INFECTION CONTROL PROTOCOL AT SNCU

Terminology Antisepsis: It is a process that inhibits the growth of microorganism. Antiseptics : It is an agent that used for antisepsis in a living tissue. Asepsis : Absence of sepsis. Disinfection : It is a process that destroys pathogenic and non-pathogenic microorganisms. Disinfectant : It is an agent that used for disinfect ion of inanimate objects. Infection : Presence and growth of microorganisms especially those that release toxins or invade body tissues Germicide : It is a substance that destroys the harmful microorganisms Sterilization: It is a process that destroys all microorganisms including spore. Concurrent disinfection : the disinfection process done, when the patient or neonates are there in the unit Terminal disinfection: when the disinfection process is maintained after discharge or death of the sick neonates.

I.

Hand hygiene and hand washing protocols

Hand hygiene is a process for the removal of visible soil and removal or killing of transient microorganisms from the hands. This also includes the maintenance of good skin integrity. It can be maintained by using soap and running water for removal of visible soil. It may also be accomplished by the use of an alcohol-based hand rub, when hands are not visibly soiled. Rules for hand hygiene Hand washing is the golden rule of infection control in SNCU. Alcohol-based hand rubs are not the substitute for hand washing. Optimal strength of alcoholbased hand rubs should be 70% to90% of alcohol. Thorough hand washing before attending the baby every time is must to prevent cross infection. Hand washing for two minutes before entering the unit is mandatory. Special emphasis should be given during hand wash on tip of the fingers, space between two fingers, mid part of the palms and root of the thumbs, as these are most dirty part of the hands. Handwash should be done upto the elbow. Subsequently everyone must wash hands before and after touching every baby at least for 20 seconds and also after touching unsterile surface and fomites. After touching an infected baby or unclean fomite, a two minutes hand wash is again compulsory. Everyone should wear half sleeve dress and take off bangles, wristwatches, rings etc. before hand washing. 193

Ensure that nails are short, well manicured and free of chipped or cracked nail polish. Skin must be free of abrasions, which harbour bacteria. Soap and running water supply for 24 hours are essential in a SNCU. There should be at least one sink or basin for every 4-5 babies, which should be conveniently located and equipped with elbow operated or foot operated taps.

Hand hygiene must be maintained when hands are visibly soiled and for the following opportunitiesBefore the activities like Direct contact with all babies. Performing invasive and sterile procedures. Preparing, handling and feeding a baby. Putting on gloves. Performing a clean procedure after having a dirty procedure on the same baby. After the activities like Removing gloves. Contact with babies. Contact with items in the patients environment. Situations or procedures in which microbial or body fluid contamination of hands may occur. Personal body functions like use of toilet or blowing ones nose. Equipments and Supplies Hand washbasin Antiseptic soap Nail cutter Hand brush Alcohol-based hand rub Hand drier Sterile paper towels Running water.

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Procedure of soap water hand washing Hand washing is cheap, simple and single most important means of preventing hospital acquired infection. It is considered as golden rule for prevention of neonatal sepsis.

Steps of hand washing must be strictly followed. Steps are as follows1. 2. 3. 4. 5. Remove wrist- watch, bangles, rings, nail polish etc. Roll sleeves above elbow. Rinse hands and arms under warm running water. Apply one full pump of liquid soap or antiseptic agent. Avoid touching the spout. Lather hands and forearms with soap or antiseptic agent. Cover all surfaces of the hands and fingers using friction. The minimum duration for lathering is 10 seconds, more time may be required if hands are visibly soiled. Ensure that all areas including thumbs, under nails and back of fingers and hands are not missed. 6. Follow the sequence as (see picture) Palms, fingers and web spaces Back of hands Fingers and knuckles Thumbs Finger tips and depressed parts of the palms Wrists and forearms up to the elbow. 7. Clean nails under warm running water with disposable nail cleaner. 8. Rinse thoroughly under warm running water. 9. Turn off the tap by the elbow avoiding recontamination of hands. 10. Keep elbows always dependent. 11. Dry hands with sterile single use towel or sterile piece of paper or hot air automatic hand drier or simple air dry. Procedure of hand hygiene with alcohol-based hand rub 1. Rinsing hands with alcohol is not a substitute for proper hand washing. 2. This procedure can be done when hands are not visibly soiled and initial two minutes hand washing is done effectively. 3. Alcohol-based hand rub must be provided in all baby care areas, at the point of care so that all persons providing care to babies can access it easily.

