students can aware of role of administer in infection control for nurses as it is vary important for them to learn and know in the detail.in a era of more infection spreads in health care institutions

1. ADMINISTRATOR’S ROLE IN
INFECTION CONTROL IN
THE HOSPITAL
BY:Dharmendra Raval
RN, Bsc(N),EMT,PGDHHM.
Nursing Tutor.
Jamnagar

3. ADMINISTRATOR’S ROLE
 Hospital’s physical environment
 Healthcare workers
 Patients & relatives
 Community
To implement infection control measures for

4. To reduce nosocomial infections to a
minimum
To provide a safe environment for our
hospital patients, employees and
visitors through prevention, control and
surveillance.
Identification of hospital and
community acquired infections
GOAL

5. The Hospital Infection control program must:
Set relevant objectives
Develop guidelines for surveillance,
prevention & practice
System to monitor infections-assess
effectiveness
Continuous training programs for healthcare
workers
Facilitate access to materials for hygiene &
safety
Monitor nosocomial infections & give feedback
to the professionals

6. INFECTION CONTROL PROGRAM
The important components are :
1) Basic measures i.e. standard and additional
precautions
2) Education and training of healthcare workers
3) Protection of healthcare workers e.g.
immunization
4) Identification of hazards and minimizing risks
5) Routine practices such as aseptic techniques,
handling and use of blood and blood products,
waste management, use of single use devices
6) Surveillance
7) Incident monitoring
8) Research

7. INFECTION CONTROL PROGRAM
Role of administrator
1. Formation of infection control
committee
2. Provide adequate resources for effective
functioning
Infection Control Committee
1. Review and approve surveillance and
prevention program
2. Identify areas for intervention
3. To assess and promote improved practice
at all levels of health facility.
4. To ensure appropriate staff training
5. Safety management

8. 6. Development of policies for the prevention and
control of infection
7. To develop its own infection control manual
8. Monitor and evaluate the performance of program
FUNCTIONS
1. Responsible for day to day activities
2. Carry out the surveillance program
3. Monitor and manage critical incidence
4. Coordinate training activities
5. Overseeing the sterilization and disinfections

9. INFECTION CONTROL COMMITTEE
 Hospital Administrator
 Representative from Nursing Dept.
 Hospital Physicians
 Clinical Microbiologists
 Pharmacist
 Representative from CSSD
 Representative from Maintenance
 Representative from Housekeeping
 Representative from Training dept.

10. THE HOSPITAL SHOULD DEVELOP
ITS OWN INFECTION CONTROL
MANUAL CONTAINING
INSTRUCTIONS AND PRACTICES
FOR PATIENT CARE

11. EDUCATION AND TRAINING
OF HEALTHCARE STAFF

13. PHYSICAL ENVIRONMENT
AIR
WATER
FOOD
HEATING, VENTILATION & AIR
CONDITIONING SYSTEM (HVAC)

14. Temperature
Humidity
Pressure
Flowers & Plants
Pests
ENVIROMENTAL SAMPLING
ENVIROMENTAL SERVICES

15. Healthcare environment have diverse
population of micro-organisms --
Out of which only few are pathogenic
Mostly they grow in moist and organic
environment
Common organism – Myco tuberculosis,
Varicella zoster virus, measles – occurs due to
inappropriate air handling.
Aspergillus, enterococus facium, clostridium

16. • Location of sinks and dispensers for handwashing
products and hand hygiene products
• Types of faucets (e.g., aerated vs. non-aerated)
• Air-handling systems engineered for optimal
performance, easy maintenance, and repair
• ACH and pressure differentials to accommodate
special patient-care areas
• Location of fixed sharps containers
• Types of surface finishes (e.g., porous vs. non-
porous)
• Well-caulked walls with minimal seams
Construction Design And Function Considerations
For Environmental Infection Control

17. • Location of adequate storage and supply areas
• Appropriate location of medicine preparations areas (e.g.,
>3 ft. from a sink)
• Appropriate materials for sinks and wall coverings
• Appropriate traffic flow (e.g., no “dirty” movement
through “clean” areas)
• Isolation rooms with anterooms as appropriate
• Appropriate flooring (e.g., seamless floors in dialysis
units)
• Sensible use carpeting (e.g., avoiding use of carpeting in
special care areas or areas likely to become wet)*
• Convenient location of soiled utility areas
• Properly engineered areas for linen services and solid
waste management
• Location of main generator to minimize the risk of system
failure from flooding or other emergency

18. AIRAIR
Droplets to droplets under direct contact
transmission through cough & sneeze
Influenza virus, rhino virus, adenovirus.
Quality of air very important

19. Ventilation – air volume per minute per
occupant
Room AIR CHANGES PER HOUR – 12 – 15
ACH Comfortable
Room ACH > 12 at the time of construction
or renovation
If the patient room is equipped with an
individual through the wall fan coil unit, the
room should not be used as AII or PE.

