INFECTION PREVENTION

PRACTICES;A BED SIDE

PERSPECTIVE.
TEAM INFECTION PREVENTION & CONTROL
DEPARTMENT OF NURSING , ZYDUS HOSPITALS AHMEDABAD
To Discuss

 Hand hygiene and Use of Hand rub

effectively.
 Protect yourself and protect  patients
from germs.
 Handling of all Indwelling lines
 Flashback to basics.
HAND
HYGIENE
Hand Hygiene and Use of
Hand rub effectively
o Steps of Hand Hygiene
o Correct technique
o Moments of Hand Hygiene
o Methods of Hand Wash
o Time required
o Placement of hand rub
Indications
Moment-1 and 4 : Moment-2 and 3: Moment-5:
Before and after Before and after aseptic After touching patient
touching a patient procedure/body fluid exposure surroundings

ü Before and after ü Skin lesion care and Wound dressing ü After contact with
     Shaking hands ü Subcutaneous injection patient area 
ü Helping a patient ü Catheter insertion ü Infusion speed
to move around, ü Opening a vascular access system or adjustment
get washed  a draining system, secretion ü Monitoring alarm
ü Applying oxygen aspiration ü Patient records
mask ü Instilling eye drops, pharmaceutical ü Holding a bed rail
ü Giving products, sterile materials etc. ü Clearing the bedside
physiotherapy ü Handling an invasive device for table
ü Taking pulse, blood patient care, regardless of whether ü Changing bed linen,
pressure,  or not gloves are used with the patient out
ü Auscultation and ü Moving from a contaminated body of the bed, etc.
palpation site to another body site during  ü After removing sterile
ü Recording ECG or non-sterile gloves
Methods of Hand Wash
Indication for using Indication for using Hand wash Indications
Hand Rub for using
hand
Scrub
ü Followed during ü Visible dirt, blood or body fluids ü Prior to
the five moments ü Potential exposure to spore any
of hand hygiene forming organisms (e.g., surgical
ü During routine Clostridium difficile); non procedure
clinical rounds enveloped viruses (e.g. Norovirus,
and handling the rotavirus, enteroviruses)
patient  ü Handling patients having
ü Emergency where diarrhea   
no time or lack of ü After using restroom
facility for hand ü Before handling medication or food
wash
ü Hands are not
visibly dirt, blood,
or body fluids
How Long?

 Time Required for effetive washing

is minimum 40 Seconds

 Time Required for hand rub is

minimum 20 seconds
Hand Rub Placement

 Corridors
 ICU entrance door
 Each Patient side
Personal
Protective
Equipment
PPE
ü Wear gloves while handling all forms of body fluids
and tubing's attached to the patient body.
ü Sterile plastic gloves can be used for administration of
medications, suctioning, Ryle's tube feeding and 
handling of central lines.
ü Intend shield mask before performing or assisting any
sterile procedure or at the time of any body fluid
exposure risk procedure.
ü Appropriate size of gloves should easily available in
patient side.
Cont.

 N-95 / Respirator (<5um) should wear in all

case of suspected and confirmed respiratory
tract infections. 
 Maintain negative pressure in air borne
Isolation
 Remove N-95 / Respirator when you leave
airborne Isolation facility.
 Remove your gown, gloves when you leave the
patient unit. 
USE OF PPE FOR EXPANDED
PRECAUTIONS
Ø Contact Precautions – Wear Gown and gloves when
coming to contact with patient or environment of
care (e.g., medical equipment, environmental
surfaces) For diseases like clostridium defficile,
draining wounds, ostomy tubes etc.
Ø  Droplet Precautions – Surgical masks within 3 feet
of patient. For diseases like pertussis, influenza,
diphtheria etc.
Ø Airborne Infection Isolation–  Particulate respirator
Negative pressure isolation room also required. For
diseases like SARS, varicella, mycobacterium
tuberculosis
What Type of PPE Would You Wear?
Taking vital signs? Generally none

Irrigating a wound? Gloves, gown, shield mask / goggles

Cleaning an incontinence patient with diarrhe
a? Gloves & gown

Drawing blood from a vein? Gloves

Responding to an emergency blood is spurting? Gloves, Gown, Shield mask / goggles.

