INFECTION PREVENTION AND CONTROL POLICIES AND ... …

1 INFECTION PREVENTION AND CONTROL POLICIES AND GUIDELINESW orld Health OrganizationRegional Office for Africa (WHO/AFRO)Commonwealth Regional Health Community Secretariat (CRHCS)East, Central and Southern African College Of Nursing (ECSACON)Prepared byUna V. ReidHRD ConsultantNovember, 2001 MANUALTABLE OF CONTENTSPageList of Illustrations .. viiAcknowledgements .. xiPreface .. xiiSECTION I: INTRODUCTION .. 1 Introduction .. 2 Purpose .. 3 Scope of the INFECTION PREVENTION and CONTROL POLICIES and guidelines Manual .. 4 General Policy Statements .. 5 SECTION II: MANAGEMENT OF THE INFECTION PREVENTION AND CONTROL POLICIES AND guidelines .. 8 Responsibility and Authority .. 9 Levels of Responsibility INFECTION PREVENTION and CONTROL Infrastructure .. 10 Rationale Organization of INFECTION PREVENTION and CONTROL The INFECTION PREVENTION and CONTROL POLICIES and guidelines Manual .. 16 POLICIES CONTROL Distribution Review CycleSECTION III: EPIDEMIOLOGY.

2 18 The Infectious Disease Process/The Epidemiological Triangle .. 19 Source Host TransmissioniiInfection PREVENTION and CONTROL POLICIES and GuidelinesSECTION IV: STANDARD PRECAUTIONS .. 23 Introduction .. Precautions .. Precautions .. 25 Elements of Standard Precautions .. Protective Equipment .. Eye Care Equipment .. and Faeces .. CONTROL .. Transport .. Specimens .. a Post-mortem .. 56 SECTION V: ISOLATION .. 59 Introduction .. 60 Policy Statements .. 61 Requirements for Isolation .. 65 Establishing Priorities for Single Rooms .. 66 Isolation Categories .. 67iiiInfection PREVENTION and CONTROL POLICIES and GuidelinesSECTION VI: TRANSMISSION-BASED OR ADDITIONAL PRECAUTIONS FOR CARE SETTINGS .. 68 Introduction .. 69 guidelines for All Health Care Facilities .. 70 Tuberculosis .. 80 Precautions for Viral Haemorrhagic Fevers (Ebola) .. 84 Dentistry .. 86 SECTION VII: DISINFECTION AND STERILIZATION.

3 96 Antiseptics and Disinfectants .. 97 Antiseptics .. 97 FUses Disinfectants .. 100 FPurposeFTypesFEffectivenessFChoice of Disinfection MethodsFGuide to the Use of DisinfectantsFCalculations of ConcentrationsFPreparing A Dilute Chlorine SolutionFUsing Chlorine-Releasing TabletsFDilutions of Household Bleach Processing .. 113 Introduction Classification of Risk Steps in Processing Summary .. 133 SECTION VIII: HOUSEKEEPING .. 136 Introduction .. 137 Policy Statements .. 138 guidelines .. 144ivInfection PREVENTION and CONTROL POLICIES and GuidelinesSECTION IX: HEALTH CARE FACILITY WASTE MANAGEMENT .. 161 Introduction .. 162 Policy Statements .. 166 Management Responsibility .. 167 Steps in Developing A Waste Management Plan Waste Management .. 173 On-site Transport .. 182 Off-site Transport ..183 Infectious Waste .. 184 Tips for Handling Waste Disposal Containers .. 187 Characteristics of an Ideal Waste Disposal Container .. 187 To Build a Burial Pit.

4 188 To Build A Drum Incinerator .. 189 Record Keeping .. 190 Training .. 191 Workers Health and Safety .. 192 SECTION X: RISK MANAGEMENT .. 193 Purpose of Risk Management .. 194 Bloodborne Pathogens .. 195 Introduction Policy Statements Methods of Compliance Post-Exposure ProphylaxisvInfection PREVENTION and CONTROL POLICIES and GuidelinesviInfection PREVENTION and CONTROL POLICIES and guidelines Laboratory Biosafety .. 207 Introduction Policy Statements Classification of Biological Agents Biohazard Spills Emergencies .. 219 Medical General First Aid Fires Accident/Incident Reporting Antibiotics Resistance in Hospitals .. 223 GLOSSARY .. 225 APPENDICES .. 2351. Checklist/Forms .. 2362. INFECTION PREVENTION and CONTROL Resources .. 2493. Job Description .. 2514. UN Packaging Requirements .. 2545. Representation .. 255 REFERENCES .. 256 LIST OF of INFECTION PREVENTION and CONTROL POLICIES and guidelines .. and Antiseptic/Antimicrobial Agents for Handwashing.

5 Of Antiseptic Agents .. Techniques .. Strategies to Improve Handwashing Techniques and Compliance .. Conditions and Transmission Characteristics .. Antiseptics and Their Use in Patient Preparation .. Classes of Chemical Disinfectants and Their Relative Advantagesand Disadvantages .. Efficacy Levels .. of Household Bleach .. of Risks .. of Instruments and Equipment .. Care Facility Cleaning/Disinfection POLICIES .. of Health Care Facility Waste .. of Health Care Facility Care Definitions .. Health Care Risk Waste Treatment Technologies .. for Management for Categories of Health Care Facility Waste .. of Risk Groups and Levels of Containment .. and Disinfection in the Laboratory .. 217viiInfection PREVENTION and CONTROL POLICIES and GuidelinesFIGURES * Handwashing Techniques .. 30 Handwashing Techniques .. : Areas for Special Attention .. on Gloves .. Gloves .. Gloves .. on Gown.