20. Airborne Infection Isolation (AII)
 Max. organisms spread via air, hence
infected
 Patients kept in isolation
 Organism spread via airborne droplet
nuclei <5 µm.
 Air changes per hour (ACH) - > 12 ACH

21. From outside adjacent space into the room.
Air exhausted outside, but may be
recirculated provided return air is filtered
through HEPA filter (High Efficiency
Particulate Air)
Direction of airflow

22. Protective environment (PE)
Specialized patient care area – Positive airflow
related to the corridor (Airflow from room to the
corridor)
HEPA filtration to be used
High number of ACH >12
Minimal Leakage of Air
“For patients who have undergone
allogenic hematopoetic stem cell
transplantation”

23. Laminar Air Flow
Move air in a single pass
One way direction – optimizes air flow.
Delivery of air @ 0.5 meters per second
However there is no specific data that
demonstrate a survival benefit for
patients in PE.

25. Heating, Ventilation and Air conditioning
system HVAC
Includes outside air inlet or intakes, filters,
humidity, modification mechanism, cooling
equipments, fans, duct work, air exhaust and
diffusers or grills.
Infections result due to:
Decreased performance of HVAC System
Filter inefficiencies
Improper installation
Poor Maintenance

26. A centralized HVAC system operates
as follows
Outdoor air enters the system where low-
efficiency or roughing filters, remove
large particulate & microorganisms,
enters the distribution syst for approp.
temp & humidity, than again filtered, than
circulated
HEPA filter efficiency monitored by
Dioctylphthelate test (DOP Test)

27.  Preventive filters and duct maintenance
(cleaning Duct vents, replacing filters)
 Dust and moisture increases risk of spread
of infection
 Stagnation should be avoided
 infectious diseases outbreaks mainly due to
Poor maintenance of HVAC systems
HVAC maintenance

28. FILTER MAINTENANCE
 Efficiency depends on density of filters
which creates a drop in pressure.
 Pressure differential across filters
measured by manometers
 Poorly maintained filters implicated in
outbreaks of aspergillosis

30. Ultra Violet Germicidal Irradiation – UVGI
For reducing transmission of airborne
bacteria and viral infections
No effect on fungal spore
Upper room air irradiation
Duct irradiation

31. WATER
Culprit in spreading infections due to
pseudomonas, Asperigillus etc

32.  Practice hand Hygiene
 Point of use filtration equipments
 Eliminate contaminated water or fluid
environmental reservoirs (e.g., in equipment
or solutions)
 Clean and disinfect sinks
 No fish tanks or decorative fountains
 Dialysis water quality – endoxin testing on
product water
 Hot water range 40.6°C to 49°C, cold water
range <20°C

33. FOOD PREPARATION AND STORAGE
The food handlers should wear Head
Gear and gloves while serving the food
The quality of Water - to prepare food
and clean fruits and vegetables.
Potentially hazardous food – maintain at
140 Fº or above or int. temp. of 41 Fº or
below

34. ENVIRONMENT SERVICESENVIRONMENT SERVICES

35. Select good disinfectants
Keep housekeeping surfaces visibly clean
Detergent and water adequate for non-patient
care areas. (E.g. Administrative Offices).
Clean and disinfect “HIGH TOUCH AREAS” like
door knobs, bedrails, light switches, surfaces
in & around toilets, on and more frequently
schedule than minimal.
Do not perform disinfectant fogging in patient
care areas

37. Temperature- range comfortable-70-
75°F (21-24 ° C)
Humidity – Relative Humidity --
comfortable range 30-60%
Pressurization
AII rooms – Negative pressure
PE Rooms – Positive pressure Neutropenic
patients
Self closing doors mandatory for both.

38. ENGINEERING SPECIFICATIONS FOR IC

39. Laundry & Bedding
One must ensure that Laundry workers
personal protective garments are not
contaminated with blood
Laundry facilities
Receiving area of contaminated textiles
must have negative pressure compared to
clean area.
Ensure Hand washing after handling
contaminated clothes & before handling
clean clothes
Do not leave damp textiles or fabrics in
machines overnight.
Disinfection of washing and drying machines
not needed, if properly maintained

40. Contaminated Laundry
 No sorting in patient care areas.
 Use leak resistant containers
 Use Identity Labels for the contaminated bags

41. Laundry process
 If hot –water laundry cycles use Detergent in
water at >=160°F for >=25 minutes
Special Situations
 Dry cleaning not required for routine
laundering
 No recommendations regarding disposable
v/s durable goods – unresolved issue
 Hygienically clean textiles – laundered not
sterilized
 Mattresses & Pillows – keep them dry
 Maintain integrity of matress – discard when
torn

