimicrobial resistance and how hospitals operate during and outside of emergencies.
Clinical waste
Clinical waste means waste from a healthcare activity (including veterinary healthcare) that:
 contains viable micro-organisms or their toxins which are known or reliably believed to cause
disease in humans or other living organisms. For example, if a patient is known or suspected to be
infected, or colonised, by an infectious agent. Clinical judgement should be applied in the
assessment of waste and should consider the infection status of a patient and the item of waste
produced.
 contains or is contaminated with a medicine that contains a biologically active pharmaceutical
agent, or
 is a sharp, or a body fluid or other biological material (including human and animal tissue)
containing or contaminated with a dangerous substance.
Learning objectives
Describe the different infection prevention and control measures in different settings
i. Hand hygiene
ii. PPEs
iii. Safe use and disposal of sharps
iv. Management of sharp injuries
v. Safe management of laundry
vi. Cleaning and decontamination of re-usable equipment
vii. Safe management of body fluid spillages
viii. Respiratory hygiene
ix. Commonly used terms related to kıllıng of mıcroorganısms

Term Definition

Antisepsis Application of an agent to living tissue to destroy or inhibit microorganisms in living tissue thereby
limiting or preventing the harmful effects of infection.
Antiseptic

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 A chemical agent that is applied to living tissues to kill microbes

Decontamination A process of destruction/killing or marked reduction in Number or activity of microorganisms

Disinfection A method of using chemical or physical treatment methods to destroy most vegetative microbes
or viruses, but not spores, in or on inanimate surfaces

A germicide that inactivates virtually all recognized pathogenic microorganisms but not
Disinfectant
necessarily all microbial forms.

Sanitization A process of reducing microbial load on an inanimate surface to a level considered

acceptable/safe for public health purposes. It is a process of cleaning objects without necessarily
going through sterilization.

Sterilization A process intended to kill or remove all types of microorganisms, including spores, and usually
including viruses, with an acceptably low probability of survival

Pasteurization A process that kills non sporulating microorganisms by hot water or steam at 65–100°C

Cleaning A process of removal of visible soil (e.g., organic and inorganic material) from objects and
surfaces and normally is accomplished manually or mechanically using water with detergents or
enzymatic products

Sources of infections

 Sources of (potential) infection include blood and other body fluids, secretions or excretions (excluding
sweat), placenta, contaminated sharps, non-intact skin or mucous membranes and any equipment or
items in the care environment that could have become contaminated.

 Other clients and attendants

 People in the community

 Health care delivery personnel

 Poorly disposed clinical waste

 Contaminated linen/laundry

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Principles of IPC
 All objects in contact with the client are potentially contaminated
 Every person is potentially infectious
 If an object is disposable, discard it as waste. However, if it is re-usable, prevent infection by
decontamination, cleaning, disinfection or sterilization.
INFECTION CONTROL MEASURES
Standard precautions represent the minimum infection prevention measures that apply to all patient care
regardless of suspected or confirmed infection status of the patient in any setting where healthcare is
delivered. These evidence-based practices are designed to both protect and prevent spread of infection
among patients and healthcare personnel.
Standard Precautions include:
 Hand hygiene
 Use of personal protective equipment (e.g., gloves, gowns, masks)
 Safe handling of potentially contaminated equipment or surfaces in the patient environment
 Safe injection practices
 Respiratory hygiene/cough etiquette
Transmission Based Precautions are practices by health workers to prevent transmission of infections
from known or suspected infectious patients, when Standard Precautions alone are inadequate to prevent
transmission.
Transmission Based Precautions include:
Contact Precautions – These apply to:
Handling of infectious agents of public health importance (e.g. multi- drug resistant organisms) that are
spread by direct contact. Situations that increase the chances of exposure to pathogens e.g. handling
wounds that drain large amounts of exudate, feacal incontinence and others
Contact Precautions include use of PPE, and isolation/cohorting of patients
Droplet Precautions are applied to prevent transmission of pathogens by large droplets (>5μ) generated
by talking, coughing or sneezing. The droplets may fall on mucous membranes (especially the nose,
mouth, and conjunctiva, of persons within a distance of 1 meter. The precautions include use of masks and
isolation
Airborne Precautions prevent transmission of infectious agents that remain suspended in the air over long
distances. Airborne precautions include isolation in well ventilated single-patient rooms, use of a mask by
the patient, and use of a respirator by the health worker
Key Message

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Good infection control practice is indicative of good quality health care for it reduces morbidity, mortality
and costs of care.
Health Care Acquired Infections are costly to the individual, health facility, health care system and the
Nation.
Benefits of IPC
Main benefits of good Infection Prevention and Control Practices include the following;
i. Reducing morbidity and mortality resulting from avoidable infections
ii. Reducing on average length of hospital stay, there by availing space for incoming patients and
reducing on overcrowding.
iii. Reducing on costs associated with management of Health Acquired Infections (HAIs).
iv. Avoiding litigation issues that may arise as a result of HAIs
v. To prevent the occurrence of infections and to minimize the risks of transmitting any infections
including hepatitis B, C, HIV to clients, health care staff and the community
Standard infection control precautions (SICPs)
There are 10 elements of SICPs in health care facilities:
a) patient placement/assessment of infection risk
b) hand hygiene
c) respiratory and cough hygiene
d) personal protective equipment
e) safe management of the care environment
f) safe management of care equipment
g) safe management of healthcare linen/laundry
h) safe management of blood and body fluids
i) safe disposal of waste (including sharps)
j) occupational safety/managing prevention of exposure (including sharps)
Standard infection control precautions (SICPs) are to be used by all staff, in all care settings, at all times,
for all patients whether infection is known to be present or not, to ensure the safety of those being cared
for, staff and visitors in the care environment.
SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmitting
infectious agents from both recognized and unrecognized sources of infection.
The application of SICPs during care delivery is determined by assessing risk to and from individuals. This
includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body
fluids.