6 Gown .. Gown .. Gown .. on a Surgical Mask .. a Mask .. on Plastic Glasses .. Plastic Glasses .. on Protective Goggles .. Protective Goggles .. on Face Shield .. Face Shield .. 4719. Removing Face Shield .. Hand Scoop Method .. 51viiiInfection PREVENTION and CONTROL POLICIES and Sharps Container .. Precautions .. Precautions .. Precautions .. Precautions .. : Decontamination .. : Cleaning .. : High-level Disinfectant .. : Sterilization .. : Use or Storage .. of Health Care Waste .. Responsibility .. Care Waste Policy .. Management .. Management: Separation .. Management: Identification .. Management: Handling .. Management: Treatment .. Management: Disposal .. Management: Storage .. Management: Transport .. 181ixInfection PREVENTION and CONTROL POLICIES and of Waste .. of Waste .. s Health and Safety ..192xInfection PREVENTION and CONTROL POLICIES and guidelines * Credits:Figures 1& 2:AVSC PREVENTION Trainer s Manual, , 161.

7 (modified).Figure 3:DesignStudio 4-19: (modified).Figure 20:AVSC PREVENTION Trainer s Manual, Figure 21:WHO, p. 8. (modified).Figures 22-24:DesignStudio 25 (Composite):WHO, USDHHS, CDC, AVSC, DesignStudio 26, 26a-26e:AVSC PREVENTION Trainer s Manual, , 263, 293, 315, 377. (modified).Figure 27:WHO, p. 28:WHO, p. 29:WHO, p. 30, 30a-30g: (modified).Figure 31:WHO, p. 32:WHO, p. 33:WHO, p. 34:WHO, p. to Figuresby DesignStudio activities associated with the preparation of the Manual of INFECTION PREVENTION andControlhas its genesis with the expressed concerns of senior nurses and midwives withrespect to the INFECTION PREVENTION and CONTROL -related practices of all health care subsequent developments including the preparation of an assessment tool, the assessmentstudies in the three countries, and the presentation of the findings at the Conference of HealthMinisters were outcomes of such World Health Organization Regional Office for Africa, and the Commonwealth RegionalHealth Community Secretariat, Arusha wish to thank:The following ECSACON members for initiating the process and for their continuing interest:Susan Otieno, Anne Kanyuga (Kenya); Maria Kawonga, Lennie Kamwendo, Agness Katsulukuta(Malawi); Mavis Nxumalo, Winnie Nhlengethwa (Swaziland).

8 Eliaremisa Ayo, Mary-ani Lema(Tanzania); and Peggy Dube, Cynthia Chasokela, Egnes Makwabarara (Zimbabwe).Mrs. Margaret Phiri, former Coordinator of Nursing Affairs, CRHCS, who initiated the late Mrs. Brigit Hansen-Sylvester of WHO, Geneva, who assisted ECSACON in addressingpractice issues; Ms. Barbara Stilwell, formerly of the EPI, Geneva, who succeeded Mrs. Evelyn Isaacs, WHO/AFRO Regional Advisor, Care and Support Unit, HIV/ aids , Hararewho assisted in the mobilization of resources, and provided technical assistance in the design ofthe project. Dr. Isaacs continues to be pivotal in the activities of INFECTION PREVENTION and WHO Country Offices in Malawi, Tanzania, and Zimbabwe for their financial and Una V. Reid, Consultant who undertook a tremendous amount of work in the preparation ofthe Manual and related Training Programme on INFECTION PREVENTION and in-country multidisciplinary teams who were very committed and who provided Dr.

9 Reidwith invaluable information on their review of the Draft 1 Winsome Williams who typed the Manual through its various drafts, Michael Christie ofDesignStudio Ltd., Jamaica, who provided the artistry through to desktop publishing andduplication, and the many others who have provided assistance in the preparation of the merit Governments of Malawi, Tanzania, and Zimbabwe through their respective Ministries ofHealth supported the country-specific activities. The activities undertaken by the Consultantcould not have succeeded without the tremendous support of these PREVENTION and CONTROL POLICIES and GuidelinesPREFACEThe preparation of this Manual of INFECTION PREVENTION and CONTROL POLICIES andGuidelinesis in response to a need to provide safe and quality care to patients, toprevent them, their families, visitors and health care workers from acquiring and/ortransmitting infections in the care HIV/ aids epidemic currently ravaging the Sub-Saharan region and the efforts by thecountries to accelerate their response also underscores the need to have INFECTION PREVENTION andcontrol POLICIES and guidelines to promote safe practices by all health care workers in all healthcare facilities and purpose of the Manual is to provide health care workers.

10 Managers and supervisors thestandards and criteria against which to measure safe practice in INFECTION PREVENTION and , it provides relevant information for communities and home-based East, Central and Southern African College of Nursing (ECSACON) instigated thepreparation of the Manual and supporting team of senior nurses, members of ECSACON, from Kenya, Malawi, Swaziland, Tanzania, andZimbabwe designed an assessment tool for the collection of data on INFECTION PREVENTION andcontrol practices. Subsequently, nurses from Malawi, Tanzania, and Zimbabwe conductedassessment studies in their countries. The findings of the three countries studies were presented at the 32nd Conference of HealthMinisters held in Swaziland in October 2000. The significance of the findings moved theMinisters to pass resolution (CRHC/RHMC32/R5), indicating that countries should be assisted todevelop and/or strengthen their INFECTION PREVENTION and CONTROL practices.