42. Flowers & Plants in patient care areas
 No restriction in immunocompetent
patient care areas
 No fresh or dried flowers or potted plants
in patient care areas for
immunosuppresed patients.
 If used, Vase water to be changed
frequently

43. PEST CONTROL
 Cockroach, Flies, maggots, ants, mice act
as vector for transmission of
microorganisms
 Pest control in Kitchen, Operating rooms,
Laundries, CSSD & other infection prone
areas
 Place Lab specimens in covered containers

44.  Advise families, visitors & patients regarding
importance of hand hygiene.
 Avoid shaking hands in the hospital – biggest
source of infection
 Avoid meeting patients in ICU’s, it can cause
cross infection
 Hospital equipments and grounds should be
maintained in a clean and sanitary condition
OTHER PRECAUTIONS

45. Aspergillus spp.
 Improperly functioning ventilation systems
 Air filters*,+
 Air filter frames
 Window air conditioners
 Backflow of contaminated air
 Air exhaust contamination+
 False ceilings
 Fibrous insulation and perforated metal
ceilings
 Acoustic ceiling tiles, plasterboard
 Fireproofing material
IMPLICATED ENVIRONMENTAL
VEHICLE FOR ENTRY OF PATHOGENS

46.  Damp wood building materials
 Opening doors to construction site
 Construction
 Open windows
 Disposal conduit door
 Hospital vacuum cleaner
 Elevator
 Arm boards
 Walls
 Unit kitchen
 Food
 Ornamental plants

47. Mucorales / Rhizopus spp.
 Air filter
 False ceilings
 Heliport
Scedosporium spp.
 Construction
Penicillium spp.
 Rotting cabinet wood, pipe leak
 Ventilation duct fiberglass insulation
 Air filters
 Topical anesthetic
Acremonium spp.
 Air filters
Cladosporium spp.
 Air filters
Sporothrix
 Construction (pseudoepidemic)

48. ENVIROMENTAL SAMPLING
 For monitoring the sterilization process
 Monthly cultures of water & dialysate in
hemodialysis unit.
 Cultures from Operation rooms and ICU’s
 No random undirected sampling of
Microorganisms

49. SPECIAL ISSUESSPECIAL ISSUES

51. Operation room
 The operation of a TB patient should be
scheduled last to have adequate ACH
 OR personnel should use NIOSH N95
respirators
 OR room to be closed after Intubation for
adequate ACH to remove 99% airborne
particles
 Temporary use of portable, HEPA filter may
eliminate air borne contaminants
 Breathing circuit filters with 0.1-0.2 ųm pore
size to be used

52. INFECTION CONTROL MEASURES DURING
RENOVATION/ REPAIR
 Identify the target population for
relocation based on risk evaluation
 At risk patient should wear protective
masks outside the PE room
 Do not transfer the patient in elevators
where the construction material is
transported

53.  Keep the entry & exit for the construction
workers separate
 Clinical lab to be free from dust
 The workers should not be allowed in the
outside clothes in the hospitals
 Shut off the return air vents in construction
zone
 Exhaust air/dust outside
 Set the pressure differential to keep at –ve
press.
 The humidity to be <65%
 Construction zone to be cleaned daily

54. TEAM INVOLVED
 Infection control Personnel
 Lab Personnel
 Hospital Administrator
 Director Engineering
 Risk management personnel
 Director of specialized services
 Employee safety personnel
 Environment service personnel
 Construction Administrator
 Project manager, contractor, architect

55. HEALTH CARE WORKERS

56. Employee Health Program
 Annual Health Examination
 Interim Health Examination
 Follow up Examination
 In house training programs for the Medical &
Paramedical staff
 Ensuring that the staff have heavy meals
before joining duty
 Needle stick injury to be reported
immediately

57. FOR PATIENTS
 Daily bathing / sponging of patient
 Daily changing of Patient linen, including
Uniform, Bed sheets, Pillow covers.
 Keeping the infected patients in Isolation
rooms
 Reducing visitor traffic in rooms
 Restricted visiting hours for ICU patients
 Use of respiratory protection indicated for
persons entering their room.

58. FOR RELATIVES
 Keeping fixed visit hours for the relatives
 Disincentives to reduce the visitors
 Restriction of Children entry in patient care
areas

59. COMMUNITYCOMMUNITY
 Maintaining records of all infected cases
identified
 Surveillance report of all the infection cases
to be reported to the government authorities
like WHO, and local authorities

62. SOME INFECTION CONTROLSOME INFECTION CONTROL
MEASURES AT STERLING HOSPITALMEASURES AT STERLING HOSPITAL
 Vaccination of Hepatitis B to employees
 Regular stool examination of food handlers
 Follow up Examination
 Maintain Register to ensure the hand
washing before and after going to the wash
room
 “UP” sign outside infected patient rooms
 Regular checking of nail, hair, uniform of
health care workers

70. THANK U !!!!