Infection Control in ICUs

Infection Control Protocol in ICU

• "The very first requirement in a hospital is that it should do the sick no harm" - Florence Nightingale
• Healthcare-associated infections (HCAI) result in economic loss, prolonged hospital stay, and adverse patient outcomes
• Average incidence of HCAI is around 5-10% in most healthcare facilities

Infection Control Definition

• Measures practiced by healthcare personnel to prevent spread, transmission, and acquisition of infection between clients, from healthcare providers to clients, and from clients to healthcare providers (HCP)
• Standard precaution and additional precaution are included

Common Organisms

• Bacteria: Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, Klebsiella, E. coli
• Viruses: HIV, HBV, HCV, CMV
• Fungi: Candida albicans, Aspergillus
• Parasites: Giardia lambia

Risks

• Low resistance of patients to infections
• Invasive procedures/interventions
• Inappropriate anti-microbial usage
• Drug resistance of endemic microbes
• Contaminated environment

Standard Safety Measures

• Standard precaution practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin, and mucous membrane
• Steps include hand washing, personal protective equipment (PPE), decontamination, and waste disposal

Hand Hygiene

• Hand washing is the single most effective measure in infection control
• 80% of diseases are spread through hands
• Important points to remember: covering cuts and wounds, gloves are not a substitute for hand washing, and maintaining soap and dispenser cleanliness

Personal Protective Equipment (PPE)

• Includes gloves, gown, mask, protective eye wear, face shield, and apron
• Sequence for donning PPE: gown, mask, goggles or face shield, gloves
• Sequence for removing PPE: gloves, goggles or face shield, mask, gown

Safe Handling of Sharps

• Never pass sharps from one person to another
• Always dispose of your own sharps
• Do not recap needles
• Dispose sharps in puncture-proof containers

Disinfection and Sterilization

• Disinfection: reduces the number of microorganisms on an object or surface but does not completely destroy all microorganisms or spores
• Types of disinfectants: high level, intermediate level, and low level
• Sterilization: removes all microorganisms, including spores, from an object
• Sterilization methods: dry heat, moist heat, chemical, and radiation sterilization

Bio-Medical Waste Management

• Definition: waste generated during diagnosis, testing, treatment, research, or production of biological products for humans or animals
• Purposes of waste disposal: reduce hazardous nature, reduce volume, prevent misuse, ensure occupational safety and health, and consider aesthetics

Legislation and Guidelines

• Ministry of Environment and Forests (MOEF) guidelines for hospitals to ensure proper and safe disposal of bio-medical waste
• Bio-medical waste management and handling rules came into effect in 1998
• BMW Rule 2016: categorizes waste into human anatomical, animal anatomical, soiled, expired, and chemical waste, and outlines treatment and disposal methods for each category

Waste Management

• 3Rs: reduce, reuse, recycle
• Waste segregation: done at the source of waste generation, responsibility of the generator, and segregation according to categories
• Waste storage: storage facility should have sufficient capacity, located within hospital premises, and untreated biomedical waste not kept beyond 48 hours
• Waste transportation: points to remember include tying and labeling bags, not touching other articles, and using a covered cart with a biohazard symbol

Training and Staff Safety

• Training on bio-medical waste management aims to develop awareness of health, safety, and environmental issues
• Roles and responsibilities of healthcare personnel in overall management program should be highlighted
• Staff safety considerations include separate trolleys for transporting waste, awareness of hazardous nature, provision of protective equipment, and immunization against tetanus and hepatitis B

Role of Infection Control Nurses

• Visit all wards and high-risk units
• Check nursing supervisor's register and records for cases suggestive of infection
• Collect samples from different areas of the hospital and send them to the lab
• Monitor and supervise infection among hospital staff
• Train nursing and paramedical personnel on correct hygiene practices and aseptic technique

Summary

• Infection control, standard precaution, hospital waste management, and staff safety are crucial concerns
• Human element is more important than technology
• Well-trained, motivated staff can make a significant difference in controlling infection