STANDARD PRECAUTIONS

Dr. K.Pragathi,
Consultant Microbiologist,
Infection Control Officer,
AIG Hospitals, Gachibowli.
 DEFINITION

Standard Precautions are a set of precautions

designed to prevent transmission of diseases while
providing health care to all patients regardless of
their diagnosis or presumed infective status.
 LIST OF STANDARD PRECAUTIONS:

 Hand hygiene

 Bio-medical waste management

 Use of personal protective equipment

 Safe injection & infusion practices

 Handling of sharps

 Safe handling of linen

 Cleaning & Disinfection of Medical Equipment.

 Cleaning & Disinfection of Environment.

 Spill management

 Respiratory and cough hygiene

HISTORY OF HAND HYGIENE

 Much higher risk of

puerperal fever in
women delivered by
physicians or medical
students as opposed to
those delivered by
midwives.
 INTRODUCTION

STANDARD IPSG: 5

The hospital adopts and implements

evidence based hand hygiene
guidelines to reduce the risk of health
care associated infections.
ROLE OF HAND HYGIENE IN PREVENTION OF HAI s
 WHY TO PERFORM HAND HYGIENE

Organism transfer from patient to hcws’ hands Organism survival on HCWs’ hands
 Failure to cleanse hands results in
Incorrect hand cleansing between-patient cross-transmission.

A
 Failure to cleanse hands results in Failure to cleanse hands during patient care
between-patient cross-transmission results in within-patient cross-transmission
B
WHEN TO PERFORM HAND HYGIENE
EVALUATION OF PRODUCT EFFICACY OF HANDRUB
AND HANDWASH AGENTS

S.NO METHOD OF HAND HYGIENE TYPE OF STANDARD RECOMMENDED

STANDARD

1. HYGIENIC HANDWASH EUROPEAN EN 1499

2. SURGICAL HANDWASH EUROPEAN EN 12791

3. HYGIENIC HANDRUB EUROPEAN EN 1500

3. HYGIENIC HANDWASH AMERICAN ASTM E-1174

4. SURGICAL HANDSCRUB AMERICAN ASTM E-1115

 METHODS OF HAND HYGIENE

Hand hygiene methods: 3 methods Hand wash

Hand wash with or without

antimicrobial solution.
Duration: 40-60 sec.
Alcohol-based hand rub
Hand rub.
Duration: 20-30 sec.

Surgical handwash.
Duration : 3min (minimum)
 BARE BELOW ELBOW TECHNIQUE

 All clinical staff to remove wrist watches/bracelets when attending to a

patient.
 No jewellery is permitted, must not wear false nails.
 Sleeves should be rolled up and above the elbow .
 Ties be removed or secured .
 Long hair should be tied back and off the collar.
 Staff with direct patient contact must not wear false nails.
HAND WASH OR HAND RUB TECHNIQUES
AREAS FREQUENTLY MISSED DURING HAND WASHING
SURGICAL HAND WASH TECHNIQUE
 FACILITIES FOR HAND WASH

 Sink with elbow operated taps.

 Hand hygiene posters near all sink

areas.

 Liquid soap or antiseptic solution /

Chlorhexidine 4% Scrub in dispenser
which should be refilled when container is
completely empty.

 Disposable paper towels in dispenser.

Waste container with foot pedal.

 CORRECT STORAGE OF ALCOHOL HANDRUB

 It is recommended that no more than five litres (10 bottles) should be held in
storage in a locked metal cupboard.

 JCI allows ABHR dispensers to be placed in corridors that at least 6feet wide.

 Dispensers in these corridors must be positions atleast 4feet apart.

 HAND HYGIENE FOR PATIENTS AND VISITORS

Patients should be encouraged to wash their hands, especially at the following times:-

 After using the toilet/bedpan/commode .

 Before eating or handling food.

 When caring for lines e.g. Hickman .

 When participating in dressings.

 Care of drains at home after discharge .

 HAND HYGIENE TRAINING PROGRAM

HIC COMMITTEE

INFECTION CONTROL OFFICER

Infection Control Nurses

HIC LINK STAFF
1. Induction & annual trainings for all staff . 1.Clinical administrators
2. Nurse in-charges To train
their
3. HK supervisors respective
2. Monitoring & audits on hand hygiene programme. 4. F&B supervisors staff
5. All managers
3. Compilation of data & presentation in HICC.