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Steps of hand rub 1. Ensure hands are visibly clean, if not then follow soap and water hand-washing steps. 2. Be sure that hands are dry before using alcohol-based hand rub, as moisture from wet hands dilutes the alcohol. 3. Apply 3-5 ml of hand rub lotion. Cover all surfaces of the hands and fingers including palms, forearms, space between fingers and nails. Use friction and rub until dry. A minimum of 15 seconds is required to cover all surfaces.

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HAND DRYING Air drying Hand dryers Autoclaved napkins Autoclaved papers

Palm and fingers

Back of hands

Finger & knuckles

Thumbs

Finger

Wrists and forearms STEPS OF HAND WASHING

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II.

Protocol for Equipment and Linen Decontamination

Equipments are important source of infections at the SNCU. Nursing personnel are mainly responsible to arrange for disinfection and sterilization procedure. They can take help from housekeeping staff (G.D.A. and sweeper). Requirement of staff in SNCU, Labor room and OT. Group D staff: One sweeper and one ward boy for each shift in Labor room , OT and SNCU Total = 4 sweeper + 4 Ward boy/ GDA for SNCU i.e. 1 per shift and night off Total = 4 sweeper + 4 Ward boy/ GDA for labor room i.e. 1 per shift and night off Training of staff in Cleaning and aseptic procedures = 3-7 days Training manual: to be prepared Waste disposal manual: to be prepared H.R. issues of scavenging staff Monitoring and surveillance record Autoclaving (Steam under pressure) Autoclaving is a best method of sterilization by the use of specially designed autoclave machine in definite pressure, temperature and time. High pressure (20 pound) autoclaving to be done for instruments, procedure sets, linens, clothing, dressings, cotton, bandage, gauge pieces, napkins etc. Low pressure (10 pound) autoclaving to be done for gloves, glass articles, rubber goods, PVC articles, tubes, resuscitation bag & mask, humidifiers, suction bottles, etc. Preparation for autoclaving1. All articles, which will be sending for autoclaving, must be well cleaned with soap and water and should be dried properly. 2. Hand washing to be done effectively before packing the articles in the drums and trays. 3. Articles will be arranged with space in between and without over loading thus to allow the steam to circulate freely. 4. Articles will be placed inside the steel drum over a dry lint piece and should be covered by another piece of lint. 5. The drums will be labeled with content articles, date, dept. and high or low pressure before sending the drum for autoclaving. 6. Re-autoclaving must be done if the articles are not used within 48 hours. 7. Sterilized materials should never be kept on the floor or over any dirty objects. 8. All sterilized articles must be handled with sterile cheatle forceps or lifting forceps. 9. Cheatle forceps and its container should be sterilized everyday. 10. No water to be used in the cheatle forceps container.

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VERTICAL AUTOCLAVE

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HORIZONTAL AUTOCLAVE

Available Sterilization Methods

Sterilization method Steam a) Small table top sterilizers b) Gravity displacement c) High-speed vacuum sterilizers Parameters Monitoring/frequency Use/advantages Disadvantages

Ethylene oxide gas

Raised pressure (preset by manufacturer) to increase temperature to 1210 C (1330 C for flash sterilizers) Time varies with temperature, type of material and whether the instrument is wrapped or not. Steam must be saturated (narrow lumen items may require prehumidification). (EtO) EtO concentration based on manufacturer's recommendation

Air detection for vacuum sterilizers - daily before first cycle of day Mechanical - each cycle,Chemical - each cycle,Biologic - at least weekly, but preferably daily, and with each load of implantable items (Bacillus stearothermophilus spores). .

