Chapter 16
Infection Prevention and Control (IPC)
Outline
• Objective/s
• Introduction
• Operational standards
• Implementation guidance
• Summary
Objectives
By the end of this session the participants will be able to:
• Clarify operational standards of infection prevention and control
• Describe the detailed implementation guide of the infection prevention practice
Introduction
• Healthcare-acquired infections – infections that are acquired in any healthcare setting during healthcare
services delivery.
• The potential for the transmission of infections in the health care setting is high.
• Both patients and HCPs are at risk of acquiring and transmitting infections.
Operational Standards of IPC
• The hospital has active surveillance for its prioritized HAIs
• The hospital implements a multimodal strategy to improve its prioritized IPC interventions
• The hospital conducts regular monitoring and audit, as well as provides feedback, to ensure compliance
with standardized IPC practice
• The facility has an appropriately built facility, materials and equipment for IPC
• Safe injection practices are implemented to minimize risk to clients, staff and the surrounding community
• The hospital practices safe healthcare waste management
• The hospital ensures cleanliness of the health care environment
• The hospital avails adequate and functional laundry service
• The hospital has a proper medical devices decontamination and reprocessing mechanism
• The hospital has a monitoring system to ensure safety of food and water served on the premises
• The hospital ensures all preventive and post-exposure interventions and procedures are in place in case of
occupational risks and hazards
Implementation Guidance
1. The Hospital Has a Functional IPC Program
• The activities of the facility-level IPC program should be guided by national strategies
• The hospital IPC program at the hospital level should be led by well-trained, dedicated full-time IPC
professionals
• Hospitals should have a minimum ratio of one full-time (or equivalent) IPC nurse or doctor per 250 beds
• The hospital IPC program should have clearly defined objectives and operational plans
• Hospitals should have dedicated budgets to implement their operations plans
2. The Hospital Has Adapted Evidence-Based IPC Guidelines, SOPs and
Monitoring Tools
• Hospitals should develop/adapt guidelines and implement them for the purpose of reducing HAI and AMR
• Guidelines should be evidence-based and reference international or national standards
• Stakeholders should be engaged in the development and production of guidelines
• HCWs should be trained on IPC guideline recommendations
• Adherence to these guidelines should be monitored by the IPC focal person in conjunction with hospital
management
• At a minimum, hospitals should develop/adapt 11 standard operating procedures (SOPs), as mentioned in
the EHSIG Guidelines
Notes:
The 11 Standard Operating Procedures recommended by the EHSIG:
◦ Hand hygiene
◦ Decontamination of medical devices and patient care equipment
◦ Environmental cleaning
◦ Health care waste management
◦ Injection safety, HCW protection (e.g., post-exposure prophylaxis, vaccinations)
◦ Aseptic techniques
◦ Triage of infectious patients
◦ Standard and transmission-based precautions (e.g., specific SOPs for the prevention of airborne
pathogen transmission)
◦ Aseptic technique for invasive procedures, including surgery
◦ Specific SOPs to prevent the most prevalent HAIs based on the local context/epidemiology
◦ Occupational health (specific detailed SOP)
3. IPC Education and Training
• The hospital should have IPC education and training for all health care workers
• It should be part of an overall health facility education strategy
• It should include: new employee orientation, and continuous educational opportunities for existing staff
Notes:
The orientation and education should be given regardless of level and position (e.g., senior administrative and
housekeeping staff). The training and education should cover the following category of human resources.
Training and Education Coverage
• IPC focal person and members of the IPC team; all IPC personnel shall update their competencies
• All health care workers should be trained on the facility-level adapted guidelines/SOPs
• Other personnel that support health service delivery
Notes:
"Other personnel" means cleaners responsible for day-to-day cleaning of the facility, auxiliary service staff, and
administrative and managerial staff responsible and accountable for the safety and quality of health service delivery
— including overall implementation of policies and guidelines and monitoring of national and local policies. Senior
managers should understand the importance of supporting IPC infrastructure and practices to reduce harm to patients
and health care workers, and the associated costs.
4. Healthcare-Associated Infections (HAIs) Surveillance
Hospital-level HAI surveillance should:
• Be conducted based on the national HAIs Surveillance Guide
• Guide IPC interventions and detect outbreaks
• Provide timely feedback to healthcare workers and stakeholders
Regular reports on healthcare-associated infections should be made available to treating clinicians.
