Hospital Management 24

Best Practice Urinary Catheterisation Catheter Care

hospitalmanagement24@gmail.com (Anonymous) — Thu, 04 Feb 2016 19:59:00 +0000

Urinary Catheter Care Best Practice

Introduction
With the inherent risk of introducing infection to the urinary tract, catheterization must be performed as an aseptic procedure and only when clinically indicated. The catheter should be removed as soon as possible or when no longer required.

Materials

Short Term (less than 10 days)
Medium term (4 - 6 weeks)
Long Term (6 weeks - 6 months)

Latex
Teflon, PVC & PVC coated
Silicone & Silicone coated catheter

Becomes very irritant if used for more than 10 days May cause inflammatory urethra stricture in males Because of soft consistency, may be difficult to insert in the presence of urinary outflow obstruction. Not suitable if the bladder contains debris, clot etc. Latex plastic catheters are not suitable for use as indwelling catheters.
Less irritant than latex catheter Easily inserted and less likely to block Catheter can degrade by splitting or peeling of the coating if used for longer than 4-6 weeks
Least irritant of materials Because of soft consistency, can be difficult to insert.

Drainage Bag
Only a sterile bag, which facilitates a closed system of drainage, should be used which should be fixed on a hanger. The bag and tubing should at all times be below the level of bladder so that the flow can be continuously maintained by gravity.

Procedure
In order to minimize the risk of infection it is extremely important that the aseptic technique be maintained throughout the procedure and the area through which the catheter is to be introduced into the bladder be thoroughly disinfected.

All equipment must be washed sterile
Hands must be washed thoroughly with antiseptic solution before and after the procedure.
Sterile gloves must be worn. Clean peri urethral area with 1% povidone iodine or 3.3% aqueoue savlon.
Prior to insertion use a disinfectant containing lubricant e.g. 0.05% chlorhexidine gluconate in glycerin.

Emptying the Drainage Bag
Extreme care must be taken when emptying the drainage bag to prevent cross infection. The hands are washed and non sterile disposable gloves must be worn when emptying each bag. The bag should be emptied via the drainage tap at the bottom of the bag. When the bag is empty, the tap should be closed securely and wiped with alcohol.

A separate jug must be used for each patient and each bag should be emptied separately as required. The jug should be disinfected in a disinfector and stored dry. After emptying urine the gloves must be discarded and hands washed.

Specimen Collection
If sample of urine is required for bacteriological examination, it should be obtained from sampling port. Wiping the sampling port with 70% alcohol in impregnated swab must disinfect this. The sample may then be aspirated using a sterile needle and syringe and transferred into a sterile container.

Do not use disconnected drainage bag to obtain a sample as these cause interruption to the closed drainage system and may pose a risk of infection to the patient.

Do not obtain sample for bacteriological culture from the drainage bad as this will not give an accurate result. Such specimens reflect the bacterial count within the bag, not the patient's urinary tract.

Bladder Irrigation
Irrigation should be avoided unless obstruction is suspected. In such cases, closed continuous irrigation may be used to prevent obstruction.

Bladder washouts with antiseptics i.e. chlorhexidine are not recommended. They rarely eradicate organisms, may introduce infection, can cause inflammation of the bladder wall and therefore increase the likelihood of systemic invasion. They may also cause damage to the catheter.

How to Clean and Disinfect a room — ICU — O.T. — Isolation room

Mop the room thoroughly.
Wash floors, walls, ceilings with clean warm water. Leave it for 10 minutes. Let it dry.
Make proper concentration solution of water with cleaning agent (E.g. Bacilloflor) Read manufacturer's instructions on how to make the solution.
Use hard brush (not a mop) to scrub floors, walls, ceilings etc thoroughly, mechanically, effectively.
Clean beds, furniture, fans with soft cloth soaked in Bacilloflor solution.
Careful while cleaning equipments. e.g. Ventilators, monitors etc.
Leave room and its contents to dry for 15 to 30 minutes.
Spray "Bacillocid" or other similar chemical. Wait for 2 hours before using the facility.
Fumigation is outdated. Thorough I to 8 steps mentioned above means proper disinfection.
Discard the mop, chemical solution and use a new one before moving to clean other room.
Teach cleaners how to do the cleaning.

Procedure for prevention of nosocomial infection in O.T.
Following steps must be ensured to prevent nosocomial infection in the O.T:

Restricted entry of personnel. Only the concerned people must be allowed top work area. Prior permission must be obtained from Sister in charge / DMS if visitors are to enter O.T.
Only personnel in O. T. dress cap and mask to be allowed inside sterile zone.
Slippers must be ear marked and used for the area. The slippers for bathroom must be marked. (Do not use same slippers for both areas)
No person must go out with O.T. dress and come back into O.T. in the same dress. Dress must be changed if person re-enters.
No septic cases must be posted in the main complex. Minor O.T. should be used. The sister in charge must be informed by doctor if any aseptic cases are being done prior to posting in minor O. T..
Due precautions must be adhered to if seropositive patients for HIV/HBsAg/HCV is posted for surgery. The doctor must be informed about the patient's status prior to posting must inform the theatre personnel.
Half an hour must be given between cases to clean up the room after each surgery.
Terminal cleaning must be done of each theatre at the end of the day.
Sister who is assisting must ensure proper disposal of sharps, blood stain, linen, gauge pieces and body parts are done at the end of each case.
During surgery, sister assisting must ensure that minimal spillage of blood, body fluids occur. The gauge pieces must be accounted for in the stand for gauge counting.
Weekend cleaning and mechanical scrubbing of the O. T. must be done. Only minor O. T. to be used for emergency cases on Sunday. No elective cases must be posted on Sunday.
One senior sister must supervise the weekly cleaning and scrubbing as per the "critical care room cleaning guidelines"

Work instructions for nurses in O. T.

All bins and sterile sets must be ensured that they are sterilized by colour change of the label.
After use, each instrument must be cleaned thoroughly in warm/hot water with a detergent and sent for sterilization.
All sharps must be disposed off in the cidex bin only. No sharps must be put into the buckets.
Nurse assisting must ensure that blood drops/spills are covered with 1% sodium hydrochloride and cleaned before leaving theatre after a case.
Nurse must supervise that proper disposal of gauge, human body parts, and the O.T. suction apparatus contents disposal.
The Nurse assisting the case must supervise all samples for investigations being sent to lab.
Nurse must use aseptic technique while using the bins. The chisel forceps must be decontaminated each day.
Nurse in charge must ensure frequent changing of the suction apparatus tubing.

Protocol for cleaning ICU's for house keeping

Supervisors to inspect that daily cleaning are done. Hands on training have to be given for reconstruction of disinfections. [Measuring cylinder to be used.] Keep a log-book for this.
Periodically supervisors have to be checked by housekeeping in charge that this is done. Log book to be checked.
Morning and Evening wet swabbing of the area has to be done with a disinfectant (correct concentration to be reconstituted as per the manufacturer) Daily vacuum to be done once a day in all ICU's.
Weekend carbonization to be done for all equipments and beds in the ward. (Date sticker to be attached to each)
Restriction of visitors to ICU's.