Heat tolerant instruments and accessories Linen Inexpensive Rapid Efficient Non toxic Can be used to sterilize liquid

Unsuitable for anhydrous oils, powders, lensed instruments, heat and moisture sensitive materials. Some table top sterilizers lack a drying cycle.

Temperature - variable Humidity 50% Time - extended processing time (several hours)

Heat sensitive items Not harmful to heat sensitive and lensed instruments

Expensive ETO systems have been changed because of the elimination of CFCs(149). Toxic to humans

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Use of Sterilizing solution Disinfectant & Chemical required : Sodium Hypochlorite available as 4% ( Merck ) Bleaching powder 5 % Savlon (cetrimide, chlorhexidine gluconate, isopropyl alcohol) Phenol(Carbolic acid Lysol(50-60% cresol) Bacillocid Special 2% (Formaldehyde ,Glutaraldehyde ,Alkyl urea derivative Benzalkonium chloride Isopropyl Alcohol 70% Sterllium ( Hand Rub) Cidex (2%) (Glutaraldehyde) Formalin (40%) Hydrogen Peroxide + Silver Salt (Virosil or Ecosheild) Betadine Solution 2% and 10 % Betadine Scrub

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Name
Bacillocid spray (2%) Cidex (2% glutaraledehyde)

Instructions for use/special issues

-Prepare solution as per manufacturers instructions. - 20 ML DISSOLVED IN 1000ML WATER -Clean thoroughly with soap and water before immersion in Cidex -Solution needs to be activated by adding the powder, supplied in a small container along with the big jar of five litre solution. -The activated solutions can be used for 14 days only from the date of activation. -Complete immersion of articles is necessary for 10 minutes in case of disinfection and for 10 hours in case of sterilization or as recommended by the manufacturer. - Date of activation should be recorded and labeled for easy reminder, on the bucket containing the activated 2% glutaraldehyde solution -Ideally the activity should be checked with indicator strips available from manufacturer For routine fumigation: 30 ml of 40% formalin in 90 ml water per 1000 cu ft area. 200ml in 800ml of demineralised water Household bleach 5% ( 5g in 1 L water) , One volume of household bleach dissolved in 9 volumes of water to prepare 1:10 chlorine solution. Keep solution covered. Pour in the dustbins . Change every 24 hours 70% isopropyl alcohol . should be used raw. After washing in soap and water, feeding utensils to be boiled for 10 minutes

Formalin

Ecoshield Sodium hypochlorite

Spirit Soap & water

Decontamination of common articles Thermometers, stethoscopes, tape measures, monitor probes, blood pressure cuffs, torches etc. should be wiped with 70% isopropyl alcohol or sterilium. Items like infusion pumps, syringe pumps, monitors, body of the ventilators, nebulizers, oxygen concentrators etc. should be cleaned with moist cloth. Oxygen hoods and air filters should be cleaned with detergent and running water. Ventilators tubings are best sterilized by ethylene oxide (EO). They can be sterilized by autoclaving or by immersing in 2% gluteraldehyde. Radiant warmer, bassinet, weighing machine and backside of the infusion pump, syringe pump and monitor etc can be cleaned with 2% glutaraldehyde. Procedure sets should be autoclaved after every use. Feeding articles should be cleaned and brushed with detergent and then boiled for 20 minutes. Use of disposable sets is more preferable. Other available chemical solutions like bacillocid-2%, bacillol-25, carbolic acid-3% etc. can also be used for decontamination of articles as per manufacturers direction.

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Protocol for equipment decontamination and housekeeping practices

A Item Thermometers,Tapemeasures, Stethoscopes, Monitor-probes, Torches, BP cuffs, Telephone. Laryngoscope without the bulb Oxygen hoods, feeding utensils, Ventilators air filter. Infusion pumps, Syringe pumps, Monitors, Ventilators body Decontamination procedures Wipe with 70% isopropyl alcohol or sterilium. Frequencies daily and after each use

Clean with detergent or soap and water Clean with moist cloth or wet mop , if contaminated with blood should be disinfected with 2% glutaraldehyde. Wipe with 2 % bacillocid

daily

daily.

