Infection Prevention and Control, By Dechasa Adare Mengistu (Ass.Professor)

Infection Prevention and Control, By Dechasa Adare Mengistu (Ass.Professor)

1. 4/10/2025 1
Haramaya University
College of Health and Medical Science
School of Environmental Health
Infection Prevention and Control
By: Mr. Dechasa Adare (Ass. Professor)
Harar, Ethiopia
Welcome
14/10/2025
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO
IPC guidlines

2. 4/10/2025
Learning outcome/ objectives
•Define infection prevention and control
•Describe how IPC practices in healthcare
settings
•Identify risk factors within the patient care
environment
•Identify how the IPC core components,
provide a blueprint for successful
implementation of IPC programs
•Identify appropriate application of standard
precautions
•The engineering, work practice, and
environmental controls that protect against HAI.
•Primary principles of public health emergency
management
•Identify barriers and personal PPE for protection
from exposure to potentially infectious material.
•Use PPE properly as per the WHO standard
2

3. 4/10/2025
Learning outcome/ objectives
•How sanitation and environmental hygiene
contribute to reducing risk of infection
transmission
•Hand and respiratory hygiene.
•Monitor cleaning, disinfection and
sterilization
•Explain food and water safety measures
•Health impacts, mitigations and adequate
responses to health care associated
infections (HAI).
•Recommendations and best practices for IPC.
•Principles for conducting HAI surveillances
•Design an approach and implement and interpret surveillances
findings.
•Describe and promote appropriate strategies for outbreaks
investigation.
•Policies and guidelines in relation to IPC
•Identify and promote non pharmaceutical interventionsto be
applied at community level
•Adherence to IPC protocol
3

4. 4/10/2025
What is infection prevention and control?
•Infection prevention and
control (IPC) is:
•A scientific approach with a
practical solutions designed
to prevent harm
•Caused by infections
•To patients and
health care workers
•Grounded in principles of :-
•Infectious disease
•Epidemiology
•Social science and
•Health system strengthening
•Rooted in patient safety and health service
quality
4

5. •It’s everyone’s business/responsibility
Break the Chain of Infection & Keep Yourself and Others Safe!
There is a need for better collaboration and coordination
among clinical and non-clinical teams.
Cont..

6. Infection prevention and Control ( IPC) (WHO )
IPC Program
IPC Guidelines
IPC Education and Training
HAI’s Surveillance
IPC Multimodal strategies
Regular Monitoring and Feedback
Staffing and workload
Built Environment
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4/10/2025

7. 7
The Principles of a Safe Environment (Source: Horton and Parker, 2002)
Cont..

8. 8
HAI is everybody’s business
Clinical
Doctors
Nurses
Microbiologists, etc.
Construction
Engineers
Architects, etc.
Facility and IPC Mngt
Cleaning
Catering
Waste Mgt
Maintenance
Estate engineering
Strategic management
Healthcare managers
Policy makers, etc.
Different
UserRoles

9. Purpose of the infection prevention and control
•Improve patient safety (prevention,
identification, and control of infections
& communicable diseases)
•Prevent HAI
•Minimize occupational health risk to
healthcare workers
9
Yourself
Family, community &
environment
The patients

10. IPC contributes to achieving the global health priorities
Cont..
10

11. IPC goals in
outbreakpreparedness
1.Toreducetransmissionofhealthcareassociatedinfections
2.Toenhancethesafetyofstaff,patientsandvisitors
3.Toenhancetheabilityoftheorganization/healthfacilitytorespondtoan
outbreak
4.Tolowerorreducetheriskofthehospital(healthcarefacility)itselfamplifying
theoutbreak
IPC goals
11

12. 6 links in a chain must be present for an infection to
occur:
Pathogen A place where pathogens can live.
On humans or insects or fomites,
non-living object
A means of escape, such as the
respiratory tract, skin, blood, gastro-
intestinal tract, and mucous
membranes.
The way a pathogen travels…
either by direct contact or airborne
droplet.
A place of entry, the same as the
means of escape PLUS damaged or
injured skin.
A host that does not resist the
infection or may have an
immunity to it.
12

13. Who is at risk of
infection?
Everyone
Who is at risk of infection?
13

14. •Knowledge: have an understanding of the IPC strategies needed for
outbreaks/epidemics, etc
•Assessment, preparedness and readiness
•Policy and SOPs development
•Participate in response and recovery
•Participate in surveillance & monitoring
•Patient management
•Infrastructurefor patient management
•Education
Role of the IPC focal point, team or committee
14

15. •EffectiveIPCrequiresconstantactionatalllevelsofthehealthsystem,
including:-
•Policymakerstofacilitymanagers
•Healthworkers
•Hygienespecialistsand
•Thosewhoaccesshealthservices.
15
Cont..

16. Adapting
IPC Core
Components
Multimodal/multidisciplinary strategies
Patient-centred
Integrated within clinical procedures
Innovative and locally adapted
Tailored to specific cultures and resource level
Adapting IPC Core Components
16

17. IPC implementation approach
A WHO IPC implementationframework
17
National
Health facility
IPC
Guidelines
Implementation packages
IPCAT2
5-Step implementation
cycle
IPCAF
Assessment Framework
Assessment Tools

18. •A multimodal strategy comprises
several elements or components
•Three or more; usually five
•Implemented in an integrated way
with the aim of improving an
outcome and changing behaviour.
18
•WHO core component 5 for effective IPC; Strong recommendation: multimodalstrategies
•It includes tools, such as checklists,
developed by:-
•Multidisciplinary teams that take
into account local conditions.

19. IPC multimodal improvementstrategy
19

20. 20
•Systemchange
•AvailabilityoftheappropriateinfrastructureandsuppliestoenableIPC
recommendationsimplementation);
•Educationandtraining
•Forhealthcareworkersandkeyplayers
•Monitoring
•Infrastructures,practices,processes,outcomesandfeedback;
•Communications
•Culturechange
•Withintheestablishmentorthestrengtheningofasafetyclimate.
The five most common components are:

21. The Role of IPC In delivery safe and quality of Healthcare Service
•Infectionpreventionandcontrol(IPC):asystemiceffortorprocessofplacing
protectivebarriers(physical,chemical,ormechanical)betweensusceptiblehost&
microorganism
•IPCisessentialfordeliveryofsafeandqualityhealthcareservices.
•Onaverageatanygiventime
•7%ofpatientsindevelopedand
•10%indevelopingcountrieswillacquireatleastoneHAI.
•DeathfromHAIoccursinabout10%ofaffectedpatients
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22. 22
•It describe how a pathogenic MOs moves from an individual &/or contaminated surface to
another person or surface.
•From mother to child,
•Between individuals
oDirect mode of transmission e.g. a touching or coughing
oIndirect mode of transmission e.g. touching shared spaces(door handles,
curtains & benches) and patient/client without cleaning your hands.
Transmission of Microorganisms

23. Multi-drug resistant organisms (MDROs)
•Organisms that have developed
resistance to antimicrobial drugs
•Growing threat to public health
Examples of MDRO
•Methicillin Resistant Staphylococcus
Aureus (MRSA)
•Vancomycin Resistant Enterococcus
(VRE)
•Extended spectrum beta lactamase
(ESBL) i.e. Klebsiella, E. Coli
•Multi-drug resistant Acinetobacter
23

24. Transmission of Infectious Agents in Healthcare
Settings
Transmissionofinfectiousagentswithinahealthcaresettingrequiresthreeelements
•asourceofinfectiousagents,
•asusceptiblehostwithaportalofentryreceptivetotheagent,and
•amodeoftransmissionfortheagent.
Sources
of
Infectiou
s Agents
Susceptibl
e hosts
Mode of
Transmiss
ion
24

25. Transmission: Direct Contact
•Gastrointestinal, respiratory, skin, and wound infections
•Most agents transmitted by droplets can also be transmitted by contact
•Transmission through the skin is the third most common mode of transmission of infection.
•Penetration through intact skin is unlikely
•Fecal-Oral
•Excreted by the feces
•Transmitted to the oral portal of entry through contaminated food, contaminated water,
milk, drinks, hands, and flies
•Site of entry: oropharynx for some microorganisms; intestinal tract for most viruses
25

26. Transmission: Droplet
Examples of organisms transmitted through Droplet Transmission:
•Hemophilusinfluenzae
•Meningococci
•Pneumococcal infections (invasive, resistant)
•Bacterial respiratory infections (Diptheria, Pertussis, pneumonic plague, pneumonia)
•Viral respiratory infections
•Adenovirus
•Influenza
•Mumps
•Parvovirus , and any paroxysmal cough
26

27. Transmission: Airborne
•Droplet nuclei are droplets of less than 5in diameter
•Transmission may occur over a long distance
•Transmitted by Droplet Nuclei
Tuberculosis (Infectious)
Suspects of TB: request sputum smear
Measles
Varicella
Smallpox (hemorrhagic)
27

28. Hospital Acquired Infections/
Nosocomial Infections/Healthcare
Associated Infections
28

29. Hospital Acquired Infections/ Nosocomial Infections/Healthcare
Associated Infections
HAIasalocalizedorsystemicconditionresultingfromanadversereactiontothepresence
ofaninfectiousagent(s)oritstoxin(s)withoutanyevidenceofitsbeingpresentorin
incubationatthetimeofadmission.
AninfectionisattributedasHAIifdateofeventoccursonorafter3rdcalendarday(CL)
ofadmissionwheredayofadmission
29

30. Tranquil Gardens
Nursing Home
Home
Care
Acute Care Facility
Outpatient/
Ambulatory
Facility
Long Term Care Facility
Healthcare Associated Infections
Source: CDC
30

31. Nosocomial Infections
Infectionacquiredinthehospital:
•With in48hours afteradmission
•$5billionannually
•Increasedhospitallength ofstay,antibiotics,morbidityandmortality
•Relatedtoseverityofunderlyingdisease, immunosuppression,invasive
medical interventions
•Frequentlycausedbyantibiotic-resistant organisms:MRSA,VRE,resistant
Gram-negativebacilli,Candida
31

32. •Death from HAI occurs in about 10%
of affected patients globally.
•About 7% of patients in
developed and
•10% in developing countries will
acquire at least one HAI on
average
•WHO 2011
32
Nosocomial Infection
TypesofTransmission
airborne
–tuberculosis,varicella,Aspergillus
contact
–S.aureus,enterococci,Gram-negative bacilli
commonvehicle
–foodcontamination
–Salmonella,hepatitisA

33. HAI Risk Factors
•Transmission of communicable diseases
•Use of indwelling medical devices e.g. central
line or urinary catheters and endotracheal
tubes
•Contamination of the healthcare environment
•Surgical Procedures
•Injections
•Overuse or improper use of antibiotics
33
33
Healthcare-associated infections include:
̶Central line-associated bloodstream infections
(CLABSI)
̶Catheter-associated urinary tract infections (CAUTI)
̶Surgical site infections (SSI)
̶Clostridium difficile infections (CDI)
Estimated more than 1 million HAI across healthcare
settings each year.
5 HAI cases per 100 hospital admissions or 1 in 20
patients acquires HAI annually.

