Infection control team. Hands together to prevent HAI

[Varghese John]

Infection Control Team (ICT) This constitutes the Infection Control Nurse, Microbiologist, Pharmacist and the Infection Control Officer who report to the Medical Director. Functions of Infection Control Team

- Surveillance and auditing throughout the hospital, on a daily basis. Carry out targeted surveillance on high risk areas on hospital acquired infections and act upon data obtained e.g., investigate clusters of infection above expected rate.

• Preparing reports and submitting to the committee.
  
• Immediate notification of infection control related problems and report to the chairman or resource doctor and implementation of effective control measures immediately without waiting for the next meeting.
  
• Training of staff on all aspects of infection control.
  
• Investigate outbreaks of infection and take corrective measures.
  
• Assist in training new employee's infection control policies and procedures.
  

- Provide policies and procedures on aseptic techniques and isolation techniques.

• Supervision of waste management
  
• Supervision of isolation procedures.
  
• Monitoring of employee health program
  
• Address all requirements of Infection Control as specified by NABH, state and local laws.
  
• Monitoring of the Quality indicators and taking CA/PA Wherever required
  

Daily Duties of Infection Control Nurse (ICN)/Team

The ICN is the link between the HICC and the wards/ICUs etc. in identifying problems and implementing solutions. In addition the ICN conducts Infection control rounds and maintains the registers. The Infection Control Team is also involved in education of paramedical staff including nurses and housekeeping staff.

a) Daily rounds: - Infection control nurse must take daily rounds in all patient care areas and non patient care areas for surveillance, consultation, implementation of policies and procedures, teaching, training and research activities. Surveillance Passive surveillance - This will be done by the Microbiologist in the ICT. The Microbiologist shall follow up the positive cultures for the indication and appropriateness of antimicrobial choices. Collect infection control reports from lab (eg.: positive cultures). Record all positive cultures with sensitivities. Tabulate cultures in terms of - Blood culture - Post - OP wound infection - Body fluid/drainage cultures - Skin swab cultures - Stool cultures - Urine culture - Catheterized & Non catheterized Active surveillance - This will be done by the ICN All patients on devices in all the ICUs will be followed up daily by the ICN to monitor for device related infections, and also calculate the device days. From the wards, the ward supervisors/in-charges have been given the responsibility for active surveillance of superficial phlebitis (by daily monitoring of VIP scores for patients on peripheral intravenous access) and device use like Foleys Cather etc. Weekly Plan - Hand hygiene compliance audits in high risk areas will be done. Monthly Plan - Biomedical Waste segregation compliance and cleaning evaluation at various areas will be done on monthly basis. All indicators relevant to Infection Control will be tabulated and presented to the ICT monthly. This will be presented in the Doctors/Nurses staff meeting on every second Thursday to provide necessary feedback. b) Implementation of infection control procedures all over the hospital. Explanation,teaching and demonstration of policies and procedures to other staff. Daily checking, collection and preparation of statistical data. c) Teaching & Training Education of the staff in all patient care areas should be done every day on an on-going basis e.g. to select one ward per day. She/He should train the staff to carry out the infection control procedures by doing regular "in-services" e.g. teaching how to carry out hand washing appropriately, teaching how to remove contaminated linen by double bagging techniques ,spillage handling, barrier nursing, various bundles ect. Evaluation of nurses in terms of their knowledge, skill and competence will be done and report submitted to HR Department. It is suggested that this scoring be considered when deciding the yearly increments in remuneration. Surveillance

Environment Surveillance The CDC guidelines suggest surveillance of the high risk areas of the hospital and surveillance of certain equipments. These include surveillance of patient care units, water supply, food supply, air conditioning, CSSD equipments etc. on a monthly basis. Personnel Surveillance Infections among the personnel must be monitored after an exposure to a communicable disease and if necessary should be excused from duty or must take precautionary measures like mask, gloves etc while doing the duty. Appropriate immunizations should be completed for all personnel working in the health care facility. Regular employee health checkups must be done for all type of communicable diseases. Surveillance Activities The following are the usual surveillance activities done in a health care facility. - Monthly statistics of Nosocomial sepsis - Monthly surgical site wound infection statistics. - Monthly statistics of ventilator related respiratory infection. - Monthly statistics of MDROs including MRSA - Monthly statistics of nososcomial infection involving urinary tract in indwelling catheter. - Monthly statistics of nosocomial diarhhoea - Monthly statistics of infectious communicable diseases. - Monthly statistics of monitoring the cleanliness of horizontal surfaces and equipments from all patient care areas. - Monthly statistics of monitoring of food and water. - Monthly statistics of needle prick injuries. Corrective measures should be done when there is evidence of nosocomial infection. Infection control Surveillance Systems- protocol The following are considered as high risk areas for the purpose of active surveillance Ø ICU s Ø Operation Theatre Ø Post operative unit Ø Cath lab Ø CSSD Ø Blood bank Ø Labor Room Ø Kitchen Methods Passive suveillance - Passive reporting is reporting by individuals outside the infection control team (laboratory reports- the most commonly used source-daily/weekly/monthly; - Electronic patient records system-daily/weekly - Patients' paper records-weekly. Active surveillance Infections in all patients hospitalized at a given point in time are identified (point prevalence) in the entire hospital, or selected units. Typically, a team of trained investigators visits every patient of the hospital on a single day. Reviewing medical and nursing charts, interviewing the clinical staff to identify infected patients, and collecting risk factor data. This is referred to as prevalence data. Repeated prevalence surveys can be useful to monitor trends by comparing rates in a unit, or in a hospital, over time. Targeted surveillance Site-oriented surveillance: priorities will be to monitor frequent infections with significant impact in mortality, morbidity, costs (e.g. extra hospital days, treatment costs), Common priority areas: -Ventilator-associated pneumonia (a high mortality rate) -Surgical site infections (first for extra -hospital days and cost) -Primary (intravascular line) bloodstream infections (high mortality) -Multiple-drug resistant bacteria (e.g. methicillin- resitant staphylococcus aureus, Klebsiella spp. with extended-spectrum beta-lactamase, Carbapenem resistant Enterobacteriaceae and extensively drug-resistant (XDR) Acinetobacter.) This surveillance is primarily laboratory-based. The laboratory also provides units with regular reports on distribution of microorganisms isolated and antibiotic susceptibility profiles for the most frequent pathogens. It could be unit or priority oriented surveillance also.