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INFECTION CONTROL PROGRAMME What is an infection control programme?

An infection control programme is the collective organised activities related to the prevention and control of infectious diseases. An infection control programme can be organised at multiple levels, including the regional, national, state, provincial or local level. Infection control programmes have proven to be successful in lowering the incidence and spread of infectious diseases provided the programmes are comprehensive, and include surveillance and prevention activities and staff training. It is imperative that support is provided from administrative and authoritative bodies from local to national and regional levels. The World Health Organization (WHO), in a 2002 report, suggests that an infection control programme should: set relevant national objectives consistent with other national healthcare objectives; develop and continually update guidelines for recommended healthcare surveillance, prevention, and practice; develop a national system to monitor selected infections and assess the effectiveness of interventions; harmonise initial and continuing training programmes for healthcare professionals; facilitate access to materials and products essential for hygiene and safety; and encourage healthcare establishments to monitor healthcare associated infections and to provide feedback to the professionals concerned. Each healthcare facility is required to: develop an infection control programme to ensure the well being of both patients and staff; formulate an annual work plan to promote good healthcare, appropriate isolation, sterilisation and other practices, staff training and epidemiological surveillance; and provide sufficient resources to support the infection control programme. The objectives of an infection control programme should be to: reduce the incidence and risk of preventable healthcare associated infection; prevent infection transmission within healthcare facilities and the community; and formulate an organisational framework that assists with the effective use of resources to delivering healthcare in a safe, cost effective and scientifically valid manner. The components of the infection control programme should include: basic measures for infection control (i.e. standard and additional transmission-based precautions); education and training of HCWs; protection of HCWs; identification of hazards and minimising risks; routine practices essential to infection control (e.g. aseptic techniques), use of single use devices, proper reprocessing of instruments and equipment, judicious antibiotic usage, management of occupational exposures to blood and body substances, and safe handling and use of blood and blood products; effective work practices and procedures (e.g. environmental management practices such as management of healthcare related waste, support services such as food and linen, use of therapeutic devices);
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surveillance; incident monitoring; outbreak investigation; infection control in specific situations; and research

Monitoring and evaluating an infection control programme

Routine monitoring and evaluation of the infection prevention process is important for measuring the programmes effectiveness. Monitoring should be done to answer the following questions: Are recommended methods being followed? Are needed equipment and supplies available in the hospital or clinic? If equipment is available, is it being used correctly? Was a training programme effective? Are more patients becoming infected? Monitoring results should be shared with healthcare staff. If the activity was done correctly, then staff should be congratulated. Staff must not be made to feel bad if they have done something wrong. If an activity was not done correctly, then possible reasons should be discussed to see what can be done. It is important to discuss results in the light of the local situation. Consider the available budget for infection control practices and equipment and supplies. Monitoring and evaluation should be performed every two months via internal audits and reviews of antibiotic resistance reports, reports of suspected nosocomial (hospital-derived) infections, and other reports. Report findings should be presented to national and local infection control committees. 2.3 Organising an infection control programme

2.3.1 Infection control committee Responsibility for coordinating, monitoring and evaluating the infection control programme is delegated by the hospital or healthcare facility management to a group of relevant staff who form an infection control committee. An infection control committee should be formed at all hospitals, as well as at the national level. The purpose of the infection control committee is to: implement and support the use of recommended infection prevention practices; develop policies, guidelines and procedures relating to infection control and ensuring their currency and accessibility to staff; review problems that may cause infection, and identify areas for intervention by using surveillance and other data; assess and promote improved practice at all levels of the healthcare facility; ensure appropriate staff training in infection control and safety management, provision of safety materials such as personal protective equipment and products; train HCWs; ensure that there is a defined programme for healthcare-associated infection surveillance that includes collection, analysis and reporting back of data to departments and clinicians; ensure that reports on the occurrence of healthcare-associated infections are received and that actions resulting from these reports are determined and monitored;
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provide guidance, advice and support is given to the infection control nurse; and ensure that resources are used efficiently and cost effectively.

