1. People:
It is the people in hospitals rather than the physical environment which constitutes the reservoir of infection. Repeated studies confirm hospital personnel as significant carriers.
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The single most important factor in the spread of nosocomial infection is the failure of hospital workers to wash their hands often enough. Conscientious washing of hands between patient contacts effectively prevents spread of cross-infection. Adequate hand washing facilities must be available in all areas.
2. Aseptic techniques:
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Strict adherence to aseptic techniques in various invasive procedures insertion and removal of catheters, surgical tubing’s, drainage tubes and packs need strict no-touch techniques even while they are done outside of operation theatres in nursing units.
3. Segregation of Contaminated Instruments:
One of the simple measures in wards and departments in a check on segregation of contaminated instruments and items from others there must be a system for keeping the contaminated pieces of linen, sputum cups, bedpans, urinals and similar items separately to minimise chances of getting mixed up with clean items.
4. Disinfection practices:
Different kinds of disinfectants vary in their reaction to different kinds of microorganisms. Phenolic compounds are active against gram-negative organisms, Quaternary ammonium compounds against staphylococci, streptococci, and Iodophores and hypochlorites have a broad spectrum of action. Selection of appropriate disinfectant for different purpose is important. The following should be checked.
i. Appropriate choice
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ii. Appropriate concentration
iii. Appropriate contact time
iv. Appropriate method of use.
Eliminate chemical disinfectants where sterilisation is the objective, where heat disinfection is possible, and where they are of doubtful value.
5. Sterilization Practices:
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An efficient CSSD ensures supply of properly sterilised articles to all users in the hospital because sterilisation process is more effectively controlled.
Each sterilisation must be monitored through the use of heat-sensitive tapes. Sterilisation in flash sterilisers in operation theatre, if used, must be done meticulously by a trained person.
All steam and ethylene oxide sterilisers should be checked at least once each week with a suitable live spore preparation by the laboratory.
Instruments which come in contact with mucous membranes but are disinfected rather than sterilised before use, such as endoscopes and anaesthesia equipment may be bacteriologically sampled on a spot check basis to ensure adequacy of disinfection.
6. Isolation Facilities:
Isolation facilities for patients with communicable diseases and those vulnerable to infection such facilities must be made available in ICU, nurseries, burn unit, transplant unit, etc.
Strict control on wearing of mask, gown and gloves must be exercised while attending to such patients. All articles taken for patient use must be treated appropriately.
7. Antibiotic Policy:
The major problem is involvement of organisms showing multidrug resistance. Use of antibiotics must be monitored and controlled.
Identification of bacterial isolates and antibiotics sensitivity testing should be done adopting standard techniques. The factors that influence antibiotic resistance in the hospital are as follows.
i. Volume of antibiotic use
ii. Extensive use of certain antibiotics
iii. Proportion of prophylactic to therapeutic antibiotic usage in monotherapy or combination therapy. The medical audit committee must specifically look for this.
8. Precautions for Staff:
Staff working in vulnerable area should be immunised against cholera, typhoid or hepatitis-B if indicated. All food handlers working in dietary department must be periodically screened for organisms causing typhoid, amoebiasis, and other intestinal parasites and must be checked for safe food handling practices. Persons with nose and throat infection must be temporarily removed from working in nurseries, ICU, or operation theatres.
9. Outpatient Department:
In outpatient department separate arrangements for receiving and examining patients suspected of having significant acute communicable condition should be made.
10. Dietary Service:
Storage of food articles and appropriate temperatures in refrigerators and deep freezers must be checked. Control of rodents and insects is a must to prevent contamination of stored food and supplies. Fruits and vegetables eaten raw must be thoroughly washed before consumption.
11. Careful Handling of Soiled Linen:
All soiled linen should be considered as potentially infected and treated with care. Such linen should be packed in separate bags before transportation to the laundry.
Linen likely to be contaminated with infectious microorganisms should be clearly labelled and handled with appropriate caution. In the laundry, soiled or infected linen should be processed separately. Water temperature above 70°C for 25 to 30 minutes will kill all microorganisms except spores.
12. Good Housekeeping:
Cleaning of walls, floors, window panes, window sills, bedside screens and tables, certain and fixtures including bathroom fixtures should be organised as a scheduled programme at predetermined intervals. Use of appropriate disinfectants must be made at such times.
13. Terminal Disinfection:
Terminal disinfection of isolation rooms must be carried out thoroughly on the same principle as operation rooms before permitting the room for reuse. At such times, the staff must use the same precautions (cap mask, gown, gloves) used for nursing in such isolation rooms.
14. Air Hygiene in Operation Theatres:
Clogging of air filters of the AC system renders the ventilation in operation theatres and such other areas ineffective. Air filters should be frequently cleaned.
Periodical smoke studies should be carried out for air movement in operation theatres and checking that the AC system is achieving the desirable number of air changes per hour.
15. Developing a Sense of Awareness:
Developing in all hospital workers a high sense of awareness, and training and retraining in the precautionary measures, prevention and control.