rraappiidd eevvaalluuaattiioonn gguuiiddee ......silvia acosta de gnass, maria paz ade, laura araya,...
TRANSCRIPT
1
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Washington, D.C.
2nd Edition, 2011
PAN AMERICAN HEALTH ORGANIZATION
Health Surveillance and Disease Prevention and Control Area
International Health Regulations, Alert and Response and Epidemic Diseases
2
Acknowledgments
This guide was produced based on an original idea by Gabriel Schmunis and counted with the
contributions of Latin American experts in prevention and infection control -
Silvia Acosta de Gnass, Maria Paz Ade, Laura Araya, Maria Isabel Gonzalez Betancourt, Pola
Brenner, Teresa Camou, Liliana Clara, Erna Cona, Alessandra Santana Destra, Silvia Fonseca,
Amparo Gordillo, Jorge Matheu, Fernando Otaiza, Pilar Ramon- Pardo, Roxane Salvatella, Gabriel
Schmunis, Valeska Stempliuk, Maria Enilda Vega, Natallie Weiller and Martín Yagui.
This publication has been made possible by the sponsorship and cooperation of the United States
Agency for International Development, Bureau for Latin America and the Caribbean, Office of
Regional Sustainable Development (grant LAC-G-00-07-00001-00) and the United States Centers
for Disease Control and Prevention (Cooperative Agreement Number 5U51/CI 000450-04).
3
Contents
Preface.....................................................................................................................................4
Introduction ............................................................................................................................4
General considerations .....................................................................................................4
Instructions for application of the rapid evaluation guide for nosocomial infection
programs .................................................................................................................................6
General instructions..........................................................................................................6
Instructions and recommendations for interviews ..........................................................6
Instructions and recommendations for document review...............................................7
Instructions and recommendations for direct observation .............................................8
Specific instructions ..........................................................................................................8
Written Report ..................................................................................................................9
Records .............................................................................................................................9
People to interview...........................................................................................................9
Proposed program ..........................................................................................................10
Glossary.................................................................................................................................10
Rapid evaluation guide for nosocomial infection programs ................................................15
AREA: ORGANIZATION ..........................................................................................................16
AREA: EPIDEMIOLOGICAL SURVEILLANCE OF INFECTIONS ..................................................17
AREA: MICROBIOLOGY..........................................................................................................18
AREA: INTERVENTION STRATEGIES......................................................................................20
AREA: STERILIZATION AND HIGH-LEVEL DISINFECTION .......................................................22
AREA: PERSONNEL HEALTH...................................................................................................23
AREA: HOSPITAL ENVIRONMENT AND SANITATION ............................................................24
AREA: INEFFECTIVE PRACTICES .............................................................................................26
AREA: NEONATOLOGY ..........................................................................................................28
4
Preface There is no doubt that infections associated with health care (nosocomial infections) pose a
problem, affecting approximately one out of twenty hospital patients. Programs for infection
prevention and control have demonstrable benefits in reducing related morbidity and mortality
and hospital costs. One of the best ways to improve the effectiveness of a program for prevention
and control of infections is through systematic and rigorous evaluation of the structural,
functional, and practical elements that have to be implemented in hospitals. Evaluations, whether
they are external or internal, make it possible to identify those areas requiring additional efforts to
comply with standards, to evaluate the strengths of institutions in comparison with their peers,
and to set priorities for interventions from the national level.
Evaluations also have formative effects on human resources of the institutions that are evaluated.
There can be an immediate effect in improvement or correction of practices, in particular, for the
prevention of nosocomial infections. However, the lack of available tools has meant that
evaluations of the programs and practices of prevention of communicable diseases have not been
made part of program routine. PAHO developed this tool in 2005, and it has been validated
through its application in the field in a number of countries of Latin America. The application of
this tool is thus based on direct observation of practices in visits carried out jointly by national and
international professionals.
After five years of the first edition, the increase of scientific evidence has made it necessary to
update the original instrument, while maintaining the same purpose and functionality. This second
edition also includes a specific annex on neonatology, expanding its objective and scope. The
addition of this new area comes at the request of the countries, given the large number of hospital
infection outbreaks in these services. It is expected that this guide will maintain its usefulness and
be used within the health services to direct implementation and maintenance of programs and
practices for control of nosocomial infections.
Introduction General considerations The purpose of this guide is to provide orientation for hospital directors on review and
improvement of the nosocomial infection programs that all such facilities should have. According
to the experts, a well-developed program in the areas currently considered necessary will contain
the components and characteristics described in this guide. It is recommended that, before an
evaluation, hospitals to be evaluated be informed about the visit and its objectives, and that they
have access to this guide.
5
The purpose of this guide is to provide a general overview rather than specifics on the status of
Infection prevention and control (IPC) activities. Therefore, it does not consider the risk of
individual patients or specific cases. By nature, it is intended only as an instrument to provide
support for an external assessment of the status of the program. It should not be considered an
accreditation system. Furthermore, it does not consider other aspects related to care outside of
surveillance, prevention, and control of nosocomial infections.
The development and use of the first edition of the Guide were possible thanks to the support and
cooperation of the Office of Regional Sustainable Development, Bureau for Latin America and the
Caribbean, U.S. Agency for International Development and the Centers for Disease Control and
Prevention of the United States of America and the experts of several countries. For its
development, specialists in nosocomial infections and microbiologists of several countries met to
lay out the principal and essential points that all hospitals should implement in terms of hospital
IPC. This guide was applied successfully in 67 hospitals, including public, private, and other
hospitals, in 7 countries of the Region of the Americas, involving national and international experts
and PAHO staff. Although the programs evaluated presented quite different levels of compliance
for the indicators evaluated, the contents of the guide were sufficient for evaluating the different
hospitals and their programs for prevention and control of nosocomial infections1.
After 5 years of the first edition, given the additional scientific knowledge accumulated during this
period, the updating of the guide became necessary. Again experts from several countries were
invited to participate. The result is a second edition that maintains the general evidentiary
principles and applicability of the previous edition. This edition also includes annex for for
prevention of infection in the neonatology area.
Description of the guide
The guide provides information on a number of aspects that, according to a group of Latin
American experts, should be included in HAI prevention and control programs. These aspects have
been organized in eight areas that include similar topics. In each area, some components
considered to be essential in a good infection program have been selected. In each component,
the characteristics considered to best describe an acceptable component have been established.
Then, indicators have been established so that the presence of the characteristics could be
considered objectively. A single characteristic may have several indicators and a single component
may have several characteristics. One or more verifiers (“suggested verifiers”) have been proposed
for each indicator. These simply offer orientation or sources of information for the evaluators that
can be used to determine whether a certain indicator is present. The evaluators can use other
methods to establish the presence of indicators.
According to this guide, evaluation of the nosocomial infection program is based solely on the
presence of indicators. The existence of the characteristics and components is based on analysis of
the indicators used for evaluation.
The only exception to the above is the “INEFFECTIVE PRACTICES” area, in which the presence of
any of the indicators is considered in a comment to the report.
6
Instructions for application of the rapid evaluation guide for nosocomial infection programs
General instructions This guide is designed to be applied within a short period of time (approximately 8 hours per
person with one team of 4 people).
• All actions carried out during an evaluation have a well-defined purpose that should be made
known during the activity.
• Take written notes on your observations at the time. Do not rely on your memory.
• The written report must be compatible with the oral comments made during the visit.
Instructions and recommendations for interviews
This process includes three main types of interviews:
Ι. Initial interview: This interview is usually with the hospital director, who may or may not
be accompanied by other people. The objectives are as follows:
• Introduction to the local authority.
• Meet the people who will accompany the evaluators during the activity.
• Become familiar with the general characteristics of the hospital.
• Explain which activities will be conducted in the hospital during the evaluation.
• Set a time for the final meeting.
• Confirm that the local authority has consented to the activity.
ΙΙ. Technical interviews: These interviews are with professionals who perform different
activities in the hospital. The objective is to obtain specific information related to the guide.
