Standard Infection Control Precautions.

Transmission-based Precautions.

Bundle approach to prevent device-associated infections.

Educational programs and strategies.

Evaluation and feedback of the program.

Before performing hand hygiene

● Expose forearms (bare below the elbow).

● Remove all hand and wrist jeweler.

● Ensure fingernails are clean and short, and do not wear artificial nails or nail products.

● Cover all cuts or abrasions with a waterproof dressing.

Follow "My Five Moments for Hand Hygiene” (Figure 1)

● Before touching a patient.

● Before clean/aseptic procedures.

● After body fluid exposure/risk.

● After touching a patient.

● After touching patient surroundings.

Use alcohol-based hand rubs when hands are not visibly soiled or tap and running water is not available. (Figure 2)

Use soap and water when hands are visibly dirty, before eating, after using the restroom, and after caring for people with infectious diarrhea. (Figure 3)

Glove

● Wear gloves during activities that may involve exposure to blood and other body fluids.

● Remove gloves after caring for a patient.

● Change gloves between tasks and procedures if moving from a contaminated body site to another body site on the same patient.

● Wear sterile gloves for aseptic procedures, such as surgery or catheter insertion.

● Do not reuse gloves after reprocessing or decontamination.

Gown

● Wear a gown to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions.

● Remove the soiled gown as soon as possible and perform hand hygiene.

Medical masks

● Wear a medical mask to protect mucous membranes of the nose and mouth against splashes or sprays of body fluids, respiratory secretions and chemicals.

● Wear a medical mask to protect the patient during aseptic procedures.

Respirators

● Wear a respirator (e.g., N95, FFP2, etc.) for protection from inhalation of airborne particles and/or when performing aerosol-generating procedures.

● Do a fit test before using a respirator for the first time, and perform a seal check every time a respirator is used.

● Replace the mask or respirator if it is damaged, soiled or wet or if breathing becomes difficult.

Eye protection

● Wear either eye protection (eye visor, goggles) or a face shield to protect mucous membranes of the eyes during activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.

● Ensure that goggles fit over and around the eyes or personal prescription lenses.

● Ensure that a face shield covers the forehead, extends below the chin, and wraps around the side of the face.

Cover mouth and nose with a tissue when coughing or sneezing.

Dispose the tissue after use in the nearest waste container.

Perform hand hygiene after contact with respiratory secretions and contaminated objects or materials.

Prepare injections in a clean workspace.

Perform hand hygiene prior to preparing the medication and touching the patient.

Use a sterile, safety-engineered syringe.

Use a sterile medication vial and diluents.

Use a sterile syringe and needle to withdraw and reconstitute medications.

Avoid use of multi-dose vials or, if used, dedicate the vial for single-patient use.

Label the multi-dose vial with the date opened, and discard according to the manufacturer’s instructions, when sterility is compromised or after 28 days.

Clean the patient’s skin with soap and water or disinfect with 60–70% alcohol prior to the procedure.

Provide a puncture-resistant sharps container for sharps disposal at the point of care.

Do not re-cap, bend, break, manipulate or manually remove the needle from the syringe.

Discard the sharps container when it is three quarters full, seal it and store it in a secure area.

In open plan ICU, there should be adequate space between each bed to reduce the risk of cross-contamination/infection occurring from direct or indirect contact or droplet transmission. Space between beds should be 1–2 meters.

A room should be cleaned before admitting a patient. There should be a policy for cleaning the room after patient discharge (terminal cleaning) and before admission.

All patient-care items used by the previous patient should be removed and replaced with clean items, e.g., bed linen, waterproof covering, oxygen humidifiers, face mask, etc. as per the housekeeping policy.

Movement and transportation of patients from the isolation room or area should be restricted to essential purposes only.

Clean and disinfect patient care areas at least once every nursing shift and when surfaces are visibly soiled.

Patient care areas should be cleaned with a detergent/ disinfectant solution.

Fresh detergent/ disinfectant solutions must be prepared every day according to manufacturers’ instructions. These solutions must be replaced with fresh solutions frequently.

Disinfectant fogging is not recommended for routine patient care areas.

Handle soiled linen and waste carefully (with minimal manipulation or agitation) to prevent personal contamination and transfer to other patients.

