INFECTION PREVENTION & CONTROL GUIDELINES guidelines
the Principal
Message by the
Principal
The healthcare facilities, especially the public sector hospitals, in underdeveloped nations are inadequately equipped, and the burden of healthcare-associated infections (HCAls) makes matters worse. The importance of infection prevention and control cannot be denied especially after the world had seen the worst pandemic of COVID-19, and other infectious diseases one after the other.The knowledge and comprehension of the core IPC practices are the ultimate need of the hour. The subject is very broad. Therefore, it is imperative to present certain key ideas in a way that is simple to access and comprehend.
I appreciate the team of Lahore General Hospital for coming up with the concept for this infection prevention and control mobile application in the hopes that it will be a helpful resource for medical professionals, nurses, paramedics, housekeeping staff, and anyone interested to learn and understand the fundamentals of IPC practices.
Muhammad Farooq Afzal
MBBS, MD, FCPS,FACS,MCPS (HPE), MBA(USA)
Fellow in Advanced Laparoscopic & Bariatric Surgery (USA)
Professor Of Surgery, PGMI/AMC/LGH LAHORE
the Medical Superintendent
Message by the Medical Superintendent
Lahore General Hospital, Lahore, Pakistan.
It gives me great pleasure to write this message on the occasion of the launch of a mobile
application for infection prevention and control guidelines. This is a commendable
initiative
by the MSDS and infection control department of Lahore General Hospital, as it will benefit
not only health care personnel but the general population as well. All crucial components,
such as hand hygiene and personal protective measures, have been addressed clearly and
succinctly. Furthermore, the use of illustrations to express all crucial and necessary
information adds clarity to the material.
Prof. Faryad Hussain
MBBS, FCPS (Pediatrics), PGPN (Boston University, USA)
Professor of Pediatric Medicine
Head, Pediatric Unit-II & Pediatric Pulmonology
the Dr.Nizam Damani
Message by the Dr.Nizam Damani
IPC Expert, Senior Consultant WHO
According to the recent World Health Organisation report, it has been estimated that out of
100 patients hospitalized, seven will be infected with healthcare-associated infections
(HAIs) and the risk of acquiring HAI is up to 20 times higher in low- and middle-income
countries. In addition, deaths are increased two to threefold when infections are resistant
to antimicrobials. This is an underestimate due to the lack of surveillance in most
healthcare facilities. HAls not only drain valuable health service resources in terms of
additional costs but also have an impact on the length of stay in the hospital as well as
additional nursing and medical time. In addition, especially in low- and middle-income
countries, the cost and impact of Hals to individuals and their families can be devastating
due to loss of income, indirect cost, and burden to family members in terms of time lost
from work in caring for the affected individual. The Covid -19 pandemic shows that both
patients and health workers can be at high risk of being infected with SARS-CoV-2 during
health care delivery and need to be protected. Therefore, the implementation of effective
Infection Prevention and Control (IPC) is now a major priority on a global basis.
Unfortunately, due to various reasons, implementation of even basic IPC practices can be
challenging, especially in low- and middle-income countries. I am delighted that Dr. Amina
Asif and the MSDS department have developed the IPC App for Lahore General Hospital,
Pakistan. This is a major achievement because the App is simple to use and is also available
in Urdu. It is available on mobile devices which allows not only easy accessibility to
implement good IPC practice at the point of care by health workers but also helps update IPC
guidelines and procedures regularly. To ease implementation, IPC procedures are illustrated
using images based on local guidelines. I am confident that the availability of the IPC App
supplemented by teaching and practical training in IPC will help the hospital to implement
good IPC practices at the point of care and will not only reduce HAIs but also help protect
health workers and visitors from other infections.
Prof. Nizam Damani
MBBS, MSc, FRCPath., FRCPI, CIC, DipHIC
Personal Protective Equipment (PPE)
1. Select PPE based on the assessment of risk. The type of PPE used depends upon the level of precaution required (standard, contact, droplet, airborne).
2. The sequence of donning and doffing should be adjusted to specific type of PPE worn.
3. Except for N95 mask/respirator, remove PPE at doorway or in anteroom. Remove N95 mask respirator after leaving patient room and closing door.
When
1. Protective, impermeable gowns or plastic aprons should be worn if potential exists for splashing, splattering or spraying of blood and body fluids (vomitus, feces, urine etc).
2. Do not wear the same gown for care of more than one person.
How?
1. Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back.
2. Fasten in back of neck and waist.
When
1. Risk of contact with respiratory secretions (contact and/or droplet and/ or airborne precautions).
2. Risk of transferring bacteria (from mouth and nose) to the potential patient ( lumbar puncture etc).
3. N95 has to be worn for aerosol generating procedures.
Aerosol Generating Procedures
1. Intubation, extubation, and related procedures, e.g. manual ventilation and open
airway suctioning (including tracheotomy care and open suctioning with invasive
ventilation).