5. Multimodal Strategies Implementation
Multimodal strategy consists of five elements implemented in an integrated way:
• System change
• Education and training
• Monitoring and audit
• Reminders in the workplace or communications
• Culture change
Notes:
Elements of the multimodal strategy are: (i) system change (availability of the appropriate infrastructure and
supplies to enable good IPC practices); (ii) education and training of health care workers and key players (e.g.,
managers); (iii) monitoring infrastructures, practices, processes and outcomes, and providing data feedback; (iv)
reminders in the workplace or communications; and (v) culture change, with the establishment or strengthening of a
safety climate.
6. Monitoring, Audit and Feedback
The hospital should conduct regular monitoring/audit and timely feedback of:
• IPC standards/IPC best practices
• Compliance with regulations
Feedback should be provided to all audited persons, relevant staff, and hospital management/senior administration.
The IPC program should also be periodically evaluated.
7. Built Environment, Materials and Equipment
Patient care activities should be undertaken in a clean and hygienic environment. The following are the minimum
requirements for the built environment, materials and equipment for proper IPC practices:
• Water should always be available from a source on the premises to perform basic IPC measures
• A minimum of two functional sanitation facilities should be available for outpatients, and one per 20 beds
for inpatient wards
• Functional hand hygiene facilities should be available at points of care and toilets
• Sufficient and appropriately labeled bins for health care waste segregation should be available and used
• Waste should be treated and disposed of safely
• Designed to allow adequate ventilation (natural or mechanical)
• Spacing of at least one meter between the edges of beds; no more than one patient per bed
• Sufficient and appropriate IPC supplies and equipment
• Dedicated space/area for performing decontamination and reprocessing of medical devices
• Adequate single isolation rooms
8. Hand Hygiene
There are basic principles when implementing hand hygiene, including:
• Guidelines on hand hygiene have to be properly disseminated, promoted and followed, and every staff
member has to be involved
• Best practices on hand hygiene have to be benchmarked
• A culture of providing positive feedback and rewarding role models
• A culture of basic orientation/training
Hospitals shall ensure the basic infrastructures (minimum requirement):
• Functional hand washing sinks
• Functional water container (if there is no running tap water)
• Water tanker for reserve water during water supply interruptions
• Functional drainage system
9. Safe Injection Practices
Hospitals should ensure the basic principles of injection:
• Eliminating unnecessary injections
• One syringe for one injection
• Avoiding recapping
• Educating patients and the community
Hospitals should ensure the availability of supplies to make injections safe. The health care provider administering
the injection should follow the procedure and guidance of the injection protocol.
10. Healthcare Waste Management
• Health care waste should be disposed of in a manner that poses minimal hazard
• Health facilities should ensure that HCWs are safely managed along the waste stream
• Waste management procedures and principles involve a multi-step process: waste minimization,
segregation, handling, collection, storage, transportation, treatment and disposal
11. Environmental Cleaning
• The hospital may use its own staff or contract out the service to clean the environment
• The housekeeping department should develop operating procedures or a work plan
• The hospital should have a regular supply of all necessary cleaning materials
• Different areas of the hospital should be cleaned based on the procedure and protocols of the hospital
regulations adopted
12. Laundry Service
• Hospitals may provide laundry service through their own staff or contract out services to an outside vendor
• Each hospital laundry should develop an operating procedure or work plan for laundry services
• The laundry should ensure there is always an available supply of detergent and bleach
13. Medical Devices Decontamination and Processing of Instruments and
Reusable Items
Decisions should be made based on Spaulding categories. Spaulding classified instruments and patient care devices
into three categories:
• Critical
• Semi-critical
• Non-critical
NB: Soaking instruments in 0.5% chlorine solution or any other disinfectant before cleaning is not recommended.
14. Food and Water Safety
• Food safety should be ensured through the provision of adequate, clean facilities for food preparation and
storage
• The kitchen should have adequate space
• Kitchen staff should maintain personal hygiene and health
A committee consisting of representatives from the kitchen, environmental hygiene, and the procurement unit
should be created to oversee the delivery of food items for the kitchen.
15. Occupational Safety
Hospitals are expected to minimize occupational hazards and ensure occupational safety practices:
• Sharp pricks which expose staff to blood-borne infection
• Availability of post-exposure prophylaxis (PEP) 24 hours a day, seven days a week
• Preventive interventions for HBV and HCV
• Facilitating vaccination of hospital staff members for HBV
• Ensuring all staff members properly utilize necessary PPE when needed
Summary
• Infection prevention and control has about 15 operational standards that all hospitals shall adhere to
• The surveillance component of infection prevention standards plays a major role in identifying a hospital's
priority problems
• Evidence-based infection control has been key in fighting hospital-acquired infections and AMR
• Hospitals should implement multimodal strategies to improve prioritized IPC interventions
Thank You!