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To protect effectively against infection risks, SICPs must be used consistently by all staff. SICPs
implementation monitoring must also be ongoing to ensure compliance with safe practices and to
demonstrate ongoing commitment to patient, staff and visitor safety.
1.1 Patient placement/assessment for infection risk
Patients must be promptly assessed for infection risk on arrival at the care area, e.g.,
inpatient/outpatient/care home, (if possible, prior to accepting a patient from another care area) and should
be continuously reviewed throughout their stay. This assessment should influence placement decisions in
accordance with clinical/care need(s).
Patients who may present a cross-infection risk include those:
 with diarrhoea, vomiting, an unexplained rash, fever or respiratory symptoms
 known to have been previously positive with a multi-drug resistant organism (MDRO), e.g., MRSA etc.
 who have been an inpatient in any hospital.
1.2 Hand hygiene
A process of keeping hands free of disease-causing germs e.g., bacteria, viruses etc.
Washing hands can keep one healthy and prevent the spread of respiratory and diarrhoeal infections.
Germs can spread from person to person or from surfaces to people when;
 Touch the eyes, nose, mouth with unwashed hands
 Prepare or eat food with unwashed hands.
 Blow the nose, cough or sneeze into hands and then touch other people’s hands and common objects.
 Hand hygiene is considered one of the most important ways to reduce the transmission of infectious
agents that cause healthcare associated infections (HCAIs).
Clinical hand-wash basins must:
 be used for that purpose only and not used for the disposal of other liquids
 have mixer taps, no overflow or plug and be in a good state of repair
 have wall mounted liquid soap and paper towel dispensers.
 Hand hygiene facilities should include instructional posters or job aids.
Before performing hand hygiene:
 expose forearms (below the elbow). If disposable over-sleeves are worn for religious reasons, these
must be removed and disposed of before performing hand hygiene, then replaced with a new pair.
 remove all hand and wrist jewellery. The wearing of a single, plain metal finger ring, e.g., a wedding
band, is permitted but should be removed (or moved up) during hand hygiene. A religious bangle can
be worn but should be moved up the forearm during hand hygiene and secured during patient care
activities

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 ensure fingernails are clean and short, and do not wear artificial nails or nail products
 cover all cuts or skin abrasions with a waterproof dressing.
To perform hand hygiene:
Wash hands with non-antimicrobial liquid soap and water if:
 hands are visibly soiled or dirty
 caring for patients with vomiting or diarrhoeal illnesses
 caring for a patient with a suspected or known gastrointestinal infection, e.g., norovirus or a spore-
forming organism such as clostridium difficile.
In all other circumstances, use alcohol-based handrubs (ABHRs) for routine hand hygiene during care.
ABHRs must be available for staff as near to the point of care as possible. Where this is not practical,
personal ABHR dispensers should be used, e.g., within the community, domiciliary care, mental health
units etc.
Where running water is unavailable, or hand hygiene facilities are lacking, staff may use hand wipes
followed by ABHR and should wash their hands at the first opportunity.
Perform hand hygiene:
 before touching a patient.
 before clean or aseptic procedures.
 Before and after eating food
 After visiting the toilet
 after body fluid exposure risk
 after touching a patient; and
 after touching a patient’s immediate surroundings.
 Always perform hand hygiene before putting on and after removing gloves.
 After blowing the nose, coughing or sneezing into the hands
 After touching an animal, animal feeds or waste
 After touching garbage

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Process of handwashing
 Completely wet hands with clean, running water (warm or cold) and apply soap
 Leather the hands by rubbing together with soap. Leather the back of hands, between fingers and
under the nails

 Scrub the hands for at least 20 seconds

 Rinse the hands well under clean running water
 Dry the hands using a clean towel or an air drier.

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Methods of performing hand hygiene
 Washing using clean water and soap
 Using hand antiseptics (hand sanitizers)
 Cutting nails short
1.3 Respiratory and cough hygiene
Respiratory and cough hygiene is designed to minimize the risk of cross transmission of known or
suspected
respiratory illness (pathogens):
 cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the
nose; if unavailable use the crook of the arm
 dispose of all used tissues promptly into a waste bin
 wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues,
or after contact with respiratory secretions or objects contaminated by these secretions
 where there is no running water available or hand hygiene facilities are lacking, staff may use hand
wipes followed by ABHR and should wash their hands at the first available opportunity
 keep contaminated hands away from the eyes nose and mouth.

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Staff should promote respiratory and cough hygiene helping those (e.g., elderly, children) who need
assistance with this, e.g., providing patients with tissues, a dedicated non-touch receptacle i.e. waste bag
for used tissues and hand hygiene facilities as necessary.
Use of Respiratory Protectors
Respiratory protection program is necessary to ensure safe and proper use where droplet spread is
anticipated.

1.4 Personal protective equipment (PPE)

Use of PPEs
PPE are devices worn by health workers for personal protection against hazards.
These are personal protective equipment
 Respiratory protection; e.g., nose mask.
 Eye protection; e.g., goggles
 Hearing protection; e.g., ear muffs
 Hand protection; e.g., gloves
 Foot protection; e.g., boots
 Head protection; helmet, face shield
 Skin protection; overalls, coats
Hierarchy of controls (HOC)
 Elimination or Substitution
 Engineering Controls
 Administrative Controls
 Practices and Procedures
 Personal Protective Equipment
Control methods at the top of the list are in general more effective and protective than those at the bottom.

