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Infection Prevention Guidelines for Healthcare Facilities with Limited Resources

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Infection Prevention Guidelines for Healthcare Facilities with Limited Resources Infection Prevention Guidelines for Healthcare Facilities with Limited Resources Linda Tietjen Débora Bossemeyer Noel McIntosh An Affiliate of JHPIEGO Johns Hopkins University WORKING TO IMPROVE THE HEALTH OF WOMEN AND FAMILIES THROUGHOUT THE WORLD Infection Prevention Guidelines for Healthcare Facilities with Limited Resources Linda Tietjen Débora Bossemeyer Noel McIntosh An Affiliate of JHPIEGO Johns Hopkins University WORKING TO IMPROVE THE HEALTH OF WOMEN AND FAMILIES THROUGHOUT THE WORLD United States Agency for International Development The authors have made every effort to check the accuracy of all information, the dosages of any drugs, and instructions for use of any devices or equipment. Because the science of infection prevention is rapidly advancing and the knowledge base continues to expand, readers are advised to check current product information provided by the manufacturer of: x each drug to verify the recommended dose, method of administration and precautions for use; and x each device, instrument or piece of equipment to verify recommendations for use and/or operating instructions. In addition, all forms, instructions, checklists, guidelines and examples are intended as resources to be used and adapted to meet national and local healthcare settings’ needs and requirements. Finally, neither the authors nor the JHPIEGO Corporation assume liability for any injury and/or damage to persons or property arising from this publication. JHPIEGO is a nonprofit international health organization dedicated to improving the health of women and families. Established in 1973, JHPIEGO—affiliated with Johns Hopkins University and headquartered in Baltimore, Maryland—works in more than 30 countries through its collaborative partnerships with public and private organizations, and local communities. www.jhpiego.org The Maternal and Neonatal Health (MNH) Program is committed to saving mothers’ and newborns’ lives by increasing the timely use of key maternal and neonatal health and nutrition practices. The MNH Program is jointly implemented by JHPIEGO, the Johns Hopkins Center for Communication Programs, the Centre for Development and Population Activities, and the Program for Appropriate Technology in Health. www.mnh.jhpiego.org The Training in Reproductive Health (TRH) Project works globally to establish integrated (pre- and inservice) education and training systems to improve the performance of reproductive health professionals. JHPIEGO Corporation Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231-3492, USA © 2003 by JHPIEGO Corporation. All rights reserved. Authors: Linda Tietjen Débora Bossemeyer Noel McIntosh Production Assistance: Youngae Kim ISBN 0929817-80-X TRADEMARKS: All brand names and product names are trademarks or registered trademarks of their respective companies. Norplant® is the registered trademark of the Population Council for subdermal levonorgestrel implants. Printed in the United States of America This publication was made possible in part through support provided by the Population, Health and Nutrition Office of the U.S. Agency for International Development/Indonesia, and by the Maternal and Child Health Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, U.S. Agency for International Development, under the terms of Award No. HRN-A-00-98-00043-00, and by the Service Delivery Improvement Division, Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development, under the terms of Award No. HRN-A-00-98-00041-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. ACKNOWLEDGMENTS This manual is a reference guide to infection prevention thinking and practices in hospitals and healthcare facilities where resources are limited, and in some countries (e.g., Nepal, Nigeria, Mozambique, Rwanda and Somalia) actually decreasing. It is based in large part on the experience gained during the last 11 years since publication of the first manual, Infection Prevention for Family Planning Service Programs1. It reflects what we (the authors) have learned from countless healthcare workers throughout the world who abstracted, translated, taught and used the simple, practical procedures and practices contained in that manual. During the past decade, the success of the first manual as an international infection prevention reference for use in outpatient settings, such as family planning programs, has been amply documented. The challenge in writing this new manual has been to keep the content as simple and practical as possible while at the same time incorporating essential information on a much larger scale—infection