Incubators, radiant warmers, bassinet, Weighing machine. Resuscitation bag and accessories Rubber goods, plastic tubing, ventilator tubings, oxygen tubings, humidifiers Ventilators circuits, Instruments, Linens, Procedures sets, gloves, Glass articles, steel swab containers, Cheatles forceps Feeding utensils, medicine tray, bowls, knife dish etc Walls Fans Window AC

daily

Dismantle, was with soap water clean dry and immerse in 2% cidex for 10 hours or 10 minutes. Autoclaving.

After each use

Clean with soap and water and boil for 20 mins 2% Bacillocid Clean with wet clean cloth Surface and filters to be washed with soap and water Defrost and clean with soap and water Soap and water

After each use Once in each shift Once a week Once a week

H I F

Refrigerator

Once a week

Buckets

Daily in the morning shift Daily in morning shift or as required

Sinks

Vim, surf

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Other House-keeping practices at SNCU Wet mopping is the most common and preferred method to clean floors. Single-bucket (basin) technique: One bucket of cleaning solution is used. The solution must be changed when dirty. (The killing power of the cleaning product decreases with the increased load of soil and organic material present.) Double-bucket technique: Two different buckets are used, one containing a cleaning solution and the other containing rinse water. The mop is always rinsed and wrung out before it is dipped into the cleaning solution. The double-bucket technique extends the life of the cleaning solution (fewer changes are required), saving both labour and material costs. Duo Buckets - Duo buckets are mop buckets that have two tanks. One tank usually contains a mop solution and the other a rinse solution. These buckets are for use in demanding hygienic environments and most have antimicrobial properties built in. Triple-bucket technique: The third bucket is used for wringing out the mop before rinsing, which extends the life of the rinse water

Do not dry mop or sweep the operating room, labour room, sick newborn care unit. (This causes dust, debris and microorganisms to become airborne and contaminate clean surfaces.) Remember: All areas of the surgical suite, labour room, Sick newborn care unit scrub sinks, scrub or utility areas, hallways and equipment should be totally cleaned, every shift regardless of whether they were used during the 24- hour period. Note: The double- or triple-bucket method is recommended for the cleaning of the operating room, labour room and other areas of the surgical suite.

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Clean with a wet mop using a disinfectant cleaning solution. Instrument: Three Bucket trolley and one clean mop with handle and one mechanized squeezer. Disinfectant: Phenol 5 %, take 50 ml in 1000 ml / bacillocid 2% 20 ml in 1000ml Make disinfectant solution in two buckets as cleaning solution and plain water in the third bucket as rinsing solution In one bucket EMPTY for rinsing. In second bucket normal concentration plain water In the third double the concentration disinfectant solution Use clean and dry mop. Wet mops are rich source of contamination Process for mopping Step 1: Dip mop in plain water and squeeze nicely, may use a mechanical wringer Step 2: Dip mop in disinfectant sol and sweep Step 3: Squeeze in the bucket kept for dirty water Step 4: Dip in the plain water Step 5: Dip in disinfectant solution then sweep again.

Never store used solution and always clean and dry the mop after use. Proper mop maintenance can make your mops last up the 5 times longer and help you do a much better job of cleaning your floors. Here are some simple steps to follow: 1. Before using a mop head clean in warm water to make sure that any chemicals that were used on prior used are rinsed out. 2. Let the mop wringer rinse the mop. Do not twist the wet mop in the wringer this can loosen the wet mop strands. 3. Try not to leave the mop in the mop water over night, this can bread bacteria and also weaken the wet mop fibers 4. After using your wet mop heads soak in hot water for up to 10 minutes and then rinse thoroughly. 5. Hang mop heads to dry after soaking, this prevents mold forming on the mop 6. Try to have a mop a different mop head for different types of jobs especially if youre using more than one type of floor cleaner. 7. Launder your wet mops heads on a regular basis this will prevent your mops being broken down by chemicals and should prevent mold. Make sure to use a mop head laundry bag so that the mops don't tangle
Atmosphere to be kept free from dust. All holes and crevices should be sealed. Walls should be wiped daily with disinfectant (bacillocid- 2%, Polysan). Working surfaces, shelves, basins and sinks should be cleaned with disinfectant-detergent solution. Environment should be kept clean. Temperature to be maintained between 28 30 degree centigrade. Adequate lighting and ventilation with 24 hours water and electricity supply. Cleaning and decontamination should be done from less dirty area to more dirty area eg metallic part of the bassinet should be cleaned first then the wheels, side rails of the bassinet should be cleaned with separate mop and separate bucket of disinfectant solution.

