NABH guidelines - Dr Chintan N Patel

NABH : National Accreditation Board for Hospitals & Healthcare Providers - guidelines for sterlity protocols, care of poly-trauma cases and hospital waste management

1. NABH : NATIONAL NABH : NATIONAL
ACCREDITATION BOARD FOR ACCREDITATION BOARD FOR
HOSPITALS & HEALTHCARE HOSPITALS & HEALTHCARE
PROVIDERSPROVIDERS
Dept of Orthopaedics , J.N.
Medical College and
Dr. Prabhakar Kore Hospital and
MRC, Belgaum
PRESENTER :
Dr CHINTAN N PATEL

2. INTRODUCTIONINTRODUCTION
•Is a constituent board of Quality Council of India.Is a constituent board of Quality Council of India.
•Set up to establish and operate accreditation programme for healthcare organisations. Set up to establish and operate accreditation programme for healthcare organisations.
•MISSION : MISSION : To be apex national healthcare accreditation and quality improvement body, To be apex national healthcare accreditation and quality improvement body,
functioning at par with global benchmarks.functioning at par with global benchmarks.

4. About 5,000 
germs live on 
our hands at 
any given time

5. MICROSCOPIC VIEWMICROSCOPIC VIEW

6. 7 STEPS OF HAND WASHING7 STEPS OF HAND WASHING

12. Blood and Body
Fluid Spill

18. •How you will prepare the site – before giving
injection/inserting iv line
Use 70 % alcohol (sprit) for cleaning the site from
centre to periphery and wait for 30 second

19. CLASSIFICATION OF SURGICAL WOUNDS (NATIONAL RESEARCH COUNCIL)CLASSIFICATION OF SURGICAL WOUNDS (NATIONAL RESEARCH COUNCIL)
SURGICAL WOUND TYPES:SURGICAL WOUND TYPES:
• Clean wound – no signs of infection / inflammation e.g.; skin, eye, Clean wound – no signs of infection / inflammation e.g.; skin, eye,
vascular system.vascular system.
•Clean contaminated wound: e.g. post – op infected cases, abscess.Clean contaminated wound: e.g. post – op infected cases, abscess.
•Contaminated wound : e.g. gunshot injury.Contaminated wound : e.g. gunshot injury.
•Dirty contaminated: where there is exposure to fecal mass, open Dirty contaminated: where there is exposure to fecal mass, open
fistulas.fistulas.

20. MANAGEMENT:MANAGEMENT:
•Clean wound: clean with Betadine 10%.Clean wound: clean with Betadine 10%.
•Wound surroundings to be cleaned and keep dry.Wound surroundings to be cleaned and keep dry.

21. CONTAMINATED WOUND:CONTAMINATED WOUND:
•Wound surface 1Wound surface 1
stst
to be cleaned with Betadine 10%. to be cleaned with Betadine 10%.
•Internal wound cleaned by H O / Saline.
₂ ₂
Internal wound cleaned by H O / Saline.
₂ ₂
•Removal of slough, (Debridement, +dressing vac +Hydrogen).Removal of slough, (Debridement, +dressing vac +Hydrogen).
•Send pus for culture sensitivity reporting.Send pus for culture sensitivity reporting.
•Antibiotics according to culture sensitivity report. Antibiotics according to culture sensitivity report.

22. DIRTY CONTAMINATED WOUND:DIRTY CONTAMINATED WOUND:
•Proper irrigation with saline.Proper irrigation with saline.
•Betadine 10% H 0 / saline cleaning.
₂ ₂
Betadine 10% H 0 / saline cleaning.
₂ ₂
•Inj TT/TT Immunoglobulin.Inj TT/TT Immunoglobulin.
•Adequate Hydration –I.V. fluids/ pcv transfusion.Adequate Hydration –I.V. fluids/ pcv transfusion.
•Antibiotics.Antibiotics.
•Prepare pt for wound debridement ± # Stabilization, ± Dressing.Prepare pt for wound debridement ± # Stabilization, ± Dressing.