34. 34
HAIs in Healthcare Settings

35. Factors Affecting HAI
•Immune status
•Hospital environment
•Hospital organisms
•Diagnostic or therapeutic interventions
•Transfusion
•Poor hospital administration
Sources of HAI
•Endogenous source-patient’s own flora
•Exogenous source
oEnvironmental sources
oHealth care workers
oOther patients
35

36. Microorganisms implicated in HAI
•The pathogens-
oEnterococcus faecium
oStaphylococcus aureus
oKlebsiella pneumoniae
oAcinetobacter baumannii
oPseudomonas aeruginosa
oEnterobacter species andEscherichia coli
36
Major types of HAISs
•Catheter-associatedurinarytractinfection(CAUTI)
•Centralline-associatedbloodstreaminfection(CLABSI)
•Ventilator-associatedpneumonia(VAP)
•Surgicalsiteinfection(SSI).

37. Catheter-associated urinary tract infection (CAUTI)
Risk factors
•Age
•Gender
•Severe underlying disease
•Placement of a urinary catheter for > 2 days.
Organisms
•Gram negative rods -majority cause UTIs
•E.coli
•Gram-positive bacteria
•S.aureus, enterococci
37

38. 38
•How can you prevent CAUTI?
•Assess the need for Foley Catheters every shift
•Initiate the Nurse-Driven Foley Removal Protocol
when appropriate
•Keep Foley bags off the floor, below the bladder and
empty
•Secure tubing to the leg to prevent tension

39. Central line associated blood stream infection (CLABSI)
•Organisms
oS.aureus–Most common
oFollowed by gram-negative
rods and Candida.
Risk factors
•Patient related:
oAge (<1 year and >60 years)
oMalnutrition
oLow immunity
oSevere underlying disease
oLoss of skin integrity i.eburn
oProlonged stay in ICUs
•Device related
•HCW related:poor IPC practices.
39

40. 40
•How can you prevent CLABSI?
•Assess the need for Central Lines every shift
•Assess the site every shift and change the
dressing if loose or soiled
•Scrub the hub before every access
–15-30 seconds and allow air dry
•Change any line placed under adverse
conditions within 24 hrs

41. Ventilator associated pneumonia (VAP)
Risk factors for VAP
•Device related
•Patient related:
•Prolonged ICU stay leading to colonization
of hospital MDROs
•HCW related: poor IPC practices
Organisms:
•Gram-negative rods such as Acinetobacter
species and Pseudomonas
•Gram positive bacteria
•How can you prevent VAP?
–Head of bead positioned at 30
O
–Oral care every 4 hours and as needed
41

42. Surgical site infections (SSI)
Definition:
•Develop at the surgical site within 30 days of
surgery
•Within 90 days if prosthetic material is
implanted at surgery, breast, cardiacetc.
•Under reported because 50% of SSIs develop
after the discharge.
42

43. 43
•Source ofpathogens:
oEndogenous flora on the patient’s skin, mucous membranes
oExogenous organisms by various pathogens
o(air in the operating room, surgical equipment, gloves/hands,
medications administered during operative procedure)
•We can protect surgical patients from endogenous and exogenous
organisms.

44. Sources of SSI in the operating room environmentspecifically
1.Endogenous infections
•Patient’s own microflora
3. Environmentalsource
Contaminated air and dust due toinadequate
ventilation andcleaning
2. Staff in the operating room
•Staphylococcifrom nasal carriage, skin of hand and
forearm via contact through puncturedglovesor
wetgown
44

45. Intact mucousmembrane
Broken skin or mucousmembrane
Foreign body implant (fullyenclosed)
Foreign body from outside to insidebody
Infection riskincreases
Assessment ofSSIrisk
Intactskin
Low Risk Infection
45

46. •How can you prevent SSI?
•Pre-op. antibiotics
•Appropriate hair removal (no
shaving)
•Glucose and temperature
control
•Skin preparation, including
intraoperativetemperature)
46
•Routes ofentry
Hands
Equipment
Intravenous
Air
•Controlling the whole surgical
patient environment is very
important /experience

47. WHO guidelines,2016
Source: Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization; 2016
(http://www.who.int/infection-prevention/publications/ssi-prevention-guidelines/en/).
47

48. Stepwise
approach
A WHO implementationframework
Sources:http://www.who.int/infection-prevention/tools/core-components/en
Preventing surgical site infections: implementation approaches for evidence-based recommendations. Geneva: World Health Organization; 2018 (http://www.who.int/infection-
prevention/tools/surgical/en/).
48

49. 49
HAI surveillance

50. HAI Surveillance
•HAI Surveillance -system that monitors the HAIs in a
hospital.
Provides endemic rate/baselineHAI
Comparing HAI rates within and between hospitals.
Identifies the problem area.
Timely feedback to the clinicians.
Input to take an actions
Surveillance is conducted to determine:-
•Catheter-associated urinary tract infection
•Central line-associated blood stream
infection
•Ventilator-associated event
•Surgical site infection
50

51. Method of conducting HAI surveillance
Preparation
Data
collection
Data
analysis
Data
interpretatio
n
Disseminatio
n
51