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WASHING LINEN Housekeeping and laundry personnel should wear gloves and other personal protective equipment as indicated when collecting, handling, transporting, sorting and washing soiled linen. When collecting and transporting soiled linen, handle it as little as possible and with minimum contact to avoid accidental injury and spreading of microorganisms. Consider all cloth items (e.g., surgical drapes, gowns, wrappers) used during a procedure as infectious. Even if there is no visible contamination, the item must be laundered. Carry soiled linen in covered containers or plastic bags to prevent spills and splashes, and confine the soiled linen to designated areas (interim storage area) until transported to the laundry. Carefully sort all linen in the laundry area before washing. Machine Washing

STEP 1: Wash heavily soiled linen separately from non soiled linen. STEP 2: Adjust the temperature and time cycle of the machine according to manufacturers instructions and the type of soap or other washing product being used. Both cold and hot water washing cycles that include bleach reduce bacterial counts in the linen. Hot-water washing: 1. Use hot water above 71C (160F) and soap to aid in loosening soil. Add bleach and sour as above. Adjust the time cycle of the machine according to the manufacturers instructions. STEP 3: When the wash cycle is complete, check the linen for cleanliness. Rewash if it is dirty or stained. (Heavily soiled linen may require two wash cycles

Drying, Checking and Folding Linen: For both hand and machine washed linens, the steps are the same. STEP 1: Completely air or machine dry before further processing. Air dry in direct sunlight, if possible, keeping the fabric off the ground, away from dust and moisture. STEP 2: After linen items are totally dry, check for holes and threadbare areas. If these are present, the item must be discarded or repaired before reuse or storage. If sterile linens are required, prepare and sterilize wrapped packs

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Guidelines for entry inside the SNCU Prevention of overcrowding must be followed inside the SNCU. Every person should enter the unit after hand washing and gowning. Both parents should be allowed to visit their baby. Hand washing and gowning should be taught to them. They should be allowed to touch, cuddle and care their baby within the permissible limits. Family members may be allowed inside the SNCU for specific situations. There should a buffer zone beyond the door of the SNCU into which visitors are not allowed without permission. Separate set of shoes to be used inside the SNCU and outside of the unit. Doctors and nurses should have special dress for the SNCU Nobody should wear ornaments, wristwatch, nail polish, and woolens inside the unit. Any person with infection should not be allowed to enter the SNCU Infected babies can be admitted in the SNCU with adequate isolation and barrier facilities. Infected baby with diarrhea, pyoderma and such contagious infections should not be admitted inside the SNCU No hospital personnel, who do not have a valid reason to be in the SNCU , should be allowed to enter.

Protection of Neonates from developing infections Exclusive breast-feeding to be provided to the baby. Mother should be involved in the care of the baby mainly for hygienic care. Number of the handling of the baby by the nurses and doctors should be reduced. No baby should be allowed to stay in the neonatal care unit unnecessarily. All babies should be carefully observed for any features of infections. The umbilical cord must be kept clean and dry. Nothing should be applied on the cord. Only sterile cord clamps or autoclaved cord ties should be used. Babies must not be bathed in the hospital or home till the cord is fallen off. They may be cleaned daily with warm sterile water with special attention to the groin, axilla and neck. Low birth weight should be given bath after body weight is 2500gm. Skin abrasions should be prevented by position changing at regular intervals, avoiding strong adhesives, placing monitors probes on different sites etc. Follow skin preparation policy for insertion of IV cannula, venepuncture, and other procedures. Prepare smallest possible area of skin as follows swab with alcohol first, allow it to dry, then swab iodine on site and allow it to dry. Swab again with alcohol to wipe off iodine and allow it to dry. Peripheral IV fluid set and tubing must be changed electively every 24 hours. The fluid in the same bottle must not be shared between babies. The bottle must not