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Before undertaking any procedure, staff should assess any likely exposure to blood and/or other body
fluids, non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects
adequately against the risks associated with the procedure. The principles of PPE use set out below are
important to ensure that PPE is used correctly to ensure patient and staff safety. Avoiding overuse or
inappropriate use of PPE is a key principle that ensures this is risk-based and minimizes its environmental
impact. Where appropriate, consideration should be given to the environmental impact of sustainable or
reusable PPE options versus single-use PPE while adhering to the principles below.
All PPE must be:
a) located close to the point of use. PPE for healthcare professionals providing care in the community and
domiciliary care providers must be transported in a clean receptacle
b) stored to prevent contamination in a clean, dry area until required (expiry dates must be adhered to)
c) single-use only unless specified by the manufacturer
d) changed immediately after each patient and/or after completing a procedure or task
e) disposed of after use into the correct waste stream, e.g., domestic waste, offensive (non-infectious) or
clinical waste
f) discarded if damaged or contaminated.
NB: Reusable PPE such as goggles/face shields/visors, must be decontaminated after each use according
to manufacturer’s instruction.
Application of PPE
How to Safely Use PPE
a) Keep gloved hands away from face
b) Avoid touching or adjusting other PPE
c) Remove gloves if they become torn; perform hand hygiene before donning new gloves
d) Limit surfaces and items touched
Gloves
Gloves must be:
a) worn to protect a person when directly handling potentially infectious materials or contaminated
surfaces where exposure to blood and/or other body fluids, non-intact skin or mucous membranes is
anticipated or likely
b) changed immediately after each patient and/or after completing a procedure/task even on the same
patient, and hand hygiene performed
c) changed if a perforation or puncture is suspected
d) appropriate for use, fit for purpose and well-fitting

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e) never decontaminated with alcohol Based Hand rub or soap between use
f) low risk of causing sensitization to the wearer
g) appropriate for the tasks being undertaken, taking into account the substances being handled, type and
duration of contact, size and comfort of the gloves, and the task and requirement for glove robustness
and sensitivity.
h) Wash hands upon removing gloves. Gloves do not replace the need for excellent hand washing!
The purpose is to protect from infectious agents/chemicals being transmitted/absorbed via;
a) hands.
b) Body fluids, mucous membranes non-intact skin
c) Contaminated equipment and surfaces
Sterile gloves must be worn:
a) when sterility is required in an operating theatre, and
b) for some aseptic techniques e.g., insertion of central venous catheters, insertion of peripherally
inserted central catheters, insertion of pulmonary artery catheters and spinal, epidural and caudal
procedures
NB: Double gloving is NOT recommended for routine clinical care. However, it may be required for some
exposure prone procedures, e.g., orthopaedic and gynaecological operations, when attending major trauma
incidents or as part of additional precautions for high consequence infectious disease management.
Gloves are NOT required to carry out near patient administrative tasks, eg, when using the telephone,
using a computer or tablet, writing in the patient chart; giving oral medications; distributing or collecting
patient dietary trays.
Considerations for use of gloves include;
a) Fit (tight fitting or loose fitting)
b) Material of the gloves (powdered, or non-powdered)
c) Sterile, non-sterile
d) Use and reuse, disposable versus reusable
Types of gloves depend on:
a) Nature of chemicals handled.
b) Nature of contact (total immersion, splash, etc.).
c) Duration of contact.
d) Area requiring protection (hand only, forearm, arm).
e) Grip requirements (dry, wet, oily).
f) Thermal protection.

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g) Size and comfort.
h) Abrasion/resistance requirements
Lab coats, scrubs, gowns, aprons and coveralls
a) Lab Coats and gowns are used to protect from infectious fluids
b) Front button cotton lab coats may not be appropriate for working with large amount of infectious liquid.
Rear fastening gowns may be appropriate for working at higher containment
c) Don’t wear lab coats outside of the lab or take them home
d) Cuffed sleeves can protect the wrists and lower arms
Gowns
Gowns are worn to protect a person from the contamination of clothing with potentially infectious material.
Wear a gown when contamination of clothing/uniform with potentially infectious material is possible. They
must be changed between patients and/or after completing a procedure or task.
The gown should fully cover the torso, fit close to the body and cover the arms to the wrists.
Protect the skin and clothing when working with dirt, paint, solvents, chemicals, oil, grease.
Overalls
These multipurpose suits are durable and can be worn over and over.
Head and body protection in a disposable coverall with elasticized cuffs to protect arms and legs.
The durable fabric is hard to tear or puncture, yet it functions as a breathable membrane that allows body
heat and sweat to escape while preventing chemicals, paints and particles from getting in.
Full body gowns or fluid-resistant coveralls must be:
a) worn when there is a risk of extensive splashing of blood and/or body fluids, e.g., operating theatre, ITU
b) worn when a disposable apron provides inadequate cover for the procedure or task being performed
c) changed between patients and removed immediately after completing a procedure or task
d) sterile when sterility is required in an operating theatre and for some aseptic techniques eg for insertion
of central venous catheters, insertion of peripherally inserted central catheters, insertion of pulmonary
artery catheters and spinal, epidural and caudal procedures.
Shoe and head covers
Shoe covers: Wear shoe covers to provide a barrier against possible exposure to airborne organisms or
contact with a contaminated environment. Footwear must be:
 visibly clean, non-slip and well-maintained, and support and cover the entire foot to avoid
contamination with blood or other body fluids or potential injury from sharps
 removed before leaving a care area where dedicated footwear is used, eg theatre; these areas must
have a decontamination schedule with responsibility assigned.