Protocol for house keeping to prevent spread of infection in case of an outbreak

Wearing gloves and masks by staff is essential. Hand washing with soap and water is mandatory.
Supervisors to inspect that daily cleaning are done. Hands on training have to be given for reconstitution of disinfectant. All used equipment to be cleaned with a disinfectant.
Morning and evening wet swabbing of the area has to be done with a disinfectant. (Correct concentration to be reconstituted as per the manufacturer.)
Weekend calibration to be done for all equipments and beds in the ward.(Date sticker to be attached to each)
All equipment used on a patient — the ventilation tubing; suction tubing must be disposed of till the outbreak lasts.
All excretion and secretion of the patient to be flushed off. The spittoon, kidney tray and bedpan to be disinfected, washed with soap and water and reused.
All spills to be covered with disinfectant. (5% sodium hypochlorite) for ten minutes with gloved hands.

Protocol for O.T. Cleaning, Carbolization and Fumigation

Every morning: O.T. is to be cleaned and carbolized before start of the first operation.
All equipments, O.T. tables, walls and floors have to be cleaned and carbolized.
Equipments and furnishings, not to be carbolized are marked" x II in red.

After every operation

Collect linen and waste material in color-coded bags according to hospital waste disposal protocol.
Collect soiled linen in separate color coded plastic bags according to hospital waste disposal protocol.
Collect sharps and sponges separately in color-coded bags according to hospital waste disposal protocol.
After removing the blood from the floor and other, spillage areas (as per hospital protocol) disinfect and wash the areas thoroughly.
Carbolize the equipments giving special attention to the foot switches.
Bacillocid spray (as per manufacturer's instructions) after every infected case operated.

Note :Carbolization procedures shall be carried by using 1% hypochlorite solution.
Check the concentration of available hypochlorite, dilute accordingly.

Example : hypochlorite solution (available 4% solution of sodium hypochlorite: dilute 1 in 4, to 250 ml of 4% sodium hypochlorite add 750 ml of water)

At the end of the last operation

Clean the O.T. area, after removing all the used material & other items to be discarded.
Mop with 1% sodium hypochlorite solution, dilute as mentioned earlier.
After mopping the floor, carbolize the O.T. walls, floor, table tops and equipments except where contraindicated (marked" x II in red)
Bacillocid spray (as per manufacturer's instructions)

The sister in charge of O. T. shall ensure that there is proper time gap between the 2 operations for removing the used material, cleaning and Bacillocid spray (if necessary).

Fumigation

Fumigation of an area shall only be resorted to in the following circumstances :
A. Newly constructed area.
B. Construction activity undertaken recently in that area.
C. In any other circumstances where need of fumigation is felt, it shall be carried out with the permission of the N. D. (Nursing Director) and with immediate information to D.M.S., M.S., Infection Control Officer, AGM (Operations), Chief Engineer and Manager House Keeping.

In all other circumstances proper cleaning, carbolization & Bacillocid spray (as per instructions of the manufacturer) shall be carried out.

Note : For effective fumigation, humidity of the area to be fumigated shall be very high.

Before fumigation

Remove any containers with hypochlorite solutions and any other article that is likely to be damaged by fumigation, to an area away from fumigation area.
Clean O.T. properly.
Fumigate

Method of fumigation

Turn off AC.
Qilution of formalin (500 ml of 40% of formalin+1000 ml of water) for thousand cubic feet.
Put the solution in O. T. care machine (fumigators)
Put on the machine for half an hour
Seal the O. T. for 10 to 12 hours.
Then turn on A.C. and exhaust the fumes.
Remaining fumes, if any, shall be neutralized with ammonia.
Clean and carbolize before use.

All the house-keeping personnel working in the OT shall use heavy duty gloves while dealing with biomedical waste.

Construction activity

Construction activity is divided into following, depending upon the type and nature of the work being carried out:
Level-I: Electrical fittings/painting jobs/minor plumbing activity.
Level-II: False ceiling repairs, PCV floor repairs and major plumbing/electrical/air conditioning repair activity.
Level-III: Demolition/Construction of walls, fixing tiles, complete ceiling replacement and floor replacement.

All construction activity in patient care area should be undertaken with following proposed guidelines
Level-I
No particular Infection, Control measure except 'Universal Precautions' to be taken by staff

Level-II

'Universal Precautions' to be followed by staff.
The area shall be isolated or cordoned off.
Patients are to be moved away from the area.
Wet cloth curtain should be provided for barricading.
Behind this, plastic curtain or at least a dry cloth curtain to be put, to seal the area.
If required, ear plugs may be provided to all likely to be affected in the nearby area.
Frequent cleaning of the construction area and surroundings is carried out.
At the end of the construction activity, air conditioning is switched on, to take out dust from ducts.
Prefilter and micro filters are cleaned at the end of each such activity.
Regular fumigation is carried out at least once and if needed twice, followed by plate counts by settle plate method.

Level-III
All the supply and return diffusers/grills to be covered and sealed before starting the construction work.

All other activities as for Level-II Construction
At least two fumigation cycles and if needed a third cycle is carried out, Plates counts are done.

Functions of the Nursing Care Service of the Hospital

hospitalmanagement24@gmail.com (Anonymous) — Thu, 14 Jan 2016 20:02:00 +0000

Functions of the Nursing Care Service of the Hospital

The functions of the nursing care in a hospital can be summarized, with the help of following diagram

Role of Nursing Services

Chief nursing officer

↓

Nursing Superintendent

↓

Deputy N.S.

↓

Assistant N.S.

1. Patient care: providing optimum care to the patient. This includes all activities necessary to provide nursing care :

a. Concerned with comfort and well being of every patient.

b. Assessment of patients need and planning of care.
c. Concerned with carrying out of medical treatment. Helping physician in carrying out procedures, preparing equipment for assisting physician with diagnostic tests and therapeutic measures. Giving medicine and carrying out treatment, observing patient for any untoward reaction following treatment and necessary measures to combat them.
d. Concerned with education of Staff Nurses (Incidental and planned).
e. Concerned with patient and relatives about maintain and improving his health and to carry out his treatment when he goes home.

2. Administration: Through which the unit functions.

3. Education: the organization of education program for nursing students.

4. Housekeeping: Involves in maintenance of clean, safe and comfortable environment. There should be a place for everything, and should be in its place.

5. Clerical: Involves maintenance of records and reports.

6. Maintenance of supplies and equipment: Involves timely maintenance of equipment, and maintenance of supplies for carrying out unit activities.

7. Off-station duties: The activities which take nurses away from the unit but have definite relationship to the patient or the unit.