52. Standard and Transmission
Based Precautions
4/10/2025 52
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

53. Standard(SP) and transmission-based precautions
(TBP)
•SPs:areasetofguidelinesdesignedtocreatephysical,chemical,andmechanical
protectivebarriers.
•Applytoallpatientcare
•TBSs:arethesecondlevelofIPCandaretobeusedinadditiontoSPfor
hospitalizedpatients.
•Preventingtransmissionsarebasedonrouteoftransmissionspreadwhollyor
partlybyairborne,droplet,orcontact.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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54. Key principles of standard precaution
•Every client or patient as potentially infectious or susceptible
•It applies to all patients and clients and
•It applies to all body-fluids and contact with body
These are blood, body fluid, secretion, execration (except sweat),
mucous membrane, intact and nonintact skin
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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55. Key Components of SP
Use of PPE
Hand Hygiene
Health-care west management
Safe injection practice
Environmental cleaning
Instrument processing
Processing of linen
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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56. Personal Protective Equipment’s (PPE)
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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57. Benefit of PPE
•HCWsareconfrontedeachdaywiththedifficultquestionofhowtoworksafely
withinthepotentiallyhazardousenvironment?
•Themostcommonoccupationalriskduetocontactwithbloodandbodyfluids
duringroutineactivities.
•ThisexposuretopathogensincreasesriskofgettingareHAIsandpossibledeath.
•UseofriskappropriatePPEisoneofthecomponentsofStandardPrecautions,
whichreferstowearingofprotectivebarriersorclothing.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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58. •ThebasicprinciplebehindwearingPPEistogetphysical
barrier/protection.
•PPEincludes:gloves,masks/respirators,eyewear(faceshields,gogglesor
glasses),caps,gowns,aprons,bootsetc.
•Themosteffectivebarriersaremadeoftreatedfabricsorsynthetic
materialsthatdonotallowwaterorotherliquids(bloodorbodyfluids)
topenetratethem.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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59. PPE should be:
•Madeavailableclosetothepointofuseforeasyaccessibility
•Storedneatlyinaclean/dryareatopreventcontaminationuntilrequiredfor
use.
•PreferablysingleuseifreusabletheremustbeaclearpolicyandSOP
forplacementinbinsafteruseandremovalforlaunderingand
recycling.
•HaveanSOPforstockorderingandrotationtoensurethereisalwaysan
adequatesupply.
•Donotwaitforstockstorunoutbeforeorderingmore.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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60. List the types, uses, effectiveness and
limitationofPPE’s
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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61. Effectiveness and limitations of PPE
List of PPE and area of Protection:
Types of PPE Provides protection for
Head Covering/Caps Hair and Scalp
Goggles Eyes
Face Masks Nose, Mouth and Lower Jaw
Face Shield Face
Gloves Hands
Gowns Upper body, skin and cloth
Apron Front of the body
Boots Lower legs and feet
Shoe cover Shoes
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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62. Head cover/Caps
Mostcommonlyusedaspartofsurgicalattireinsurgicalandprocedure
areas.
Facialhairisalsorequiredtobecoveredforsurgicalproceduresinsterile
areas(e.g.,intheoperatingtheater)
Cleaningofhardcover/capsshouldbeinthesamestandardwithsurgicrabs.
Inthesurgicalandprocedureareas,anewcleanheadcoveringshouldbe
worneachday.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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63. Surgical Head Coverings
The same standard and regularity of cleaning expected for surgical scrub.
Head covers are not part of routine PPE for Contact, Droplet or Airborne
Precautions but are used for during outbreaks.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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64. Protective Eye Wear
•Protectsthestaffduringaccidentalsplashofbloodorotherbodily
fluidsbycoveringtheeyes.
•Therearefourdifferenttypesofeyeprotectionforpreventinginfection
Goggles
SafetyGlass
Masksattachedshield
Faceshield
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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65. Different types of Eye Protection Equipment’s
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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66. Masks
•Therearedifferenttypesofmasksusedtocoverthemouthand
nose.
•Masksmadefromcottonorpaperarecomfortablebutarenot
fluid-resistant(donotprotectfromsplashes)and
•Theyarenotaneffectivefiltertopreventinhalationof
microorganismstransmittedviadropletnuclei(≤5µm).
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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67. Masks cont’d…
•Masksmadefromsyntheticmaterialsprovideprotectionfrom
largedroplets(>5µm)spreadbycoughsorsneezes.
•TheuseofmasksduringpatientcareispartofStandard
PrecautionswhenthereisapotentialforsplashesORdroplet
transmissionandispartofDropletPrecautions.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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68. Types of Masks frequently used by health care
workers
See your participant manual page for detail comparison
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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69. Gowns
•GownsshouldfullycoverthetorsooftheHCW,fitcomfortablyover
thebody,andhavelongsleevesthatfitsnugglyatthewrists.
•Therearethreetypesofprotectivegownsusedinhealthcarefacilities:
A.Isolationgowns,
B.Surgicalgowns,and
C.Coverallsuits
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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70. When to wear gowns
•During Standard Precautions, an isolation gown (with gloves) is worn
for blood or body fluid contact, spills, or splashes.
•During Contact and Droplet Precautions, an isolation gown (with
gloves) is used to prevent transmission of an infectious agent.
•During surgical procedures a sterile surgical gown is worn in deliveries
or other aseptic procedures to protect the sterile field
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guidlines
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71. Coveralls
•Arefull-bodysuitsmadefrommaterialsthatarelightweight,breathable,
andimpermeabletoliquids.
•ThesearetobewornbyallHCWswhoworkinisolationareasfortreating
highlyinfectiousdiseases(e.g.,VHF).
•Designedtogooverascrubsuitandcreateabarriertoeliminateorreduce
contactexposuretoblood,bodyfluids,andhighlyinfectious
microorganisms.
•Coverallswithoutattachedhoodandwiththumbholesarerecommended.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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72. HCWswearGlovesfortheFollowingThreeReasons:
1.Toreducetheriskofacquiringinfectionstothestaff
2.Toreducetheriskoftransmittingmicroorganismsincludingskinflorato
clients/patients
3.Toreducecontaminationofthehandsofthestaffbymicroorganisms
whicharetransmissiblefromonepatienttoanother(cross-contamination).
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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73. Types of gloves
•SurgicalGlove-shouldbeusedwhenperforminginvasivemedicalorsurgical
procedures.
•CleanExaminationGloves-canbeusedwhenevercontactwithmucous
membraneandnon-intactskinisanticipated(e.g.duringmedical
examinationsandproceduressuchaspelvicexamination).
•UtilityorHeavy-DutyGloves-shouldbewornwhenprocessing
instruments/equipment,forhandlinganddisposingcontaminatedwaste,
cleaning.
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guidlines
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74. Some Do’s about Gloves
•Dowearthecorrectsizegloves,
•Dochangesurgicalglovesperiodically(every45minutes),protective
effectoflatexglovesdecreaseswithtimeandtearsmayoccur.
•Dokeepfingernailstrimmedmoderatelyshort(lessthan3mm)
•Dopullglovesupovercuffsofgown(ifworn)toprotectthewrists.
•Dousewater-solublehandlotionsandmoisturizersoftentoprevent
handsfromdrying,andcracking.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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75. Some Don’ts about Gloves
•Don’tuseoil-basedhandlotionsorcreams,becausetheywilldamagegloves.
•Don’tuselatexglovesifyouorthepatientshaveanallergytolatex.
•Don’tstoreglovesinareaswherethereareextremesoftemperature.
•Don’treprocessexaminationglovesforreuse.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
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76. Donning and Doffing of PPE
•DonningonanddoffingofPEintheproperorderandmanneris
justasimportantaswearingPPE.
•FailuretoproperlyputonorremovePPEcouldleadtoexposureto
orlackofprotectionagainstinfectiousagents.
•TheorderofputtingonPPEandremovingPPEdependsuponthe
purposeforwhichthePPEisbeingused.
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76

77. Sequence for donning on PPE for Standard and Transmission-based
Precautions
1.Putonprotectivebootsorshoecovers(ifneeded).
2.Performhandhygiene.
3.Putonagown.
4.Putonaproceduremask/N95respirator.
5.Putongogglesorafaceshield.
6.Lastly,putongloves.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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77

78. Sequence for doffing of PPE for Standard and
Transmission-based Precautions
1.Remove gloves.
2.Remove goggles/ face shield by the “clean” head band or ear pieces.
3.Remove the gown.
4.Remove the mask or respirator.
5.Dispose of single-use and reusable PPE in designated containers.
6.Remove shoe covers or boots (if used) before leaving the area.
7.Perform hand hygiene.
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78

79. PPE management during Outbreak
•PPE recommended by the World Health Organization (WHO) for HCWs who
provide care and treatment to VHF (E.g. Ebola) patients includes:
•Fluid-resistant coverall or gown:
•Without an attached hood
•With thumb holes or loops
•Waterproof apron
•Waterproof boots
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79

80. PPE management during Outbreak
•Fluid-resistantisolationmaskwithadesignthatdoesnotcollapseagainstthe
mouth
•Faceshield
•Respirator—requiredwhenperformingaerosol-generatingproceduresis
anticipated
•Headcoverthatcoversheadandneck(separatefromthegownorcoverall)
•Doublegloveswithcuffstomid-forearm(nitrilepreferredoverlatex)
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80

81. Summary
•TheuseofPPEisrecommendedtoprotectHCWsfromhazardsencountered
duringtheirregular,dailyduties.
•AnadequatesupplyofPPEshouldbeavailableforuseatthepointofcare.
•Insituationswithlimitedresources,PPEshouldbeprioritizedtoprovide,ata
minimum,implementationofStandardPrecautions.
•StaffshouldbeeducatedandtrainedontheindicationsforPPE,thebenefitsand
limitationsofspecificPPE,andthecorrectprocedurefordonningon,wearing,
anddoffingofPPEsothatPPEcanbeusedeffectivelyandefficiently.
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81

82. HAND HYGIENE
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82

83. Importance of Hand Hygiene
Handhygieneisthesinglemostimportantmeasuretopreventtransmission
ofinfection
Properhandhygienecanpreventtransmissionofmicroorganismsand
decreasethefrequencyofHAIs
Thegoalistoremovesoil,dirt,anddebrisandreducebothtransientand
residentflora.
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83

84. Failure to perform appropriate hand hygiene
•Leadingcauseof…
•Healthcareassociatedinfections(HAIs)
•Spreadofmultidrugresistantmicroorganisms
•Significantcontributortooutbreaks
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84

85. When to perform hand hygiene?
Hand hygiene opportunities
•Beforemakingcontactwithapatient
•Beforeperformingaclean/aseptictask,includingtouching
invasivedevices
•Afterperformingataskinvolvingtheriskofexposuretoa
bodyfluid,includingtouchinginvasivedevices
•Afterpatientcontact
•Aftertouchingequipmentinthepatient’ssurroundingareas
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85

86. Other opportunities for hand hygiene
•Before touching the face (eyes, nose
or mouth)
•Before and after cleaning the
environment
•Before and after preparing food
•Before eating and drinking or
serving food
•After visiting the toilet.
•Immediatelyonarrivalandbefore
departurefromwork(thehealth
facility).
•Immediately after touching
contaminatedinstrumentsorarticles.
•Beforeputtingonglovesandafter
removingthem
•handsbecomevisiblysoiledafternasal
blowing
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86

87. Hand hygiene methods
Hand Washing With Soap And Water
•Purpose of routine hand washing in health care is to remove dirt, organic material
and microbial contaminants
•Water alone is not effective at removing substances containing fats and oils
•Requires soap, which is rubbed on all hand surfaces, followed by thorough rinsing
and drying
•The entire hand washing procedure should take 40–60 seconds
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88. 4/10/2025
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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88

89. Hand washing with soap and water is recommended:-
1.If hands are visibly soiled or contaminated with blood or body fluids
2.After using the toilet
3.Before eating
4.To remove the buildup of emollients on hands after repeated use of ABHR
5.In outbreaks of C. difficile, but not in health care settings with only a few cases
of C. difficile.
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90. Alcohol-based hand rub
•Antimicrobial activity of alcohol results from its ability to denature proteins and
kill microbes
•ABHR is more effective in killing transient and resident flora than hand washing
with antimicrobial agents
•ABHR should be used at any of the 5 Moments
•To be effective, approximately 3–5 mL of ABHR FOR 20–30 seconds should be
used.
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90

91. 4/10/2025
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91

92. Improving Hand Hygiene practice in health facilities
•GiveeachstaffmemberasmallbottleofABHR.
•CreateascheduleforstafftorefillABHRbottles.
•WorkwithmanagementtoensureasteadysupplyofABHR.
•Observestaffduringtheirworkandprovidefeedbackonhandhygiene.
•Rewardstaffwhoconsistentlyperformproperhandhygiene.
•Putupsignsinthehealthcentertoremindstaffofbestpracticesinhand
hygiene.
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92