207

be repeatedly punctured. When the covered seal of the bottle is removed, it should be cleaned with spirit swabs and then use betadine soaked sterile cotton to cover the stopper of the bottle. All fluids except lipids and blood should be given through the filter. Strict aseptic technique to be followed for preparation and administration of fluid therapy. A baby should be allocated to a particular team of doctor and nurse. Non-invasive methods of monitoring should be used whenever possible. Cluster-care approach to be followed for the individual baby. Universal precautions must be adopted during procedures. Sterile gloves must be worn for all invasive procedures and endotracheal suctioning. Chest tube insertion, lumber puncture, exchange transfusion and central line insertion should be considered as surgical procedure with strict aseptic precautions. Formal record must be maintained of all cultures samples along with the positivity and sensitivity findings. Environmental cultures must be taken from all representative surfaces, equipments, fomites, taps, sinks, refrigerators, laminar flow devices and air conditioning vents at least 4 monthly intervals as routine surveillance program.

1.5. Protocol for Room Decontamination. Routinely room decontamination to be done at one month interval by fumigation or fogging .In between, it may be done after termination of infected baby. Before fumigation all AC machine to be switched off and AC duct to be sealed. Doors and windows are to be kept closed and sealed properly. For fumigation--OT care machine can be used with 30 ml 40% formalin in 90 ml water per 1000 cubic feet area. Desired amount of formalin and water to be taken in the OT care machine and it should be switched on for half an hour. Then the room to be kept closed for 6 hours. In case the room needs for earlier use, then 180 ml of Ammonium Hydroxide is added in OT care machine after removal of formalin. For fogging Fogging machine is used with 200 ml Eco-shield lotion in 800 ml dimineralised water per 1000 cubic feet area. Same procedure is followed as fumigation. Before fogging same precautions are to be taken as fumigation.

Fogger machine

ETO Machine

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REQUIREMENTS FOR INFECTION CONTROL MEASURES

Equipments for Asepsis and House Keeping Protocols: Sl.No. Item Requirement 1 for Labour Room, , 1for SNCU, 1 for 1 Three Bucket Trolley Neonatal ward Wet Mop (Cut End Mops Four-ply, cut-end yarn. Absorbent natural cotton fiber for general mopping) with alumunium Hand 2 Stand " Proper covered Dustbin with polythene 3 lining 1 for each bed 1 for OT, 1 for Labour 4 Vertical Autoclave room, 1 for SNCU Electric boiler or sterilizer This unit is completely made up of stainless steel .The instrument trey is automatically lifted when cover is opened, reliable thermostat is also provided for intermittent operation to minimize 2 for OT, 2 for labour 5 electricity consumption room, 2 for SNCU 4 of each size for OT, Labour room, & Autoclave drums Large, medium , small SNCU(Total 16 with 4 6 size of each size) Mechanical Disinfected pressure Sprayer ( 1 for OT,1 For Labour 7 Knapsack sprayer) for walls room, & 1 for SNCU Fogger machine: Fog machine saves the consumption of the uses of disinfectant 1 for OT,1 For Labour solution and time. Its area capacity is up to room, & 1 for SNCU 8 3000 cubic feet. Total = 3 Disinfectant Tray: 1 for OT,1 For Labour This unit should be completely made up of room, & 1 for SNCU 9 stainless steel capacity of five liters. Total = 3 1 for OT,1 For Labour room, & 1 for SNCU 10 Washing Machine with hot water Total = 3 1 For Labour room, & 11 Dryer for clothes 1 for SNCU Total = 3 1 for OT,1 For Labour room, & 1 for SNCU 12 Hot air oven Total = 3 209