8. Patient care: It is the nucleus of all the activities which comfort, nutrition, human needs, and special care of the patients. It also includes preparing patient for procedures and follow up there after, carrying technical procedures, health education, supportive care, recording, collection, examination of specimen.

9. Discipline: nursing unit should be able to maintain discipline in the ward.

Factors influencing In-patient care

a. General factors : There are a number of factors which are responsible for the quality patient care in the in-patient department. The presence or absence of these factors or the extents to which a particular hospital tries to achieve better standards with regards to these factors will indirectly reflect the quality of hospital care.

b. Hospital staff Medical care is provided by hospital staff. Their efficiency, effectiveness, training and experience will affect the patient care.

c. Continuing Medical Education (CME) : Continued education and in-service training of entire hospital staff will contribute to a large extent to better patient care.

d. Physical facilities and equipment: Adequate space, good design and layout of wards, clean and pleasant environment and availability of adequate equipments which contribute greatly towards effective discharge of hospital function, thereby improved patient care.

e. Clinical and service facilities: Availability of adequate and appropriate clinical facilities.

f. Effective use of beds: Effective utilization of beds is a factor as well as a measure of the quality of care

g. Quantum of work: Work load on a particular hospital affects the quality of care and serves as an index for deployment of resources.

h. Administration: Proper administration and management of hospital by trained and experienced administrators can contribute towards improvement of quality of patient care.

i. Motivation of staff If the staff is motivated, that leads to improved patient care.

j. Image of the hospital: The image of the hospital is also responsible for the morale of the staff working in the hospital and the performance leadership itself is an important determining factor for the quality of patient care in any hospital.

Factors influencing in-patient care

↓

General factors
Hospital staff
Continuing medical education(CME)
Physical facilities and equipment
Clinical and service facilities
Effective use of beds
Quantum of work
Administration
Motivation of staff
Image of the hospital

Medical Audit

Medical audit is entirely different from the general perception of the audit, what is in minds of the people. “Medical audit is the evaluation of medical care in retrospective manner through analyzing the clinical records”. The objective of medical audit is ultimately improvement of patient care. This topic has been discussed in the chapter on quality in health care.

Universal Protocol for Invasive Procedures in HIV-HCV Cases

hospitalmanagement24@gmail.com (Anonymous) — Sun, 10 Jan 2016 16:14:00 +0000

Protocol for Invasive Procedures in HIV/HBSAG/HCV Seropositive Cases

The following protocol has to be followed strictly to prevent occupational exposure :

It is mandatory that all personnel handling patients with seropositive reports are aware of the patient’s status and know all the procedures to be followed as listed below (SIC must ensure the above and indicate on patient record by yellow and red stickers)
The bed to be covered with disposable sheets (incident for AIDS kit from materials department). If soiling of hospital linen occurs, soak it in 10% fresh bleaching powder overnight and send for hot laundry.
A bit plastic bin with double plastic cover lining to be placed near the bed. Once it is 3/4 th full, send it for incineration.
All parenteral material (Syringes, Catheter, IV lines, Gloves) used for the patient to be discarded into bin.
Use Cidex cans to be used for discarding sharp objects. Once it is 3/4 th full, fill it with Cidex and keep it overnight and send for incineration.
Double gloves to be worn while starting IV line, Throat secretion suction, drawing blood.
All samples sent to lab must be put in Biohazard Polythene cover with red/yellow sticker. Gloves to be worn by ward boy while transporting samples. Request slip must never be soiled with sample.
Bed to be covered with absorbent padded sheets (indent from materials department) if bleeding, or ooze is anticipated. If bed is soiled then it is wiped with 5% Sodium Hypochlorite and Carbolised.
After patient is discharged, ensure room is sterilized as per room sterilization protocol.
All instruments used for the patient must be washed, soaked in Cidex overnight, washed with detergent and sterilized.
All excretion and secretion to be flushed. Container to be disinfected with Sodium Hypochlorite, washed with detergent before reuse.
Cidex (2 cans of monir case, 4 if major), Lysol (1 can), Sodium Hypochlorite — 5%
Gloves, masks and eye shields
Big buckets with plastic cover lining
Big and small plastic bags
Used Cidex cans for putting in needles.
AIDS disposable kit (2 kits if minor case, 6 if major case)

Seropositive cases

Sample collection, radiology department and nuclear medicine

The following protocols have to be followed strictly to prevent occupational exposure :

It is mandatory that all personnel handling patients with seropositive reports are aware of the patient’s status and know all the procedures to be followed as listed below. Sister in charge must ensure the above and indicate on patient record by red and yellow stickers.
A closed plastic bin with double plastic cover lining to be placed in the room. Contents to be sent for incineration once procedures are over.
All potential material (syringes, catheter, IV lines, gloves) used for the patient to be discarded into bin.
Used Cidex to be used for discarding sharp objects. Once it is 3/4 th full, fill it with Cidex and keep it overnight and send it for incineration.
Double gloves to be worn for any procedure.
All samples sent to lab must be put in biohazard polythene cover either red/ yellow sticker. Gloves to be worn by ward boy while transporting samples. Request slip must never be soiled with the sample.
Bed to be covered with absorbent padded sheets (indent from materials department) if bleeding, or ooze is anticipated. If bed is soiled then it is wiped with 5% sodium hypochlorite and carbonized.
All instruments used for the patient must be washed, soaked in cidex overnight washed with detergent and sterilized.
All excretion and secretion to be flushed. Container to be disinfected with sodium hydrochloride, washed with detergent before reuse.
In all cases of exposure to blood or body fluids the flowing procedures should be followed :

Encourage the affected area of skin to bleed for the few seconds
Do not suck the puncture site
Rinse immediately under running water and wash with soap and water and then alcoholic/ chlorhexidine solution.

If the spillage of the blood and body fluids has occurred on intact skin then the effected area should be rinsed immediately under running water and washed with soap and water. Do not scrub. Rinse and dry. Exposed mucous membrane or conjunctive should be irrigated immediately with copious amounts of water using either running tap water or an eyewash bottle.

Manual on Hospital Waste Management Guidelines

hospitalmanagement24@gmail.com (Anonymous) — Mon, 28 Dec 2015 17:25:00 +0000

Manual for Hospital Waste Management

Preface

Hospital waste can not be seen as a new problem in the South Asia. One of the major areas of today’s concern is the west management more specifically “Hospital waste management” which has always been overlooked and thereby has produced many of the health hazards for the people in terms of morbidity and mortality. Through out the world at present times, the proper way to handle the wastes and its disposal has become one of the major problems, especially hospital waste. A significant proportion of biomedical waste is actually regular garbage and has been continuously posing a threat to the human health, starting right from its generation up to the final disposal.

Hazardous portion of hospital waste includes all infection and pathological waste. Despite the possible danger by this type of waste, rational management has yet to be introduced. Moreover proper care is not being taken in collecting, handling, separating, carrying, storing and disposing of hospital waste by the workers, who are thus exposed to a wide range of hazards.