93. Summary
•Thegoalofhandhygieneistoremovesoil,dirt,anddebrisandreduce
bothtransientandresidentflora.
•Fivemomentsofhandhygieneare;beforemakingcontactwitha
patient,beforeperformingaclean/aseptictask,afterperformingatask
involvingtheriskofexposuretoabodyfluidandafterpatient
contact.
•ABHRismoreeffectiveinkillingtransientandresidentflorathan
handwashingwithantimicrobialagentsorplainsoapandwater.
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93

94. Sharps and Injection Safety
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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94

95. Overview
SafeInjection:isaninjectionthatdoesnot
harmtherecipient,doesnotexposetheHCWto
anyavoidablerisks,providedbyskilledperson,
usingappropriateinjectionequipmentanddoes
notresultinwastethatisdangerousforthe
community.
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96. •Globally 16 billion injections are administered each year
•Concurrently, it is also estimated that at least 50 % of all injections are
unsafe.
•A study conducted in Ethiopia showed (2004 and 2005) showed;
•74% of injections were unsafe, 72% of health facilities practiced
unsafe disposal
•The prevalence rate of needle stick injury was 30 to 35%.
•45% of the community members preferred injections to other
preparations.
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96

97. Risks of Unsafe Injections
1. Risk to patients
Transmission of blood-borne
infections (HBV, HCV,
HIV/AIDS…etc).
Injectionabscesses
Paralysis
Drug/allergicreactionsshock
2. Risk to Health Care Workers
•Occupational exposure to sharps
injuries.
•Estimation; 39% of HCV, 37% of
HBV, and 4.4% of HIV infection
•The indirect medical costs
•The psycho-social impact is also
immense
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97

98. Best Practices in Injection Safety
Many injectable medications have an oral equivalent that are
equally strong, effective, and much safer.
Unnecessary injections should be reduced through:
A. Avoid unnecessary injections. Injections should only be used in:
•Life threatening conditions
•Mal-absorption syndromes or
•Inability to swallow
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98

99. Best practice…
Prescribers and Service providers should also:
Encourage patients to accept oral medications when possible.
Injections should be given only when necessary.
Explain the risks associated with injections
Inform patients of the potential side effects of medications that are being
prescribed
Explore why patients prefer injections
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99

100. Best practice…
•Educating the patients
•Encourage patients to accept oral medications
•Explain the risks associated with injections, when possible, to limit the use
only when necessary.
•Administer Injections Safely: Ensure the right ways to give safe
injection
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100

101. Principles of Safe Injection Practice
UseSterileInjectionEquipment
PreventContaminationofInjectionEquipmentandMedication
PreventInjuriestotheProvider
PreventAccesstoUsedNeedlesandSyringes
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101

102. Principles of safe injection…
Apply standards for Administering Injections
Keep the injection preparation area free of clutter
Use injection: sterile, single-use needles and syringes
Wash hands with soap and water; dry
Check for expiry date, breach,leaks, particles, or contamination.
Wipe the top of the vial with 70% alcohol using a swab or cotton-wool ball.
Allow it to dry.
Ensure aseptic technique while giving theinjection,
Dispose the used syringes and needles immediately into the sharp’s container
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102

103. Best Practices for Administering Injection
Select safe medicines
Use of sterile equipment
Avoid contamination (Adhere to principles of Aseptic Technique)
Re-constitute drugs or vaccines safely
Disposal of injection wastes and sharps properly
Disseminate public health education and information.
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103

104. Practical guidance on handling parenteral medication
•When giving medication:
ALWAYS follow the one needle, one syringe, and one injection rule.
DO NOT use a single-loaded syringe to administer medication to several
patients even if you change the needle every time between patients.
DO NOT use the same mixing syringe and needle to reconstitute several
vials.
DO NOT combine leftover medications for later use.
DO NOT use single-use vials for multiple patients, if possible
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105. Cont…
When using single-use vials:
•“single-dose", "single-use”, or “preservative-free” should be used only for a
single patient.
•If used for multiple patients, can be repackaged one time into multiple
single-use syringes
•Store for only 24 hours.
•Follow the principle of one syringe, one needle, one time.
•Discard the single-use vial after use or If sterility or content is compromised, if
not properly stored after opening
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106. Cont…
When using multi-dose vials:
Follow the principle of one syringe, one needle, one time.
avoid double-dipping
label the multi-dose vial
DO NOT store multi-dose vials in patient care areas
Discard a multi-dose vial if sterility is compromised, not properly stored
after opening, undated, has a visible hole in the rubber septum
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106

107. Cont…
Practical guidance on setting up for preparing injections
•Keep the injection preparation area free of clutter so all surfaces can be
easily cleaned
•Disinfect injection preparation surface 0.5% sodium hypochlorite solution,
70% alcohol
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107

108. Cont…
Procedure for vials with a rubber septum
•Wipe the access rubber septum with 70% alcohol
•Use a new, single-use, disposable, sterile syringe and needle for each
insertion into a vial.
•Never leave a needle in a multi-dose vial
•Once the loaded syringe and needle have been withdrawn from a multi-
dose vial, administer the injection as soon as possible.
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109. Cont…
•Always use sterile injection equipmentto withdraw the reconstitution solution
from an ampoule or a vial
•Remove the needle and syringe and discard them immediately
•Mix the contents of the vial thoroughly until all visible particles have dissolved
•If a dose cannot be administered immediately, cover the needle with the cap
using a one-handed scoop technique:
•Should not be used >24 hrs.
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110. After reconstitution, label container with:
•Date and time of preparation
•Type and volume of diluent
•Final concentration
•Expiry date and time after reconstitution
•Name and signature of the person
reconstituting the drug
•For multi-dose medications that
DO NOT require reconstitution
•Date and time of first piercing of
the vial
•Expiry date and time after
reconstitution
•Name and signature of the person
first piercing the vial
Cont…
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110

111. Safe administration of injections and handling of sharps
Important points
DO NOT allow the needle to touch any contaminated surface.
DO NOT reuse a syringe, even if the needle has been changed.
DO NOT touch the rubber septum after disinfection with the 70% alcohol
(isopropyl alcohol or ethanol).
DO NOT re-enter a multi-dose vial with the same needle used for mixing or
reconstituting medications.
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111

112. Cont…
•DO NOT re-enter a vial with a needle or syringe used on a patient if that vial will
be used again (whether it is for the same patient or for another patient).
•DO NOT use bags or bottles of intravenous solution as a common source of supply
for injections (e.g., normal saline flushes) for multiple patients
•Avoid recapping needles, but if a needle must be recapped, use a single-handed
scoop technique
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112

113. Cont…
Safety box Do’s
•Put safety box at arm‘s reach.
•Do mark the fill line at the
three-quarters full level.
•Always put on a heavy-duty
glove when handling sharps
containers.
Safety box Don'ts
•Shake a container
•Use boxes that are open,
overflowing, or punctured.
•Place containers in high traffic
areas
•Don‘t place containers on the
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113

114. Cont…
•Sharp safety Do’s
•Wear gloves when using needles
•Discard sharps immediately
after use
•Discard sharps in safety box
•Use receivers to pass sharps to
others
•Sharp safety Do not’s
•Walk around with needles and
other sharps
•Do not remove bend, break
needle
•Do not routinely recap needles
after use
•Do not point sharps at yourself
or others
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114

115. Summary
•Injectionspresentriskstopatients,HCWs,andthecommunityand
shouldbelimitedwherealternativeadministrationroutesare
available.
•SafeinjectionpracticesareoneofthecomponentsofStandard
Precautions.
•ItistheresponsibilityofeachHCWtoensuresafeinjection
practice
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115

116. Healthcare Waste
Management
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117. •Source and type of heath care
waste
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118. Overview
•Health-carewasteisaby-productofhealthcarethatincludes
potentialriskandnon-riskwastes.
•Ahealthcarefacilityisresponsibleformanagingpublichealthand
protectingtheenvironment.
•Wastemanagementprocess(generation,collection,transport,
storage,anddisposal)entailsconsiderablecomplexity.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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119. Categories of Healthcare Wastes
HealthcareWastesisclassifiedintwo:-
•Non-Hazardous/Non-risk/Non-infectious
HCW
•Hazardous potentially-risk/infectious
HCW
•Approximately75-90%ofthegeneralwaste
producedbyhealthcarefacilitiesisnon-
contaminated.
HazardousHealth
CareWaste
Sharps waste
Infectious waste
Pathological
waste
Pharmaceutical
waste
Cytotoxic waste
Chemical waste
Radioactive waste
General waste
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120. •Blood and blood products in a free flowing,
unabsorbed state;
•Contaminated sharps,
•Isolation Wastes,
•Laboratory wastes, and
•Unfixed pathological tissues
HC waste..
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121. Risk associated with Healthcare
Waste
121
HC waste..
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122. Risks associated with Healthcare Waste
•Exposureto
•Pathogenicorganisms,
•Harmfulchemicals,
•Toxins,or
•Radioactivesubstances
•Injuryfromsharpitemspotentialcausefor
Infection
GI and Respiratory conditions
Skin and eye infections,
Blood borne virus infections and
Hemorrhagic fever including
Ebola virus disease
122
HC waste..
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123. 3. Management of Healthcare
Waste
123
1. Sorting 2. Collecting 3. Transporting
4. Storing 5. Treat 6. Final disposal
HC waste..
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124. Management of Health Care Waste
Preventingwasteproduction,
Reducingwasteproduction,
Reusingandrecyclingwaste,and
Treatinganddisposingofsmallamountofhealthcarewaste
Wastemanagementinvolvedinwastegeneration,collection,transport,
storage,andfinaldisposalofwaste.
ReductionofHealthcareWaste
Thepreferredstrategiesforreducingormanaginghealthcarewasteareto
minimizewastegenerationby
Theleastpreferablestrategyis
treatinganddisposingofhealthcare
waste
124
HC waste..
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125. Segregationof Waste at Point of Generation
Type of Waste Color of Container and Markings Type of Container
Highly infectious waste
(includes all pathological
waste)
Yellow,marked “highly
infectious”withbiohazard
symbol
Strong,leak-proofplasticbag
orcontainercapableofbeing
autoclaved
Otherinfectiouswaste Yellow with biohazard symbolLeak-proofplasticbagor
container
Sharps Yellow,marked“SHARPS”
withbiohazardsymbol
Puncture-proof container
Chemicalandpharmaceutical
waste
Brown, labeled with
appropriatehazardsymbol
Plastic bag or rigid container
Radioactivewaste LabeledwithradiationsymbolLeadbox
Generalhealthcarewaste Black Plasticbagorcontainer
125
HC waste..
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126. Waste Management
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126

