National Guidelines for Infection Prevention and Control in Healthcare Facilities

Healthcare-associated infection (HAI), previously referred to as “nosocomial” or “hospital” infection, occurs in a patient during the process of care in a hospital or other healthcare facility (HCF), but was not present or incubating at the time of admission. HAIs include occupational infections among healthcare providers. 

HAIs are one of the most common adverse events during healthcare delivery and a major public health issue affecting morbidity, mortality and quality of life. HAIs are largely preventable through effective infection prevention and control (IPC) measures.

The National Guidelines for Infection Prevention and Control in Healthcare Facilities integrates evidence-based, standard, internationally accepted IPC practices for HCFs in India. Its key purpose is to support improvement in IPC at the HCF level and control HAIs. 

Basic concepts of prevention of HAI

HAIs can be prevented by breaking the epidemiological triad. The most effective way to prevent HAI is by introducing a barrier between the susceptible host and the infecting organism. Most HAIs can be prevented through readily available and relatively inexpensive strategies such as compliance with recommended infection prevention practices such as:

• Hand hygiene
• Appropriate use of personal protective equipment (PPE)
• Following aseptic techniques stringently
• Paying attention to established practices for cleaning and decontamination of soiled instruments, followed by either sterilization or high-level disinfection
• Appropriate disposal of biomedical waste (BMW)
• Appropriate cleaning and disinfection of the environment
• Improving safety in operating rooms and other high-risk areas where the most vulnerable patients are housed and there is a high risk of exposure to infectious agents
• Maintaining a safe working environment and safe work practice 

Bundle approach for prevention and control of HAI

Care bundles include a set of evidence-based measures that need to be implemented together, to show a signifi cant improvement in patient care. Together they have a greater effect on the outcome than the isolated implementation of individual measures. Adherence to bundles helps to deliver consistent and reliable patient care. Care bundles that have shown signifi cant impact on the prevention of HAI include sets of bundles for the prevention of central line-associated bloodstream infections (CLABSIs), bundle for the prevention of catheter-associated urinary tract infections (CAUTIs), bundle for the prevention of VAP, and bundle for the prevention of SSIs.

Bundles need to be simple, clear and precise so that they can be followed easily and appropriately. The measures included in a bundle also have to be adapted to the local setting and suited to the patient care culture of the hospital. Adherence to the bundle should be recorded and evaluated to ensure compliance by all members of the involved healthcare team. 

Infection prevention and control programme

Objectives of the IPC programme

The objective is to minimize the risk of HAIs to patients, HCWs and visitors. This is achieved by: x enabling and assisting all categories of HCWs to adhere to comprehensive IPC practices at all levels of care; and x providing safe and quality healthcare and improving outcomes by reducing morbidity and mortality.

Structure of IPC programme

The head of the HCF or lead administrator should establish a hospital infection control committee (HICC) with well-defi ned composition, roles and responsibilities; and provide adequate resources for the effective functioning of the IPC programme.

Hospital infection control committee

The HICC is an integral component of the IPC programme of the HCF. It is responsible for establishing and maintaining the IPC programme and its various functions of monitoring, surveillance, reporting, research and education. The HICC should have wide representation from all relevant disciplines or departments in the facility.

Prerequisites for an effective IPC programme

• Policies and guidelines including best practices and standard operating procedures (SOPs)
• Adequately trained and motivated human resources
• Continuous and adequate supply of personal protective equipment (PPE)
• Antimicrobial use policy and links with the antimicrobial stewardship programme (AMSP)
• Integration with activities of the quality and safety department
• HAI surveillance and outbreak investigation x Microbiology laboratory support
• Environmental protection
• Links with other patient safety programmes in the healthcare facility (HCF)
• Evaluation of the programme activities: monitoring and feedback
• Budget allocation for all the above
• Implementation through a multimodal approach

For the complete guidelines, click here.

Source : Ministry of Health and Family Welfare