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Presentation on theme: "INFECTION PREVENTION IN LABOUR WARD"— Presentation transcript:

Dr. Owende- Odongo Specialist-Obstetrician&Gynaecologist, Kenyatta National Hospital

2 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.

3 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.

4 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.

5 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.

6 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

7 Infection prevention chain
Clean Hands Safe practices Risk management Microorganisms -identification -Antibiotics Reservoirs -Immunisation. -environmental cleaning Disinfection and sterilisation Exit points -hand hygiene -Waste disposal -PPE Transmission route -Hand washing -Air flow -Isolation Place of entry -Wound care -Aseptic techniques Skin preparation Susceptible host -Nutrition -Recognition of high risk patients.

8 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 . Contagious conditions like viral illnesses: chicken pox, measles,; Others are TB etc.

9 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.

10 Infection prevention through clean and sterile environment.
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.

11 Clean and sterile environment c’d
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. 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. 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. Pre- op prophylactic antibiotics and rational use of antibiotics post operatively. Access to storage area is limited to department personnel.

12 Infection prevention through proper waste management.
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.

13 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.

14 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).

15 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.

16 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.



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