Members of the committee should include staff from a variety of departments. For example, the committee might include some or all of the following: infection control nurse nurse doctor midwife or doctor working in obstetrics administrator housekeeper operating room staff responsible for sterilisation laboratory technician. The infection control committee should not have more than five to ten members or it becomes unmanageable. However, specialists from various departments (for example, the pharmacist or laundry manager) can be called to meetings when a problem arises in their department, or when they can offer specialised information. The infection control committee should meet on a routine basis (at least every two months) to discuss infection prevention activities, and to solve problems. In the event of a critical incident or outbreak situation, the committee should be able to convene promptly. The committee should establish and document terms of reference and have these approved by an appropriate authority, such as a senior healthcare administrator or director of health services. The committee should appoint a secretary and keep records of its activities. An agenda should be prepared and distributed prior to each meeting. Minutes of the previous meeting should be distributed with the agenda. The agenda should include a: review of monitoring activities; report on actions taken on problems identified at the last meeting; report on training activities and needs; list of new problems; and set of recommendations for change, if needed, and a list of who will be responsible. For each agenda item, a designated person should be responsible for preparing a report, and for applying the recommendations for change. At each meeting, the designated person (or people) should report on progress made toward specific goals.

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Meeting minutes should adopt a consistent format such as the one below. 1. 2. 3. Present: Apologies: Minutes of previous meeting: List all those present at the meeting List apologies received Confirmation of the minutes of the previous meeting as a true and correct record of proceedings. (Once confirmed, minutes should be signed off by the Chairperson.) Discussion on any matters arising from previous minutes Consideration of reports as circulated or presented to meeting New business as listed on the agenda or any other matters raised at the meeting Enter the agreed upon meeting date and time Note the time the meeting closed For the Chairperson to sign once minutes have been confirmed

4. 5. 6. 7. 8. 9.

Matters arising: Reports: General business: Date and time of next meeting: Meeting closed: Signature block:

Meeting minutes should include the following information. A brief (few sentences) summary of each agenda items discussion. Recommendations of tasks or actions to solve a problem (e.g. training programme, buying equipment, making posters). The name of the person to be responsible for applying the changes recommended, and the date (deadline) by which the person or task group should have carried out the assigned task. The results of the actions taken to solve a problem. Other information to note includes: Was the goal accomplished? If there were problems, were they identified and solved? How were problems solved (e.g. staff were trained in infection control procedures, supplies were purchased)? Keeping a record of this information will make it easier to solve a similar problem later. Minutes should be written as soon as possible after the meeting. The committee secretary should maintain the master set of minutes. Minutes should be kept in a folder. Care is needed when handling folders to ensure that pages are not lost. The infection control committee should decide how infection prevention practices can be applied based on the amount of available equipment. It is important to make decisions that are practical and standard. Good communication and exchange of ideas with staff can improve work habits and attitudes. Staff should be informed about the infection control committee and the purpose of the programme. Hospital management should share ideas and materials with staff, and be ready to listen to their perspective. Good communication at all staff levels is the key to a successful infection prevention programme.

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Infection control nurse

Each hospital or healthcare facility should have a designated person responsible for implementing infection prevention policies and activities, and developing methods for reviewing practices to minimise the incidence of infection. This person may be a nurse but may also be any other person with knowledge of infections (e.g. laboratory staff, medical officer). Ideally, this person would have received specialist training in infection control and prevention. The infection control nurse must be a member of the infection control committee. The infection control nurses role is to work with all departments to provide an environment free of infection for patients and staff. The infection control nurses responsibilities are to: coordinate and conduct training activities; carry out surveillance activities; develop and disseminate infection control policies; observe infection control practices and make suggestions for improvement; help identify problems and assist in problem-solving; and report to the infection control committee at every meeting. It is generally recommended that there be one full-time equivalent infection control nurse per 125 hospital beds (see sample position description in Annex 4). 2.5 Infection control guidelines