In order to make the most of these interviews, the following is recommended:
• You should always be accompanied by a professional from the hospital
• Interview the person in charge of the unit or activity. A meeting with personnel working
under him or her should be held only with his or her consent.
• Introduce yourself and explain the reason for the interview.
• Tell them what information is required.
ΙΙΙ. Final interview: This interview is usually with the hospital director, accompanied by other
people. This objectives of this interview are as follows:
• Report the main findings of the observations.
o Briefly summarize each area, highlighting aspects that are partially or fully
acceptable as well as those that can be improved. Use clear examples. Avoid going
into detail.
• Compile any information that was not included previously.
• Receive comments and clarifications on your observations.
• Thank the facilities and the appropriate individuals for having participated in the activity.
7
It is recommended strongly that the evaluation team meet alone for a few minutes before the final
interview and agree on the points that will be dealt with.
Instructions and recommendations for document review Some of the information will be obtained from documents that directly or indirectly contribute
data that can be used as a basis for determining compliance with the characteristics in the guide.
Document review tends to be a long and complex process. For document review:
• Focus the document review on the objectives of the guide.
• Request that your local contacts indicate where the information is found in the documents.
Review by a person unfamiliar with the local documentation system may be tedious and
fruitless. Be explicit about your needs.
• Avoid requesting a particular document. It is preferable to request documentation for the
activities. Each hospital has its own form of documentation.
For example: In order to find out about training activities, avoid requesting “committee
minutes” since the information needed may not be found there. However, if you request
a list of training activities carried out, there may be different types of documentation (e.
g., annual summaries of activities and specific training reports).
8
Instructions and recommendations for direct observation Evaluation of many of the characteristics is based on observation of how activities are conducted
in practice.
• When direct observation activities are conducted, tell your contacts your expectations before
beginning observation. After completing the observation, summarize whether what you found
met expectations or the practices did not meet the requirements.
• Be cautious about your comments and your reactions to noncompliance with best practices,
particularly because the visits are often accompanied by personnel who may have a partial or
distorted understanding of the practices.
• If you observe failure to comply with techniques or inappropriate practices, it is important to
take note and possibly mention it at the meeting. However, this does not necessarily mean
that it represents a trend unless the practice is repeated.
Specific instructions Some areas have special conditions to be evaluated.
AREA: INTERVENTION STRATEGIES This is one of the most important areas of the evaluation. It is also usually the area in which
there are the greatest numbers of observations. In order to evaluate this area, fill out the
“PREVENTION AND CONTROL STRATEGIES RECORD FORM.” Each indicator refers to the
summary of one of the columns on the RECORD FORM.
The evidence-based concepts used to evaluate the preventive strategies are only some of the
best well-known and least controversial concepts. Therefore, they should be included in the
usual practice of all hospitals.
AREA: INEFFECTIVE PRACTICES There are a series of practices that have been introduced in the past in hospitals to prevent
infections but which do have bases to support their effectiveness. That is, it has been
documented that they do not prevent infections. In some cases, there is even enough
information to advise their elimination because they increase the risk of infection.
In this evaluation it is enough to take note and confirm the presence of an ineffective measure
that increases the risk of infection in order to include a comment about it in the final review
and the written report. Information on the presence of ineffective measures may be acquired
from multiple sources. It often occurs by chance during observations in the clinical units.
AREA: NEONATOLOGY This area includes all aspects of prevention of hospital infection, as well as prevention of
vertical transmission from mother to child. Experts agree that these points should be included
in hospital practices for IPC.
9
Written Report
Instructions and recommendations for the preparation of the report
• When the field activities have been completed, a final written report should be prepared.
• It is recommended that the report be written on the same day as the evaluation was made,
particularly if more than one hospital has been evaluated that day.
• This is an activity that should be carried out by the entire team. If more than one hospital has
been evaluated on the same day, it is recommended that the hospitals be analyzed one at a
time.
Records Indicate whether or not each indicator in the guide is present by recording YES, NO, or PARTIAL.
Whenever NO or PARTIAL is recorded, a brief written description of the actual status should be
provided so that there can be records for local follow-up. UNEVALUATED should only be recorded
in extraordinary circumstances, and the reason should be explained.
People to interview
• Director
• Person in charge of the IPC Program or Committee
• IPC nurse
• Medical epidemiologist
• Microbiologist
• Sterilization supervisor
• Unit chiefs for intensive care, pediatrics, and surgery
• Head of nursing
• Personnel health supervisor
10
Proposed program
Activity Estimated
duration
minutes
Number of
evaluators
Objective
Initial interview 40 All Presentation set final meeting.
Meeting with technical committee 90 to 120 1
recommended: all
Review of information, documents,
evaluates the organization and
surveillance.
Sterilization 45 to 60 1 Evaluate the sterilization and
disinfection processes.
Laboratory 30 to 45 1 Evaluate microbiology.
Intensive Care Unit 30 to 45 1
Pediatrics 30 to 45 1
Surgery 30 to 45 1
Medicine 30 to 45 1
Visit to
services
Other services,
depending on time
available.
30 to 45 1
Evaluate intervention strategies.
Integration of the program into
routine practice.
Aspects of the physical plant and
environmental sanitation.
Identify ineffective practices.
Meeting with personnel health
supervisor 30 to 40 1 Evaluate personnel health.
Meeting with governing body 30 to 60 All Oral report on findings.
Writing report 120 to 180 All Prepare report.
Glossary
access
In this document this refers to the situation in which a hospital
provides a service that is not necessarily directly under it. For
example, it may not have a microbiology department. Rather,
the service is provided by an external laboratory on a timely
basis whenever required. In this case it has “access” to
microbiology.
annual discharges Includes normal discharges, discharges due to death, and
transfers, over the period of a year.
annual occupied bed days
Based on a daily count of the number of patients in the patient
care location. This count is recorded at the same time every
day. Daily totals are summed up at the end of the month, and
monthly totals summed up at the end of the year.
basic HAI indicators Minimum ongoing information that a hospital should have in
11
order to determine infection status. The following infections
are included in this minimum: central venous catheter-related
sepsis, catheter-associated urinary infections, pneumonias
associated with mechanical ventilation, surgical site infections
by type of operation, and puerperal endometritis by type of
delivery. These indications may be different if an
establishment has other frequent high-risk procedures.
biological sterilization controls
Biological controls are currently the only available means to
confirm sterilization of an article or to determine the
effectiveness of the sterilization process.
Bowie-Dick test
This is a method for evaluating the effectiveness of the
vacuum system of an autoclave, by measuring the presence or
absence of air or other gases in the sterilization chamber that
can hinder rapid and uniform penetration of the steam into
the contents being sterilized.
chemical sterilization controls
These tests are based on chemical reactions and are sensitive
to the parameters of the different sterilization methods
(saturated steam, temperature, and time). They contain paper
strips printed with ink and other non-toxic reagents that
change color when the requirements for the process are met.
disinfection
Procedure designed to eliminate pathogenic agents from
articles and other patient care equipment in order to decrease
the risk of infection. Microbial spores are not usually
eliminated. Different levels are distinguished using Spaulding's
classification. High-level disinfection is of particular interest.
epidemiological surveillance
Ongoing information system on diseases (usually infectious
diseases), in the population in order to determine their
frequency, risk factors, morbidity, and mortality, for early
detection of epidemics.
evidence Certainty derived from studies on a given subject that are
currently considered to be conclusive. This usually includes,
12
but is not limited to, several controlled clinical trials with
concordant conclusions.
external performance
evaluation
System for retrospective and objective comparison between
laboratories, organized by an independent external entity.2
goals
Quantified objectives expected to be achieved. They are
usually expressed numerically in ratios, rates, proportions, or
other similar indicators.
guide
Document with recommendations for action on a given
subject. The subjects are usually technical, and the
recommendations are not compulsory.
healthcare associated
infection (HAI)/ nosocomial
infections (NI) /hospital
infections
Infection that occurs during or as a result of hospitalization,
and was not present or in incubation at t he time of patient
admission. This definition does not distinguish between severe
and minor infections, or between preventable and non-
preventable infections.