It relevant current aspect of waste management practice from its point of generation to final disposal and found a strategy for effective hospital waste management. Wastes generated at Hospital are indeed varied both in composition and in quality. Hospitals offer a wide range of serious and encompass a variety of activities, each of which generates different characteristic waste.

Waste management in most Asian countries is running in an old traditional way for decades. It is not possible to bring massive changes within a short time. At present our aim is to ensure that waste should be handled and disposed off efficiently and economically as per as possible. A reduction in the indiscriminate disposal of hospital waste will give immediate benefits to the service providers and community, safety at the hospital waste will give immediate benefits to the service providers and community, safety at the hospital improvement of local quality of the environment and results in lowering the level of pollution to the eco-system.

This manual-under the activity of “Short term immediate action” is aimed for the Hospital managers, Health providers, Policy makers and all the Administration, with an interest to ensure hospital waste that are generated and disposed off efficiently and economically, as far as possible to make an environmental friendly hospital.
A.

1. Introduction
Environmental pollution is now one of the major human concerns and medical wastes constitute an important component of this emerging catastrophe. Apart from indirect risks through environment, medical waste also poses a direct threat to human health and welfare, and it also creates a socio-Psychological devastation as medical facilities are conceived, as institutions, which save life, not endanger life. Realizing its importance, WHO arranged a consultative Meeting in 1992 on this issue and, in 1995, it conducted a survey in 9 countries of South East Asian Region. A regional consultative meeting was also organized in Thailand in 1996.

Health-care waste management, as well as poisoning technical problems, is strongly influenced by cultural, social and economic circumstances. A well designed waste policy, a legislative framework and plans for achieving local implementation are essential. Change will be gradual and should be technically and financially sustainable in the long term.

2. Vision of Hospital Waste Management
To ensure safe, efficient, cost-effective, acceptable and sustainable management of hospital waste and to minimize the occupational health hazard towards an Environmental friendly hospital.

3. Scope and Opportunity regarding Waste Management

Is to provide information within the National Health Service (Waste management) policy and to give guidance on their implementation.
Compliments the strategic guide for “Chief executive or managers” of the health care establishment.
Provides a regime with an aim of ensuring the safe and effective disposal of hospital waste.
Indicates some of the areas by which hospital executives may need to familiarize themselves and they may need to take steps to ensure operational requirements in waste management.
Indicates the need of “Health and Safety Policy” for health care employees. Considers in the development of “Management policy” and “Legislation” on Hospital waste management.

4. Definition of Hospital Waste
Practice of generating, handling separating collecting carrying storage and finally disposing the waste as per the policy of the hospital. Level of knowledge attitude of the waste generator and their practice are the key issues for successful waste management. Waste management varies with different circumstance for each hospital but should take into account of there major issues. In the other hand Hospital waste refers to the waste resulting directly from patient’s diagnosis, prevention, research, alleviation of disablement and treatment purpose, as well as waste generated from all other departments of the health-care establishment.
B.

5. Classification of Medical Waste
There is no study on type of medical waste in Bangladesh however it seems that the usual classification is also applicable here.

HOSPITAL WASTE

↓

5.1 Suggested classification of waste as per type
Type-1 General Waste
Type-2 Infectious/Pathological/Anatomical Waste
Type-3 Cytotoxic/Pharmaceutical Waste
Type-4 Radioactive Waste
Type-5 Sharp Waste
Type-6 Liquid Waste

5.2 Definition of the hospital waste category
5.2.1 General waste
General waste comes mostly from the administrative and housekeeping functions of healthcare establishments and may also include waste generated during maintenance of health-care premises. General wastes should be dealt with by the municipal waste disposal mechanism.

5.2.2 Infectious waste
Infectious waste is suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts. This category includes :

Cultures and stocks of infectious agents from laboratory work;
Waste from surgery and autopsies on patients with infectious diseases (e.g. tissues, and materials or equipment that have been in contact with blood or other body fluids);
Waste from infected patients in isolation wards (e.g. excreta, dressings from infected or surgical wounds, clothes heavily soiled with human blood or other body fluids);
Waste that has been in contact with infected patients undergoing haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels, gowns, aprons, gloves, and laboratory coats);
Infected animals from laboratories;
Any other instruments or materials that have beer in contact with infected persons or animals.

5.2.3 Pathological waste
Pathological waste consists of tissues, organs, body parts, human fetuses and animal carcasses, blood, and body fluids. Within this category, recognizable human or animal body parts are also called anatomical waste. This category should be considered as a subcategory of infectious waste, even though it may also include healthy body parts.

5.2.4 Sharps waste
Sharps are items that cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades knives, infusion sets, saws, broken glass, and nails. Whether or not they are infected, such items are usually considered as highly hazardous health-care waste.

5.2.5 Pharmaceutical waste
Pharmaceutical waste includes expired, unused, split and contaminated Pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of appropriately. The category also includes discarded items used in the handling of Pharmaceuticals, such as bottles or boxes with residues, gloves, masks, connecting tubing, and drugs vials.

5.2.6 Genotoxic waste
Genotoxic waste highly hazardous and may have mutagenic, teratogenic, or carcinogenic properties. It raises serious safety problems, both inside hospitals and after disposal, and should be given special attention. Genotoxic waste may include certain cytostatic drugs (see below), vomit, urine or faces from patients treated with cytostatic drugs, chemicals, and radioactive material.

5.2.7 Chemical waste
Chemical waste consists of discarded solid, liquid and gaseous Chemicals for example from diagnostic and experimental work and form cleaning, housekeeping and disinfecting procedures. Chemical waste form health care may be hazardous or nonhazardous, in the context of protecting health, it is considered to be hazardous if it has at least one of the following properties :

Toxic
Corrosive (e.g. acids of pH < 2 and bases of pH >12);
Flammable
Reactive (explosive, water-reactive, shock-sensitive)
Genotoxic (e.g. cytostatic drugs)

Formaldehyde
Photographic Chemicals
Solvents
Organic Chemicals
Inorganic Chemicals

5.2.8 Waste with high content of heavy metals
Waste with a high heavy-metals content represent subcategory of hazardous chemicals waste, and are usually highly toxic. Mercury wastes are typically generated by spillage from broken clinical equipment but their volume is decreasing with the substitution of solid-state electronic sensing instruments (thermometers, blood pressure gauges etc.). Whenever possible, spilled drops are mercury should be recovered. Residues from dentistry have a high mercury content. Cadmium waste comes mainly from discarded batteries. Certain “reinforced would panels” containing lead are still used in radiation proofing of X-ray and diagnostic departments. A number of drugs contain arsenic, but these are treated here as pharmaceuticals waste.

