Asepsis, House-keeping and Waste Disposal
Hospital acquired infection is the most common cause of morbidity and mortality in admitted babies. Prevention of infection by the means of establishing asepsis routines is best policy.
IMPORTANT POINTS FOR ASEPSIS
tip
- Hand washing is the single most important means of preventing nosocomial infections.
- 60 seconds of hand washing must always be done before entering the unit.
- Always wear sterile gloves while performing invasive procedures like sampling, starting IV lines, giving IV injections etc.
ASEPSIS
- Strict hand washing is mandatory for maintenance of asepsis in the ward. Parents of the baby should be guided and supervised about proper hand washing technique.
- Remove shoes, socks, woolens, watch, bangles, rings and sacred threads and wash your hands before entering into the baby care area.
- Disinfect your hands with alcohol hand rub solution for 20 seconds before and after touching babies.
- Change intravenous sets after every 72 hours or as required.
- Do not keep fomite e.g. files, X-ray films, pens etc. on the baby crib.
- Discard stock solutions, dextrose/ IV fluid/ saline bottles after each trolley.
- Antibiotic vials should be changed according to their shelf-life.
DISINFECTION METHODS AND THEIR FREQUENCY
| Name | Disinfection Method |
|---|---|
| Baby linen Cotton gauze Sets for procedures Cheattle forceps | Autoclave Always use autoclaved |
| Utensils - Paladai, katori, spoons, steel utensils Swab container Injection and medicine tray | Wash daily and between every use with soap and water and then boil for 10 minutes |
| Stethoscope, measuring tape, thermometer, BP cuffs, probes of radiant warmer, sensor of pulse oximeter | Clean daily and between every child with spirit swab |
| Laryngoscope | Clean with spirit swab thoroughly after each use. If used for an infected baby, wash with soap and water. Put the blade in 2% gluteraldehyde after removing the bulb. Wash thoroughly with running water after removing from gluteraldehyde. |
| Ambu bag and reservoirs, oxygen tubing, humidifier bottle and tubing of suction machine | Clean with detergent/ soap and water after dismantling. Immerse in gluteraldehyde for 4-6 hours and then rinse in distilled water/ running water. Daily and after each use. |
| Suction trap bottle | Pour freshly prepared sodium hypochlorite solution and keep it for 20 minutes. Discard the solution in yellow bag and wash with soap and water. Daily and after each use. |
| Syringe pumps | Clean with wet clean cloth daily. If blood stained, use soap and water. |
| Oxygen hood, radiant warmer | Wash with soap and water daily and during terminal disinfection. |
| Face mask | Clean with soap and water, immerse in gluteraldehyde for 20 minutes, rinse in distilled/ running water. After each use. |
| Weighing machine | Wipe with soap and water daily. Wipe the weighing surface with spirit swab after each use. |
HOUSE-KEEPING ROUTINES
| Name | Procedure | Frequency |
|---|---|---|
| Floors | Wet-mopping with phenyl/ lysol solution | Once in each shift Never dry sweep |
| Walls | Phenyl/ lysol solution | Once daily |
| Fans | Wipe with wet clean cloth | Once a week |
| Air conditioner | Surface and filters to be washed with soap and water | Once a week |
| Refrigerator | Defrost and clean with soap and water | Once a week |
| Buckets | Soap and water | Daily |
| Sinks | Detergent water | Daily |
Nursery environment
- The nursery temperature should be maintained between 28 - 30ºC
- The environment should be calm. Background noise should not be more than 45 dB and peak intensity should not be more than 80 dB.
- Ensure 24 hours water and electric supply with adequate lighting and ventilation
- Clean utility and dirty utility should have separate marked areas.
- All the records of the baby should be maintained and preserved.
| BABY RECORDS - Doctor | BABY RECORDS - Nurse |
|---|---|
| Doctor's routine notes | Feeding record and feeding consent form (if applicable) |
| Consent forms for procedures and high risk | Kangaroo Mother Care Record |
| Doctor's treatment chart | Terminal disinfection record |
| Monitoring sheet NICU | Incident reporting form |
| Nurses treatment chart | |
| Growth chart | |
| Nurses monitoring sheet |
SAFE DISPOSAL OF HOSPITAL WASTE
- Segregation of bio-medical waste is the responsibility of generator of the waste, viz. doctors, nurses, paramedical staff, attendants of the patients.
- Segregation of bio-medical waste must be done at the point of generation.
- Nursing staff should be aware of bio-medical waste disposal guidelines and supervise the process of waste disposal in their wards.
- Waste bins should preferably be emptied in every shift.
| COLOR CODE | WASTE SEGREGATION |
|---|---|
| Black bags | Left-over food, fruits, feeds, vegetables, waste paper, packing material, empty box, bags etc. |
| Yellow bags | Infected non-plastic waste e.g. human anatomical waste, blood, body fluids, placenta etc. |
| Blue bags | Infected plastic waste such as used disposable syringes, needles (after destroying them in needle destroyer) Used sharps, blade and broken glass Patient's IV set, blood transfusion set, endotracheal tube, catheter, urine bag etc. should be cut into pieces and disposed in the blue bag |
References
- Module on Infection Prevention - Neonatal Division, AIIMS, New Delhi
Document Information
Current Version
Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena
Contributors: Nurse Ajeeta George and senior Neonatal Teaching Nurse: Helene Bjornstad
Previous Versions: v1.0