high level disinfectants with
proven effectiveness
Formulations based on glutaraldehyde, >2%;
orthophthalaldehyde (OPA), 0.55%; hydrogen peroxide, 7.5%;
peracetic acid, >0.2%; hydrogen peroxide, 7.35%. and
peracetic acid, 0.23%; hydrogen peroxide, 1%, and peracetic
acid, 0.08%.
immunization coverage
Proportion of persons vaccinated of the total planned. For this
guide, no distinction is made whether or not the
immunological response to the vaccine was evaluated.
immunization program
Activities designed to vaccinate a given population, which
establishes who should be vaccinated, which vaccines should
be used, dosages, methods, periodicity, and any other relevant
characteristics of immunization.
invasive procedure
Clinical procedure that includes mechanical disruption of the
body's defense barriers (e. g., skin perforation or insertion of
catheters that change the normal flow of fluids.
major surgeries A major surgery is any procedure carried out in an operating
13
room that requires incision, excision, manipulation, or suture
of a tissue. It usually requires local anesthesia, general
anesthesia, or deep sedation to control pain.1
management of personnel
with/exposed to infections
Perform rapid diagnosis and appropriate post-exposure
prophylaxis following accidents in the workplace
manual
Reference document that organizes and summarizes the
regulations, instructions, procedures, or any other type of
information, usually operational, on a specific subject.
medical sharps box
A container for disposing safely of sharp objects sued. The
medical sharps box should safely contain contaminated sharp
objects: immediately after use; during temporary storage; and
during transport and handling up to the point of final
treatment and disposal.
official document
Document that meets local requirements to be considered
obligatory for familiarity and compliance. At minimum it must
have the signature of the person in charge of the hospital.
orientation program
Organized training activities to ensure that recently hired
personnel are familiar with the hospital's technical and
administrative procedures.
professional Worker with a university education and degree.
program Organized set of resources and activities to attain a known
end. It also includes objectives, goals, and persons responsible.
routine Customary practice without a rationale that is performed
according to current practice.
standard Standing order that must be complied with.
sterilization
Procedure designed to eliminate all forms of microbial life
from articles and other patient care equipment in order to
decrease the risk of infection.
structures responsible for the
program
A specific stable unit or service that includes those responsible
for the safety of clinical activities (departments or unit chiefs).
In addition to the individuals themselves, this includes their
14
method of communication and the hierarchical structure of
the organization.
supervision
Process of observation for measuring compliance with
standards, instructions, care procedures, or other
characteristics of daily practice.
1 ALIANZA MUNDIAL PARA LA SEGURIDAD DEL PACIENTE. SEGUNDO RETO MUNDIAL POR LA
SEGURIDAD DEL PACIENTE. LA CIRUGÍA SEGURA SALVA VIDAS. Organización Mundial de la Salud.
http://whqlibdoc.who.int/hq/2008/WHO_IER_PSP_2008.07_spa.pdf
2 Curso de Gestión de calidad y buenas prácticas de laboratorio. II Edición, Washington, D.C.,
2009.http://new.paho.org/hq/index.php?option=com_content&task=view&id=1077&Itemid=12
73&lang=e
Rap
id e
valu
atio
n g
uid
e fo
r n
oso
com
ial i
nfe
ctio
n p
rogr
ams
DE
SC
RIP
TIO
N O
F H
OS
PIT
AL
Eva
lua
tio
n d
ate
:
Na
me
of
the
ho
spit
al:
Cit
y:
Co
un
try
:
Ad
min
istr
ati
ve s
tatu
s:
s
tate
p
riva
te
u
niv
ers
ity
O
the
r:
Be
ds:
A
nn
ua
l d
isch
arg
es:
An
nu
al
occ
up
ied
be
d d
ay
s:
Be
ds
in I
nte
nsi
ve
Ca
re U
nit
(IC
U):
M
icro
bio
log
y l
ab
ora
tory
:
ICU
be
ds
for
ad
ult
s:
Nu
mb
er
of
iso
lati
on
s/y
ea
r:
ICU
be
ds
for
pe
dia
tric
s:
Nu
mb
er
of
an
tib
iog
ram
s/y
ea
r:
ICU
be
ds
for
ne
on
ato
log
y:
Clin
ica
l Se
rvic
e
# A
nn
ua
l d
isch
arg
es
#
An
nu
al
ma
jor
surg
eri
es
or
chil
db
irth
s
Su
rge
ry
Ob
ste
tric
s
Pe
dia
tric
s
Inte
rna
l m
ed
icin
e
Ne
on
ato
log
y
Ad
ult
in
ten
siv
e c
are
Ma
rk t
he
cli
nic
al
or
surg
ica
l
serv
ice
s th
at
the
ho
spit
al
ha
s
Oth
er
sub
spe
cia
ltie
s
Na
me
s a
nd
po
siti
on
s o
f th
e p
eo
ple
in
terv
iew
ed
:
Na
me
s o
f e
valu
ato
rs:
16
AR
EA: O
RG
AN
IZA
TIO
N
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Pre
sen
t?
There is an o
ffic
ial
do
cum
en
t* d
esi
gn
ati
ng
th
ose
re
spo
nsi
ble
fo
r
IPC
in
th
e h
osp
ita
l.
Do
cum
en
t si
gn
ed
by
lo
cal
au
tho
rity
.
Th
e f
un
ctio
ns
for
ea
ch p
ers
on
re
spo
nsi
ble
are
la
id o
ut.
D
ocu
me
nt
sig
ne
d b
y l
oca
l
au
tho
rity
.
The
str
uct
ure
s re
spo
nsi
ble
* fo
r In
fect
ion
Pre
ven
tio
n
and
Co
ntr
ol (
IPC
) in
th
e
ho
spit
al a
nd
th
e d
ivis
ion
of
resp
on
sib
iliti
es
ha
ve b
ee
n
de
fin
ed
. T
he
pe
rso
nn
el
resp
on
sib
le f
or
IPC
are
at
a h
igh
le
vel
wit
hin
th
e
inst
itu
tio
n.
Do
cum
en
t si
gn
ed
by
lo
cal
au
tho
rity
.
Th
ere
are
an
nu
al
go
als
* f
or
IPC
fo
r th
e h
osp
ita
l.
Off
icia
l d
ocu
me
nt
of
the
inst
itu
tio
n (
pro
gra
m,
pla
n
or
an
nu
al
rep
ort
).
Th
ere
is
evi
de
nce
th
at
de
cisi
on
s a
re m
ad
e t
o a
chie
ve t
he
go
als
.
Min
ute
s, r
ep
ort
s, o
r
inte
rve
nti
on
pro
gra
ms.
Lead
ers
hip
IPC
fu
nct
ion
s ar
e d
ire
cte
d
and
eva
luat
ed
by
the
h
igh
est
leve
l of
the
o
rgan
izat
ion
. G
oa
ls a
re m
on
ito
red
an
d e
valu
ate
d a
t le
ast
on
ce a
ye
ar
by
th
e
ho
spit
al
ma
na
ge
me
nt.
Min
ute
s, r
ep
ort
s, o
r
an
nu
al
rep
ort
.
IPC
Ed
uca
tio
n
The
IPC
pro
gram
is
con
sid
ere
d t
o b
e a
n
inte
gral
par
t o
f w
ork
by
all
pe
rso
nn
el.
Th
ere
is
an
ori
en
tati
on
pro
gra
m* f
or
ne
w p
ers
on
ne
l a
nd
th
is
pro
gra
m i
s im
ple
me
nte
d.
Wri
tte
n p
rog
ram
th
at
incl
ud
es
IPC
sta
nd
ard
s.
Re
po
rt o
n c
om
pli
an
ce
wit
h t
he
pro
gra
m.
*
See Glossary.
1
AR
EA: E
PID
EMIO
LOG
ICA
L SU
RV
EILL
AN
CE
OF
INFE
CTI
ON
S
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Pre
sen
t?