Giving a bed bath? Gloves & plastic gown

Suctioning oral secretions? Gloves & Mask

Transporting a patient in a wheel chair? Generally nothing required

Handling of
Indwelling
Lines
Know your Care Bundle
Prevention of CAUTI
Insertion Bundle Maintenanc Bundle

Use sterile items / Catheter Care

equipment for cathter • Strict hand hygiene has to be followed
insertion use • Vaginal / meatel care has to be taken daily
• Perineal cleaning has to be done daily
Use closed drainage Check closed drainage system is maintained.
system
Use catheter of Check urinary catheter secured or not
appropriate size
Insert catheter by strict Always keep drainage bag above the floor and below the bladder
aseptic non-touch
technique
Secure catheter after Use single gloves while handling/ emptying for each patient 
insertion
Make sure no contact between urine pot and bag
 Prevention of CLABSI
INSERTION BUNDLE MAINTENANCE BUNDLE

Perform Hand Hygiene before start Daily aseptic CL care during handling

Follow maximal  sterile barrier precautions • Hand hygine before touching the line

Site of insertion- Subclavian preferred, avoid • Alcohol hub decontamination

femoral
Skin should be disinfected before insertion • CHG 2% for dressing changes

Use sterile drape • Inform any local signs of Infection

Blood aspirated freely from lumens § Change the transparent dressing

Use semi permeable dressing • Assessment of readiness to remove –

documented?
Hand wash after procedure

Document data and time of insertion

Prevention of VAP

 Adhere to hand Hygiene

 Elevaton of the head of the bed to 30-45
degree
 Daily oral  (chlorhexidine 2%)
 ET / TT Care
 Suction
 Need of PUD
 DVT prophylaxis
 Daily assessment of readiness to remove
Prevention of Surgical Site
Infection
 Appropriate use of antibiotics.
 Appropriate hair removal
 Pre-operative bathing with CHG soap reduce bacterial load
 Antibiotic prophylaxis is given before 1 hour prior to incision. (2
hours for Inj. Vancomycin & Inj. Ciprofloxacin.)
 Strict Hand hygiene before touching the patient.
 Blood glucose level should be maintained at less than 200mg/dl.
 Frequency of dressing should be kept minimum and dressing
should not be opened for 48 hours after the operations unless
infection is suspected.*
 Post operative glucose control (major cardiac surgery patients)
 Postoperative normothermia
Flashback to Basics

 Handing & Taking Over

 Cleaning and disinfection of patient unit
 Patient Possessions
 Reminder system
 Offering system
 Change of dressing
 Single and reuse 
 Change of Infusions
IV SETS

Administration Type Administration Set Set Change Frequency

Continuous ( Not Containing blood, P r i m a r y set,

1 Day
blood products or fat emulsions ) Piggy Set

Intermittent (Not containing blood,

Primary Set  1 Day
blood products or fat emulsions. )

Intra- Venous fat emulsion containing P r i m a r y s e t , Should be changed with each

TPN's Piggy Set new container

TPN without Intravenous fat

Primary Set  New set with every new bag.
emulsions

C h a n g e a f t e r e a c h
Blood and blood products Primary Set 
administration.

Every 6 to 12 hours when vial is

Propofol Primary Set  changed. (Should have dedicated
CATHETERS

Peripheral Assess the IV cannula on each shift. Remove the cannula in case
IV Cannula
Catheters of  any signs of phelibitis .

Central line
All Lines Remind the physician and consultant on every 7th day of  line. 
Catheters  (PICC)

All Catheter All Transparent dressings are to be assessed daily and change
 Dressings
dressings every 3rd day or earlier if it gets soiled / peeled off.

Foleys  ,
Indwelling  Change indwelling catheters if there is any signs of  infection
Silicon &
Catheters UTI.
SPC

Ventilator Circuits When visibly soiled.

Bacterial filter 
in Ventilator
for both Filter 48 hours or earlier if blocked or soiled.
inspirator and 
expirator

HME filter in
Tracheostomy HME​ 24 Hours or earlier if soil  or blocked​
Patients​

Catheter
 Dressings​ 48 hours or earlier if soiled or blocked​
Mount ​

In O2 flow
24 Hours, Keep upside down on meter, if not
Distilled Water​ meter
required​
funnel​