Education of HCWs is an inherent component of the work of the infection control team.
(WHO Guidelines)
 Global burden of health care-associated infections
• Global Patient Safety Challenge

• Morbidity, mortality, and costs associated with HCAIs

Transmission of pathogens
Contents of • Routes of transmission
educational and • Consequences for the patient and the HCW (colonization and infections)
training
Strategy to prevent the transmission of pathogens
programme • Standard precautions
for Health-Care
• Hand hygiene
Workers
• Care-associated precautions
Indications for hand hygiene
• Concept of health-care area and patient zone

• “My five moments for hand hygiene”

• Hand hygiene agents and procedures: Care of hands

Glove use
MONITORING COMPLIANCE TO HAND HYGIENE
Element of Policy Lead Tool/Method Frequency Who will Where results will
to be monitored undertake be reported.
Hand Hygiene IPT Hand Hygiene daily Audits: Daily ICNs and Link HIC Committee
Practice Inpatient areas/ Outpatient Nurses. meetings
Areas/surgical scrub .

Hand Hygiene IPT Saving Lives observation Twice a year ICN/ Infection HIC Committee
Practice. audits (CVC, PVC, Urinary for each control Link meetings
Catheter Care, Renal audit. Nurses.
Dialysis) (Max 10
observations for each area).

Process for IPT HIC Link staff to ensure that

checking that staff all their staff receive hand Induction HIC Link staff. HIC Committee
attend Hand hygiene and annual meetings.
Hygiene training training. trainings.
on induction and
following up those
who fail to attend.
HAND HYGIENE COMPLIANCE RATE JUL-2021 TO FEB-2022

100,00%

95,10%
95,00%
92,90%
91,51%
90,79%
89,86%
90,00% 88,70%

86,37%
85,00%
82,26%

80,00%

75,00%
Jul.21 Aug.21 Sep.21 Okt.21 Nov.21 Dez.21 Jän.22 Feb.22
MONTHLY HAND HYGIENE AUDIT REPORT
HAND
HYGIENE
AWARENESS
CAMPAIGN
BIO-MEDICAL WASTE MANAGEMENT
 What is Biomedical waste ?

Bio-medical waste means any waste, which is generated during-

• The diagnosis

• Treatment

• Immunization of human beings or animals

• In research activity.
 WHY BMW MANAGEMENT?

Potential health hazard to

• Patients

• Patients relative

• Health care workers

• Environment

Legal issues
 WHY BMW MANAGEMENT?

• Sharp injuries to collectors or transporters

• Health hazard to rag pickers

• Prevent reuse of disposable items

• Prevent outbreaks of infections

• Separate noninfectious waste from infectious waste

 WHO IS RESPONSIBLE FOR BMW MANAGEMENT?

All persons who-

• Generate,
• Collect,
• Receive,
• Store,
• Transport,
• Treat,
• Dispose or
• Handle biomedical waste in any form.
 WHAT ARE THE RULES FOR BMWM?

 BMW rules were formed under Environment Protection Act,1986 by the

Ministry of Environment and Forest; Government of India.

 Biomedical waste Management and Handling rules,1998 implemented on

20th July 1998.

 The guidelines have been prepared to enable each hospital to implement the
said rules.

 Further amendments of the Biomedical Waste (Management & Handling)

Rules 1998, were done by Government of India in the year 2000 & 2003.
Who ever breaks the rules of BMWM
is liable for punishment in the form of

5 years of imprisonment
Or
Penalty of 1 Lakh
Or
Both

As per new guidelines under Biomedical Waste Management

Rules, 2016
CLASSIFICATION OF HEALTH CARE WASTE

Health care Waste

85% Non-infectious 15%

Infectious/Hazardous
 STEPS IN BMW MANAGEMENT

1. Waste segregation at source

2. Transport to common collection facility
3. Central storage
4. Final transport and disposal
5. Record keeping
6. Updating of Information in Website
CATEGORIES OF BIOMEDICAL WASTE (SEGREGATION)
 TRANSPORT TO COMMON COLLECTION FACILITY

 Time of collection : Should be fixed and appropriate to the quantity of waste

produced.
 PPE : Staff handling BMW should be provided with appropriate PPE.
 Packaging :Bags should be sealed when 3 / 4th full.
 Labeling : Color coded bags should be printed with Bio hazard symbol and labelled
with details.