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Headwear
Headwear is not routinely required in clinical areas unless as part of theatre attire or to prevent
contamination of the environment such as in clean rooms. Wear head covers to protect the hair and scalp
from possible contamination when sprays or airborne exposure is anticipated.
Headwear must be:
a) worn in theatre settings and clean rooms, e.g., central decontamination unit
b) well-fitting and completely cover the hair
c) changed or disposed of between clinical procedures/lists or tasks and if contaminated with blood and/or
body fluids
d) removed before leaving the theatre or clean room
e) individuals with facial hair must also cover this in areas where headwear is required, eg wear a snood.
NB: Headwear worn for religious reasons such as turbans, veils, headscarves must not compromise
patient care and safety. These must be washed and/or changed daily or immediately if contaminated and
comply with additional attire requirements, for example, in theatres.
Eye and facial masks
PPE can protect mucous membranes and prevent ingestion whenever there is potential for splash to
eyes/face especially during the following:
a) Spill Clean up
b) Invasive procedures
c) Tail vein injections
d) Other high risk activities
Surgical masks with attached face shield protects mouth, nose and eyes from droplets but does not protect
from aerosols: It is not respiratory protection!!!
Eye or face protection (including full-face visors) must:
a) be worn if blood and/or body fluid contamination to the eyes or face is anticipated or likely, e.g., by
members of the surgical theatre team and always during aerosol generating procedures; regular
corrective spectacles are not considered eye protection
b) not be touched when being worn.
Fluid resistant surgical face masks (FRSM) are required:
a) as a means of source control, e.g., to protect the patient from the wearer during sterile procedures such
as surgery, and
b) to protect the wearer when there is a risk splashing or spraying of blood, body fluids, secretions or
excretions onto the respiratory mucosa.

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FRSM must be removed or changed:
a) at the end of a procedure/task
b) if the mask’s integrity is breached, e.g., from moisture build-up after extended use or from gross
contamination with blood or body fluids

Procedure for donning and doffing of PPE

PPE are devices worn by health workers for personal protection against hazards. They can be a source of
hazard if not properly used.
General procedures for donning
a) Remove ALL personal items (jewelry, cell phones, pens, watches, …)
b) Put on scrub suit and boots in the changing rooms
c) Move to the clean area at the entrance of the isolation unit
d) Gather PPE items (correct size)
e) Perform hand hygiene
f) Follow donning sequence under the guidance and supervision of a trained and skilled observer
g) Put on 1st pair of gloves
h) Put on coverall (gloves under cuff) – preferably when seated
i) Make thumb hole to anchor the gown
j) Ensure wrist is not exposed or too tight when arms are fully extended/stretched.
k) Put on face mask
l) Put on goggles
m) Hood up (integrated hood with coverall)
n) Or put on face shield and bonnet – a head cover that covers the neck and sides of the head
o) Put on Apron

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p) Put on second pair of gloves (over cuff)
Specific sequences for donning
Gown
a) Fully covered torso from neck to knees, arms to end of wrists, and wrap around the back.
b) Fasten in back of neck and waist.
Mask or respirators.
a) Secure ties or elastic bands at middle of head and neck.
b) Fit flexible band to nose bridge.
c) Fit snug to face and below chin.
d) Fit check respirator
Gloves.
a) Select correct type and size
b) Insert hands into gloves
c) Extend gloves over isolation gown

Do’s and dont’s of using gloves

a) Work from “clean to dirty”
b) Limit opportunities for “touch contamination” – protect oneself, others, and the environment
c) Don’t touch the face or adjust PPE with contaminated gloves
d) Don’t touch environmental surfaces except as necessary during patient care
e) Change gloves during use if torn and when heavily soiled (even during use on the same patient)
f) Discard in appropriate biohazard bin
g) Never wash or reuse disposable gloves
General procedure for doffing
a) Always remove PPE under the guidance and supervision of a trained observer (colleague).
b) Enter decontamination area by walking through chlorine tray.
c) Perform hand hygiene on gloved hands (0.5% chlorine).
d) Remove apron taking care to avoid contaminating your hands by peeling it off.

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e) Perform hand hygiene on gloved hands (0.5% chlorine).
f) Remove hood or bonnet taking care to avoid contaminating your face.
g) Perform hand hygiene on gloved hands (0.5% chlorine)..
h) Remove coverall and outer pair of gloves:
i) Tilt head back to reach zipper, unzip completely without touching any skin or scrubs, remove coverall
from top to bottom.
j) After freeing shoulders, remove the outer gloves while pulling the arms out of the sleeves.
k) With inner gloves roll the coverall, from the waist down and from the inside of the coverall, down to the
top of the boots.
l) Use one boot to pull off coverall from other boot and vice versa, then step away from the coverall and
dispose of it safely.
m) Perform hand hygiene on gloved hands (0.5% chlorine)..
n) Remove the goggles or face shield from behind the head (keep eyes closed).
o) Remove mask from behind the head (keep eyes closed).
p) Remove inner gloves with appropriate technique and dispose of safely.
q) Decontaminate boots appropriately and move to lower risk area one foot at a time.
r) Perform hand hygiene (0.05% chlorine).
Specific sequence for doffing
Gloves
a) Outside of gloves are contaminated
b) Grasp outside of glove with opposite gloved hand; peel off
c) Hold removed glove in gloved hand
d) Slide fingers of ungloved hand under remaining glove at wrist
e) Peel glove off over first glove
f) Discard gloves in waste container
Gown
a) Gown front and sleeves are contaminated
b) Unfasten ties
c) Pull away from neck and shoulders, touching inside of gown only
d) Turn gown inside out

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e) Fold or roll into a bundle and discard

Mask or respirators.
a) Front of mask or respirator is contaminated - DO NOT TOUCH
b) Grasp bottom, then top ties or elastics and remove
c) Discard in waste container

How to Don Eye and Face Protection

a) Position goggles over eyes and secure to the head using the ear pieces or headband
b) Position face shield over face and secure on brow with headband
c) Adjust to fit comfortably