127. CollectionandTransportationofWasteinHealthCareFacilities
Wastecollectiontimetablesandrouteshouldbecarefullyplanned
accordingtothewastegenerationpatternsofthevarious
departments.
Collectwasteonaregularbasissuchasdailyorsoonerifneeded
accordingtotherateitisgeneratedandthesizeofthewaste
containers.
Donotmixinfectious/hazardousandgeneralwasteduringcollection
ortransport.
127
HC waste..
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128. Collection and Transportation Cont…
Collectandtransportinfectiouswastetodisposalsitesinleak-proof,
covered,contaminated-wastecontainers.
Donotuseequipment(e.g.trolley/cart)thatisusedtoholdand
transportwastesforanyotherpurposeinthehealthcarefacility.
UsePPEwhenhandlingwastes.
128
HC waste..
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129. Steps for collection and transportation of HCW:
Step 1
•Wear full PPE when handling and transporting all waste.
Step 2
•Collect waste containers and transport to the storage area or treatment
area for final disposal.
Step 3
•Clean and disinfect infectious-waste containers each time they are emptied
Step 4
•Remove utility gloves and perform hand hygiene after handling wastes
Step 5
•Wash and dry gloves
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130. Storageof Waste in Health Care Facilities
•An easy-to-clean, hard floor with good drainage
•Separate areas for infectious and general waste
•Separate cabinets to store pharmaceutical and other toxic wastes
•Adequate water supply with a sink for hand hygiene
•Regular cleaning
•Identification (signs) as a “waste storage area”
•Lockable door/gate.
130
HC waste..
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131. Disposalof Health Care Waste
•Choosingthebestcurrentlyavailablewastedisposalmethod
•Workingtowardssaferwastedisposaltoprotectthecommunityand
theenvironmentisessential.
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132. Disposal Cont…
Healthcare Waste
Hazardous Non Hazardous
Biodegradable(Kitchen,
Landscape)
To Compost
Inorganic
Recyclable
To Market
Other
132
HC waste..
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133. Disposal. Cont…
Hazardous
Hazardous
Cytotoxicdrug, toxicchemicals,
radioactivewaste stored in cement
tanks until half life
Clinical Waste
(Infectious Waste)
Sharps
Steam Sterilize, Shared deep
Burial Encapsulation
Non-Sharp
133
HC waste..
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134. Disposal .cont…
Non Sharp
Clinical Waste –from Patient care
Non Plastics
Cotton, Gauze Dressing Contaminated With Blood,
Secretions and Excretions
Steam Sterilize and Shred or Incineration
Landfill
Plastics
Disposable Syringes, IV Sets,
Catheters Tubes
Steam Sterilize and Shared
Landfill
Laboratory
134
HC waste..
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135. Disposal .Cont…
Laboratory
Specimens
Blood, Body Fluids, Secretions
and Excretions
Steam Sterilize
Landfill
Microbiology Lab.
Waste
Steam Sterilization and
Shred
Sewer or
Landfill
Anatomical Parts, Animal
Carcasses
Incineration/
Cremation
Ash to
Landfill
135
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136. Summary
Healthcarewasteispotentiallyhazardous.
Wasteminimizationisthemostimportantstepstoreducewaste
production.
Choosingthebestavailablewastedisposalmethodcanprotectthe
communityandenvironment.
Effectivewastemanagementwillsaveresources,reducecosts,and
preventinjuriesandexposuretoinfectiousdisease.
136
HC waste..
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

137. Standard laundry service
1374/10/2025
Linen Management
Analyzetheproperlinenmanagementin
healthcarefacility.
ProcessingReusableTextilesandLaundry
Services
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

138. Why launder?
To prevent infectious or infestations spread to patients, staff or
community by linen, towels, mops etc…
“Comfort” and warmth in bed
To prevent allergic reactions or contact dermatitis from textiles
Public relations aspect of “clean, long sheets”
To keep clean linen clean until it reaches the patient
To prevent dirty linen from contaminating patients, staff and
environment,
138
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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139. What does the community require from the laundry?
A.Notoxicdischarges
B.Efficientuseofwaterandmaterials
C.Cleanandsafehealthfacilitiestextiles
139
Community and laundry?
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140. What do visitors require from the laundry?
•Patientsmayequatecleanfloors,
whitelinenwithgoodcare.
140
Visitors and laundry
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141. How should the laundry
impact the staff?
A.Nodiseasetransmission
B.Noneedlestickinjuries
C.Noallergies
D.Accesstocleanlinenonsite
141
Laundry and staff
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142. Administration require of the laundry procedures?
A.Low cost (equipment, energy, chemicals)
B.Simple-procedures can be used on multiple stains
C.Chemicals involved are legal, safe, stable, non-hazardous
D.Rapid turn-around to minimize linen needed
E.Not only low pathogen count but looks “clean”
F.Easy to clean carts, bags
142
Administration &laundry
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143. Many ways to do laundry
As long as the process and outcome meets the needs of the patients, visitors,
hospital staff, infection control team and hospital administrators there are
many acceptable solutions.
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144. Processes necessary to infection control
•Identify all fabric items that could transmit disease if not
laundered:
Sheets, towels, napkins
Surgical drapes, wraps,
Window drapes, room curtains
Rags, mops
Uniforms cover gowns, lab coats
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

145. Key steps of processing used linens
Collecting
Store used textile
in separate area
&transport to
launderyfrom
service area
sortingWashing &
Ironing
Re
Distributing
clean dress
service area
Steps
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

146. Steps in the process:
Collectusedtextiles
Storeusedlaundryuntilpickupinseparateareafromclean
suppliesorpatients
Transport
Sortinlaundry-donotsortonward
Placeinwasherandwash
Placeindrier
Foldoriron
Storeinseparatecoveredcartandredistribute
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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147. 1474/10/2025
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148. What is needed: Linen bags
Dirty linen bags of a size so maximum weight is less than 20 kgs (measure
wet linen)
No need to double bag from isolation rooms
If wet, fold wet areas to the inside
Bag racks are ideal so linen is not held next to body, and, keeps linen off floor
Assume all used linen is contaminated no need for color coding
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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149. What is needed: Dirty Laundry Cart
Cleanablesurfaces
Wheelsingoodworkingorder
Canseearoundorovercart
Canbeloadedwithminimalagitation
Besttohaveseparatecleananddirtycarts
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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150. Sorting Area
Barrier to separate clean from dirty
Limited traffic area
Need to have a work surface at or above waist
height
Need disposable gloves, sink, soap, towels
Need sharps container
Need lost and found box, plastic bags and register
Sorting Area
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

151. Floors, walls, ceilings, vents
Can be cleaned……
Tolerate heat and humidity
Vacuuming or blow down of dust that otherwise can cause fires
Power cords should not run across floors to prevent shock and
electrocution
Power cords on floors cause falls
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

152. Laundering
Kill or remove pathogens
Remove stains
Have pH and residue safe for skin
About Laundering
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

153. Soiled Sort
areas
Separated from other parts of laundry
Work surfaces non-porous, and can withstand frequent
cleaning
Air vent exhausts to outside or should be filtered
Sharps container present
Separate handwashing area
Slanted floors with drains so they can be hosed down
and wet mopped without puddles.
Sort areas
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154. Chemical storage area
Chemicals should be stored in an area separate and containers do not
get wet.
Separate area away from traffic,nothing above eye level.
All containers should be labeled, and their dangerous ingredients
known.
Measuring equipment in use before added by machine.
Chemical storage area
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

155. Ironing kills organisms
100%cottonproductsarepartiallydriedbeforeironing.
50%polyester/50%cottonproductsmightbeironeddirectly.
Ifcottonisnotpartiallydried,itmaynotdrycompletelyduring
ironing.
Handfoldingcantransfergermsthatcangrow.
Ironing
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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156. Presentation/test (15%)
•Group one: Introduction IPC
•Group 2: HAI
•Group 3: HAI surveillance
•Group 4: Standard precaution(PPE and Safe injection)
•Group 5: Standard precaution (HCWM, Linen management and Hand hygiene)
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guidlines
156

157. Environmental cleaning
157
General principles of cleaning.
Ways of preparing disinfectant cleaning solutions.
When and how to clean low and high risk areas.
Cleaning spills of blood or other body fluids.
Cleaning the housekeeping equipment
Summary
Keys
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158. Environmental cleaning practices in the healthcare facilities including:
•The compound
•Floors
•Walls
•Various type of equipment
•Tables and other surfaces.
•It is cleaning of environmental surfaces and maintenance of cleanliness.
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159. Purpose of general environmental cleaning
Reducenumberofmicroorganismsthatmaycomeincontactwith
patients,visitors,staffandthecommunity;
Provideacleanandpleasantatmosphereforpatientsandstaff.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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160. General principles of cleaning and disinfection
From the least soiledareas to the most soiled areas
Drysweepingand dusting should be avoided
Instructions should be strictly be followed for preparation of cleaning agents
Cleaning methods based on the type of the surface
Written cleaning schedules depending on the extent of the soil present and
the purpose of the area.
PPEfor cleaning staff
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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161. Preparation of cleaning and disinfecting solution
•Cleaning products: include liquid soap,
and detergents
•Disinfectants: Used after cleaning and
are not substitutes for cleaning. E. g
0.5% Chlorine solution
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