Biohazard symbol

Barcode labels :
SPECIFICATIONS FOR PLASTIC BAGS AND CONTAINERS

Plastic bags :
 Labelling :
• Name and Registration number of
manufacturer
• Thickness of bag.
• Type of material

 Plastic bags must bear a label of

“Recycle”
 For compostable plastic bags -
“COMPOSTABLE” label.
 Thickness of non chlorinated plastic bags
- 50-micron width.

Containers :
For collection of sharps and glassware – as per
WHO in PQS performance specifications.
 IN HOUSE TRANSPORTATION OF BIO MEDICAL WASTE

Transportation trolleys : Closed

trolleys.

Route of transport :

• Should not be through High risk areas

and High traffic areas.
• Supplies and waste transport should be
separate.
• Central waste collection area should be
easily accessible.
 CENTRAL WASTE COLLECTION ROOM

 Location : Away from public/visitors

access.
 Size : Sufficient to store at least 2 days
of waste.
 Rooms should be under lock & key.
 Entrance : Must be through a concrete
ramp.
 Flooring : Should be easy to clean.
 Exhaust fans: For ventilation.
 Water supply : Adjacent to BMW
storage area.
 Signage board : ‘Entry for authorized
personal only’ and logo of Bio Medical
Waste hazard.
 RECORD KEEPING

 Category wise quantity of waste generated must be recorded in register.

 Records on training on BMW management – Induction and In service.
 Records for annual health checkup.
 Records of vaccination
 Records of any accidents including CAPA taken.
 Records of Autoclave maintenance.

All records related to handling of BMW should be retained for a period of 5 years.
NON-COVID BMW WEIGHTAGE REGISTERS
COVID BMW WEIGHTAGE REGISTERS
HK STAFF INDUCTION TRAINING RECORDS
UPDATING OF INFORMATION IN WEBSITE
 STANDARDS FOR AUTOCLAVE

Recording of operational parameters :

Temperature, Pressure and time are displayed on

monitor of the Autoclave.

Holding time : 60 min.

Chemical indicator / external tape : With each

batch.

Spore testing : Once a week.

AUTOCLAVE REGISTER
AUTOCLAVE PRINT REPORT
 CYTOTOXIC WASTE DISPOSAL
CYTOTOXIC WASTE DISPOSAL
All items of Cytotoxic waste except sharps are discarded in Yellow bins with Cytotoxic label C
CYTOTOXIC WASTE DISPOSAL
CYTOTOXIC WASTE DISPOSAL
RAPID ANTIGEN TEST KITS DISPOSAL

Covid-19
waste
DISPOSAL OF ABG SYRINGES
SAFE INJECTION AND INFUSION PRACTICES
 SAFE INJECTION PRACTICES

A set of measures intended to prevent transmission of infectious

diseases between one patient and another or between a patient
and health care personnel (HCP) during preparation and
administration of injectable (e.g., intravenous, intramuscular
injection) medications.
 SAFE INJECTION PRACTICES

PROCESS FOR SAFE INJECTION

PROCESS FOR SAFE INJECTION
 WHAT IS PPE?

Personal protective equipment (PPE) is refers to

equipment designed to protect the wearer from injury or
the spread of infection or illness.
 PPE INCLUDES:

Gloves
Gown
Mask
Goggles or face shield
Head cap
Shoe cover
 SEQUENCE FOR DONNING PERSONAL PROTECTIVE
EQUIPMENT (PPE).

• Gown
• Mask or respirator
• Goggles or face shield
• Gloves
 SEQUENCE FOR REMOVING PERSONAL PROTECTIVE
EQUIPMENT (PPE)

• Gloves
• Goggles/face shields
• Gown
• Mask
ENVIRONMENTAL CLEANING AND DISINFECTION
PRINCIPLES OF ENVIRONMENTAL CLEANING AND DISINFECTION

• Cleaning is an essential first step in any disinfection process.