Cost per Unit Rs. 8,000/each

Essential

yes

Rs. 1,000/each Rs. 250/each Rs. 70,000/each

yes yes yes

Rs. 7,000/each

yes

Rs. 10,000/(total) Rs 5,000 each

yes yes

Rs 38,000 each

yes

Rs 1000 each Rs 15,000 each Rs 20,000 each

yes

yes yes

Rs 8,000 each

yes

13

Ethylene Oxide Sterilizer Bucket trolley with mop for cleaning bathroom Washable slippers

14 15

16

Gowns for Group D staffs , Mothers, Doctors, Nurses Rubber boots and Leather heavy duty gloves Hot water Geysers & Water Heater

17. 18.

1 for SNCU 1 for OT,1 For Labour room, & 1 for SNCU Total = 3 Adequate number of each size for OT, Labour, SNCU Adequate number of each size for OT, Labour, SNCU For Sweeper , GDA 1 for OT,1 For Labour room, & 1 for SNCU Total = 3

Rs 1, 50,000

Desirable

Rs 8,000 each Rs 2,000 yes Total Rs 10,000 yes

Yes

Rs 1,000 for each set Rs 10,000 each

Plenty of disposables to prevent infection Disposable Item Cord Clamp Small blood transfusion set Dee Lees Mucus trap Suction Catheter # 10,12 Fr Sterile Gloves Feeding tubes # 5,6,7 Fr Sterile drapes Micro drip set with burette Cotton Neoflon 24 G Surgical gauze Syringes : Tuberculin 1cc, 2,5,10,50 cc with needle 22, 24,26 size Normal saline ampoules Plenty of disinfectants of good quality INDICATION FOR ISOLATION OF BABIES o Acute gastroenteritis o Draining abscesses o Congenital CMV, Rubella, Chickenpox, Syphilis, Tetanus o Babies with meningitis / pneumonia do not need isolation o Cohort babies with documented sepsis

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WASTE DISPOSAL ROUTINE A system needs to be in place for management of all potentially infectious and hazardous wastes in accordance with the Bio-Medical Waste (Management and Handling) Rules 1998.

NEED FOR BIO-MEDICAL WASTE MANAGEMENT (a) (Statutory) Legal Obligation : In accordance with the provisions of the Bio-Medical Waste (Management and Handling) Rules 1998, deadline for GMC was 31st December 1999, by which the rules must be conformed with, failing which legal action can be initiated. (b) Health hazards associated with improper hospital waste management: A number of hazards and risks are associated with this viz. * Injuries from sharps to all categories of hospital personnel and waste handlers. * Nosocomial infections in patients from poor infection control and poor waste management. * Risks of infections outside hospitals for waste handlers, scavengers, and (eventually) the general public. * Risks associated with hazardous chemicals, drugs, being handled by persons handling wastes at all levels. c) Environmental hazards : Improper hospital waste management also results in air, water and soil pollution, especially due to imperfect treatment and faulty disposal methods SAFE DISPOSAL OF HOSPITAL WASTE Proper disposal of hospital waste is important to keep the environment clean. To keep the environment clean, in each unit of ward, the waste should be disposed off in a proper way. The following are different colour drums with different color polythene for different type of waste, to be disposed off in a different way. Black drums / Bags : Left over food, fruits feeds, vegetables, waste paper, packing material, empty box, bags etc. This waste is disposed off by routine municipal council committee machinery.

Yellow drums / Bags: Infected non-plastic waste Human anatomical waste, blood, body fluids, placenta etc. This type of waste requires incineration.

Blue drums / Bags: Infected plastic waste Used disposable syringes, needles (first destroy the needle in the needle destroyer). Used sharps, blade and broken glass etc. Patients IV set, BT set, ET tube, catheter, urine bag etc. should be cut into pieces and disposed in blue bag. This waste will be autoclaved to make it non infectious. This is then shredded and disposed off.

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NOTES

NOTES

NOTES