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Foot wear
a) Footwear should be comfortable, with nonslip soles, leather or synthetic and fluid-impermeable.
Disposable, fluid resistant shoe-covers may be worn for activities where splashing is anticipated.
b) Open-toed sandals are inappropriate as footwear and not allowed in the laboratory. For routine work in
the laboratory, flat comfortable shoes are recommended.
1.5 Safe management of care equipment
Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious
agents. Consequently, it is easy to transfer infectious agents from communal care equipment during care
delivery.
Before using any sterile equipment check that:
a) the packaging is intact
b) there are no obvious signs of packaging contamination
c) the expiry date remains valid
d) any sterility indicators are consistent with the process being completed successfully.
Decontamination of reusable non-invasive care equipment must be undertaken:
a) between each use/between patients
b) after blood and/or body fluid contamination
c) at regular predefined intervals as part of an equipment cleaning protocol
d) before inspection, servicing or repair.
If providing domiciliary homecare, equipment should be transported safely and decontaminated as above
before leaving the patient’s home.
Process of cleaning and decontamination of reusable equipment
a) Clean medical equipment as soon as practical use because soiled materials become dried onto the
instruments making the removal process difficult.
b) Place the equipment under running water to remove body fluids like blood, urine etc
c) Remove visible organic residue (e.g., residues of blood and tissue) and inorganic salts with cleaning
agents that are capable of removing visible residues.
d) Place all unclean equipment and instruments in a cleaning sink/plastic bucket/basin and rinse under
warm water or cold water and detergent (0.5% JIK) to remove all contaminants.
e) Use detergents and enzymatic cleaners that are compatible with the metal material used. Ensure the
rinse step is adequate for removing cleaning residues to levels that will not interfere with subsequent
disinfection process. Involves scrubbing with a brush, detergent and water. The detergent is important
for effective cleaning because water alone does not remove proteins, oils and grease.

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f) Wash in soapy water.
g) After thorough washing, rinse in clean plain running water.
h) Dry the equipment in a drying cabinet (hot air oven) or use lint-free cloth.
i) Package the instrument by itself in a package that is large enough to open the instrument as far as
possible so that steam can penetrate all surfaces (during sterilization) of the instrument.
j) Seal the package and label with details of instruments
k) Store the equipment to prevent contamination after processing. Do not store instruments or other items
such as scalpel blades and suture needles in solutions, always store them dry.
1.6 Safe management of the care environment
The care environment must be:
a) visibly clean, free from non-essential items and equipment to facilitate effective cleaning
b) well maintained, in a good state of repair and with adequate ventilation and lighting for the clinical
specialty.
Routine cleaning
a) the environment should be routinely cleaned appropriately.
b) use of detergent wipes is acceptable for cleaning surfaces/frequently touched sites within the care area
c) a fresh solution of general-purpose neutral detergent in warm water is recommended for routine
cleaning. This should be changed when dirty or when changing tasks
d) cleaning protocols should include responsibility for, frequency of, and method of environmental
decontamination.
1.7 Safe management of linen/laundry
Healthcare laundry include: all types of beddings, cloth aprons used to protect personal
Healthcare linen is categorised as:
a) Clean linen – linen washed and ready to be used.
b) Used (soiled and fouled) linen – used linen, irrespective of state, which on occasion may be
contaminated by blood or body fluids, and
c) Infectious linen – linen that has been used by a patient who is known or suspected to be infectious.
The aim is to maintain a hygienic and controlled environment
a) Use and wear PPEs; wear tear-resistant reusable rubber gloves when handling and laundering soiled
linen.
b) Sort all the linen according to colour etc to avoid colour bleaching and staining of white linen.
c) Do not store clean and dirty linen together to avoid risks of contamination.
d) Carefully roll-up soiled linen to prevent contamination of the air, surfaces and cleaning staffs.

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e) Sock the linen in water.
f) Place soiled linen into a clearly labelled leak-proof bag. Donot attempt to wash contaminated items in
same room or location where it was used.
g) Clean and disinfect the designated container for soiled linen after each use.
h) To avoid cross-contamination between clean and dirty laundry, create two separate areas. Both areas
should be free from food, beverages or personal belongings and should have handwashing facilities
and job aids to assist staff with proper procedures. Preferably, separate entrance for soiled linen and
exit of clean linen.
i) Minimise bacteria by using hot/warm water or an eco-friendly ozone system. The use of chlorine bleach
assures an extra margin of safety.
j) Regularly clean and disinfect washing machines and materials using disinfectants to remove other
additional microbes that may not have been removed by laundry process.
k) The laundry should be dried and pressed (ironed) before being transported back to the room. Be sure
the items are well packaged before transportation to prevent contamination from dust and dirt.
Storage and handling of clean linen:
a) Hand hygiene should be performed prior to handling clean linen.
b) Clean linen should be removed from plastic bags before storage to prevent the growth of Bacillus
cereus.
c) Clean linen should be stored above floor level in a designated area, preferably an enclosed cupboard
that is clean, dry and cool.
d) If clean linen is not stored in a cupboard, then the trolley used for storage must be designated for this
purpose and completely covered with an impervious covering/or door that is able to withstand
decontamination.
e) Clean linen storage areas should be dedicated for the purpose and appropriately designed to prevent
damage to linen and to allow for the rotation of stocks.
f) Clean linen should be physically separated from used/infectious linen when in storage and during
transport.
g) Storage and handling of used (previously known as soiled/fouled linen) and infectious linen:
h) Staff handling used and/or infectious linen must wear appropriate PPE.
i) Hand hygiene must be performed after handling used and/or infectious linen.
j) Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen
deposit.
k) Used items of linen should be removed one by one and placed in the used linen hamper/stream.