Ph
ysi
cia
n t
rain
ed
in
ba
sic
ep
ide
mio
log
y a
nd
IP
C
Inte
rvie
w,
cert
ific
ate
s
Th
e p
rogr
am h
as a
p
hys
icia
n f
or
the
ac
tivi
tie
s.
# o
f p
hy
sici
an
s:
T
ota
l ho
urs
pe
r w
ee
k:
Inte
rvie
w1
Nu
rsin
g p
rofe
ssio
na
l tr
ain
ed
in
ep
ide
mio
log
ica
l su
rve
illa
nce
, IP
C,
an
d
sup
erv
isio
n
Inte
rvie
w,
cert
ific
ate
s
The
pro
gram
has
a
nu
rsin
g p
rofe
ssio
nal
fo
r H
AI c
on
tro
l.
# o
f n
urs
ing
pro
fess
ion
als
:
To
tal
ho
urs
pe
r w
ee
k:
Inte
rvie
w2
Pe
rso
nn
el
Mic
rob
iolo
gist
A
cce
ss* t
o p
rofe
ssio
na
l m
icro
bio
log
ist
In
terv
iew
Sta
nd
ard
ize
d d
efi
nit
ion
s o
f m
ost
fre
qu
en
t in
fect
ion
s
Loca
l d
ocu
me
nt
At
lea
st
we
ek
ly
case
-fin
din
g
in
risk
g
rou
ps,
b
y
revi
ew
o
f cl
inic
al
his
tori
es
an
d l
ab
ora
tory
da
ta
Su
rve
illa
nce
re
cord
she
ets
, in
terv
iew
Ca
se-f
ind
ing
ca
rrie
d o
ut
by
pro
fess
ion
als
In
terv
iew
Surv
eill
ance
is c
on
du
cte
d
wit
h a
ctiv
e d
ata
colle
ctio
n m
eth
od
s
Sta
nd
ard
ize
d d
efi
nit
ion
s o
f e
xpo
sed
in
div
idu
als
(d
en
om
ina
tors
of
rate
s) a
nd
of
ho
w i
nfo
rma
tio
n o
n s
uch
in
div
idu
als
is
coll
ect
ed
Loca
l p
roce
du
re a
nd
inte
rvie
w
Ha
s m
on
thly
HA
I ra
tes
for
ea
ch b
asi
c in
dic
ato
r*3
Nu
mb
er
of
mo
nth
s In
th
e l
ast
ye
ar
the
in
dic
ato
r w
as
pro
vid
ed
:
Re
po
rts
An
nu
al
an
aly
sis
an
d r
ep
ort
on
an
tim
icro
bia
l d
rug
re
sist
an
ce
Re
po
rt
An
nu
al
an
aly
sis
of
HA
I tr
en
ds
tha
t id
en
tifi
es
pro
ble
ms
an
d p
rop
ose
s
solu
tio
ns
R
ep
ort
Eva
lua
tio
n s
yst
em
(e
. g
., p
rev
ale
nce
) o
f th
e c
ap
aci
ty o
f th
e
surv
eil
lan
ce s
yst
em
to
de
tect
in
fect
ion
s
Eva
lua
tio
n r
ep
ort
Surv
eill
ance
m
eth
od
Ep
ide
mio
logi
cal
info
rmat
ion
is a
nal
yze
d
to d
ete
ct H
AI p
rob
lem
s an
d e
valu
ate
th
e im
pac
t o
f in
terv
en
tio
ns
Id
en
tifi
es
ep
ide
mic
ou
tbre
ak
s a
nd
ha
s o
utb
rea
k r
ep
ort
Nu
mb
er
of
ou
tbre
ak
s in
th
e l
ast
ye
ar?
Ave
rag
e t
ime
fo
r d
ete
ctio
n o
f o
utb
rea
ks:
Ou
tbre
ak
re
po
rt
Pe
rio
dic
re
po
rt w
ith
an
aly
sis,
re
com
me
nd
ati
on
s, a
nd
kn
ow
n
dis
trib
uti
on
Re
po
rt o
r b
ull
eti
ns
an
d l
ist
of
dis
trib
uti
on
Dis
sem
inat
ion
of
info
rmat
ion
Info
rmat
ion
is
dis
sem
inat
ed
to
all
wh
o
ne
ed
it
Up
-to
-da
te i
nfo
rma
tio
n i
s a
vail
ab
le a
nd
kn
ow
n i
n a
ll t
he
de
pa
rtm
en
ts
invo
lve
d i
n s
urv
eil
lan
ce
Inte
rvie
w m
an
ag
ers
*
See Glossary.
1- minimum of 10 or more hours a week – Core components for infection prevention and control programmes WHO/HSE/EPR/2009
2- minimum of one full-time professional per 250 beds - Haley RW et al. Am J Epidemiol. 1985 Feb; 121(2):182-205.
3- minimum of at least 80% of the year
1
AR
EA: M
ICR
OB
IOLO
GY
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
st V
eri
fie
r
Pre
sen
t?
Ide
nti
fica
tio
n o
f a
ero
bic
ba
cte
ria
to
sp
eci
es
leve
l in
blo
od
cu
ltu
res
En
tero
cocc
us
fae
ciu
m a
nd
En
tero
cocc
us
fae
cali
s
Pse
ud
om
on
as
ae
rug
ino
sa
Sta
ph
ylo
cocc
us
au
reu
s
En
tero
ba
cte
ria
cea
e
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Ide
nti
fica
tio
n o
f vi
ral
ag
en
ts:
He
pa
titi
s B
an
d C
HIV
Ad
en
ovi
rus
Infl
ue
nza
Sy
ncy
tia
l re
spir
ato
ry v
iru
s
Ro
tavi
rus
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Ide
nti
fica
tio
n o
f M
. tu
be
rcu
losi
s
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Ide
nti
fica
tio
n o
f C
an
did
a
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
The
est
ablis
hm
en
t h
as
acce
ss* t
o id
en
tifi
cati
on
of
the
mo
st r
ele
van
t m
icro
bia
l ag
en
ts in
HA
I
De
term
ina
tio
n o
f C
lost
rud
iun
dif
fici
le
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Ide
nti
fy s
usc
ep
tib
ilit
y p
att
ern
s fo
r th
e m
ost
fre
qu
en
t a
ge
nts
or
tho
se o
f e
pid
em
iolo
gic
al
imp
ort
an
ce f
or
HA
I
Me
thic
illi
n-r
esi
sta
nt
Sta
ph
ylo
cocc
us
au
reu
s
Va
nco
my
cin
-re
sist
an
t S
tap
hylo
cocc
us
au
reu
s, w
ith
CIM
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Dia
gno
stic
ca
pab
ility
Va
nco
my
cin
-re
sist
an
t E
nte
roco
ccu
s.
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
En
tero
ba
cte
ria
an
d n
on
ferm
en
tin
g b
aci
lli
tha
t p
rod
uce
carb
ap
en
em
ase
s a
nd
ext
en
de
d-s
pe
ctru
m b
eta
-la
cta
ma
ses
(ES
BL)
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Has
ro
uti
ne
pro
ced
ure
s an
d
cap
acit
y to
ide
nti
fy
susc
ep
tib
ility
to
an
tim
icro
bia
l dru
gs o
f H
AI
age
nts
iso
late
d
No
nfe
rme
nti
ng
ba
cill
i p
rod
uct
ive
of
carb
ap
en
em
ase
s
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
*
See Glossary.