Remove heavily soiled material (e.g., faeces) from linen, while wearing appropriate PPE, before placing it in the impermeable laundry bag.

Store clean linen in a manner that protects it from environmental contaminants.

Cleaning of patient-care areas and equipment should be carried out by a team of dedicated personnel trained in the appropriate cleaning procedures.

Treat waste contaminated with blood, body fluids, secretions and excretions as hazardous infectious waste.

Treat human tissue and laboratory waste that is directly associated with specimen processing as hazardous infectious waste.

Minimize the amount of waste produced by the healthcare facility.

Handle equipment soiled with blood, body fluids, secretions and excretions in a manner that prevents skin and mucous membrane exposure, contamination of clothing and transfer of pathogens to other patients, or the environment.

Clean and disinfect (or sterilize, depending on the type and use of patient care equipment) reusable equipment before use with another patients.

Discard single-use devices after each use.

Clean and disinfect or sterilize reusable equipment/devices according to the manufacturer’s instructions, national or international standards, using efficient methods and based on intended use.

Wear appropriate PPE.

Place disposable towels over spillage to absorb and contain it.

Apply chlorine solution of 10,000 parts per million to the towels.

Follow manufacture’s instruction for contact time or leave for 3 minutes.

Discard the gross contamination into healthcare waste bag.

Rinse the area with clean water to remove the disinfectant residue (if required).

Patients must be promptly assessed for infection risk on arrival at the care area.

A single room should be used for a patient who poses a risk of transmission to others

Type of Precaution

Selected patients

Major Specifications

Contact

● Colonization of any bodily site with multidrug-resistant bacteria (MRSA, VRE, drug-resistant gram-negative organisms).

● Enteric infections (Norovirus, Clostridioides difficile, Escherichia coli O157:H7).

● Viral infections (HSV, VZV, RSV, parainfluenza, enterovirus, rhinovirus, certain coronaviruses [eg, SARS-CoV-2, MERS-CoV]).

● Scabies.

● Impetigo.

● Noncontained abscesses or decubitus ulcers (especially for Staphylococcus aureus and group A Streptococcus).

● In addition to standard precautions:

● Private room preferred; cohorting allowed if necessary.

● Gloves required upon entering room. Change gloves after contact with contaminated secretions.

● Gown required if clothing may come into contact with the patient or environmental surfaces or if the patient has diarrhoea.

● Minimize risk of environmental contamination during patient transport (eg, patient can be placed in a gown).

● Noncritical items should be dedicated to use for a single patient if possible.

Droplet

Known or suspected:

● Neisseria meningitidis.

● Haemophilus influenzae type B.

● Mycoplasma pneumoniae.

● Bordetella pertussis.

● Group A Streptococcus.

● Diphtheria.

● Pneumonic plague.

● Influenza.

● Rubella.

● Mumps.

● Adenovirus.

● Parvovirus B19.

● Rhinovirus.

In addition to standard precautions:

● Private room preferred; cohorting allowed if necessary.

● Wear a mask when within 3 feet of the patient.

● Mask the patient during transport.

● Cough etiquette: Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.

Airborne

Known or suspected:

● Tuberculosis.

● Varicella.

● Measles.

● Smallpox.

● Coronaviruses.

● Ebola.

In addition to standard precautions

● Place the patient in an AIIR (a monitored negative pressure room with at least 6 to 12 air exchanges per hour).

● Room exhaust must be appropriately discharged outdoors or passed through a HEPA filter before recirculation within the hospital.

● A certified respirator must be worn when entering the room of a patient with diagnosed or suspected tuberculosis. Susceptible individuals should not enter the room of patients with confirmed or suspected measles or chickenpox.

● Transport of the patient should be minimized; the patient should be masked if transport within the hospital is unavoidable.

● Cough etiquette: Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.

Appropriate educational material on IPC should be made available to all HCWs, patients and visitors.

Continuing educational interactive programs and awareness drives should be conducted periodically

Evaluate the IPC program periodically to assess the extent to which the objectives have been met.

Evaluation can be done using following indicators.

● Process indicators: compliance with hand hygiene, care bundles.

● Outcome indicators: HAI rates, mortality and morbidity.

The results of the evaluation should be shared with the hospital infection control program.