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Do not:
a) rinse, shake or sort linen on removal from beds/trolleys
b) place used linen on the floor or any other surfaces e.g., a locker/table top
c) re-handle used linen once bagged
d) overfill laundry receptacles (not more than 2/3 full); or
e) place inappropriate items in the laundry receptacle e.g., used equipment/needles
f) Infectious linen must not be sorted but should be rolled together and sealed in a water-soluble bag
(entirely water soluble ‘alginate’ bag or impermeable bag with soluble seams), which is then placed in
an impermeable bag immediately on removal from the bed and secured before leaving a clinical area.
g) Store all used/infectious linen in a designated, safe, lockable area while awaiting collection. Collection
schedules must be acceptable to the care area and there should be no build-up of linen receptacles
h) All linen that is deemed unfit for re-use, e.g., torn or heavily contaminated, should be categorized at the
point of use and returned to the laundry for assessment and disposal.
i) Linen used during patient transfer, eg, blankets, should be categorized at the point of destination.
j) Linen from patients infected with, or at high risk of having, Hazard Group 4 organisms (haemorrhagic
fever viruses such as Lassa Fever) should be disposed of at the point of use as Category A waste and
must not be returned to a laundry.
1.8 Safe management of blood and body fluid spillages
a) Spillages of blood and other body fluids may transmit blood borne viruses. Spillages must be treated
immediately by staff trained to undertake this safely.
b) Blood and body fluids make up the most source of healthcare samples and this include, blood, Pleural
fluids, Aspirates, Urine, Sputum etc.
c) All these fluids should be handled with PPE gears, be handled as infectious and disposed off
appropriately following waste disposal guidelines.
d) All spillages should be cleaned immediately.
e) Care should be taken while pipetting to avoid aerosol formation.
Handling spillages
Spillages of blood and body fluids occurring in the healthcare working environment must be cleaned and
decontaminated promptly with strong disinfectant to render the place clean and safe to work in. The
consequences of a spill may be minimized by covering the work benches or work surface with a plastic
backed absorbent liner, when working with hazardous or potentially hazardous organisms or biological
materials.
Spots or small spills

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Spots or drops of blood or other small spills (up to 10cm) can easily be managed by wiping the area
immediately with paper toweling and then cleaning with saline and 0.5% sodium hypochlorite, followed by
rinsing with water and drying the area with towel.
Large spills
Large blood spills that have occurred in ‘dry’ areas should be contained and generation of aerosols should
be avoided. Soak the contaminated area for 10 min with 0.5% sodium hypochlorite, followed by rinsing with
water and drying the area with a towel.
General guidelines for large spillages
a) Notify others working in the same environment and evacuate immediately to prevent spreading spilled
material.
b) Close the room door to restrict access to the spill area and post warning sign, if needed. Wait until 30
minutes for aerosols to settle before entering spill area.
c) If individuals are exposed, immediately remove contaminated protective equipment and clothing, place
in biohazard bag to be decontaminated.
d) Wash hands and exposed skin with plenty of soap and water (rinse for up to 15 minutes).
e) Put on protective equipment (disposable gown, gloves and if needed, safety glasses and shoe covers
or gum boots) and assemble clean-up materials (disinfectant, biohazard bag, forceps, sharps
container, and paper towels).
f) Pick up broken glass (if available) with forceps and dispose into SHARPS container.
g) Initiate clean up with disinfectant as follows:
h) Cover the spill with dry paper towel (to absorb the liquid) and add appropriately diluted disinfectant or
another disinfectant-soaked towel over the spill.
i) Encircle the spill with another disinfectant taking care to minimize aerosol creation while assuring
adequate contact.
j) Collect all contaminated materials within the spill area into a biohazard waste container for
decontamination.
k) After at least 20 minutes contact time, pick up the paper towels and re-wipe the spill area with
appropriately diluted disinfectant.
l) Disinfect contaminated reusable materials.
m) Discard contaminated disposable materials using appropriate biohazardous waste disposal
procedures.
n) Remove the gloves and wash hands with soap and water.
1.9 Safe disposal of waste (including sharps)

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Purpose of waste disposal
 Minimize/prevent the spread of waste-related infections to the hospital personnel that handle waste
 Prevent the spread of infection to the local community
 To prevent injuries such as needle stick injuries that may result in transmission of infections
(Hepatitis B and C, HIV)
 To minimize environmental pollution
 To avoid vermin and rodents
Types of Infectious Waste
 Blood and other body fluids, sputum, vomitus and others
 Anatomical wastes; amputated limbs, placentae and other body parts
 Pathological waste; biopsy specimens and other diseased parts
 Sharps waste; used needles, scalpels, broken ampoules, infusion sets and others
Other Types of Hazardous Waste
 Chemical Waste (capable of causing a reaction),
 Pharmaceutical Waste (expired and residual medicines)
 Radioactive Waste
 Genotoxic Waste
 Pressurized Containers
 Heavy Metals
Non-hazardous Wastes
 Domestic waste
 Office waste
Waste Management Process
The following components are the WHO recommended steps for Health care waste management:
i. Minimization of waste,
ii. Segregation,
iii. Collection and Storage (Handling of waste)
iv. Treatment,
v. Transportation and
vi. Disposal
a) Waste Minimization
Possible ways in which waste minimization are achieved include:
i. substituting a hazardous material used in a process with a non-hazardous material

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ii. Process changes – e.g. wiping bench tops with suitable disinfectants vs. use of paper bench coat.
iii. reducing the amount of hazardous materials used
iv. Recovering and reusing materials
b) Segregation
In order for the biological wastes to be removed from a laboratory, the following procedures must be
followed:
i. Biological wastes derived from human sources (e.g., blood, body fluids, tissues, turmors, etc.) are
hazardous biological wastes and are placed in a red biohazard bag, however in the event where there
is a stock out of any of the colored biohazard bag, the available shall be used but LABELLED with type
of waste to be contained.
ii. These wastes are stored (decontaminated) before burning/incineration
iii. Liquid wastes generated from the laboratory equipment are poured down the drain after dilution with
huge amount of water. If the liquid waste contains a high concentration of acids or bases, then it is
neutralized before it is disposed.
iv. Sharps and sharp objects such as glass, syringes, disposable pipettes, and pipette tips that may be
contaminated with biological waste or pathogenic material are placed in a rigid, leak-proof, puncture-
resistant container.
v. Non-infectious wastes are placed in appropriate black waste bags, and put in a location for removal by
waste handlers. The process is practiced every morning of a working day.