1
Th
e p
rog
ram
ma
inta
ins
qu
ali
ty c
on
tro
l re
cord
s o
n i
de
nti
fica
tio
n
of
ag
en
ts a
nd
an
tim
icro
bia
l su
sce
pti
bil
itie
s in
acc
ord
an
ce w
ith
NC
CLS
or
oth
er
sta
nd
ard
s
Re
po
rt,
reco
rd,
an
d
lab
ora
tory
in
terv
iew
Th
e p
rog
ram
is
sub
mit
ted
to
an
ext
ern
al
pe
rfo
rma
nce
eva
lua
tio
n
pro
gra
m a
t le
ast
on
ce a
ye
ar
Re
po
rt f
rom
refe
ren
ce l
ab
ora
tory
Q
ual
ity
con
tro
l
Mic
rob
iolo
gy a
ctiv
itie
s ar
e
eva
luat
ed
pe
rio
dic
ally
wit
h
inte
rnal
an
d e
xte
rnal
q
ual
ity
con
tro
l T
he
re i
s a
ma
nu
al
of
pro
ced
ure
s fo
r in
tern
al
qu
ali
ty c
on
tro
l,
up
da
ted
at
lea
st e
very
3 y
ea
rs,
wh
ich
is
dis
sem
ina
ted
to
th
e
pe
rso
nn
el
co
nfi
rm
Th
ere
is
a s
pe
cim
en
co
lle
ctio
n a
nd
sh
ipp
ing
ma
nu
al,
up
da
ted
at
lea
st e
very
3 y
ea
rs,
wh
ich
is
dis
sem
ina
ted
to
th
e p
ers
on
ne
l
co
nfi
rm
Sp
eci
me
n
colle
ctio
n,
pro
cess
ing,
an
d
ship
pin
g st
and
ard
s
The
re a
re s
tan
dar
diz
ed
te
chn
iqu
es
and
pro
ced
ure
s
Th
ere
exi
sts
a s
pe
cim
en
pro
cess
ing
ma
nu
al,
up
da
ted
at
lea
st
ev
ery
3 y
ea
rs,
wh
ich
is
dis
sem
ina
ted
to
th
e p
ers
on
ne
l
co
nfi
rm
Pe
rio
dic
re
po
rt o
n t
he
ag
en
ts r
esp
on
sib
le f
or
HA
I b
y s
pe
cim
en
typ
e a
nd
th
e d
ep
art
me
nt
of
ori
gin
Ho
w m
an
y i
n a
ye
ar?
Mic
rob
iolo
gy
re
po
rt
Pe
rio
dic
re
po
rt o
n a
nti
mic
rob
ial
susc
ep
tib
ilit
y p
att
ern
s fo
r
rele
van
t e
tio
log
ic a
ge
nts
Ho
w m
an
y i
n a
ye
ar?
Mic
rob
iolo
gy
re
po
rt
an
d r
eco
rd
M
icro
bio
logi
cal
info
rmat
ion
C
linic
al i
nfo
rmat
ion
an
alys
is
Th
ere
is
an
ale
rt m
ech
an
ism
fo
r u
nu
sua
l m
icro
bio
log
ica
l fi
nd
ing
s
Re
po
rt a
nd
re
cord
s
A l
ab
ora
tory
sta
ff m
em
be
r is
pa
rt o
f th
e H
AI
con
tro
l co
mm
itte
e o
f
con
tro
ls
Re
cord
s
P
arti
cip
atio
n in
th
e c
om
mit
tee
fo
r H
AI p
reve
nti
on
an
d c
on
tro
l
Re
lati
on
of
the
m
icro
bio
logi
st t
o t
he
HA
I co
ntr
ol c
om
mit
tee
P
art
icip
ati
on
of
the
la
bo
rato
ry i
n t
he
pre
pa
rati
on
of
ma
nu
als
an
d
gu
ide
lin
es
of
the
HA
I co
mm
itte
e
Co
nfi
rm
2
AR
EA: I
NTE
RV
ENTI
ON
STR
ATE
GIE
S
Co
mp
on
en
t
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Co
nso
lidat
ed
ac
tivi
tie
s1 P
rese
nt?
Exi
ste
nce
of
a c
om
ple
te r
eg
ula
tory
te
chn
ica
l b
asi
s
Sta
nd
ard
s*,
gu
ide
s* o
r
ma
nu
als
*
Su
mm
ary
co
lum
n (
a)
Th
e r
eg
ula
tio
ns
ha
ve b
ee
n u
pd
ate
d w
ith
in t
he
la
st
thre
e y
ea
rs
Sta
nd
ard
s *
, g
uid
es
*
or
ma
nu
als
*
Su
mm
ary
co
lum
n (
b)
Pri
nci
pal
act
ivit
ies
for
IPC
ar
e r
egu
late
d in
ac
cord
ance
wit
h b
est
cu
rre
nt
kn
ow
led
ge
Th
e c
on
ten
ts a
nd
in
dic
ato
rs o
f th
e t
ech
nic
al
reg
ula
tio
ns
are
evi
de
nce
-ba
sed
Sta
nd
ard
s *
, g
uid
es
*
or
ma
nu
als
*
Su
mm
ary
co
lum
n (
c)
Th
e r
eg
ula
tio
ns
ha
ve b
ee
n d
isse
min
ate
d w
ith
eff
ect
ive
act
ivit
ies
to t
ho
se p
ers
on
ne
l w
ho
sh
ou
ld
be
fa
mil
iar
wit
h t
he
m
Tra
inin
g p
rog
ram
eva
lua
ted
, a
tte
nd
an
ce
rep
ort
s
Su
mm
ary
co
lum
n (
d)
Su
pe
rvis
ion
* o
f co
mp
lia
nce
wit
h t
he
re
gu
lati
on
s b
y
pe
rso
nn
el
Su
pe
rvis
ion
re
po
rts
S
um
ma
ry c
olu
mn
(e
)
Inte
rve
nti
on
s to
im
pro
ve H
AI
pre
ven
tio
n a
nd
co
ntr
ol
Co
mp
lian
ce w
ith
re
gula
tio
ns
is p
rom
ote
d
and
eva
luat
ed
Th
ere
is
evi
de
nce
of
com
pli
an
ce w
ith
th
e b
asi
c
reg
ula
tio
ns
Dir
ect
ob
serv
ati
on
S
um
ma
ry c
olu
mn
(f)
1
Use the “PREVENTION AND CONTROL STRATEGIES RECORD FORM” to record the detailed information consolidated here.
*
See Glossary.
2
PR
EVEN
TIO
N A
ND
CO
NTR
OL
STR
ATE
GIE
S R
ECO
RD
FO
RM
C
ha
ract
eri
stic
s
Infe
ctio
n p
rev
en
tio
n
act
ivit
ies
(a)
Pre
sen
t
(b)
Up
da
ted
(< 3
ye
ars
)
Evi
de
nce
-ba
sed
2 c
en
tra
l co
nce
pts
(c)
Are
th
ese
con
cep
ts i
ncl
ud
ed
in t
he
sta
nd
ard
?