2. Cardiopulmonary resuscitation.
3. Bronchoscopy (unless carried out through a closed- circuit ventilation system).
4. Surgery and post-mortem procedures in which high- speed devices are used.
5. Dental procedures.
6. Non-invasive ventilation (NIV), e.g. bi-level positive airway pressure ventilation (BiPAP).
7. Continuous positive airway pressure ventilation (CPAP)
8. High frequency oscillatory ventilation (HFOV).
9. Induction of sputum.
10. Collection of lower respiratory tract specimens (e.g. bronchial and tracheal aspirates), and autopsy procedures.
How?
1. Secure ties or elastic bands at middle of head and neck.
2. Fit flexible band to nose bridge.
3. Fit snug to face and below chin.
4. Fit-check respirator
Sequence of Steps in a Particulate Respirator Fit Test
1. Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang freely below your hand.
2. Position the respirator under your chin with the nosepiece up. Pull the top strap over your head resting it high at the back of your head. Pull the bottom strap over your head and position it around the back of neck below the ears.
3. Place fingertips of both hand at the top of the metal nosepiece. Would the nosepiece (USING TWO FINGERS OF EACH HAND) to the shape of your nose. Pinching the nosepiece using one hand may result in less effective respirator performance.
4. Cover the front of the respirator with both hands, being careful not to disturb the position of the respirator.
4A Positive Seal Check:
Exhale sharply. A positive pressure inside the respirator means no leakage. In case of leakage, adjust position and/or tension straps. Retest the seal.
4B Negative Seal Check:
Inhale deeply. In case of no leakage, negative pressure will make respirator cling to your face. Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal.
Warning
While doffing your respirator do not touch the front side. Remove N 95 by carefully pulling the straps away avoiding touching the surface of the mask.
Source: Infection prevention and control of epidemic and pandemic prone acute respiratory infection. Geneva: World Health Organization, 2014
When
1. Wear eye protection/face protection (face shield or goggles) along with mask or respirator to protect the conjunctivae and the mucous membranes of the nose, eyes and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, excretions or.
Aerosol Generating Procedures.
Aerosol Generating Procedures
1. Intubation, extubation, and related procedures, e.g. manual ventilation and open
airway suctioning (including tracheotomy care and open suctioning with invasive
ventilation).
2. Cardiopulmonary resuscitation.
3. Bronchoscopy (unless carried out through a closed- circuit ventilation system).
4. Surgery and post-mortem procedures in which high- speed devices are used.
5. Dental procedures.
6. Non-invasive ventilation (NIV), e.g. bi-level positive airway pressure ventilation (BiPAP).
7. Continuous positive airway pressure ventilation (CPAP)
8. High frequency oscillatory ventilation (HFOV).
9. Induction of sputum.
10. Collection of lower respiratory tract specimens (e.g. bronchial and tracheal aspirates), and autopsy procedures.
Source: Infection control precautions to minimise transmission of acute respiratory tract infections int healthcare settings. London: Public Healthcare England, 2016.
How?
Place over face and eyes and adjust to fit.
Hand hygiene should be performed before wearing and after taking off the gloves regardless of their type.
Sterile Gloves
When
(For all surgical and aseptic procedures).
1. All surgical procedures/Vaginal delivery.
2. Performing Vascular access and procedures (central lines, IV line, urinary catheters, chest drain, etc).
3. Performing lumbar puncture, giving epidural, etc.
4. Invasive radiological procedures.
5. Preparing total parental nutrition and chemotherapeutic agents.
How?
Non Sterile Gloves/ Examination Gloves
When
(When risk of touching blood and body fluid or contact with microorganisms either from patients, items, equipment or the environment.)
1. Contact with not-intact skin or mucous membranes, e.g. vaginal or rectal examination, oral/dental care, emptying urinary bag, suctioning of endotracheal tubes.
2. Contact with potential presence of infectious against bot on intact and non-intact skin.
3. Indirect contact with blood and body fluids by handling and cleaning of contaminated items and equipment (emptying urine bag, emesis container etc.)
4. Handling of clinical/infectious waste.
5. Cleaning up spills of blood and body fluids.
How?
Gloves not Indicated
When
(No potential for exposure to blood or body fluids or contaminated environment).
1. Taking vitals (blood pressure, pulse, temperature).
2. Performing intra muscular and subcutaneous injections.
3. Giving oral medicines.
4. Vascular line manipulation in absence of blood leakage.
5. Using the telephone, writing in patient’s chart, moving patient’s furniture.
Source: Centers for Disease Control and Prevention (CDC)