Outbreaks of Infection
Hospital outbreak is a serious challenge for both caregiver and the Infection Control (IC) staff. You may be asked to apply stricter and more intensive infection control precautions to contain the outbreak.
It is important when you suspect the occurrence of an outbreak of infection to notify the infection control department to confirm, investigate and take the necessary action. An urgent infection control committee is usually for this purpose.
Outbreaks of multidrug resistant (MDR) organisms (e.g., MRSA, ESBL-producing gram negative organisms, or Carbapenem-resistant enterobacteriacae) necessitate isolation of cases and full adherence to contact precautions including proper hand hygiene and wearing personal protective equipment (PPE) like gloves and gowns.
In case of MRSA outbreak, IC staff may obtain from you a nasal swab for culture particularly if there is a potential epidemiological link between healthcare personnel and the occurrence or propagation of the outbreak. IC staff may also ask for agar plate hand prints as part of their investigation.
Always follow the recommendations issued by the Infection Control Department and be aware of any updates.
Direct visitors to report to the nurse station before visiting their patients to get the required instructions.
Constructin and Renovation
Hospital design should ensure that patients, especially immunocompromised patients, are at no greater risk for infection within the hospital than outside.
The concerned department should provide the infection control department with the functional program of the newly constructed/renovated project to decide the requirements accordingly.
Infection control department should be involved during planning and designing construction projects. The designs should be reviewed for implementation of infection control standards.
Infection control permit should be obtained before construction begins.
Infection control risk assessment should be performed to quantify the risks associated with construction or renovation projects including patient Risk Groups, areas surrounding the project area for potential impact and specific site of activity e.g., patient rooms, medication room, etc.
Infection control in conjunction with engineering department and related departments shall consider the following:
1. Containment measures and the types of barriers that can be used (e.g., solids wall barriers and portable HEPA filter) to isolate the construction area from the occupied areas.
2. Issues related to ventilation, plumbing, finishing and electricity etc.
3. Potential risk of water damage or risks that can be due to compromising structural integrity (e.g., wall, ceiling, roof).
4. Assessment whether the work to be done during work hours or non-patient care hours.
5. Assessment whether plans allow for adequate number of isolation rooms, the required number & type of hand washing sinks.
6. Issues related to traffic flow, housekeeping, and construction debris removal.
Environmental Sampling
- Obtaining environmental sampling may be required during outbreak investigation and mandatory after renovation/construction projects to ensure a healthy environment before providing patient care.
- Environmental sampling is conducted by specialists form occupational health department.
- Ordering environmental sampling is the role of infection control department. However, prior arrangement and preparation of the sampling area by the engineering, hotel service and nursing departments should be done.
- For renovated and newly constructed areas, sampling shall be considered after the area has been properly cleaned, prepared as ready for use and closed, AC working for 24 hrs.
- The service in areas renovated or newly constructed shall not commence till the results of environmental sampling are released at least as satisfactory.
Blood and body fluid exposure
- • Prevention of needle stick/sharp injury and exposure to body fluids
- • Healthcare workers are at risk of occupational exposure to blood borne viruses (BBVs), including HBV, HCV, and HIV.
- • Sharp injuries often occur after use and before disposal of a sharp device
- • Every HCP should be immunized against HBV (3 doses vaccine at 0, 30 and 180 days) and tested for anti-HBs Ab 1-2 months after the third dose.
- • Healthcare workers should report and document needle stick/sharp object injury or splash upon exposure to the incident.
Prevention of sharp injury and exposure to body fluids include:
- • Hazard Elimination
- • Engineering controls e.g., sharps containers, safety engineered device, appropriate lighting and regular checks of equipment
- • Administrative Controls e.g., following the approved policy and wearing the appropriate personal protective equipment (PPE).
- • Work Practice Controls e.g.,
- • Apply standard precautions especially hand hygiene and glove use.
- • Cover cuts and abrasions with waterproof dressings.
- • Safely handle sharps and injection equipment.
- • Do not bend or recap needles.
- • Properly clean and decontaminate the equipment or environment.
- • Label specimens from patients with known or suspected BBV as “Biohazards” and transport in sealable transparent plastic bags.
- • Ensure proper waste management. This requires trained personnel, foot-operated receptacles, sharp containers, and colour-coded waste bags.
- • Safely dispose of blood/body fluids.
Immediate measures following exposure:
- • Perform the first aid measures
- • Wash with soap and water.
- • Flush splashes to the nose, mouth, or skin with water.
- • Irrigate eyes with clean water, saline, or sterile irrigants.
- • Report the incident to In-Charge person (Head nurse, or chief technologist)
- • Document the incident on the Needle stick injury form (NSIF) or Blood/Body fluids exposure form (BBEF).
- • Head to the preventive medicine (7 am -2 pm) or casualty physician (2pm -7 am).
- • Never delay post-exposure prophylaxis (PEP)
- • If you exposed to HIV positive source, PEP should be ideally given within 2 hours.
- • For HBV positive source, PEP can be given within 24-48 hours.
The following instructions should be followed if you exposed to HBV or HCV positive source:
- • Ladies should refrain from becoming pregnant. An exposed nursing mother might continue to breastfeed.
- • Refrain from donating blood, plasma, organs, tissue, or semen until follow-up testing by the healthcare provider has excluded seroconversion.
The following instruction should be followed if you exposed to HIV positive source:
- • Breastfeeding women should temporarily discontinue breastfeeding following exposure until the six months serologic test is negative.
- • Refrain from donating blood, plasma, organs, tissue, or semen until follow-up testing by the healthcare provider has excluded seroconversion