162. Preparation cont…
•Always follow manufacturer’s instructions
for preparation.
•Most cleaning products work at an
optimum dilution
•Use proper PPEduring preparation of
solutions
•Provide trainingand simple instructions
for preparation
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

163. Preparation of 0.5 % chlorine solution
A dilute solution from a concentrated solution
•Check concentration (% concentrate) of the chlorine solution.
•Determine total parts of water using the formula below.
Mix1partconcentratedbleachwiththe9partsofwaterrequired
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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164. Risk area categorization and cleaning schedule
Low-Risk Areas: Waiting Rooms, Administrative Areas
•Clean with mop dampened with detergent and water at least once daily
Intermediate Risk Areas: Patient Wards
•Should be cleaned daily and right after patient is discharged
High Risk Areas: Isolation wards, intensive therapy units, operating room
•Clean and disinfect after each procedure and whenever visibly soiled
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165. Cleaning methods
•Cleaning of frequently surfaces
•General cleaning process
165
Cleaning methods
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166. Cont..
Wet Mopping Method-(Preferable for Floor Cleaning)
•Single-Bucket (Basin) Technique: -
•Double-Bucket Technique: -
•Triple-Bucket Technique: -
Flooding Followed by Wet Vacuuming Method
Wet dusting
Dry Vacuuming
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167. •Methods that produce mists and aerosols should be avoided
•Solutions will be contaminated almost immediately during cleaning.
Replace frequently.
•Don't leave cleaning cloth or mop head soaking in dirty cleaning
solutions.
•Bucketsshould be washed with detergent and warm water and stored
dry after each use .
•Mops should be cleaned and disinfected then thoroughly dried daily.
167
Cleaning …
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168. Management of small blood/ spills
Procedure
•Wear non-sterile (medical or examination) gloves for this procedure.
•Wipe the area immediately with paper towel and clean with water and
detergent
•Disinfect the area with a towel soaked in 0.5% hypochlorite (bleach)
solution;
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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169. Management of large blood spills
Clean gloves, single use apron, foot wear
Remove blood with paper towel then dispose it in hazardous bag
Clean thoroughly, using detergentand warm watersolution.
Disinfect with 0.5% chlorine solution, amount depending on the size
of the spill).
Allow the disinfectant to remain wet on the surface for 10 minutes
Rinse the area with clean water to remove the disinfectant residue
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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170. Chapter Summary
Dust, soil and microbial contaminants on environmental surfaces are
potential source of HAIs.
Cleaning methods and schedules are necessary to maintain a clean and
healthy environment
Cleaning should start with the least soiled area and extend to the most
soiledarea and from high to low surfaces.
It is important to train staff on environmental cleaning
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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171. Reprocessing of Instruments
and reusable Items
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines
171

172. Assignment +presentation (15 pts)
1.Importanceandstepsinstrumentprocessingandothermedical
device.
2.Effectivenessofmethodsofprocessinginstruments.
3.Factorsthataffectdisinfectionandsterilizationprocess.
Reported both in word and ppt.
Deadline: April 25, 2025
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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172

173. Overview of instrument/reusable items reprocessing
practices
Primeconcernofsafetyproceduresistoprotectbothpatientsand
thestafffrominfection
Instrumentswhicharereusedwithoutbeingproperlyprocessedand
madesafeareoneofthecausesofinfectionsindevelopingcountries.
Healthcareworkersareincreasinglyatriskofbecominginfectedwith
seriousbloodbornevirusessuchasHBV,HCVandHIV.
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174. •8to16millionnewinfectionsofHepatitisBannuallyduetounsterile
injectionsindevelopingcountries.
•HIVsurvivesinneedlesandsyringesformorethan4weeksatroom
temperature.
•Properhandlingoftheinstruments/reusableitemstominimizetherisk
ofaccidentalinjuryorexposuretobloodandotherbodyfluids
174
Cont…
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

175. Spaulding’s category of potential infection risk
•Spauldingclassifiedinstrumentsandpatientcaredevicesintothreecategories,
baseduponhowthedeviceisused.Itemsareclassifiedas:
•Non-critical—comeincontactwithintactskinbutnotmucousmembranes
•Semi-critical—comeincontactwithmucousmembranesornon-intactskin
•Critical—comeincontactwithsterileareasofthebodyincludingthe
vascularsystem
175
Level of Disinfection or Sterilization required
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guidlines

176. Spaulding’s Risk Classification and Level of Processing
Risk categoryLevel of disinfection/
sterilization
Examples
Critical Sterilization Reusable surgical instruments
Semi-critical High-level
disinfection
Respiratory instruments, specula
used for vaginal examination
,endoscopes
Non-critical Cleaning Blood pressure cuffs, stethoscopes
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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177. Commonly Used Chemical Disinfectants
•Chlorine and chlorine releasing
compounds
•Sodium hypochlorite (Chlorine
bleach)
•Calcium hypochlorite or
chlorinated lime
•Sodium dichloroisocyanurate
•Glutaraldehyde
•Formaldehyde
•Iodine and Iodophor solutions
•Hydrogen Peroxide
•Orthophthalaldehyde(OPA)
•Alcohols
177
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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178. Steps instrument processing and other medical devices
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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179. 179
Soaking of instruments in disinfectant prior to cleaning
soaking of instruments in 0.5% chlorine solution or any other disinfectant
prior to cleaning is not recommended for the following reasons:
Itmaydamage/corrodetheinstruments
Couldbecomeasourceofmicrobialcontaminationandformationof
biofilm
mayposearisktohealthcareworkersandresultininappropriate
handlingandaccidentaldamage
Maycontributetothedevelopmentofantimicrobialresistanceto
disinfectants.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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180. Effectiveness of Methods of Processing Instruments
METHOD
EFFECTIVENESS (killor
remove microorganisms)
ENDPOINT
Cleaning (soap and
rinsing with water)
Up to 80% Until visiblyclean
High-LevelDisinfection
95% (does not inactivate
endospores)
Boiling or chemical for 20
minutes
Sterilization
100%
High-pressure steam, dry
heat or chemical for the
recommended time
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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181. Cleaning
•Cleaningisaprocessofphysicallyremovinginfectiousagentsandotherorganicmatterson
whichtheyliveandthrivebutdoesnotnecessarilydestroyinfectiousagents.
•Itisanessentialpre-requisitetoensureeffectivedisinfectionorsterilizationbyreducingthe
numberofmicroorganisms,especiallyendosporescausingtetanus.
•Cleaningisthefirstandacriticalstepinreprocessingadeviceafteruse..
•Itreducesdamagetoinstruments.
•Itmakesinstrumentseasiertoprocess.
•Onecancleanwithoutsterilizing,butonecannotsterilizewithoutcleaning!
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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182. Cleaning Products and their properties
•Thereisnosinglecleaningagentthatremovesalltypesofbio
burden.
•Bioburdenismadeupofavarietyofmatter,whichmaybe
solubleorinsolubleinwaterandcanbeorganicorinorganic.
•Thefirststepincleaningistheuseofsurfactantsorsurface-active
agentstoreducetension,whichassistsinsoilbeingheldinthe
cleaningsolution.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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183. Packingand Wrapping
•Items that doesn’t needto completely dry can be flushed with distilled or
boiled water just prior to packaging for steam sterilization after
cleaning. E.gneedles
•All jointed instruments should be open (or be unlocked) and
disassembled.
•Reusable cloth items should be laundered and dried after use or prior to
sterilization in order to:
183
Packing and Wrapping of Medical Devices
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184. Packing and wrapping for steam sterilization
•Wrapping items to be sterilized permit sterile items to be handled and stored without
being contaminated
•Materials used for wrappers should:
•Allow air removal and steam penetration
•Act as a barrier to microorganisms and fluids
•Capable of withstanding high temperatures
•Resist tears and punctures and be free of holes
•Be nontoxic and low-lint
•Not be costly
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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185. Tips for wrapping
•At least two layers of wrapping should always be used to reduce the
possibility of contaminating the contents during unwrapping.
•Do not wrap packages too tightly.
•If they are wrapped too tightly, air can become trapped at the center of the packages
preventing the temperature from getting high enough to kill all the microorganisms.
•Also, wrapping with strings or rubber bands or tying linen too tightly can prevent steam
from reaching all surfaces.
•Hemmed strips of about ½ inch wide and of varied lengths., one or two of
such strips can be used for each package.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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186. Cont…
•Becausetheycanfittoalmostanysizeofpackage,theyeliminatetheneedfor
anexpensiveandhard-to-removeindicatortape.
•Theouterwrapperofthepackcanbelooselysecuredusinglinenties.
•Packscanbesecuredwithlinentiesmadefromthesamecloth.
•Donotwrapitemsinanywaterproofmaterialsuchasplasticorcanvas
forsteamsterilizationasthesteamcannotpenetratethematerialandleave
theitemunsterilized.
•Wrappersshouldnotbereusediftheyaretorn,stainedwithoilsorhavehard
orgummydeposits. 1864/10/2025
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