5.2.9 Pressurized containers
Many types of gas are used in health care and are often stored in pressurized cylinders, cartridges, and aerosol cans. Many of these, once empty or of no further use (although they may still contain residues), are reusable, but certain types — notably aerosol cans — must be disposed of. Whether inert or potentially harmful, gases in pressurized containers should always be handled with care, containers may explode if incinerated or accidentally punctured.

5.2.10 Radioactive waste
Ionizing radiation can not be detected by any of the sense and other than bums, which may occur in exposed areas — usually cause no immediate effects unless an individual receives a very high dose. The ionizing radiation of interest in medicine include the X-rays, a- and B- particles, and -y- rays emitted by radioactive substances.
C.

6. Sources of Medical Waste
Wastes generated in the health care establishment are in solid, liquid and gaseous forms. Health care waste comprises not only the by-product of health care activities but also the waste from administrative activities, housekeeping, patient themselves, support services etc that’s from every corner of the health care establishment. The composition of the Medical Waste varies from country to country, among hospitals within the same country, even within departments within the same hospital.

7. Sources of Medical Wastes
The Type, Composition and site of Medical Waste are as follows :
View Source

8. Risk associated with Hospital waste management
A part of the hospital waste is hazardous and may cause a threat to health and life not only to patients and staff but also to the community at large.

Injuries from sharps to all categories of hospital personnel and waste handlers.
Nosocomial infections in-patients from poor infection control and poor management.
Risk of infections outside the hospital for waste handles, scavengers and general change of microbial ecology and antibiotic resistance.
Risk associated with hazardous chemicals, drugs, being handled by persons hazardous wastes al all levels.

8.1 Identified constraints in Hospital waste management

Lack of awareness
Negligence
Lack of accountability and responsibility
Operational insufficiency
Inadequate final disposal facilities
Lack of formal/informal sectors in waste recycling
Inadequate manpower
Inadequate financing
Job security
Trade union
Lack of National policy/plan

D.

9. Definition of Medical waste Management
Health-care waste includes all the waste generated by health-care establishments, research facilities and laboratories. In addition, it includes the waste originating from minor or scattered source — such as that produced from the administrative and housekeeping functions of health-care establishments and may also include waste generated during maintenance of health-care premises. In the other hand Hospital waste refers to the waste resulting directly from patient’s diagnosis, prevention, research, alleviation of disablement and treatment purpose, as well as waste generated from all other departments of the health-care establishment.

Practice of generating, handling separating collecting carrying storage and finally disposing the waste as per the policy of the hospital. Level of knowledge attitude of the waste generator and their practice are the key issues for successful waste management. Waste management varies with different circumstance for each hospital but should take into account of there major issues.

The risks involved (Financial, Technical and legal)
The cost of each option
The managerial skill and time required
Careful management of hospital waste required to achieve the goal minimize occupational health hazard and for environmental friendly hospital.

9.1 Organizational structure of Hospital Waste Management methodology

Management

↓

Director (Health-care)

↙ ↘

Matron/Ward master

↓

Nurse

↓

Aayaa

Administrative Officer

↓

Supervisor (Waste management)

↓

Cleaner

Hospital waste management - Present practice and recommended option for Bangladesh

10. Management of Medical Waste
Strategies for Hospital waste management — Steps and organizational structure : Steps for Hospital waste management :

The United Nation Conference on the Environment and Development recommends a set of measure for effective waste management, which are —

Prevent and minimize waste production
Reuse and recycle the waste to the extent possible
Treat wastes by safe and environmentally sound methods
Dispose off the final residues by landfill in confined and carefully designated areas

As per WHO, for effective waste management the life cycle of hospital waste must follow the pathway of some elements are —

Waste minimization
Waste identification
Waste segregation
Waste handling
Waste treatment and hospital
Security
Record keeping
Training
Supervise & Monitoring

Different time of wastes is generated in different quantities at different section of the hospital. The life cycle of the wastes must follow the pathway of some elements, which should be addressed in terms of personnel, material cost and health risk and safety.

10.1 Waste Minimization
Administration and staff should play positive role in minimization the amount and type of waste. Minimization waste may eventually reduce handling and operational cost. Waste minimization should be done by :

Source reduction by purchasing and supplying materials, which generate less hazardous waste
Recyclable products should be used more.
Use oldest stock and short term period expiry dated goods first.
Checking the expired dated at the time of receiving and supply of goods.
Monitoring the follow of chemical and pharmaceuticals form receipt to supply.
Monitoring the dated of different drugs and equipment every 3 (three) months.
Plastic disposable goods should be limited as far as possible, because of non-biodegradability, subject to illegal recycling and reuse, generates hazardous materials if burned or incinerated.
Select non-PVC plastic materials.

10.2 Waste management plan for a health-care establishment Assignment of responsibilities
The proper management of health care waste depends largely on good administration and organization but also requires adequate legislation and financing, as well as active participation by trained and informed staff.

The head of the hospital should form a waste management team to develop a waste management plan. The team should have the following members :

Head of Hospital (as chairperson)
Head of hospital departments
Infection control officer
Chief pharmacist
Radiation Officer

10.3 Safe management of wastes from health-care activities

Matron (or senior nursing officer)
Hospital Manager
Hospital Engineer
Financial Controller
Waste Management Officer (if already designated).

In certain establishment, the structure may include a hospital Hygienist, in addition to or instead of the infection Control Officer, to address specific problems relating to hospital hygiene. In such cases, some or all of the duties of the infection control officer specified below will be carried out by the hospital hygienist.

The head of Hospital should formally appoint the members of the waste management team in writing, informing case of them of their duties and responsibilities as outlined in the following section. (In an institution that is not directly involved in patient care, Such as a medical research institution the head of the establishment should use his discretion to appoint members of the waste management officer with overall responsibilities for the development of the hospital waste management plan and for the subsequent day-to-day operation and monitoring of the waste disposal system. Depending on Availability of relevant staff, this post may be assigned to the hospital Engineer, to the hospital manager, or to any other appropriate staff member at the discretion of the head of Hospital.

10.4 Organizing Hospital Waste Management
For effective Waste Management there should be one “Hospital Waste Management committee” chaired by Hospital Director and he will delegate responsibilities to the sub group. Member of the committee should include :

Director of the Hospital/Hospital superintendent
Head of the Department/Consultants
Nursing superintendent/Matron or in charge (senior staff nurse).
Ward Master
DD/Designated Waste Management officer (WMO)
Engineer in charge of the Hospital/PWD
Other members may be
Medical technologists
Accountant

10.5 Operation and Auditing of hospital Waste Management

Each hospital will assign one senior officer as the “Waste Management officer” for ensuring that Waste Management system is appropriate and functioning well”
The WMO should ensure that the Hospital Waste Management policy and guidelines are procedures by simple graphic instruction on waste handling.
Giving guidelines constantly reinforces cleaners understanding on Waste Management procedures by simple graphic instruction on Waste handling.
Staff will segregate Waste at the point of generation and dispose it to the appropriate containers.
Cleaners will use protective devices for the handling and transpiration of waste.
Every unit head/department head/institutional head will be responsible for Waste

10.6 Management activity of his/her unit/department/institution

Waste receptacles, trolleys, containers, storage facility/area will be kept clean and will maintain good condition.
Collection and transportation of waste will follow specific guidance marked by hospital authority.
Hospital spill clean-up procedures will be followed if there is any spillage of waste
Officer responsible will ensure record and reporting regularly on quantity and quality of waste and will take action to improve practice.
Facility (Poster, all writing, neon sign and video show) will be available within hospital for the awareness of the patients and attendance.
Ensure availability of waste containers at all points of necessity.
Training/retraining/workshop orientation will be arranged for ensuring awareness on waste management for all level of staff.
Liaison will be maintained between WMO and managers responsible for supplies and all departments in the hospital.