Storage (Handling of waste)

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Waste is temporarily stored in the waste storage room before they are taken for disposal. However, some
waste maybe burnt within.

Treatment;
Disinfect and destroy waste before its final disposal. This is done by pouring 0.5% jik before being taken for
temporary storage by the staff.
Transportation
The waste should be treated at point of generation before being transported to the final disposal point.

Disposal
Finally, the waste can be disposed by burning, incineration, burying, crushing (sharps).
Liquid waste

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Liquid waste from supernatants and other suspensions of potentially infectious materials should be
discarded in a suitable container or poured down the sink followed by diluting with water.
Liquids should be gently poured down the side of the tube to avoid splashing.
The discard container is replaced when half-full, whichever occurs first.
Once the container has been emptied, it must be cleaned and disinfected before re-use.
Non-Infectious waste
Bottles containing non-infectious waste liquids are discarded and the containers washed and rinsed
thoroughly before re-use.
Non-hazardous liquids are disposed of in the sink and rinsed thoroughly with running water.

Potentially infectious solid waste

All potentially infectious solid waste must be placed in a plastic bag and sealed before transportation to the
waste storage area. This is done at the beginning of each working day.
Potentially infectious solid waste materials are burnt by cleaning staff.

Highly infectious waste e.g., anatomical limbs, placentas, soiled cotton, soiled gloves, containers with
body fluids etc should be discarded in red biohazard bag (bin).

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All these activities are done with the following objectives;
i. minimizing the hazards in handling, collecting, transporting, treating and disposing of waste; and
ii. minimizing harmful effects to the environment.
iii. All samples and other biological material no longer required should be discarded in containers
specifically designed, intended and marked for disposal of hazardous waste. Biological waste
containers should not be filled beyond their designed capacity.
iv. Laboratory management ensures that hazardous waste is handled by appropriately trained
personnel using appropriate personal protective equipment.
v. Healthcare facilities should not allow waste to accumulate. Filled containers should be removed
from work areas every morning and discarded
vi. Transport of waste that has not been treated may be allowed, provided that the material is
packaged and transported in a manner consistent with hazardous waste regulations to a facility for
safe and appropriate disposal.
Safe use and disposal of sharps
Sharps disposal container or safety box is specially designed puncture –resistant, rigid, impenetrable and
leak-proof container for collection and disposal of sharps. Wastes collected here include blood prickers,
syringes, needles, broken glasses, scalpels, and all forms of sharps.
Ensure the safety boxes are not filled to the brim. Once filled, seal off the cover and keep in a designated
area until final disposal by burning or incineration. Use disposable needles and syringes only once and
always wear gloves while handling sharps
Sharps containers must:
 have a handle (small community boxes do not require a handle) and temporary closure mechanism,
 employed when box is not in use
 be disposed of when the manufacturers’ fill line is reached

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Sharps injury
Sharps injury is an incident which causes a needle, blade/scapel or other medical instrument to penetrate
the skin.
There is a potential risk of transmission of a BBV (blood borne virus) from a significant occupational
exposure and staff must understand the actions they should take when a significant occupational exposure
incident takes place. A significant occupational exposure is:
 a percutaneous injury e.g., injuries from needles, instruments, bone fragments, or bites which break the
skin; and/or
 exposure of broken skin (abrasions, cuts, eczema, etc); and/or
 exposure of mucous membranes including the eye from splashing of blood or other high risk body
fluids.
Management of sharps injuries
 avoid unnecessary use of sharps
 sharps must not be passed directly hand to hand
 used sharps must be discarded at the point of use by the person generating the waste
 Never recap/re-sheath or bend a sharp object
 Keep fingers away from the tip of a sharp object
 If the object is reusable, put it in a secure, closed container after use.
 Allow the wound to bleed normally by holding it under running water
 Wash the wound with soapy water. Don’t scrub the wound while washing it.
 Dry the wound and cover with a waterproof plaster or dressing.
 Give PEP or appropriate if the victim’s serostatus is negative or unknown
 Give a tetanus toxoid (TT) vaccine to prevent infection

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Community processes and practices of infection prevention and control

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Infection control and prevention at community level starts by changing behavior including;
a) Regular handwashing
b) Appropriate use of face masks and other PPEs (protect from and prevent spread of respiratory
infections)
c) Using insect repellents
d) Ensuring upto-date routine vaccinations and participating in immunization programs
e) Taking prescribed medications such as antibiotics as directed by health professionals
f) Social distancing; avoiding contact with others
g) Using condoms when having intercourse especially with a new partner
h) Modifying the environment to eradicate pests, parasites, disease-causing vectors etc
i) Surveillance of diseases
j) Food safety
k) Improving air quality
l) Safe injection practices
m) Safe handling of potentially contaminated equipment or surfaces.
5S pillars

The 5S pillars provide a methodology for organizing, cleaning, developing and sustaining a productive work
environment

1S: Sort: remove unnecessary items or tools from the workplace and remain with what is needed only.
Store often used items on easily accessible areas close to point of use.

2S: Set (neatness); put items and tools where they best meet their functional purposes.