187. High level disinfection
•Surgicalinstrumentsandmedicaldevicesthatcomeincontactwithnon-intactskinor
mucousmembranesmust,ataminimum,behighleveldisinfected,thoughsterilizationis
alwayspreferablewhenpossible.
•DestroysallmicroorganismsincludingHBV,HCV,andHIV;doesnotreliablykillall
bacterialendospores
•High-leveldisinfectioncanbeachievedby:
•Pasteurization/Boilinginwater,
•Steaming
•Soakinginstrumentsinchemicaldisinfectants(chemicaldisinfection).
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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188. High-level disinfection using chemicals
•Althoughanumberofdisinfectantsarecommerciallyavailableinmostcountries,four
disinfectants-
•OPA,
•Glutaraldehydes,
•Formaldehydeand
•Peroxide-areroutinelyusedashigh-leveldisinfectants.
•Thesechemicalscanachievehigh-leveldisinfectioniftheitemsbeingdisinfectedare
thoroughlycleanedbeforeimmersion.
•Ahigh-leveldisinfectantshouldbeselectedforusebasedonthecharacteristicsoftheitemsto
bedisinfected,thephysicalareaandtheskillsofpersonnelavailabletodotheprocedure.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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189. Key steps in Chemical High-level Disinfection
•Thoroughly clean instruments and other items that may have been
contaminated
•Completely immerse all items in the high-level disinfectant.
•Soak them for 20 minutes.
•Remove items using high-level disinfected or sterile forceps or gloves.
•Rinse well with boiled and filtered (if necessary) water three times and air
dry.
•Use promptly or store in a dry, high-level disinfected and covered container
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190. Factors That Affect Disinfection Process
•Quantity and location of the microorganisms
•Quantity and location of organic matter
•Concentration of the disinfectant
•Physical and chemical factors
•Duration of exposure
•Resistance of microorganism to the chemical agent
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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191. Sterilization
•Sterilizationisaprocessinwhichthedestructionofallmicro-organisms
includingbacterialendosporestakesplace.
•Thiscanbeachievedbyeitherphysicalorchemicalmethodsandisnecessary
especiallyformedicaldevicespenetratingsterilebodysitesorhavingdirect
contactwiththebloodstream
•Sterilizationinhealthfacilitiescanbeachievedby:
•Highpressuresteam(autoclaves),
•Dryheat(oven),
•Chemicalsterilants(Glutaraldehydeorformaldehydesolutions)
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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192. The effectiveness of any sterilization method is
dependent upon four other factors
1.Thetypeofmicro-organismpresent.
2.Thenumberofmicro-organismspresent.
3.Theamountandtypeoforganicmaterialthatprotectsthemicro-
organisms..
4.Thenumberofcracksandscratchesonaninstrumentthatmight
harbormicro-organisms.
•Sterilizationisaprocess,notasingleevent;therefore,allphasesandsteps
intheprocessmustbecarriedoutcorrectly.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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193. High pressure steam sterilization method
•Saturated steam is an extremely effective carrier of thermal
energy that makes it many times more effective in conveying the
necessary energy to the items to be sterilized than dry air.
•Steam is an effective sterilant in that it can soften any resistant
and protective outer layer of the micro-organisms allowing
coagulation of the inner sensitive portion of the micro-organisms.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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194. There are three types of high-pressure steam sterilizers:
•Gravity displacement
•Prevacuum
•Flash or Immediate use sterilizers (IUS)
194
Cont…
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195. Operation
•Asteamsterilizerwillreliablysterilizeitemsonlywhenkeptingoodworking
conditionandoperatedcorrectly.
•Sterilizationbysteamrequiresfourconditions:
•Adequatecontact,
•Sufficienttemperature,
•Propertimeand
•Sufficientmoisture.
•Eveniftheseconditionsareallnecessaryforsterilizationtotakeplace,
sterilizationfailuresinhealthfacilitiesaremostoftencausedbylackofsteam
contactorfailuretoattainadequatetemperature
195
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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196. Effective sterilization depends on correctly following
procedures of the process:
•These include:
•Routine maintenance,
•Preparing items to be sterilized,
•Packaging and wrapping,
•Loading,
•Operating, and
•Unloading the sterilizer.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

197. Remember
•Maintainasteamsterilizerlogincludingheatbegun,correcttemperatureand
pressureachieved,heatturneddown,andheatturnedoff.
•Eachloadshouldbemonitoredwithmechanical(time,temperatureand
pressure)andchemical(internalandexternalchemicalteststrips)indicators.
•Autoclaveshouldbetesteddailywithanair-removaltesttoensureproper
removalofair.
197
Operating a steam sterilizer
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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198. Dry heat sterilization method
•Dryheatsterilizationiscausedbyhotairthatdestroysmicro-organismsthroughoxidationthatcausesslow
destructionofthemicro-organismsprotein.
•Itisaccomplishedbythermal(heat)conduction.Initially,heatisabsorbedbytheexteriorsurfaceofanitem
andthenpassedtothenextlayer.
•Eventually,theentireobjectreachesthetemperatureneededforsterilization.
•Dryheatsterilizationmethodshavelimitedvaluebecauseitisdifficulttomaintainthesametemperature
throughouttheprocess.
•Moreover,dryheatsterilizationtakeslongerthansteamsterilization,becausethemoistureinthesteam
sterilizationprocesssignificantlyspeedsupthepenetrationofheatandshortensthetimeneededtokill
microorganism.
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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199. Conditions for effective use of dry-heat sterilizers
•Adherencetospecificinstructions
•Airflowrateanddistribution
•Loadconfigurationanddistribution
•Temperature
•Time
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200. Chemical sterilization
•Chemicalsterilizationisanalternativetohigh-pressuresteamordry-heatsterilizationand
oftencalled“coldsterilization”.
•Ifobjectsneedtobesterilizedandwhentheavailingmethodslikehigh-pressuresteamordry-
heatsterilizationwoulddamagethemorequipmentarenotavailable(oroperational),they
canbechemicallysterilized.
•Manychemicals,bothinliquidandgasform,areavailableforprocessinginstruments.
•Chemicalsthatareapprovedassterilantcanalsobeusedashigh-leveldisinfectantsbutthose
approvedonlyforHLDcannotbeusedassterilant.
•Formaldehydeisnolongerincludedasasterilantorahigh-leveldisinfectantduetoitstoxicity.
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201. •Sterilizationprocedurescanbemonitoredroutinelyusinga
combinationof
•Biological,
•Chemicaland
•Mechanicalindicatorsasparameters.
•Differentsterilizationprocesseshavedifferentmonitoring
requirement.
201
Monitoring Sterilization Procedures
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202. Storage area
•Allsterileitemsshouldbestoredappropriatelytoprotectthem
fromdust,dirt,moisture,animalsandinsects.
•Thestorageareashouldbelocatednexttotheplaceofsterilization
or
•connectedtoitinaseparatelyenclosedareawithlimitedaccess
thatisusedjusttostoresterileandcleanpatientcaresupplies.
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203. Instructions for Storing Sterile Items
1.Keep the storage area clean, dry, dust-free and lint-free.
2.Control temperature and humidity (approximate temperature 24oC and
relative humidity <70%) when possible.
3.Packs and containers with sterile (or high-level disinfected) items should be
stored
•20 to 25cm off the floor, 45 to 50cm from the ceiling and 15 to 20cm from an outside wall.
4.Do not use cardboard boxes for storage because cardboard boxes shed dust
and debris and may harbour insects.
5.Date and rotate the supplies (first in/first out). Distribute sterile and high-
level disinfected items from this area
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204. Shelf Life
•Theshelflifeofanitem(howlongitemscanbeconsideredsterile)aftersterilizationisevent-
related.
•Anitemremainssterileuntilsomethingcausesthepackageorcontainertobecomecontaminatedas
timegoesonsincesterilizationisnotthedeterminingfactor.
•Aneventcanbea
•Tearorworn-outareainthewrapping,
•Thepackagebecomingwetor
•Anythingelsethatwillenablemicroorganismtoenterthepackagethepackageorcontainer.
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205. The shelf life of sterilization depends on the following factors
•Qualityofthewrapperorcontainer.
•Numberoftimesapackageishandledbeforeuse.
•Numberofpeoplewhohavehandledthepackage.
•Whetherthepackageisstoredonopenorclosedshelves.
•Conditionofstoragearea(e.g.humidityandcleanliness).
•Frequentorimproperhandlingorstorage.
•Useofplasticdustcoverandmethodofsealing
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206. Summary
•ApplyingSpaulding’sclassificationofnon-critical,semi-critical,orcriticalitems
determinesthemethodthatshouldbeusedtoprocessinstruments.
•Allinstrumentsmustbethoroughlycleanedbeforefurtherprocessing.
•Allsemi-criticalinstrumentsanddevicesthatcomeincontactwithmucous
membranesandnon-intactskinshouldbe,ataminimum,high-leveldisinfected.
•Monitoringthequalityofthesterilizationprocesswillassisthealthcarefacilitiesin
optimizingthesafetyofsterilemedicaldevicesandsurgicalinstruments
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207. Cont..
•Allsterileitemsshouldbestoredappropriatelytoprotectthemfrom
dust,dirt,moisture,animalsandinsects.
Transporthigh-leveldisinfectedandsterileinstrumentsandother
itemstoinaclosedcartorcontainerwithacovertoprevent
contamination.
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208. Traffic Flow and Activity
Pattern
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208

209. Significance of Traffic flow and activity pattern
•Regulatingtheflowofvisitors,patientsandthestaffplaysacentral
roleinpreventingdiseasetransmissioninhealthcarefacilities.
•Numberofmicroorganismsinadesignatedareatendstoberelatedto
thatofthenumberofpeoplepresentandtheiractivity.
•Microbialcontaminationisminimizedbyreducingthenumberof
peoplecomingtotheareaanddefiningtheactivitiestakingplaceat
eachplace.
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209

210. Cont …
•Itisimportanttodirectactivitypatternsandtrafficflowtokeep
contaminatedareasseparatefromareaswhereprocedurestakeplace.
Themajorareasare:
•Triage
•Procedureareas
•Surgicalunits
•Workareas
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210