prevention guidelines for hospitals providing general medical, surgical and obstetric services. Therefore, to make it as useful as possible, we sought input from a wide range of health professionals and international organizations, and we are deeply indebted to them for their interest, support and contributions. Specifically, the authors and JHPIEGO wish to thank: x The two key reviewers, Patricia Lynch, RN, MBA, co-author of Infection Prevention with Limited Resources: A Handbook for Infection Committees, and Mark S. Davis, MD, FACOG, author of Advanced Precautions for Today’s O.R., who worked closely with the authors and provided technical and organizational guidance as well as collegial support throughout the writing. Over the years, both individuals have contributed greatly to making hospitals safer for patients as well as for the healthcare professionals and staff working in them. In particular: x Pat Lynch has worked in the field of infection control since 1968. She was the first president of the US Association of Professionals in Infection Control and Epidemiology (APIC) in 1972, and is one of the original developers of the isolation system known as Body Substance Isolation that was incorporated into the Centers for Disease Control and Prevention’s revised Guideline for Isolation Precautions in Hospitals in 1996. She also has consulted with practitioners in numerous hospitals with limited resources in the US and developing countries. 1 Tietjen L, W Cronin and N McIntosh. 1992. Infection Prevention for Family Planning Service Programs: A Problem- Solving Reference Manual. Essential Medical Information Systems, Inc.: Durant, OK. x Mark Davis is an experienced surgeon who now devotes much of his time to promoting safety in hospitals, the healthcare industry and manufacturers of medical and surgical safety products. His contribution to Chapter 7 (Safe Practices in the Operating Room) and Appendix D (Precautions for the Surgical Team) was crucial and freely given. We also would like to acknowledge his consultation on JHPIEGO’s new infection prevention video, Safe Practices in the Operating Room, which is an integral part of the learning materials used in training health workers. x Both publishers, ETNA Communications LLC and Sweinbinder Publications, LLC respectively, for permitting adaptation and use of portions of the above publications in this manual. x The more than 20 US and international technical experts whose helpful comments were incorporated into the final version. Special thanks go to: x In Africa: Srs. Dorothy Andere and Lunah N’Cube (Kenya), Rick Hughes, MPH (Zambia), Dr. Robert J. Leke (Cameroon) and Dr. Abdel Karim Kourmaré (Mali). x In Asia: Dr. Kamlesh Giri (Nepal), Dr. Chandrakant Ruparelia (India) and Dr. Abdul Bari Saiffudin, Anne Hyre, MPH, CNM and Dr. Ricky Lu (Indonesia). x In Latin America and the Caribbean: Drs. Julio Aguilar and Miguel Espinoza (Peru) and Dr. Erwin Ochoa (Honduras). x In the United States: Robyn Gerhshon, PhD, an environmental health specialist at Columbia University who provided valuable comments and suggestions regarding the content of the manual. Throughout development of this manual, the support and advice of Molly Gingerich and Monica Kerrigan USAID/Indonesia were of enormous assistance. In addition, we are indebted to Teresa McInerney, BA, BSN, RN, who provided new information and drew most of the illustrations in Chapter 5 (Personal Protective Equipment and Drapes) and Chapter 13 (Processing Linen), and to JHPIEGO/Baltimore staff, especially Ann Blouse, Paul Blumenthal, Sue Brechin, Julia Brothers, Patricia Gomez, Barbara Kinzie, Harshad Sanghvi and Jeffrey Smith, who made many helpful and important suggestions. Finally, this manual could not have been produced without the exceptional patience, editing and desktop publishing expertise of Youngae Kim. TABLE OF CONTENTS PREFACE xvii PART 1. FUNDAMENTALS OF INFECTION PREVENTION ONE INTRODUCTION TO INFECTION PREVENTION Background 1-1 Definitions 1-2 Important Concepts 1-3 Which Process to Use 1-4 The Disease Transmission Cycle 1-6 Preventing Infectious Diseases 1-10 New Isolation Guidelines and Recommendations 1-11 References 1-13 TWO STANDARD PRECAUTIONS Background 2-1 Standard Precautions 2-2 Key Components and Their Use 2-3 References 2-5 THREE HAND HYGIENE Background 3-1 Definitions 3-3 Hand Hygiene Practices 3-4 Improving Hand Hygiene Practice: What Works 3-9 Other Issues and Considerations Related to Hand Hygiene 3-12 References 3-14 FOUR GLOVES Background 4-1 When to Wear Gloves 4-2 Types of Gloves 4-3 Glove Requirements for Clinical Procedures 4-5 Accidental Contamination of Sterile or High-Level DisinfectedSurgical Gloves 4-6 Some DOs and DON’Ts About Gloves 4-7 Allergic Reaction to Gloves 4-7 References 4-8 Infection
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