Transcript infection prevention in labour and delivery units.

INFECTION PREVENTION IN
LABOUR WARD
Dr. Owende- Odongo
SpecialistObstetrician&Gynaecologist, Kenyatta
National Hospital
Introduction and definition of terms
Infection – The entry and development of
disease producing agent in the body.
Three essential elements are required to
spread infection.
• A source of infecting microorganism or
other infectious agent in a reservoir in
sufficient numbers to cause infection.
• A susceptible host
• A path for transmission (exit, transmission
route and place of entry) to the susceptible
host.
Introduction and definition of
terms cont’d
Infection prevention – Refers to
procedures/practices used to minimize the
risk of spreading infections, especially in
hospitals and health care facilities.
Transmission-based infection control
practices are central to preventing the
transmission of microorganisms within
health care settings.
Introductory remarks cont’d.
• Infection prevention procedures should be
observed in labor wards, operation theatres,
any obstetric emergency evaluation areas
(such as admission room), changing rooms,
scrub rooms, autoclave rooms and instrument
processing and storage areas.
• Active hospital infection control committees,
combined with maternal death reviews, audits,
training and feedback on infection rates tend to
promote infection control practices.
Importance of infection prevention
• Hospitals are notorious sources of infection,
which can be resistant to antibiotic
treatment.
• Poor infection prevention practices in labor
and delivery units also cause puerperal
sepsis, neonatal sepsis and other infections
of childbirth.
• The health workers are also at risk of
contracting infections in L&D units.
Scope
• Admissions
• Clinical environment
- clean equipment and supplies
-clean and sterile environment: labor ward,
operation theatres, recovery area
• Waste management
• Injection safety
• Blood safety
• Role of health care worker
Infection prevention chain
Susceptible host
-Isolation
-Nutrition
-Recognition of high
risk patients.
Place of entry
-Wound care
-Aseptic techniques
Skin preparation
Microorganism
s
-identification
-Antibiotics
Infection
prevention
Clean Hands
Safe practices
Risk
management
Transmission
route
-Hand washing
-Air flow
-Isolation
Reservoirs
-Immunisation.
-environmental
cleaning
Disinfection and
sterilisation
Exit points
-hand hygiene
-Waste disposal
-PPE
Infection prevention at admission.
• Proper assessment should be done. If known or suspected
contagious disease ,refer to the appropriate guidelines.
• Infectious patients should be admitted to the private labor room.
Patient should be informed of why they are being isolated .
Garbage receptacles should be placed within limits of the
patient’s room, covered and bagged with red biohazard bags.
Neonatal Intensive Care Unit (NICU) should be notified
regarding the status of the labor patient suspected of confirmed
contagious disease.
• Patient care items must be labeled to eliminate cross
contamination .
Infection prevention through clean
equipment and supplies.
• Protective clothing such as aprons, gloves,
caps and face masks ,Sterile gowns, linen
packs, delivery packs and packs for
operative procedures should be available.
• Equipment and supplies: decontamination,
high level disinfection for tubings etc,
cleaning and disinfection of patient
monitors and resuscitation equipment.
Infection prevention through clean
and sterile environment.
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Simple practices include hand washing with soap and wiping with paper
towels.
Availability of running water, design of taps, sinks placement and cleaning of
contaminated surfaces are important adjuncts to hand washing.
Dirty equipment should be taken to the dirty utility room after each patient
use and cleaned by designated personnel with a hospital approved
disinfectant.
All soiled linen, equipment; utensils and garbage are handled as contaminated
and appropriately managed.
Linen is changed as necessary and between patients.
A hospital-approved disinfectant/cleaner is used to wipe down non-critical
equipment.
labour / delivery rooms: - Personnel will abide by the visitation regulations
laid down by the hospital. Visitors should report to the nurses station.
Clean and sterile environment c’d
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Operating Room: No unauthorized person may go beyond the OR suite doors.- No greater
than ten persons should be allowed in a single OR except in cases of multiple births,
emergency situations. Operating room door to remain closed at all times.