Infection control guidelines assist healthcare staff in preventing the transmission of healthcare associated infections. Sections of the regional guidelines may be adapted to local situations. In such cases, an infection control nurse in collaboration with an infection control committee develops the guidelines for the local healthcare facility. After approval by the infection control committee, the guidelines must be distributed to each department in the facility. The guidelines must be reviewed on an annual basis and changes made in accordance with available evidence-based practice research and information. 2.6 Education and training of healthcare workers, patients and visitors

An infection prevention programme can be successful only when everyone is involved. People are usually willing to change bad habits to good ones when they understand the reasons and the importance of each procedure. Therefore, each healthcare facility should plan frequent in-service education programmes for staff, patients and visitors. In-service training is an ongoing process. Inservice training should be used to teach good practices, change bad habits, and demonstrate new equipment or procedures.

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Every level of staff (i.e. nurses, doctors, housekeepers, cleaners, students) need to learn the importance of infection prevention. Even workers who have little contact with patients, such as pharmacy or kitchen staff, should be included. All staff are important in preventing infections in the healthcare facility. All HCWs should: understand how infection spreads in the healthcare facility; know the important role each staff member plays in preventing infection; and be able to describe or demonstrate various methods of preventing the spread of microorganisms, such as hand hygiene. The training programme should be made as interesting as possible by using discussion, audio-visual aids, posters, role playing and games. The following programmes should be established. 2.6.1 Orientation Orientation is a basic programme for all new staff, and should include the principles and methods of preventing the spread of infection within staff members unit or department. The new employee should have their responsibility in preventing infection explained to them. 2.6.2 In-service education A programme of frequent in-service education should be planned for all staff, beginning as soon as the infection control guidelines are introduced. Regularly scheduled in-service education workshops can be used to identify and solve problems, introduce new techniques, and provide general reminders about the importance of safe practices to prevent the spread of micro-organisms. 2.6.3 Patient teaching It is the HCWs responsibility to instruct patients about their role in the prevention of infection or the spread of infection. For example, a HCW may teach patients with respiratory illnesses to cough into a handkerchief, or teach patients with enteric disease to thoroughly wash their hands before and after using the toilet, or teach a patient with a wound to keep it clean and dry. 2.6.4 Visitor teaching Visitors should be made aware of the risks they pose by spitting in halls, using toilets improperly, crowding around patients, and handling intravenous sets, catheters and other patient care equipment. Every opportunity should be used to give one-on-one education in order to increase visitors knowledge about infection prevention. An excellent time to educate visitors is when they are waiting in the hospital or clinic. For example, small classes on infection prevention can be given using a video player (if available). 2.6.5 Steps to a successful training programme In-service education programmes can be short, simple and interesting. In addition, HCWs can be a role model for other staff and patients. Staff and others should be reminded to wash their hands frequently, and perform tasks correctly. A training programme should: Clearly identify the group that is being trained (e.g. nurses, community health workers, cleaners, laboratory technicians); Be carefully planned. It will be necessary to decide on: o what will be taught,
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o how it will be taught (what teaching aids and supplies are needed), o when it will be taught (making use of a schedule), and o where it will be taught (e.g. in a classroom, on the ward); Describe clearly the tasks that staff need to learn at the beginning of the session; Determine what they know before you start (it may be more or less than you expect); be realistic: train people to use facilities that are available; Give necessary information about the reason for certain procedures and about the consequences of not carrying them out (e.g. infection or even death); Make learning interesting by: o encouraging discussion, o linking information about caring for patients and cleanliness in healthcare facilities with local tradition and beliefs, and o using teaching aids such as posters, field trips, role playing, and audio-visual aids; Select a teaching method that is best for the specific audience; Provide information, examples and training skills; Teach skills using practice session of tasks; Use case presentations to identify problems, and exchange ideas on how to better handle a given situation; Give learners feedback on their practice (in a respectful way) so they will know how well they are doing; Evaluate the training by watching learners do the tasks on the job or issue a survey; and Use the results of the evaluation to improve training.

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