•Helps to remove pathogens .
•Disinfectant concentration and contact time are also critical for effective surface disinfection .
•Cleaning should progress from the least soiled (cleanest) to the most soiled (dirtiest) areas.
•Use fresh cloths at the start of each cleaning session .
• Soiled cloths should be reprocessed properly after each use .
• SOP should be available for the frequency of changing cloths.
•Equipment used for isolation areas for patients with COVID19 should be colour-coded and separated from
other equipment.
•Fresh solution should be prepared ideally for each cleaning shift.
• Buckets should be washed with detergent, rinsed, dried and stored inverted to drain fully when not in use.
•Appropriate personal protective equipment (PPE) should be worn to avoid chemical exposure.
CLEANING IS AN ESSENTIAL FIRST STEP IN ANY DISINFECTION
PROCESS.

DUSTING SCRUBBING MOPPING

 DISINFECTANTS FOR CLEANING AND DISINFECTION

Hypochlorite products Hydrogen Peroxide > 0.5% Alcohol : 70-90% .

DILUTION PROTOCOLS USED FOR VARIOUS DISINFECTANTS IN
AIG HOSPITALS.
Disinfectant Purpose Disinfectant Water Total volume

Sodium Work Surfaces 25 ml 975 ml 1000 ml

hypochlorite 0.1%
Sodium Discarding jars,test 62.5 ml 937.5 ml 1000 ml
hypochlorite tubes .
0.25%
Sodium Spillages 250ml 750 ml 1000 ml
hypochlorite 1%

Hydrogen Floors and surfaces 500 ml 4500 ml 5000 ml/ 5 Lit

peroxide 10 %

Hydrogen Fogging 200 ml 800 ml 1000 ml/1 Lit

Peroxide
20 %
 CLEANING AGENTS

PRODUCT
RECOMMENDED USAGE KEY AREAS
PRODUCT DESCRIPTION
Bathroom cleaner Normal soiling: 10ml in 1 liter of water. All surfaces in bathroom, sink, tub,
R1 & R6 (TASKI) cum sanitizer
Heavy soiling: 30ml in 1 liter of water tiles, floor and fittings,
concentrate
All hard surfaces (eg: TV cabinets,
photo frames, telephones, etc)
Hygienic hard Hard surface: 20-50 ml in 1 liter of water including glass mirrors and also on
R2(TASKI) surface cleaner shiny floor surfaces like polished
concentrate Glass: 10-20ml in 1 liter of water
marble, granite etc.

All types of glass, windows, mirrors

Glass cleaner and glass display cases
GLASS CLEANER 20-50ml in 1 liter of water
concentrate

Removes lime scale deposits and

stubborn stains and leaves toilet
R6 (TASKI) Toilet bowl cleaner ready to use product bowls and urinals sparkling clean

Normal soiling: 20ml in 1 liter of water Used for both wet mopping as well as
Floor cleaner
R2 (TASKI) scrubbing with a machine on all kind
concentrate Heavy soiling: 50ml in 1 liter of water of floors
CATEGORISATION OF HOUSE KEEPING AREAS​

Different areas in the hospital have been broadly categorised into :

General areas :
Only general traffic is present ; admitted patients are not present
patient care activities and procedures are not performed: street clothes
and footwear are worn.
Eg : Corridors, parking spaces, registration area etc.

Patient Care Areas :

All areas in the hospital where patients are admitted and patient care
activities and procedures are performed.
Eg: Operation theatres, ICU’s, HDU’s, Isolation rooms, IPwards,
OPD’s etc.
 Classification Based on Risk analysis :

Level -1( Very high risk): OTs,Post-op recovery .

Level-2(High risk ) : ICU’s,HDU’S, ISOLATION, ER, CATH

LAB,DIALYSIS, , CSSD, ENDOSCOPY,INTERVENTIONAL
RADIOLOGY.

Level-3 (moderate risk ) : F and B,Blood bank,Mortuary.

Level -4 ( Low risk ) : IP wards and OPDs.

Level 5 ( Very Low risk ) : Administrative areas and Parking.

DISINFECTION OF LAUNDRY & LINEN
 DISINFECTION OF LINEN

Sorting of linen at the point of generation

Dirty Linen Soiled Linen Clean Linen

Pack in infection control

laundry bags
(water soluble)
OT Linen
Laundry--- CSSD---- OT

Sluice machine

Out sourced
laundry

COVID AREAS/PATIENTS WITH COMMUNICABLE DISEASES - ONLY DISPOSABLE LINEN .

