Learn — Infection control & sterilisation

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Infection control — standard precautions

Standard precautions are the set of infection-prevention practices applied to every patient, at every contact, whatever the diagnosis or presumed infection status, on the working assumption that blood, all body fluids and secretions except sweat, non-intact skin and mucous membranes may carry an infectious agent. They matter at the bedside because most healthcare-associated infection is transmitted on the hands and equipment of staff moving between patients, so this baseline layer, and not the extra transmission-based precautions stacked on top of it, is what prevents the majority of cross-infection.

The WHO My 5 Moments for Hand Hygiene are: before touching a patient, before a clean or aseptic procedure, after a body fluid exposure risk, after touching a patient, and after touching the patient's surroundings.
An alcohol-based handrub takes 20 to 30 seconds of rubbing until the hands are dry; a soap-and-water handwash takes 40 to 60 seconds including wetting, lathering, rinsing and drying, and surgical hand preparation is longer again and follows the product's stated contact time.
The six-step technique covers palm to palm, palm over the back of the hand with fingers interlaced, palm to palm with fingers interlaced, the backs of the fingers into the opposing palms, rotational rubbing of each thumb, and the fingertips rotated into the opposite palm; thumbs, fingertips and the webs are the areas most often missed.
PPE is donned in the order gown, then mask or respirator, then eye protection, then gloves, after hand hygiene; it is doffed in the order gloves, eye protection, gown, then mask or respirator, with hand hygiene between steps and at the end, and the mask or respirator is always removed last and outside the patient's room.
Sharps are never recapped; if recapping cannot be avoided the one-handed scoop technique is used, the needle is cut at the point of use where a hub cutter is available, and the container is puncture-proof and closed at three-quarters full.
Transmission-based precautions are added on top of standard precautions: contact precautions need gown and gloves and dedicated equipment, droplet precautions need a surgical mask on entry and at least one metre of distance, and airborne precautions need an N95 or FFP2 respirator and a negative-pressure room with the door kept closed.
Respiratory hygiene means the coughing patient covers the mouth with a tissue or the bend of the elbow, discards the tissue into a yellow bag, performs hand hygiene, and wears a surgical mask while waiting at least one metre from others.
Environmental control means high-touch surfaces such as bed rails, lockers, monitors and door handles are cleaned at least once a shift, and a blood or body fluid spill is covered, flooded with 1% sodium hypochlorite for at least 10 minutes of contact and then wiped from the outside of the spill towards its centre.

Spill management — BMW

Biomedical waste management is the segregation, containment, treatment and disposal of the waste generated in patient care, governed in India by the Bio-Medical Waste Management Rules 2016 and their amendments, which fix a colour for each category at the point where the waste is generated. Spill management is the part of it done at the bedside: a spill of blood or body fluid is contained, disinfected with the right strength of hypochlorite for the right contact time, and then cleaned up from the outside inwards so the contamination is not spread.

The yellow bag takes human anatomical waste, animal waste, soiled waste such as dressings, cotton and items contaminated with blood or body fluids, expired and discarded medicines, chemical waste, discarded linen contaminated with blood or body fluids, and laboratory and microbiology waste, which must be pre-treated on site; it is disposed of by incineration, plasma pyrolysis or deep burial.
The red bag takes contaminated recyclable waste, meaning used disposable plastic items such as tubing, bottles, intravenous sets, catheters, urine bags, syringes without needles and gloves; it is treated by autoclaving, microwaving or hydroclaving and then sent for recycling.
The white translucent puncture-proof container takes waste sharps, including used and contaminated needles, scalpels, blades and the contents of the needle-tip cutter, and is treated by autoclaving or dry heat sterilisation followed by shredding, encapsulation or a concrete pit.
The puncture-proof and leak-proof box or container with blue marking takes broken, discarded and contaminated glass, including medicine vials and ampoules, and metallic body implants; it is disinfected, washed and recycled.
Needles are cut at the point of generation with a needle destroyer or hub cutter and are never recapped; every container is filled to no more than three-quarters, tied and labelled with the biohazard symbol and the date, and waste is not stored on site beyond 48 hours.
For a blood or body fluid spill: put on gloves, and an apron and eye protection if splashing is possible, cordon off the area, cover the spill with absorbent paper, pour or spray 1% sodium hypochlorite over it and leave it for at least 10 minutes of contact, then wipe from the outer edge of the spill towards its centre, lift the soiled material into a yellow bag, clean the area again with detergent and water, discard the gloves into a red bag and perform hand hygiene.
Strengths are examined: 1% sodium hypochlorite for a blood or body fluid spill, and about 0.5% for routine surface disinfection and equipment; the solution is prepared fresh because it loses strength in heat and daylight, and it corrodes metal.
Never mix hypochlorite with an acid cleaner or with ammonia, because the reaction releases chlorine gas; never pour it onto a large uncontained spill without covering it first, because it splashes.
Broken glass in a spill is never picked up by hand: use forceps, a scoop or a dustpan and brush kept for the purpose and place it in the blue container.
A mercury spill from a broken thermometer is not swept or vacuumed: collect the beads with a syringe, a piece of card or adhesive tape into a container of water, seal it, label it and send it for mercury disposal.
The rules also require training of all staff, immunisation of every waste handler against hepatitis B and tetanus, a barcoded tracking system for bags leaving the facility, an annual report to the pollution control board, and a record of every spill and accident.

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