(d
)
Dis
sem
ina
te
d t
o
pe
rso
nn
el
(e)
Su
pe
rvis
ion
pla
n f
or
the
sta
nd
ard
ap
pli
ed
(f)
Co
mp
lia
n
ce w
ith
the
sta
nd
ard
Pre
ve
nti
on
of
ba
cte
rem
ia a
sso
cia
ted
wit
h c
en
tra
l v
en
ou
s
cath
ete
r
•
Ma
xim
um
ba
rrie
rs (
surg
ica
l p
rep
ara
tio
n o
f p
ati
en
t a
nd
ph
ysi
cia
n)
for
its
inst
all
ati
on
•
Cir
cuit
ha
nd
lin
g w
ith
ase
pti
c te
chn
iqu
e
•
Use
of
chlo
rhe
xid
ine
fo
r m
ain
ten
an
ce o
f t
he
sit
e o
f
inse
rtio
n
Pre
ve
nti
on
of
pn
eu
mo
nia
ass
oci
ate
d
wit
h m
ech
an
ica
l
ven
tila
tio
n
•
Clo
sed
asp
ira
tio
n o
r w
ith
aid
of
secr
eti
on
s
•
Ha
nd
lin
g o
f ci
rcu
its
wit
h a
sep
tic
tech
niq
ue
•
Cir
cuit
s ch
an
ge
be
twe
en
pa
tie
nts
•
Use
of
circ
uit
s w
ith
at
lea
st h
igh
-le
vel
dis
infe
ctio
n
•
Se
mi-
recl
inin
g p
osi
tio
n
•
Ora
l h
yg
ien
e
Pre
ve
nti
on
of
uri
na
ry
infe
ctio
n a
sso
cia
ted
wit
h u
rin
ary
ca
the
ter
•
Cir
cuit
pe
rma
ne
ntl
y c
lose
d
•
Ba
g e
mp
tie
d a
nd
ha
nd
s w
ash
ed
be
twe
en
pa
tie
nts
•
Co
lle
ctio
n b
ag
pe
rma
ne
ntl
y b
elo
w b
lad
de
r le
vel
Pre
ve
nti
on
of
surg
ica
l
wo
un
d i
nfe
ctio
ns
•
Infe
ctio
us
foci
eli
min
ate
d b
efo
re s
urg
ery
•
Su
rgic
al
site
no
t sh
ave
d w
ith
ra
zor
bla
de
•
An
tim
icro
bia
l p
rop
hy
laxi
s is
ad
min
iste
red
wit
hin
a
ho
ur
be
fore
th
e s
urg
ica
l in
cisi
on
Sta
nd
ard
pre
cau
tio
ns
an
d a
dd
itio
na
l
pre
cau
tio
ns
•
Use
of
glo
ves
for
ha
nd
lin
g s
ecr
eti
on
s
•
Ha
nd
-wa
shin
g b
efo
re a
nd
aft
er
pa
tie
nt
care
•
Use
PP
E (
for
exa
mp
le,
glo
ves,
go
wn
, m
ask
s),
ap
pro
pri
ate
fo
r th
e l
ev
el
of
exp
ect
ed
co
nta
min
ati
on
wh
en
pa
tie
nt
is t
rea
ted
in
iso
lati
on
Ase
pti
c te
chn
iqu
e
•
Ha
nd
-wa
shin
g b
efo
re a
nd
aft
er
pa
tie
nt
care
•
Use
of
an
tise
pti
cs f
or
skin
pre
pa
rati
on
be
fore
in
vasi
ve
pro
ced
ure
s
•
Use
of
ste
rile
ma
teri
al
in i
nva
sive
pro
ced
ure
s
Re
stri
cte
d-u
se
an
tib
ioti
cs
•
Va
nco
my
cin
•
Th
ird
-ge
ne
rati
on
ce
ph
alo
spo
rin
of
3ra
ge
ne
rati
on
.
•
Oth
ers
?
Sp
eci
fy w
hic
h:
2
These concepts are based on well-designed studies that permit the conclusion that compliance is effective in preventing infection
2
AR
EA: S
TER
ILIZ
ATI
ON
AN
D H
IGH
-LEV
EL D
ISIN
FEC
TIO
N
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Pre
sen
t?
Ap
pro
pri
ate
me
tho
ds
On
ly s
teri
liza
tio
n m
eth
od
s o
f p
rove
n e
ffic
acy
are
use
d3
Inte
rvie
w,
sta
nd
ard
s,
dir
ect
ob
serv
ati
on
Stan
dar
diz
ed
pro
ced
ure
s
Sta
nd
ard
s a
nd
pro
ced
ure
s h
ave
be
en
est
ab
lish
ed
fo
r a
ll p
roce
sse
s
rela
ted
to
ste
rili
zati
on
Sta
nd
ard
s a
nd
pro
ced
ure
s m
an
ua
l
Use
of
ind
ivid
ua
l ch
em
ica
l in
dic
ato
rs i
n e
ach
pa
cka
ge
D
ire
ct o
bse
rva
tio
n
Use
of
bio
log
ica
l in
dic
ato
rs a
t le
ast
fo
r im
pla
nts
an
d a
fte
r
eq
uip
me
nt
rep
air
R
eco
rd
Da
ily
use
of
Bo
wie
-Dic
k t
est
fo
r p
re v
acu
um
au
tocl
av
es
R
eco
rds
Su
rgic
al
inst
rum
en
ts p
roce
sse
d a
re f
ree
fro
m o
rga
nic
ma
tte
r
Dir
ect
ob
serv
ati
on
All
pa
cka
ge
s a
re l
ab
ele
d w
ith
exp
ira
tio
n d
ate
s a
nd
are
wit
hin
th
e
eff
ect
ive
pe
rio
d
Dir
ect
ob
serv
ati
on
Un
da
ma
ge
d c
on
tain
ers
th
at
are
ap
pro
pri
ate
fo
r th
e m
eth
od
4
Dir
ect
ob
serv
ati
on
Ste
riliz
atio
n p
roce
sse
s co
ntr
olle
d t
o g
uar
ante
e
resu
lts
Use
Fla
sh a
uto
cla
ve
on
ly i
n e
me
rge
nci
es
R
eco
rds
Ste
riliz
atio
n*
me
tho
ds
Pro
cess
es
are
pe
rfo
rmed
o
n o
per
atio
nal
eq
uip
me
nt
Th
ere
is
a p
rog
ram
fo
r p
rev
en
tive
ma
inte
na
nce
of
the
ste
rili
zati
on
eq
uip
me
nt
Ma
inte
na
nce
pro
gra
ms
reco
rds
Ap
pro
pri
ate
met
ho
ds
O
nly
hig
h-l
ev
el
dis
infe
ctio
n o
f m
eth
od
s o
f p
rov
en
eff
ica
cy5 a
re
use
d
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
Sta
nd
ard
s a
nd
pro
ced
ure
s a
re e
sta
bli
she
d f
or
all
pro
cess
es
rela
ted
to
dis
infe
ctio
n
Sta
nd
ard
s a
nd
pro
ced
ure
s m
an
ua
ls
Ap
pro
pri
ate
exp
osu
re t
ime
is
con
tro
lle
d i
n e
ve
ry c
ycl
e
Sta
nd
ard
s a
nd
re
cord
s
Hig
h-l
eve
l d
isin
fect
ion
*
me
tho
ds
H
igh
-le
vel d
isin
fect
ion
p
roce
sse
s c
on
tro
lled
to
gu
aran
tee
re
sult
s
Ch
em
ica
l in
dic
ato
r o
f co
nce
ntr
ati
on
at
lea
st d
ail
y
Re
cord
s
*
See Glossary.
3 As of the date this document was prepared: autoclaves, dry heat, ethylene oxide in automated equipment, formaldehyde in automated equipment, hydrogen perxoide
plasma in automated equipment, peracetic acid in auomated equipment.
4
Fenstrated boxes for use in autoclaves, use of memory-free paper for all paper packaging, cellulose-free packaging for plasma sterilization
5 As of the date this document was prepared, : 2% glutaraldehyde, peracetic acid, orthophthalaldehyde (OPA). For dialysis filters 4% formaldehyde can be used
2
AR
EA: P
ERSO
NN
EL H
EALT
H
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Pre
sen
t?