23. WOUND CARE GUIDELINESWOUND CARE GUIDELINES
•In poly-trauma cases Provide Airway In poly-trauma cases Provide Airway
and Urgent resuscitationand Urgent resuscitation
•Treat open fractures as emergenciesTreat open fractures as emergencies
•Immobilise injured extremity and cover wound with sterile dressing - Immobilise injured extremity and cover wound with sterile dressing -
cover with saline soaked gauzecover with saline soaked gauze
•IV Antibiotics within 3 hours of injury and continue for 72 hoursIV Antibiotics within 3 hours of injury and continue for 72 hours
•Serial neurovascular examinationsSerial neurovascular examinations
•Vascular repair ≤6 hoursVascular repair ≤6 hours
•Urgent optimum wound debridementUrgent optimum wound debridement
•External fixation for damage control, definitive internal fixation at the External fixation for damage control, definitive internal fixation at the
earliest (within 72 hours and not exceed 7 days)earliest (within 72 hours and not exceed 7 days)
•Early bone graftingEarly bone grafting
•Delayed wound closure with SSG/FlapDelayed wound closure with SSG/Flap

26. SUCTION PROTOCOLSUCTION PROTOCOL
•The purpose of suctioning is to maintain a patent airway and improve The purpose of suctioning is to maintain a patent airway and improve
oxygenation by removing mucous secretions and foreign material (vomit oxygenation by removing mucous secretions and foreign material (vomit
or gastric secretions) from the mouth and throat (oropharynx).or gastric secretions) from the mouth and throat (oropharynx).
•PROCEDURE:PROCEDURE:
•Wash hands and wear personal protective equipment as indicated.Wash hands and wear personal protective equipment as indicated.
•Adjust vacuum between-80 to -120 mmHg for adults or -60 to-80 mmHg Adjust vacuum between-80 to -120 mmHg for adults or -60 to-80 mmHg
for pediatrics.for pediatrics.
•Provide semi-fowler’s position (30 to 40 degree elevation).Provide semi-fowler’s position (30 to 40 degree elevation).

27. •Check heart rate before, during and after procedure .(If tachycardia or Check heart rate before, during and after procedure .(If tachycardia or
bradycardia occurs discontinue the procedure until it resolves).bradycardia occurs discontinue the procedure until it resolves).
•Put clean gloves on both hands.Put clean gloves on both hands.
•Open suction catheter exposing only the connector, attach to connective tubing Open suction catheter exposing only the connector, attach to connective tubing
and maintain sterility of catheter.and maintain sterility of catheter.
•If patient has an artificial airway in place, hyper oxygenate with a resuscitations If patient has an artificial airway in place, hyper oxygenate with a resuscitations
bag or mechanical ventilator.bag or mechanical ventilator.

28. •Insert the catheter through the nose or endotracheal tube to the point Insert the catheter through the nose or endotracheal tube to the point
of restriction without applying suction (do not aggressively force the of restriction without applying suction (do not aggressively force the
tip of the catheter )tip of the catheter )
•Slowly insert catheter & ask patient to take deep breaths or watch for Slowly insert catheter & ask patient to take deep breaths or watch for
inspiration.inspiration.
•Pinch and Pass catheter into trachea, and slowly withdraw while Pinch and Pass catheter into trachea, and slowly withdraw while
applying intermittent suction and rotating. applying intermittent suction and rotating.
•Hyper oxygenate the intubated patient or request the non-intubated Hyper oxygenate the intubated patient or request the non-intubated
patient to take several deep breaths.patient to take several deep breaths.
•Auscultate the patient’s chest if secretions can still be heard repeat the Auscultate the patient’s chest if secretions can still be heard repeat the
suctioning proceduresuctioning procedure

29. •Before re-suctioning, clear catheter with normal salineBefore re-suctioning, clear catheter with normal saline
•Discard gloves and catheters in an aseptic manner, clear connective Discard gloves and catheters in an aseptic manner, clear connective
tubing with remaining NS and turn off suction.tubing with remaining NS and turn off suction.
•Note: -Note: - Coat tip of catheter with lubricant only if nasotracheal Coat tip of catheter with lubricant only if nasotracheal
suctioning is to be performed.suctioning is to be performed.
•Remember:Remember:
- Suction should not be applied for more than 10 sec.- Suction should not be applied for more than 10 sec.
- First oral suction to be done and followed by ET suctioning. - First oral suction to be done and followed by ET suctioning.
- ET tube pressure - 25-30 mmHg.- ET tube pressure - 25-30 mmHg.

30. THANK YOUTHANK YOU