10.7 Existing system of Hospital waste management in Bangladesh
There are no well-defined rules and regulation of Hospital waste management in our court means no specific definition of Hospital waste and no specific and separate regulation for disposal Hospital waste. There is less priority for proper disposal of waste by the authorities and accountability of the concern authorities. More over people are not aware of harmful hazardous waste on community and environment.

11. “DO”s” and “Don’t”s for Hospital waste management
11.1 “DO”s” for waste management :

Do segregation of waste at the point of generation
General from hazardous
Sharps from all other waste
Radioactive, chemicals and pharmaceuticals
Infectious and pathological
Do collect in color coded bags
Yellow for infectious and pathological wastes.
Black for general wastes.
Red for Radioactive, chemicals and pharmaceutical
Yellow box for sharps.
Do shred plastic waste from its original form.
Do use needle and syringe destroy?
Do label before collection by waste handlers.
Do quantification of waste.
Do use recyclable and reusable items as possible.
Do cover the waste collection containers.
Do secure store areas.
Do provide protective equipments to the waste handlers.
Do wear protective equipments during handling of waste.
Do immunize all waste handlers.
Do transport through covered trolleys and through designated route.
Do chemical disinfection for inactivate pathogenic organism.
Do train and educate all categories of staff on waste management.
Do take measures for waste recycling.
Do documentation on waste management.
Do send the report to the designated person.

11.2 “Don’ts” for Hospital waste management

Don’t mix the hazardous waste with general waste.
Don’t handle the waste with bare hands and without protecting equipments.
Don’t throw sharp waste out of specified puncture proof container.
Don’t recap the needle after use.
Don’t fill the waste bag more than 3/4 th of its size.
Don’t handle the broken, tear and punctured waste containers.
Don’t drag the waste containers over the floor.
Don’t handle the waste containers without tying the neck of the bag.
Don’t use open bucket for infectious and sharp wastes.
Don’t try to change any waste from infectious waste containers to general waste containers.
Don’t incinerate PVC containing plastic goods.
Don’t dispose clinical waste in loose manner over ground in and or around hospital.
Don’t fires, to be lit to burn clinical waste.

12. Existing system for disposal in Bangladesh
Waste management system in our country has been running in an old traditional way for decades. Hazardous portion of hospital waste includes all infectious and pathological waste. Despite the possible danger by this type of waste, rational management has yet to be introduced. Moreover, proper care is not being taken in collecting, handling, separating, carrying, storing and disposing of hospital waste by the workers, who are thus exposed to a wide range of hazards.

13. Economic aspects of Medical waste management
There is no available data to know the economic status of Medical Waste Management System. There is limited study on Economic status. Recently a study done by BRAC. Findings of this study are as follows :

Item

Price (tk./kg)

Syringe
Saline bag
Water Bottle
Paper
Plastics
Broken Glass
Metal container

10-20
10-24
7-10
2-5
10-20
1.5-5
4-10

There is no exact economic value in Re-cycling process,Composting for fertilizer, Safe land filling. This also required for survey which can be done by Expert group/Private Sector/NGO sector under control of MOHF&W.

14. Steps taken by the Government in Bangladesh
Country’s participation in WHO-SEAR survey (1995) provides its scenario on regional basis; but need for having its scenario on wider national context as envisaged is being increasingly felt. Accordingly, Line Director, Hospital services, DGHS proposed a survey named “Situation assessment and analysis of hospital waste management” with an aim to identify/revise and recommend on present hospital waste management practice all over the country. Hospital managers, service providers, waste generators and waste handlers of the country’s five hospitals (Secondary and Tertiary) were interacted for observation. It reviewed the current aspect of waste management practice from its point of generation to final disposal and found a strategy for effective hospital waste management.

15. Non Govt. initiatives involved in Waste Management Area
Some NGO’s are working on Waste Management study and build up of awareness about the Medical Waste hazards. Among them BRAC, Waste Concern CATALYST, PRISM are prominent. But reflection of there efforts in national level is relatively small in comparison to the volume and multifarious nature of health hazards.

16. Existing Situation
Even of most of the Govt. Hospitals which provide 57% (more or less) of health care services in the country, have no special arrangement for disposal of the medical waste produced by them and it is learnt that the same way of disposal i.e. throwing to the nearby dustbins producing the cause for hazards and suffering for the people.

Private Sector Hospitals, Clinics, Medical Colleges and Diagnostic Centers provide 43% of the Healthcare Services in the country. These Private Sector Health Care units generate a substantial volume of Medical Waste and most of them do not have any proper Medical Waste Management systems. This hazardous waste is thrown to the dustbin and the impact is most alarming un-think able damage to the public health and environment too.

Moreover, there is no organization who are solely managing or organizing Medical Waste Management. Considering the magnitude of the Medical Waste and the depth and range of the bad effects it generates, wide participation of Govt. and Private sector organizations is the need of the time.

The disposal of Wastes are the Generators responsibility and Collection/transportation and disposal may be contracted out to private organization as already done in some European Countries, Australia and very recently in India also.

17. What Should We Do Now?
The hospital waste is critically linked to the quality and quantity of patients care. There is a wide variation in the hospitals within the country and thus all methods and strategies may not be applicable in all hospitals. Although it is not possible to achieve the optimum standard at one time, a partial approach is the best strategy towards a sustainable system. At present our aim is to ensure that waste should be handled and disposed off efficiently and economically as far as possible.

In our opinion these are the following issues which should be addressed immediately

17.1 Need for a coordinating body

Options
Formation of Specific Ministerial Body e.g. Ministry of Health & Family Welfare
Inter-ministerial body.
Formation of Apex body.

17.2 Need for Regulations and Regulatory Authority

Formulate policy and
Ensuring accountability
Public Sector,
Private Sector &
NGO Sector

17.3 Situation Analysis studies

Volume of Waste
Nature of Waste
Close monitoring &
Supportive Supervision
Safe Disposal
Economic aspects of Medical waste

17.4 Pilot studies

Generation of Medical Waste
Waste minimization
Collection identification
Disposal system in different level

E.