Sta
ff t
rain
ing
on
pre
ve
nti
on
of
exp
osu
re t
o s
ha
rps
an
d o
n
imm
un
iza
tio
n
Pro
gra
m a
nd
ca
re r
eco
rds
Pro
gra
m *
in
wri
tin
g f
or
He
pa
titi
s B
im
mu
niz
ati
on
of
pe
rso
nn
el
exp
ose
d t
o b
loo
d
Pro
gra
m
He
pa
titi
s B
pro
gra
m c
ove
rag
e *
g
rea
ter
tha
n o
r
eq
ua
l to
80
% o
f th
e t
arg
et
po
pu
lati
on
R
eco
rds
an
d c
ov
era
ge
Pro
gra
m *
in
wri
tin
g f
or
an
nu
al
infl
ue
nza
imm
un
iza
tio
n f
or
all
he
alt
h
sta
ff
Pro
gra
m
Infl
ue
nza
pro
gra
m c
ov
era
ge
* g
rea
ter
tha
n o
r
eq
ua
l to
80
% o
f th
e t
arg
et
po
pu
lati
on
R
eco
rds
an
d c
ov
era
ge
Pro
gra
m *
in
wri
tin
g f
or
rub
ell
a i
mm
un
iza
tio
n f
or
wo
me
n a
nd
su
sce
pti
ble
me
n
Pro
gra
m
Imm
un
iza
tio
n*
pro
gra
m
Ru
be
lla
pro
gra
m c
ove
rag
e *
gre
ate
r th
an
or
eq
ua
l
to 8
0%
of
the
ta
rge
t p
op
ula
tio
n
Re
cord
s a
nd
co
ve
rag
e
The
re
are
acti
viti
es
for
pre
ven
tio
n
of
infe
ctio
ns
that
ca
n
be
tr
ansm
itte
d
be
twe
en
h
eal
th
wo
rke
rs
and
pat
ien
ts
Ma
na
ge
me
nt
of
exp
osu
res
to b
loo
d c
au
sed
by
in
juri
es
fro
m s
ha
rp
ob
ject
s u
sed
wit
h p
ati
en
ts
Sta
nd
ard
an
d r
eco
rds
Ma
na
ge
me
nt
of
pe
rso
nn
el
wit
h c
om
mu
nic
ab
le6 i
nfe
ctio
ns
tha
t is
sup
erv
ise
d*
an
d c
om
pli
ed
wit
h
Sta
nd
ard
an
d r
eco
rds
Pre
ven
tio
n o
f in
fect
ion
s th
at
can
be
tr
ansm
itte
d
be
twe
en
he
alth
w
ork
ers
an
d
pat
ien
ts
Pe
rso
nn
el i
nfe
ctio
ns
are
m
on
ito
red
an
d m
eas
ure
s ta
ken
to
pro
tect
exp
ose
d
pe
rso
nn
el a
nd
pat
ien
ts
Ma
na
ge
me
nt
of
exp
osu
res
of
mu
cou
s m
em
bra
ne
to
blo
od
an
d
org
an
ic f
luid
s a
nd
to
in
juri
es
fro
m s
ha
rp o
bje
cts
use
d w
ith
pa
tie
nts
S
tan
da
rd a
nd
re
cord
s
* See Glossary.
6 Establish whether personnel with infectious communicable diseases may be in contact with patients or whether they should be absent from work during the course of the
infection
2
AR
EA: H
OSP
ITA
L EN
VIR
ON
MEN
T A
ND
SA
NIT
ATI
ON
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d
veri
fie
r
Pre
sen
t?
Po
tab
le w
ate
r is
ava
ila
ble
on
an
on
go
ing
ba
sis
wit
h a
min
imu
m
of
eig
ht
ho
urs
su
pp
ly
Dir
ect
ob
serv
ati
on
Acc
ess
ible
7 a
nd
op
era
tio
na
l w
ash
ba
sin
s w
ith
so
ap
an
d s
up
pli
es
for
dry
ing
ha
nd
s in
all
pa
tie
nt
care
are
as
Gly
ceri
na
ted
alc
oh
ol
in a
ll p
ati
en
t ca
re a
rea
s
Dir
ect
ob
serv
ati
on
Ha
nd
-
wa
shin
g
Op
era
tio
na
l w
ash
ba
sin
s w
ith
acc
ess
ible
su
pp
lie
s in
all
dru
g
pre
pa
rati
on
an
d i
nva
sive
pro
ced
ure
s a
rea
s
Dir
ect
ob
serv
ati
on
Se
pa
rati
on
of
a m
ete
r o
r m
ore
be
twe
en
be
ds
in p
ed
iatr
ics
D
ire
ct
ob
serv
ati
on
Min
imu
m
spa
ce
Se
pa
rati
on
of
a m
ete
r o
r m
ore
be
twe
en
be
ds
in i
nte
nsi
ve
ca
re
un
its
Dir
ect
ob
serv
ati
on
Bas
ic s
tru
ctu
ral c
on
dit
ion
s fo
r in
fect
ion
pre
ven
tio
n
exi
st
Pa
rtic
ipa
tio
n b
y I
PC
te
am
if
rem
od
eli
ng
or
con
stru
ctio
n t
ak
es
pla
ce i
n a
rea
s
wh
ere
act
ivit
ies
of
clin
ica
l im
po
rta
nce
are
co
nd
uct
ed
Min
ute
s, a
nd
inte
rvie
ws.
Ava
ila
bil
ity
of
roo
m f
or
iso
lati
on
of
ind
ivid
ua
l p
ati
en
ts o
r g
rou
ps,
wit
h
op
era
tio
na
l w
ash
ba
sin
s, a
cce
ss t
o g
lyce
rin
ate
d a
lco
ho
l so
luti
on
, su
pp
lie
s,
clo
sed
do
ors
, a
nd
pe
rso
na
l p
rote
ctio
n e
qu
ipm
en
t
Dir
ect
ob
serv
ati
on
Fo
r p
ati
en
ts w
ho
ne
ed
re
spir
ato
ry i
sola
tio
n,
roo
ms
are
ava
ila
ble
fo
r is
ola
tio
n o
f
ind
ivid
ua
l o
r g
rou
ps,
wit
h o
pe
rati
on
al
wa
shb
asi
ns,
acc
ess
to
gly
ceri
na
ted
alc
oh
ol
solu
tio
n,
sup
pli
es,
clo
sed
do
ors
, a
nd
pe
rso
na
l p
rote
ctio
n e
qu
ipm
en
t.
Th
e i
sola
tio
n r
oo
ms
ha
ve
air
ve
nts
to
th
e o
uts
ide
Dir
ect
ob
serv
ati
on
Are
as
for
iso
lati
on
an
d p
ati
en
ts i
n i
sola
tio
n a
re m
ark
ed
D
ire
ct
ob
serv
ati
on
Ph
ysic
al p
lan
t co
nd
itio
ns.
Co
nd
itio
ns
exi
st f
or
ind
ivid
ual
iso
lati
on
of
pat
ien
ts
Th
ere
is
a s
pa
ce r
ese
rve
d f
or
pro
ced
ure
s th
at
ge
ne
rate
a
ero
sols
D
ire
ct
ob
serv
ati
on
San
itat
ion
co
nd
itio
ns
Sh
arp
s ar
e h
and
led
in a
su
ch a
way
as
to p
reve
nt
Dis
po
sal
in w
ate
rpro
of,
pu
nct
ure
-re
sist
an
t co
nta
ine
rs
Dir
ect
ob
serv
ati
on
7
Washbasins should be inside the patients' hospital rooms
2
Th
e c
on
tain
ers
fo
r sh
arp
s a
re i
n a
sa
fe p
lace
ad
eq
ua
te f
or
gu
ara
nte
ein
g t
he
safe
ty o
f p
ati
en
ts a
nd
he
alt
h w
ork
ers
Dir
ect
ob
serv
ati
on
ac
cid
en
ts
Pe
rso
nn
el
ha
nd
lin
g w
ast
e u
se p
rote
ctiv
e8 b
arr
iers
Dir
ect
ob
serv
ati
on
an
d i
nte
rvie
w.
8
Thick waterproof gloves, eye covers if splashing may occur during activities
2
AR
EA: I
NEF
FEC
TIV
E P
RA
CTI
CES
The
fo
llow
ing
pra
ctic
es
ha
ve b
ee
n u
sed
in
th
e p
ast
for
pre
ven
tio
n o
f in
fect
ion
s. T
he
re a
re c
urr
en
tly
are
no
bas
es
for
reco
mm
end
ing
the
ir c
on
tin
uat
ion
. P
rese
nt?