The staff should wear scrub dress or pants and top, cap, mask and shoe covers prior to
entering the Operating room. Non touch techniques in procedures eg skin preparation and
catheterization. UV lighting when OR is not in use, fumigation as per protocol.
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Recovery room: Each patient cart/stretcher should be thoroughly cleaned with hospital
approved disinfectant after the patient is transferred. Horizontal surfaces (except ceiling) will
be cleaned with hospital approved disinfectant daily. Patients will be transported via a
Recovery Room cart or wheelchair from the Recovery room to the Mother-Baby Unit.
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Labor /delivery Rooms -All furniture in the labor rooms and birth rooms should be
thoroughly cleaned (bed, Intravenous stands, bedside table and stand, chairs, bathroom, sink,
counter tops and toilet) with hospital approved disinfectant. The appropriate personnel
should clean monitoring equipment after each patient contact.
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Pre- op prophylactic antibiotics and rational use of antibiotics post operatively.
Access to storage area is limited to department personnel.
Infection prevention through proper
waste management.
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L&D units generate several forms of waste e.g. placentae, blood and body fluids
etc. Identification, collection, segregation, handling, storing , transporting and
the disposal of infectious waste should be managed in a safe and responsible
manner. Job aids providing segregation guidance should be displayed.
Waste should be properly segregated in containers and no co-mingling of
infectious and noninfectious waste is observed using colour coded and/or
labeled waste containers located at all points of care.
Syringes and sharps are collected in WHO-approved safety boxes. Sharps
containers are to be changed when ¾ full.
Infectious waste is temporarily stored in an area that is secure/protected from
the weather;
On-site treatment of infectious waste is conducted by high temperature
incineration or autoclaves, and equipment operation and maintenance are
documented in logbooks.
Off-site treatment is conducted by contractor with close supervision from
facility.
Infection prevention through
injection safety
• Appropriate injection and phlebotomy equipment/supplies
should be available to reduce risk of blood borne pathogen
transmission to patients and healthcare workers.
Checklist:
• Disposable gloves.
• Syringes with needles (different sizes)
• Evacuated blood collection sets(needle + holder)
• Equipment for pediatric blood drawings(winged sterile needles
or small size needles (blue 23G)),Lancets for adults and
pediatric, capillary blood drawing.
• Variety of blood collection tubes:(purple/lavender, red, grey)
• Safety boxes. Sharps containers are to be changed when ¾ full.
• Cord blood samples can obtained by needle less technique and
sent to the laboratory.
Infection prevention through blood
safety:
• Maternity units utilize huge amounts of blood and blood
components.
• The unit should receive blood supply solely from NBTS
and BTU.
• Blood storage: the unit should have appropriate blood
bank refrigerator and freezer, well arranged with no
mixing of blood and reagents or other specimens.
• There should be National guidelines on appropriate
clinical use of blood with an active hospital transfusion
committee or someone who oversees transfusion issues
in the hospital (hemovigilance officer).
Role of health care workers
• All health care personnel are required to adhere to
Standard Precautions. Labour ward staff may not visit
general wards and A&E during the time they are on duty
and vice versa unless permission is granted.
• Participate in at least one Infection Control in- service,
Pre-employment physical annual assessment.
• Employee Health: All personnel with infectious disease
should have no direct patient contact.
• Orientation related to general hospital procedure and
specific unit procedures is provided, including personal
hygiene and hand washing.
Role of health care workers cont’d
• Periodic in-services related to infection prevention
should be held.
• HCWs attire should be clean and the visibly soiled,
must be changed.
• Personal protection equipment such as shielded
mask/goggles, gowns and gloves will be available
and utilized. When entering the restricted area
operating room – -All head and facial hair must be
covered. -Shoe covers should be worn. -A mask must
be worn.
• There shall be no food or beverage at the nurse’s
station.
THANK YOU