Healthcare Associated Infections (HAI) can easily qualify as the most important patient safety concerns in hospitals. To address the menace of HAI, infection control is kept as one of the main objectives, while designing any healthcare delivery structure, policies and processes. Almost all activities that are done within hospital has a bearing on infection control and there are a large number of studies that has resulted in various good practices for controlling infections. NABH has also dedicated a full chapter on Infection Control, while standards and objective elements under various other chapters also incorporates infection control aspects in it. A list of all infection control measures, grouped under appropriate heading is given below for hospitals to keep a check on.
A. Facility and infrastructure for infection control
a.
Appropriate distance must be maintained between
adjacent beds. Various standards such as ASHRAE, JCAHO, BSI recommends a
minimum distance of 8 feet (2.4 meters) to be maintained between centres of
adjacent beds in a multi-bed ward. In ICU however, the inter-bed distance
should be higher, about 10 feet (3 meters), or an area of at-least 20 square
meter per bed.
b.
Adequate hand wash basins must be available in wards
and ICUs. Recommended norms are one hand wash basins for every 6 beds in wards
and for every 2 beds in ICU. Hospitals can however have lesser number of wash
basins, but it must be ensured that staff can easily access hand wash basins
from anywhere in ward. Alternatively, if the number of hand wash basins are
less, it can be compensated by providing hand rub solutions on every bed.
c.
Isolation rooms must be available, both in wards
and in ICU. These must be of both types, positive and negative isolation rooms.
Number of isolation room must be adequate as per the size and workload of
hospital. The isolation room must have appropriate, pressure, airlock, exhaust
depending upon its type.
d.
Adequate and demarcated space should be
available in wards to keep urine, stool samples of patients, their disposal,
washing and storage of contaminated / soiled linen, place to make disinfectant
solution and placement of bedpans etc.
e.
Separate room for storing dirty utility and
soiled linen must be available in all wards. These rooms must have facility for
bed pan sink, Macintosh sink, slop sink and supply of hot and cold water.
f.
Demarcated space for keeping biomedical waste containers
should be available in each ward. Each area should also have Janitor’s closet
to store housekeeping items.
g.
The floor and walls, especially in ICU must be easily
cleanable and non-porous.
h.
ICU should have defined protective and clean
zone. An air-curtain must be provided at entrance of ICU.
i.
ICU should have minimum 15 air changes per hour
(5 fresh + 10 recirculation) as per ASHRAE standards
j.
Operation theatre must meet zoning and ventilation
requirements. The details of OT related structural requirements can be referred here.
B. Organization for Infection control
Following HR and organizational structures must
be in place for infection control
a.
Infection control officer – He/she could be an
infectious disease specialist or a medical microbiologist, who works as an
in-charge of infection control
b.
Infection control nurses (ICN) – These are
nurses that are trained in infection control practices, surveillance and
monitoring. 2-3 ICN is required for a 100 bed hospital. ICN works for
implementation of infection control practices and for data collection through
surveillance
d.
Infection control team for implementing
infection control practices and measures across the hospitals
e.
Infection control programme: Infection control
programme describes everything that is planned and done to prevent infections
in the hospitals. This programme must be updated once a year
f.
Infection control manual – The manual documents
infection control practices for various functions in the hospital
C. Policies, processes, practices and implementation
Following policies and process must be in
place for infection control
a.
High risk areas within the hospitals should have
been identified and listed. These are areas which has higher potential of
spreading infection. Such areas include, OT, ICU, post-operative ward, blood
bank, CSSD, post-mortem area etc.
b.
High risk procedures that are performed within
hospital must be identified and listed. These are procedures that has higher
chance of causing infection to patients. Such procedures include, endoscopies,
long surgeries, cardiac catheterization, bone marrow transplants etc.
d.
Staff must use appropriate hand hygiene guidelines.
These guideline includes, when wash hands, what kind of hand washing is
required in different situations, proper method of hand washing (6 point or 9-point
hand wash) and other measures to keep hand hygienic
e.
Hand washing technique must be displayed near
every hand wash basin
f.
Personal protective equipment must be available
in all patient care area as per requirements. These include thing like gloves,
masks, aprons etc. The healthcare staff must know when and how to use the
personal protective equipment
g.
The policy of “One needle, one syringe, only one
time” must be followed across the hospital. Staff giving injections and
infusions must be trained on best injection practices
h.
Barrier nursing practices must be followed for
isolation patients
i.
Appropriate care bundles must be used for patients
on high risk of acquiring HAI, such as patients on ventilator, urinary
catheters, central line catheter and surgical patients
j.
An antibiotic policy must be available and
followed for prescribing antibiotics – Antibiotic policy is a policy document
that guides what kind of antibiotics should be prescribed for different kind of
clinical conditions. The antibiotic policy must be revised from time to time.
k.
A policy should be there for change of linen –
The linen must be changed daily, and whenever it gets soiled. It should also be
changed for every new patient getting admitted.
l.
Laundering process must adhere to infection control
measures. These include segregation and cleaning of soiled linen.
m.
Kitchen should be hygienic and sanitized condition.
Health check-ups of food handlers must be done to identify those who are
suffering with communicable diseases
n.
Housekeeping procedures must be defined and
standardized to achieve optimal infection control
o.
Procedure for identifying and handling infection
outbreaks must be available
q.
Procedure of segregation and handling of
biomedical waste should be followed, as per regulatory guidelines
r.
When any notifiable diseases are discovered, it
must be notified to appropriate authority
D. Surveillance, monitoring and indicators
a.
Surveillance for infection control should be
regularly carried out. The frequency of surveillance in high risk areas should
be higher
b.
Surveillance must include both, patient
surveillance and environmental surveillance
c.
The data of HAI should be collected through
surveillance
d.
The data collected through surveillance must be
verified
e.
During surveillance, monitoring of certain significant
type of infections should be done, such as occurrence of multi-drug resistant
organisms
f.
Compliance of hand-hygiene guidelines by
healthcare staff must be monitored
g.
Effectiveness of housekeeping services must be
monitored
h.
Following indicators must be used to determine
effectiveness of infection control measures
i.
Catheter-associated urinary tract infection rates
ii.
Ventilator associated pneumonia
iii.
Catheter linked blood stream infections
iv.
Surgical site infections