Pro
cess
ing
wit
h d
isin
fect
an
ts t
ha
t d
o n
ot
ha
ve p
rove
n e
ffic
acy
fo
r st
eri
liza
tio
n o
r h
igh
-le
vel
dis
infe
ctio
n
Sy
rin
ge
s o
r n
ee
dle
s th
at
are
use
d o
n m
ore
th
an
on
e p
ati
en
t (e
. g
., i
n a
ne
sth
esi
a o
r in
ne
on
ato
log
y)
Use
of
Fla
sh s
teri
liza
tio
n a
s a
ro
uti
ne
me
tho
d t
o s
teri
lize
in
stru
me
nts
Sh
avi
ng
su
rgic
al
site
wit
h r
azo
r b
lad
e
Use
im
me
rsio
n i
n c
he
mic
al
ag
en
ts f
or
ste
rili
zati
on
En
viro
nm
en
tal
dis
infe
ctio
n w
ith
fo
rma
lde
hy
de
Ste
rili
zati
on
wit
h f
orm
ald
eh
yd
e t
ab
lets
Ste
rili
zati
on
of
ma
teri
als
in
pla
stic
ba
gs
an
d e
thy
len
e o
xid
e a
mp
ou
les
Re
cycl
ing
of
dis
po
sab
le p
eri
ph
era
l v
en
ou
s in
fusi
on
ma
teri
al
Use
of
air
co
nd
itio
nin
g w
ith
ou
t fi
lte
r in
op
era
tin
g r
oo
m
Use
of
inse
cure
bo
xes
for
dis
po
sal
of
sha
rps
Cri
tica
l a
rea
s fo
r p
ati
en
t ca
re,
inva
sive
pro
ced
ure
s, a
nd
pre
pa
rati
on
of
me
dic
ati
on
s sh
ou
ld n
ot
ha
ve v
en
tila
tors
Kn
ow
n t
o b
e
ine
ffe
ctiv
e
pra
ctic
es
th
at
incr
eas
e r
isk9 .
Ch
em
ica
l d
eco
nta
min
ati
on
of
con
tam
ina
ted
ma
teri
al
Ro
uti
ne
cu
ltu
res
for
pe
rso
nn
el
wh
o a
re c
arr
iers
11
Use
of
top
ica
l a
nti
sep
tic
on
op
en
wo
un
ds
Co
nti
nu
ati
on
of
an
tib
ioti
c tr
ea
tme
nt
aft
er
the
op
era
tio
n e
nd
s
Ro
uti
ne
cu
ltu
res
of
vasc
ula
r ca
the
ter
tip
s
Kn
ow
n t
o b
e
ine
ffe
ctiv
e a
nd
exp
en
sive
pra
ctic
es.
10
Dis
infe
ctio
n o
f h
osp
ita
l w
ast
e (
exc
ep
t fo
r m
icro
bio
log
y l
ab
ora
tory
)
9 These concepts are based on well-designed studies that lead to the conclusion that they do not prevent infection and, to the contraary, may increase the risk of infection.
10 These concepts are based on well-designed studies that lead to the conclusion that they do not prevent infection. Although they do not increase risk, they often cause
unnecessary expense.
11 These practices are not useful unless there is an epidemic in which there is reason to consider the existence of carriers as a risk factor.
2
Use
of
foo
twe
ar
cove
rs i
n a
ll a
rea
s o
f th
e h
osp
ita
l
Ro
uti
ne
cu
ltu
res
of
uri
na
ry c
ath
ete
r ti
ps
Ro
uti
ne
en
viro
nm
en
tal
cult
ure
s (e
. g
., a
ir,
surf
ace
s, o
r so
ap
)
2
AR
EA: N
EON
ATO
LOG
Y
Co
mp
on
en
ts
Ch
arac
teri
stic
s
Ind
icat
or
Su
gge
ste
d v
eri
fie
r
Pre
sen
t?
Nu
mb
er
of
nu
rsin
g p
rofe
ssio
na
ls
Are
th
ere
su
ffic
ien
t n
urs
ing
pro
fess
ion
als
, d
ep
en
din
g o
n t
he
seve
rity
of
the
ch
ild
ren
's i
lln
ess
es?
Inte
rvie
w
Acc
ess
ible
an
d o
pe
rati
on
al
wa
shb
asi
ns
wit
h s
oa
p a
nd
su
pp
lie
s
for
dry
ing
of
ha
nd
s in
all
th
e p
ati
en
t
care
are
as
Dir
ect
ob
serv
ati
on
Gly
ceri
na
ted
alc
oh
ol
in a
ll t
he
pa
tie
nt-
care
are
as
Dir
ect
ob
serv
ati
on
Ha
nd
-w
ash
ing
O
pe
rati
on
al
wa
shb
asi
ns
wit
h
acc
ess
ible
su
pp
lie
s in
all
are
as
for
pre
pa
rati
on
or
dru
gs
an
d f
orm
ula
s
an
d f
or
inva
siv
e p
roce
du
res
Dir
ect
ob
serv
ati
on
The
re
are
b
asic
ge
ne
ral
stru
ctu
ral
con
dit
ion
s fo
r
pre
ven
tio
n
of
in
fect
ion
s
Min
imu
m s
pa
ce
Se
pa
rati
on
of
a m
ete
r o
r m
ore
be
twe
en
cra
dle
s in
ne
on
ato
log
y
Dir
ect
ob
serv
ati
on
Use
of
ase
pti
c te
chn
iqu
e f
or
inse
rtio
n
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
Use
of
chlo
rhe
xid
ine
fo
r ca
re o
f th
e
inse
rtio
n p
oin
t.
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
P
rev
en
tio
n o
f b
act
ere
mia
ass
oci
ate
d w
ith
cen
tra
l ve
no
us
cath
ete
r
Wit
hd
raw
al
of
CV
Cs
wit
h p
osi
tive
he
mo
cult
ure
s
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
Ea
rly
be
gin
nin
g o
f th
e e
nte
ral
die
t
Inte
rvie
w
Bre
ast
mil
k i
s o
ffe
red
by
mo
the
rs
on
ly t
o t
he
ir o
wn
ch
ild
ren
In
terv
iew
, st
an
da
rds
Pre
ven
tio
n o
f in
fect
ion
s th
at
can
be
tr
ansm
itte
d t
o
pat
ien
ts
The
re
are
ac
tivi
tie
s fo
r p
reve
nti
on
o
f in
fect
ion
s th
at
can
b
e
tran
smit
ted
b
etw
ee
n
pat
ien
ts
and
he
alth
wo
rker
s
En
tera
l n
utr
itio
n a
nd
bre
ast
mil
k b
an
k
Th
ere
is
ava
ila
bil
ity
of
pa
ste
uri
zed
bre
ast
mil
k
In
terv
iew
, st
an
da
rds,
an
d d
ire
ct o
bse
rva
tio
n.
Dru
g m
an
ag
em
en
t
Th
ere
is
a p
roto
col
for
dru
g
fra
ctio
na
tio
n
Sta
nd
ard
s
2
All
fra
ctio
na
l d
rug
s h
av
e t
he
da
te
an
d h
ou
r o
f d
ilu
tio
n a
nd
th
e d
ate
an
d h
ou
r o
f va
lid
ity
or
exp
ira
tio
n
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
T
he
re i
s a
pro
toco
l fo
r p
reve
nti
on
of
vert
ica
l tr
an
smis
sio
n o
f H
IV
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
T
he
re i
s a
pro
toco
l fo
r p
reve
nti
on
of
vert
ica
l tr
an
smis
sio
n o
f H
BV
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
Th
ere
is
a p
roto
col
for
de
colo
niz
ati
on
of
mo
the
rs
colo
niz
ed
wit
h S
tre
pto
cocc
us
B
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
Pre
ven
tio
n o
f in
fect
ion
s th
at
can
be
tr
ansm
itte
d f
rom
m
oth
er
to c
hild
The
re a
re a
ctiv
itie
s fo
r p
reve
nti
on
of
infe
ctio
ns
that
can
b
e t
ran
smit
ted
ve
rtic
ally
C
oll
yri
um
12 is
use
d f
or
go
no
cocc
al
op
hth
alm
ia p
rop
hy
laxi
s
Inte
rvie
w,
sta
nd
ard
s,
an
d d
ire
ct o
bse
rva
tio
n.
12 1
% s
ilve
r n
itra
te o
r e
ryth
rom
yci
n o
ph
tha
lmic
oin
tme
nt