18. Waste Identification and Segregation
The key of effective management of Hospital waste is segregation and has a major influence on the options for the treatment and disposal of waste, budget and also on manpower.

First decide, which category of particular waste is being disposed and where?
Never do guess and do not dispose any waste without knowing thoroughly.
Ensure that waste materials are properly and completely thrown into the waste containers and lids are firmly closed.
Staff should never attempt to correct segregation by placing items from one container to another container
Wastes should be segregated at source point as per (segregated for Bangladesh) color code for easy identification of category of the waste.
If generation and hazardous waste are mixed together, the mixed waste should be considered as hazardous waste
If any staff is confused about the type of waste. Treat the waste as infections waste during segregation
Red color containers should contain Cytotoxic, and pharmaceuticals that should be returned to suppliers or manufactures.
Radioactive waste materials will be contained in “Silver” colored lead proof container that must not be incinerated rather should be collection, treatment and disposal as per instruction of the “Atomic Energy Commission” of Bangladesh.
Plastic and rubber materials should be segregated in Black or Yellow color container, identifying its natures, whether it is infected or not.
All drainage bags, used in infusion or transfusion, all types of tubes should be shredded before putting into respective c colored container.
Waste should be dropped/collect in the respective colored containers, some common examples are.
It is better into not to segregated/collect Bangladesh and Biodegradable general waste altogether with in the same container, color of container will be different.
Refers to the waste resulting directly from patient’s diagnosis, prevention, research alleviation disablement and treatment purpose, as well as waste generation from all other departments of the health care establishment.

18.1 Magnitude of Impacts and risks

Contamination of whole mass of soil waste by infectious hospital waste.
Spread of diseases in professional and hospital staff.
Recycling of contaminated sharps.
The risk of silent epidemics of infectious diseases, like Viral hepatitis, Typhoid Pneumonia, AIDS etc.
Due to unhealthy dumping of hazardous waste, there is risk of surface water and air pollution.
It cerates public nuisance. It clogs sewers and drains, encroach road, diminished landscape aesthetics, volatile organic.
Winds also carry the pathogenic and hazardous materials, thus open the route of infection.
Health hazard of Tokai/Rag pickers for scavenging the valuables from wastes.
Laboratory and radioactive waste materials have potentially serious effects on soil microbial pollution, reduce the rate of decomposition and lowers the soil fertility.

18.2 Waste containers should be impervious, washable rigid with average size with covering lid’s and color should be chosen depending upon the type of waste :

Waste containers and its placement

General Waste (Type—1)
Infectious/Pathological/Anatomical Waste (Type—2)
Cytotoxic / Pharmaceutical Waste (Type—3)
Radioactive Waste (Type—4)
Sharp Waste (Type—5)
Liquid Waste (Type—6)

Plastic bins
Plastic bins/Polythene bags
Polythene bags
Special Lead proof container approved by Atomic Energy Commission, Bangladesh
Paper/Wooden rigid box
Plastic bowl/Containers

Black
Yellow
Red
Silver
Yellow
Blue

F.

19. Organizational responsibility
Hospital management must document amount If waste generated and encourage waste management practice. There must be comprehensive audit on current personnel duties, responsibilities and reporting practice. Each departmental head or nominated efficient officer should conduct audit in his department. The audit should record waste separation, storage, collection, transportation and amount of waste produced, related materials and supplies used.

20. Head of the hospital has the following responsibilities

Formation of hospital waste management team and develop management plan.
Designate the waste management office, who will do addition job with his own job.
The efficiency and effectiveness of waste disposal should be monitored
Immediate appoints a successor in absence of personnel from key position, if the procedure is delaying one responsible person should assign temporarily.
Ensure training to the officer and staff related with waste management
Call periodical meeting, exercise of views, suggestion and cooperation to improve or modify the plan.
The hospital director remains overall responsible for ensuring effective waste management
Proper documentation

21. Waste management officer (WMO)
21.1 WMO should be responsible for operation and monitoring of waste management. He will maintain good communication with other members of the committee and will be responsible to the director for all activities. The WMO will be the key person in waste management. The WMO should :

Ensure for availability and placing of colour-coded containers.
Ensures the patient, attendant and auxiliary workers for correctly changing the used bag with a new one.
Ensures cleanliness around the coloured containers.
Ensures printed posters labelled at different places of the hospital
Make linkage with the supply department, about the availability of the materials and equipment
Correct use of central storage facility
Maintains system for inaccessibility of unauthorized person
Monitors waste disposal operation properly.
Monitors transport of waste both in-site and off-site
Ensures that the waste is not stored for long time.
Ensures about the labeling of all-waste containers
Should clean the outflow of waste and note the source, type and quality produced
Communications with departmental heads for waste segregation at the generation
Make liaison and ensures that people are performing their responsibilities.
Ensures that the quality of the waste in its life cycle is properly measured and recorded.
Ensures quantifying waste and reporting system
WHO will monitor operational cost, supply cost, training cost and cost of contracted service?

21.2 Departmental Head

Continuously communicates with WHO
Ensures that doctors and nurses are awarding/teaching the patients properly about segregation.
Training of the key members related with hospital waste management.
Ensures medical and nursing staff to be vigilant.
Responsible for waste management for his/her department.
Ensuring hat all the doctors, nurse and other staff working in the department are aware about segregation standard and storage procedures.
Ensure quantifying waste and reporting system

21.3 Nursing Superintendent/Matron/Senior Staff Nurse

Liaison with WMO and other members of the committee especially with the departmental heads.
Ensure that he nurses are working well on segregation and separation of waste.
Ensures training for nursing staff, medical assistants and auxiliary staff

21.4 Ward Master

Implements effective waste disposal procedure
Ensures that adequate waste containers are kept and well maintained at all strategic areas
Timely supply and monitor the necessary equipment of workers
Ensures labelling and quantifying of the wastes
Ensures the audit and the records related to hospital waste management.
Should arrange periodic health check up and immunization for the workers
Ensure quantifying waste and reporting system.

21.5 Waste handlers (Cleaners)

Will collect the waste from bins and carry it to the containers in the trolley.
Will collect the waste-containing bags if used in the trolley.
Will push trolley containing waste to the disposal or storage area, following the designated road marked by the Hospital executive.
Before fine disposal, will segregate the recyclable waste from general waste bins.
Will transfer the liquid waste from containers to latrine or sewerage system after neutralization or dilution with water
Will transfer the biodegradable waste from the pits to the municipal lorry or public dustbins.
Will clean and wash each bin, trolley and containers with 5% Chlorine solution and or water.
Will replace the bins or containers with a new one if damaged.
Will strictly follow the waste management standards.