 DISINFECTION OF LAUNDRY & LINEN

USED / DIRTY LINEN STORAGE OF DIRTY LINEN

SOILED/INFECTED LINEN
SLUICE MACHINE

INFECTION
CONTROL
LAUNDRY BAG
STORAGE OF CLEAN LINEN
RESPIRATORY COUGH ETIQUITTE
 REPROCESSING OF MEDICAL EQUIPMENT
THE SPAULDING CLASSIFICATION

CATEGORY DEFINITION DEVICE APPLICATION REQUIRED LEVEL OF

DISINFECTION
Contact with the bloodstream or sterile Sterilization
tissues.
CRITICAL Eliminates all forms of microbial life.

Surgical instruments, e.g. scalpels, tweezers, Eg: Plasma / ETO sterilization

scissors, kidney dishes and clamps.

Contact with mucous membranes or High level Disinfection

non-intact skin.
SEMI-CRITICAL Destroys all vegetative
microorganisms, mycobacteria,
enveloped and non-enveloped viruses,
fungal spores and some bacterial
spores.
Endoscopes and endo cavity ultrasound probes.
Eg: Glutaraldehyde, Hydrogen
peroxide.

Intermediate –level disinfection

Destroys mycobacteria, most viruses,
most fungi and bacteria.

Eg: Sodium hypochlorite

Contact with intact skin. Abdominal ultrasound probes.
NON-CRITICAL
Low – Level disinfection

Destroys most bacteria, some viruses

and some fungi.

Eg: Chlorhexidine, Alcohol.

Stethoscopes and blood pressure cuffs.
SPILL MANAGEMENT
 DEFINITION OF SPILL MANAGEMENT

Spill management in hospitals is

vital due to the combination of
hazardous substances, busy
environment and vulnerable
patients, but with the correct
training and equipment in place,
staff can minimize the risk to
themselves, to visitors and to
patients.
 TYPES OF SPILL

Types

Minor Spill Major Spill

(<30ml or <10cm) (>30 ml or
>10cm)
ACTIVATING CODE YELLOW – MAJOR SPILL

Any major spill will be consider for the announcement of “code yellow ”
Code yellow will be activated by – calling ‘3333’ and announce “ code yellow ” with location – three
times
CODE YELLOW – MAJOR SPILL

AIG staff to inform call Centre about incident of

Spill

Call Centre to inform Hazmat team

Hazmat team to act as per Spill management

Protocol

Nurse In charge/House keeping to raise the

incident form
 HAZMAT TEAM

Nursing Supervisor(Floor)
Nursing In-charge (Floor)
Infection Control Nurse(Floor)
House keeping Supervisor(Floor)
GDA staff
Security Supervisor(Floor)
CONTENTS OF SPILL KIT
 CLASSIFICATION OF SPILL MANAGEMENT
CHEMICAL SPILL
BLOOD/BODY FLUIDS CYTOTOXIC SPILL URINE SPILL
ACID SPILL ALKALI SPILL
↓ ↓ ↓ ↓ ↓
Put caution board Put caution board Put caution board Put caution board Put caution board
↓ ↓ ↓ ↓ ↓
Wear PPE Wear PPE Wear PPE Wear PPE Wear PPE
↓ ↓ ↓ ↓ ↓
Mark the area Mark the area Mark the area Mark the area Mark the area
↓ ↓ ↓ ↓ ↓
Put Sodium bicarbonate powder to
Put Tissue papers Put Sand/Absorbent powder Put citric acid to cover the entire spill Put Absorbent powder /Sand
cover the entire spill
↓ ↓ ↓ ↓ ↓
Pour 1% sodium hypochlorite(dilute
Leave for 5 - 10 mins Leave for 5 - 10 mins Leave for 5 - 10 mins Leave for 5 - 10 mins
it- 1:3)
↓ ↓ ↓ ↓ ↓
Leave for 20 mins Put Tissue papers Put Tissue papers Put Tissue papers Put Tissue papers
↓ ↓ ↓ ↓ ↓

Collect the tissue with dustpan & Collect the dry powder along with tissue with Collect the dry powder along with tissue Collect the dry powder along with tissue Collect the dry powder along with
wiper dustpan & wiper with dustpan & wiper with dustpan & wiper tissue with dustpan & wiper

↓
Put it in the Yellow bag
Tie the yellow bag, paste the label with date time & department
Send it to B3
Disinfect the Floor with R2.
Discard the PPE

NOTE: In case of Cytotoxic spill, put a Cytotoxic Sticker after tying the bag, before sending it to B3.