3S: Shine (cleanliness); inspection for and elimination of waste, dirt and damage e.g., remove old notices,
clean the areas, filled up waste bins etc.

4S: Standardize (uniformity); develop a set of best practices and make sure everyone knows and agrees
with them. Apply methods consistently and revisit them frequently.

5S: Sustain (discipline); practice the habit of doing what is required, maintain and continually improve on
the 5S practices all the time.

Lastly ensure Safety

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Total quality management (TQM)

Total Quality Management (TQM) refers to the management process that includes the commitment and
dedication of every employee in the organization to maintain a high-level quality in every sector for
customer satisfacations

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Benefits of TQM

 Strengthened competitive position in a business market

 Adaptability to changing or emerging market conditions and to environmental/governmental regulations
 Enforces higher productivity from the workers
 Enforces elimination of defects and waste of resources
 Higher profitability
 Improved job security for employees
 Improved customer focus and satisfaction

Surveillance of Health/facility acquired infections (HAIs)

QN: Define

i. Healthcare acquired infections (HAIs)

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 ii. Surveillance and Explain its importance in IPC programmes
1. HAIs are infections acquired in hospital by a patient who was admitted for a reason other than that
infection.
2. An infection occurring in a patient in a hospital or other health care facility in whom the infection was
not present or incubating at the time of admission. This includes infections acquired in the hospital but
appearing after discharge, and also occupational infections among staff of the facility. These HAIs are
caused by viral, bacterial, and fungal pathogens.
Surveillance is the ongoing systematic collection, analysis, interpretation, and dissemination of data. Such
data is used to monitor the occurrence of health events, set priorities, plan and evaluate interventions and
programs. For infection control programmes, data is often collected on:
 Specific health care associated infections e.g. surgical site and catheter associated infections.
 Infection or colonization with organisms of major IPC importance e.g. Clostridium difficile or multiply
antibiotic resistant organisms like Methicillin Resistant Staphylococcus Aureus (MRSA) and
Carbapenem resistant enterobacteriaceae (CRE)
 Patient care practices aimed at preventing health care associated infection (HAI) e.g. hand washing
and use of the aseptic technique
Importance/role of surveillance in IPC programmes
1. Early detection of outbreaks of HAI to facilitate timely intervention
2. Detect lapses/failures in infection control practices so as to institute timely corrective action
3. Understand the epidemiology of particular HAI in order to facilitate development/implementation of
appropriate IPC measures
4. Provide baseline data, and data at various points of time to enable monitoring/evaluation of the
success of various IPC interventions
5. Raise questions that could be subjects of detailed studies/research
Common HAIs
1. Pneumonia
2. Urinary tract infections (UTIs) caused by E. coli or multidrug resistant Klebsiella.
3. Gastroenteritis is the most common nosocomial infection in children, where rotavirus is a chief
pathogen: Clostridium difficile is the major cause of nosocomial gastroenteritis in adults
4. Sinusitis and other enteric infections, infections of the eye and conjunctiva.
5. Endometritis and other infections of the reproductive organs following childbirth.
6. Gangrene caused by Anaerobic Gram-positive rods (e.g. Clostridium)
7. Surgical site infections

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Viruses
There is the possibility of nosocomial transmission of many viruses, including the hepatitis B and C viruses
(transfusions, dialysis, injections, endoscopy), respiratory syncytial virus (RSV), rotavirus, and
enteroviruses (transmitted by hand-to-mouth contact and via the faecal-oral route). Other viruses such as
cytomegalovirus, HIV, Ebola, influenza viruses, herpes simplex virus, and varicella-zoster virus, may also
be transmitted.
Parasites and fungi
Some parasites (e.g. Giardia lamblia) are transmitted easily among adults or children. Many fungi and other
parasites are opportunistic organisms and cause infections during extended antibiotic treatment and severe
immunosuppression (Candida albicans, Aspergillus spp., Cryptococcus neoformans, Cryptosporidium).
These are a major cause of systemic infections among immunocompromised patients. Environmental
contamination by airborne organisms such as Aspergillus spp. which originate in dust and soil is also a
concern, especially during hospital construction. Sarcoptes scabies (scabies) is an ectoparasite which has
repeatedly caused outbreaks in health care facilities.
Flora from another patient or member of staff (exogenous cross-infection). Bacteria are transmitted
between patients:
(a) through direct contact between patients (hands, saliva droplets or other body fluids)
(b) in the air (droplets or dust contaminated by a patient’s bacteria)
(c) via staff contaminated through patient care (hands, clothes, nose and throat) who become transient or
permanent carriers, subsequently transmitting bacteria to other patients by direct contact during care
(d) via objects contaminated by the patient (including equipment), the staff’s hands, visitors or other
environmental sources (e.g. water, other fluids, food).
Flora from the health care environment (endemic or epidemic exogenous environmental infections).
Several types of microorganisms survive well in the hospital environment:
1. in water, damp areas, and occasionally in sterile products or disinfectants (Pseudomonas,
Acinetobacter, Mycobacterium)
2. in items such as linen, equipment and supplies used in care; appropriate housekeeping normally limits
the risk of bacteria surviving as most microorganisms require humid or hot conditions and nutrients to
survive
3. in food
4. in fine dust and droplet nuclei generated by coughing or speaking (bacteria smaller than 10 μm in
diameter remain in the air for several hours and can be inhaled in the same way as fine dust).
Factors influencing acquisition of HAIs

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1. patient immune status, age, underlying diseases, and any other therapeutic interventions
2. acquisition of a drug resistant agent
3. Crowded conditions within the hospital, frequent transfers of patients from one unit to another, and
concentration of patients highly susceptible to infection in one area (e.g. newborn infants, burn
patients, intensive care) all contribute to the development of HAIs.

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