Our lesson today is on infection prevention and control and water sanitation and hygiene. The key objectives for this lesson is to understand the basic principles of IPC/ WASH, to know conditions that allow transmission of infections, to understand the IPC/ WASH relationship. IPC is the prevention of health care associated infections and contributes to provision of high quality service to ensure patient safety. And WASH is a core component of quality improvement in health and patient safety programmes. Patient safety includes care of, safety of the health provider as well as the patient and therefore, IPC practices are not practical without WASH services.
Patients receiving health care are at risk of acquiring infections due to nature of the microorganisms, patient factors– for example age, if patient is on drugs like steroids or chemotherapy. Environmental factors can also contribute to acquired acquisition of infections, as well as engineering factors, for example, our IPC practices as well as the design of the hospital. It is important for health workers to know and use IPC/ WASH principles to minimise the risk.
The principles of IPC/ WASH includes standard precautions, hand hygiene, personal protective equipment, needle stick and sharp injuries, cleaning and disinfection, waste management, as well as environmental hygiene. Strategies to prevent these principles are based on risk assessment that is evidence based, cost effective, and easy to comply to. The first one is standard precautions, which is designed to reduce the risk of transmission of microorganisms from known and unknown sources. Standard precautions apply to all patients and situations regardless of diagnosis or one’s status in society. They apply to body fluids and secretions. Hand hygiene is the second principle. This is the most important activity to prevent transmission.
As health providers always use five moments of hand hygiene, which is before patient contact, number two, before clean or aseptic procedure, number three, after body fluid exposure, and number four, after touching a patient, and number five, after touching patient surroundings. Hospital managers must consider clean running water when designing hospitals. Efficacy of hand hygiene preparations in killing bacteria depends on which method you use. A alcohol-based hand rub has proved to be the best to kill bacteria, and second is anti-microbial soap, and last is plain soap. So it is preferable if we can use alcohol-based hand rub. However, hand rubs are not suitable when there’s organic contamination.
Therefore, you always need to have a dedicated hand washing basin for hands only and no clinical waste should be poured in these basins.
It is also important to promote hand hygiene through education of patients and staff. Educate your patients that staff should not touch them before they wash their hands. Observation and feedback– As lead IPC persons, always observe what is happening around you in hand hygiene practices and provide feedback to your colleagues. As managers they must provide hand washing amenities that include hand rub. Posters as reminders in strategic places is included. And also, as managers, administrative sanctions and rewards are sometimes necessary. Personal protective equipment is another method of infection prevention principle. You need to conduct a risk assessment before any procedure, irrespective of physical appearance of the patient. If exposure to fluid is expected wear appropriate PPE.
Those are just examples of some of the practices that need you to put PPE.
PPE must not be substituted for IPC/ WASH practices. Discard PPE after use between patients and also do not use PPE for extended periods, otherwise you transmit infections. Sharps and injuries are a major cause of injuries to health care workers. High risk of causing infections from blood borne viruses such as Hepatitis B, HIV. Minimise injuries by undertaking a risk assessment when you’re using sharp instruments. Dispose your sharps at point-of-use and do not let anybody dispose your sharps. That is just an example of a sharp disposal, which was seen at another hospital.
Cleaning and disinfection– Surgical instruments are a major source of health care association because they are sharp. Clean water is necessary for cleaning equipment. And the method used for decontamination will depend on how the equipment or the instruments were used. You can clean without sterilisation but you cannot sterilise or disinfect without cleaning. Therefore, it is necessary to have a central sterilisation department where cleaning is done to ensure good work flow. The design must be that when you are working in a dirty area, they must not also work in a clean area to avoid cross-contamination of instruments that have already been cleaned.
Waste management– The purpose is to protect people who handle waste from accidental injuries and also to prevent the spread of infection to health workers and local community. So this waste is also protecting our environment. Poor management discourage patients from accessing our health services. There are different types of waste– clinical, non-clinical, and domestic waste. All of these are disposed in different containers with colour codes. Or if you don’t have colour coded waste disposal bags, posters on what should be discarded can be used. And then keep our waste containers closed without over filling. Environmental hygiene plays a vital role in transmission of pathogens. Good IPC/ WASH starts with a clean environment.
And our health care environment is a breeding ground for germs and spread of antimicrobial if it’s not looked after. To reduce visible dirt and to make the environment pleasant, we need to clean our environment. And it also reduces the number of microbes if we clean. So the general principles when we are cleaning– always use clean water, have a schedule for cleaning, and then adequate time should be allocated. Clean from least soiled or most soiled, and must be from top to bottom. Sanitation and hygiene of toilets and bathroom facilities should be considered. Our cleaning staff must be trained to adhere to these practices.
So the relationship between IPC and WASH is you need to provide hand hygiene amenities, that’s soap and alcohol-based hand rub, ideally at entrance of the ward or after every six beds. And also these hand washing facilities must be provided in toilets. There must be proper waste disposal facilities and PPE must be provided. Promote facility with good ventilation to prevent accumulation of microbes so that they must be natural air circulating. Patients must be allowed access to bathrooms and toilets to prevent open defecation surrounding the hospital premises. IPC lead persons to be part of design of facilities and procurement of equipment of the hospitals.
All this must be done on hand hygiene practices, environmental hygiene, waste management, sharps injuries, decontamination of equipment, and availability of clean water and electricity. Are there any questions? Thank you very much for you listening.