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. 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.

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

 

c. Infection control committee for taking decisions on matters related to infection control

 

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

 

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.

 

c. Standard precautions must be followed across the hospital while providing patient care. 

 

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

 

p. Procedures for CSSD activities for preventing spread of infections must be followed

 

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

 

 

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