211. Cont …
Designatingappropriatetrafficflowforpatients,HCWs,andequipmentto
ensuresafeseparationbetweencontaminateditemsandclean/sterileitems.
Developingpoliciesandproceduresthatestablishclearauthority,
responsibility,andaccountability
Regulatingtheflowofvisitors,patients,andstaffusing
Signs(e.g.,authorizedpersonnelonly),
Reminders(e.g.,redlineonthefloor),and
Physicalbarriers(e.g.,closeddoors).
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211

212. Cont …
•Usingworkpracticesthatpreventcontaminateditemsfromcontactingclean
items,suchasworkingfromdirtytoclean.
•Ensuringthatallstaffunderstandsthepoliciesandprocedures;
•Newstafforientation
•ongoingtraining
•EnsuringappropriateventilationofOperationTheaters(OTs),procedureareas,
CentralSterileSupplyDepartments(CSSDs),andinstrumentprocessingareas.
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212

213. Floorplanforinstrumentcleaning,disinfectingandsterilization
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213

214. Client Education on Infection
Prevention and Control
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214

215. Significance of Client education
•Clienteducationcanbedefinedas…
•“Clienteducationcanbedefinedasthetransmissiontothepatient,
family,caregiverandcommunityoftheknowledge,skillsandattitude
whichempowersthemtoactivelyparticipateinthepromotionand
maintenanceofasafehealthcarefacilityenvironment,particularlyfor
infectionprevention.”
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215

216. Cont..
•Educatingandempoweringpatientsandclientstoactively
participateintheircarehelpreduceapatient'sriskofhospital
acquiredinfections.
•Creatinganopendialogue,however,canbeachallengeintoday's
healthcaresystem.
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216

217. •Four components have been reported as being fundamental to
the process of patient/client empowerment:
•Patient understands of his/her own role;
•Patient’s acquisition of sufficient knowledge on their ability to
collaborate or involve with their healthcare provider;
•Patient’s knowledge and skills; and
•The presence of facilitating environment
Cont..
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217

218. Components of Effective Client Education Program
1.Have clear policies and procedures
2.Have a clear assignment of roles and responsibilities
3.Incorporate training on procedures and basic principle for patient
education into the educational curricula
4.Develop and include an evaluation component
5.Background of evidence on effective patient/client education
program
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218

219. Cont..
1.Make the patient comfortable
2.Help the patient become an active participant
3.Let patients know what their care should look like as well
4.Don't forget about high-risk patients
5.Understand the patient's rights of education
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219

220. Models of Client Education Program
1.Reminders and Motivational Messages
2.Role modelling
3.Graphic Illustrations (pictures, pictographs, models)
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220

221. Summary
•Educatingandempoweringpatientsandclientstoactively
participateintheircarehelpreduceapatient'sriskofhospital
acquiredinfections.
•Supplementarytothepracticescarriedoutbyhealthworkerswhen
providingcare,allindividuals(includingpatientsandvisitors)
shouldcomplywithinfectioncontrolpracticesinhealthcare
settings.
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221

222. Antimicrobial Resistance (ARM) and Rational use
of antibiotics
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222

223. Overview of AMR and Rational use of antibiotics
•AMRistheabilityofamicroorganism(suchasbacteria,viruses,
fungi,andparasites)toresisttheeffectsofanantimicrobialagent
usingvariousresistancemechanisms.
•Rationaluseofantibioticsensuresthatpatientsreceiveantimicrobial
agent(s)thatareappropriatetotheirclinicalneeds,adequatedoses
andperiodoftime.
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223

224. Cont..,
•Antimicrobialresistance(AMR)alongwithirrationaluseof
antibioticsisamajorthreattohealthandhumandevelopment,
affectingourabilitytotreatarangeofinfections.
•Whenaninfectionisnolongertreatablebyanantibioticor
antiviral,ithasdevelopedantimicrobialresistance
(AMR).Antimeans“against,”micromeans“small,”
andbialreferstolife.
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224

225. Cont…
•AMRisabroadtermthatappliesto:
•Fungibecomingresistanttoantifungals;
•Parasitesbecomingresistanttoantiparasiticdrugs;
•Bacteriabecomingresistanttoantibiotics;and
•Virusesbecomingresistanttoantivirals.
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225

226. •Antibioticresistanceisaspecifictermthatreferstoasubsetof
AMR;itreferstobacteriabecomingresistanttoantibiotics.
•Theoveruse,misuse,irrationalprescribing,dispensing,poorpatient
adherenceandself-medicationwithantimicrobialshaveledto
persistentexpansionofantimicrobialresistance.
Cont…
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226

227. Consequences and Magnitude of Antibiotic Resistance…
•Antibioticresistancehasasignificantimpactnotonlyonpatients,
butalsoonthehealthcarefacilityandsystem.
•IncreasePatientmorbidity,mortalitylongerhospitalstays
•Greaterburdentothefacilities,thehealthcaresystemand
Increaseshealthcarecosts
•Complicationsoftreatment,increasedtoxicityandadverse
effectstothepatients
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227

228. Cont..
•MagnitudeofAntibioticResistanceWHOhasclassified
prioritypathogensintothreecategoriesforwhichnew
antibioticsshouldbedeveloped
•Priority1:Critical
•Priority2:High
•Priority3:Medium
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228

229. 1.Naturalcauses:-
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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229
Cause of Antibiotics

230. 2.SocietalContributions:-SomeantibioticusepracticesbyHCWsandcommunities
createpressurethatallowsresistantorganismstosurviveandgrow.
•Inappropriateselection,dosage,anddurationofantibioticsprescribedby
clinicians
•Prescribersnotcomplyingwithprescribingtherightdrug(onlywhen
indicated),intherightdose,fortherightduration,andwiththerightroute
ofadministration.
•Prescriptionofbroad-spectrumantibioticsratherthanaspecificantibiotic
Cont…
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230

231. •Poorcompliancewithrecommendedinfectionpreventionandcontrol
(IPC)practices
•Lackofpoliciesandregulatoryframeworkstocontrolmisuseof
antibiotics
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Cont…
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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232. Rational use of Antibiotics
•Medicationsareusedrationallywhentheyare:
•Clinicallyappropriateforthepatient
•Prescribedindosesthatmeetthepatient‘srequirements
•Takenfortherecommendedtimeperiod
•Takenattherecommendedfrequency
•Thelowestcostoptionforthepatientandthecommunity
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232

233. Cont..
•Medicationsarenotusedrationallyinthefollowingcircumstances:
•Excessiveuseofmultiplemedicines(polypharmacy)
•Useofinjectionswhenoralformulationswouldbean
equallyappropriate
•Inappropriateuseofantibiotics,
•Antibioticselectionnotonstandardtreatmentguidelines
•Self-medicationwithantibiotics
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233

234. DeterminantsofIrrationalUseofAntibiotics
•Lackofproviderknowledge
•Prescriberhabits(prescribingwithoutfollowingtheguidelines).
•Non-availabilityofstandardtreatmentguidelines
•Non-availabilityofaspecificdrugtotreataclinicalcondition
•Lackofcontinuingmedicaleducationandsupervision
•Excessivepromotionandincentivesforprescribing
•Perceivedpatientdemand.
•Lackofdiagnosticandlaboratorysupport.
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234

235. Promoting Rational Use of Antibiotics
•Promotingrationaluseofantibioticsandothermedicinesrequires
concertedeffortsatalllevels,startingfromtheMinistryofHealth
atthenationallevelandextendingouttothecommunity
•WHOrecommendationat:-
Nationallevel
Facility-level
Generalpublic/community-level
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235

236. IPC Governance and
Management
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237. Overview of National IPC Policy and Strategic Plan
•IPC programs must have clearly defined objectives based on the facility
context according to
•Risk assessment and
•Functions that align with and contribute to the prevention of HAI and the
spread of AMR in health care.
•Developing an IPC policy and strategy provides a framework to develop
and implement IPC guidelines and standard operating procedures (SOPs)
in order to improve the quality of service in healthcare facilities.
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238. •Ethiopia’s National Infection Prevention and Control Policy,
Strategy, and Strategic Roadmap are based on WHO eight core
components.
•The rational for developing the national IPC document was to
establish the foundations for IPC programs at the national, regional,
and healthcare facility levels and across both public and private health
sectors.
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239. 6.Workload, staffing & bed occupancy
7.Built environment, materials &
equipment
8.Research and development
9.Monitoring, Evaluation, Audit and
Feedback
10.Advocacy, Social Mobilization and
Partnership
11.Resource allocation and mobilization
•The policy focus areas includes:
1.IPC Program Management and
Institutional Coordination
Structure
2.National Infection Prevention and
Control Standards and Guideline
3.IPC education, training, and quality
improvement
4.HAIs’ surveillance
5.Multimodal strategies and policy
implementation
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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240. IPC Program Governance and
Management
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241. Components of Effective Client Education Program
1.Have clear policies and procedures
2.Have a clear assignment of roles and responsibilities
3.Incorporate training on procedures and basic principle for patient
education into the educational curricula
4.Develop and include an evaluation component
5.Background of evidence on effective patient/client education program
2414/10/2025
Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
guidlines

242. IPC Program Governance and Management
•Major role in the oversight of a successful program include:
1.Administrative leadership:
2.IPC committee:
3.Task forces/working groups:
4.National or regional public health authorities:
5.Facility level staffs
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243. Attributes of Effective Infection Prevention and
Control (IPC) Programs
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244. Attributes of Effective IPC Programs
•Tangible support from facility
leadership
•Adequate resources for IPC
activities
•Partnerships with key stakeholders
and front-line HCWs
•Effective communication about
IPC
•A successfulIPC program must acquire and retain the following attributes:
•Designated staff member/Team
who is responsible and
accountable for IPC at the facility
•Competent IPC Program leaders
with appropriate training and
education
•Formal authority granted to the
IPC program
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245. Thank You
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Mr. Dechasa Adare (Ass. Professor) ፡ref. EMOH & WHO IPC
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