Prevention and management of infection is the responsibility of all staff working in health and social care, and an integral element of patient safety programmes. It is applicable to all health and social care organizations, regardless of the patient setting or care provider. Infection prevention and control is the clinical application of microbiology in practice. Infection or disease may be caused by different groups of microorganisms such as bacteria, fungi, viruses or prions and can result in a wide variety of infections that include, for example, urinary tract, wound, respiratory, blood, bone and skin infections. Not all infections are transmissible, however some, such as clostridium difficile (C. difficile), influenza and norovirus, have the potential to spread from one patient to another causing infection with additional significant implications for health and social care facilities. Understanding how infections occur and how different microorganisms act, and spread is crucial to preventing infections.

Standard infection control precautions, formerly known as universal precautions, underpin routine best practice, protecting both staff and patients from microorganisms that may cause infection.

Hand Hygiene

Hand hygiene is a term used to describe processes that render the hands of health care workers safe (having reduced the number of microorganisms present that are acquired through activities that involve touching patients, equipment or the environment in the workplace). The term hand hygiene includes handwashing, surgical scrub and the use of alcohol gel. The type of hand hygiene performed is dependent on the type of care that will or has been carried out.

• When to perform hand hygiene

Hand hygiene can be undertaken using soap and water or hand sanitizers, namely alcohol hand rubs.Alcohol hand rubs provide an efficient and effective way of disinfecting hands and are actively promoted by health and social care organizations. Hand hygiene is relevant in all health care settings including hospitals, GP surgeries/ clinics, patients’ homes, mental health and care homes. Personal hand rub dispensers are available for settings where end-of-bed or free-standing dispensers are not appropriate for use. Care should be taken to avoid risks of patients or visitors ingesting hand sanitizers as these can cause harm including death.

• Hand hygiene at the point of care

It is important to recognize that the hands of health care staff will always carry bacteria, be it their own bacteria or those that have attached because of activities (handling equipment, touching surfaces or patients). Although it is not possible to ‘sterilize’ hands, the number of bacteria present can be reduced significantly through good hand hygiene practice. While it is not possible to perform hand hygiene on every occasion during the working day or night, there are several occasions when hand hygiene is specifically recommended to guide staff in best practice. Situations that pose the greatest risks include, but are not limited to:

• Before patient contact
• Before contact with a susceptible patient site (such as an invasive device or wound)
• Before undertaking an aseptic technique or procedure
• After exposure to body fluids (blood, vomit, feces, urine and so on)
• After glove removal
• After patient contact
• After contact with the patient’s immediate environment

Personal protective equipments (PPE)

Personal protective equipment (PPE) includes items such as gloves, aprons, masks, goggles or visors. PPE is used to protect health care workers from harm, in this case from risks of infection. PPE such as gloves may also be required for contact with hazardous chemicals and some pharmaceuticals, for example, disinfectants or cytotoxic drugs.

Safe handling and sharps disposal

Sharps include needles, scalpels, stitch cutters, glass ampoules, bone fragments and any sharp instrument. The main hazards of a sharp injury are blood borne viruses such as hepatitis B, hepatitis C and HIV. It is not uncommon for staff to be injured by the unsafe or poor practice of others; for example, cleaners who sustain injuries because of sharps being placed in waste bins. Sharps injuries are preventable and learning following incidents should be put in place to avoid repeat accidents. To reduce the risk of injury and exposure to blood borne viruses, it is vital that sharps are used safely and disposed of carefully, following your workplace’s agreed policies on use of sharps. Education and guidance should be available on how to manage sharps safely. Some procedures have a higher-than-average risk of causing injury. These include surgery, intra-vascular cannulation, venipuncture and injection.

Sharps best practice points: -

You should ensure that:

• Handling of sharps is kept to a minimum.
• Syringes or needles are not dismantled by hand and are disposed of as a single unit straight into a sharp's container for disposal.
• Sharps containers are readily available as close as possible to the point of use (sharps trays with integral sharps boxes are a useful resource to support this practice point).

• Needles are never re-sheathed/recapped.
• Needles are not broken or bent before use or disposal.
• Single use sharps containers.
• Sharps containers are not filled to more than two thirds or to the fill line.
• Sharps boxes are signed and dated on assembly and disposal.
• Sharps containers are placed at eye level and within arms’ reach.
• Establish a means for the safe handling and disposal of sharps before the beginning of a procedure.
• Sharps bins are stored safely away from the public and out of reach of children (in other words, not

stored on the floor or at low levels).

• Staff report sharps injuries in line with MOH reporting procedures/policies.
• Staff attend training on the safe use of sharps and safety engineered devices.
• Staff are aware of and comply with their local sharps or inoculation injury policy.

Safe handling and waste disposal

Waste reduction, segregation and disposal are all crucial to sustaining a healthy environment and reducing subsequent public health implications and financial costs. Nursing staff are central to efforts on green issues such as waste management as they represent the largest proportion of the healthcare worker workforce that purchase equipment and manage subsequent waste generated. The ineffective management of healthcare waste can also result in additional costs related to the disposal of waste if not segregated appropriately. Every workplace should have a written policy on waste segregation and disposal which provides guidance on all aspects, including special waste, like pharmaceuticals and cytotoxic waste, segregation of waste, and audits. All health care and support staff should be educated in the safe handling of waste, including segregation, disposal and dealing with spillages. Organizations should consider systems for segregating waste that allows it to be recycled.

Spillage management

Spillages of blood and bodily fluids should be dealt with quickly, following your workplace’s written policy for dealing with spillages. The policy should include details of the chemicals staff should use to ensure that any spillage is disinfected properly, considering the surface where the incident happened. All spills to be dealt with as per the hospital policies.

Other practices that used to reduce the hospital acquired infections

• Asepsis and aseptic technique
• Decontamination of equipment
• Achieving and maintaining a clean clinical environment
• Appropriate use and management of indwelling devices
• Managing accidental exposure to blood-borne viruses
• Antimicrobial resistance (AMR)

About the author:
Jibi Thankachan is the Former Senior Preventionist/Specialist of Infection Control at King Saud Medical City & Rapid Response Team Lead at MOH, Saudi Arabia.