21.6 Waste generators (Nurse/Technologists)

Will ensure the placement of bins or bags in or around the designated piece.
Will supervise the work of cleaners, ward-boys and ayas.
Will motivate patients, attendant and visitors to follow waste management standard
Will ensure minimization and segregation of waste as per standard.
Will ensure and record the quantity and quality of generated waste.
Will ensure about cutting the needle and nozzles and segregation of sharps.
Will restrict, especially sharps recycling.
Will strictly follow the waste management standard.

21.7 Doctors

Will ensure and follow the waste management standards.
Will monitor the activities of staff and of working places by using checklist
Will conduct on job training on waste management for the staff.
Will ensure minimization and segregation if waste as per standard.
Will support (consultative) the activities of staff on waste management.
Will be responsible for sending report (monthly or annual) on waste to the WMO and or Director! superintendent
Will supervise the work of staff.

21.8 All staff of the hospital

Will strictly follow waste management standards.
Will motivate patients, attendant, follow and visitors to follow waste management standard.
Will help and cooperate each other’s to follow waste management standard.

G.

22. Public education on hazards linked to health-care waste
Promotion of the appropriate handling and disposal of medical waste is important for community health, and every member of the community should have the right to be informed about potential health hazards. The objectives of public education on health-care waste are the following :

To prevent exposure to health-care waste and related health hazards: this exposure may be voluntary, in the case of scavengers, or accidental, as a consequence of unsafe disposal methods.
To create awareness and foster responsibility among hospital patients and visitors to health-care establishment regarding hygiene and health-care waste management.
To inform the public about the risks linked to health-care waste focusing on people living or working in close proximity to, or visiting health-care establishments, families of patients treated at home and scavengers on waste dumps.

The following methods can be considered for public education on risks waste segregation, or waste disposal practices :

Poster exhibitions on health-care waste issues, including the risks involved scavenging discarded syringes and hypodermic needles.
Explanation by the staff of health care establishment to incoming patients and visitors on waste management policy. This may be difficult to achieve, in which case the distribution of leaflets should be considered.

Hospital Monitoring System for Infection Control

hospitalmanagement24@gmail.com (Anonymous) — Mon, 14 Dec 2015 20:07:00 +0000

Hospital Monitoring System

The Sterilization procedure must be monitored routinely by a combination of mechanical, chemical and biological parameters. These process parameters evaluate the sterilization conditions and indirectly the microbiological status of the processed items.

1. The mechanical techniques for sterilization include a daily assessment of cycle time and temperature by examining the temperature record chart as well as an assessment of pressure via the pressure gauge (unfortunately, two other essential elements for ETO sterilization (i.e. gas concentration and humidity) cannot be monitored)

2. Chemical Indicators :

These are indicators that show exposure to sterilization processes by means of physical/ chemical change.
Chemical indicators are usually paper printed with either heat or chemical sensitive inks that change colour when one or more germicidal related parameters are present.
They are affixed on the outside of each pack to show that the package has been processed through a sterilization cycle.
Preferably, a chemical indicator should also be placed on the inside of each pack to verify steam penetration.
Indicators are designed for one or more than one critical parameters.
Nowadays integrating indicators are available which are designed to react with all the critical parameters over a specified range of sterilization cycles.
These very nearly duplicate the function of biological indicators.

3. Biological Indicators :

Are standardized preparations of specific micro-organisms relatively resistant to the particular sterilization process.
Are used to demonstrate in a positive manner the adequacy of sterilization process.
An aliquot (containing about a million spores) of a viable culture of a known species of micro-organism is added to disks, filter papers or any other suitable carrier.
The disks or strips are placed within the test packs in the sterilization.
B.subtilis spores (10^6) are used to monitor ETO and dry heat and incubated at 35 to 37 C after process.
B.stearothermophilus spores (10^5) are used to monitor steam sterilization and incubated at 55 C.
Steam sterilizers should be monitored at least weekly and ETO with every cycle using the appropriate commercial preparation of spores.
Each load should be monitored if it contains implantable objects.
When feasible, do not use implanted items until results of spore tests are known to be negative.

Bowie Dick test

This is the test used to determine that there is complete air removal in pre vacuum sterilizers.

This test is to be done daily

There will be an even and rapid penetration of steam into the load in a porous load sterilizer only if sufficient air and non condensable gases are removed from the chamber and the load before steam is admitted.
If air and non condensable gases are not removed from the chamber and the load or from the steam supply, they may not be obtained.
This test does not confirm that sterilizing conditions have been achieved in the load.

Proves whether or not steam penetration of the pack has been even

An adhesive tape, which is printed with a chemical substance, is fixed in the shape of a cross to a piece of suitable paper.
This test sheet is placed in the center of a stack of towels.
The chemical substance shows a change in colour when exposed to phase boundary steam.
To obtain optimum colour change for interpretation, the test must not be run for longer than three and a half minutes at 134- 135 degree C.
The tape will show a uniform colour change if all the air is removed and steam penetrates rapidly and completely. If all air is not removed, then air will collect in the form of a bubble. The colour of the tape in the region of the bubble will be paler than elsewhere because of low temperature or reduced moisture level.

Basic Nursing Care Needs of the Patients

hospitalmanagement24@gmail.com (Anonymous) — Thu, 10 Dec 2015 19:04:00 +0000

Nursing Needs of the Patients

The patient being the central figure in the hospital.

Function of Nursing Care

Provision of the nursing care services
Planning, organizing of the nursing care
Education, practice
Quality assurance
Supervision and control
Communication with patients, staff, visitors and administration.
Collection, documentation, classification and reporting of the information needed for nursing care/medical care and hospital administration.
Formulation of policies, strategies for the nursing care of the hospital.

Disinfection and Sterilization Infection Control Guidelines

hospitalmanagement24@gmail.com (Anonymous) — Fri, 04 Dec 2015 13:10:00 +0000

Disinfection and Sterilization Infection Control Guidelines

Environmental, Instrumental Disinfectants and Wound, Skin Care Products Use.

a. Cidezyme J&J, b. New product available now, c. Ethylene Glycol 7% [3 MM], d. Lysoformin
Lysol Bacillocid
Spiral detergent
Formalin
a. Cidex
Microshield PVP-S-(555)
Wasa-soft
Dettol
Savlon
a. AHD special, b. Sterlium
Microshield PVP
Aerodesin 2000
Aldasan 2000
Spirit

Enzymatic detergent, Ethylene Glycol 100 g contains : 7.5 g Glyoxal. 9.6 g didecyl dimethyl ammonium chloride.
Disinfectant
Detergent
Formaldehyde
2% Glutaraldehyde
Povidone iodine antiseptic solution (iodine-10%)
Liquid soap
Antiseptic Germicide
Antiseptic liquid
2.5% Chlorhexidine gluconate with 75% & ethanol
Povidone iodine hand scrub
100 g contains 32.5 g 1 propanol 18 g Ethanol & 0.1 g Glutaral
9.8 g formaldehyde, 9.9 g gluteral
Alcohol

To disinfect the endoscopes and other. Add 8 ml cidezyme detergent liquid concentrate in 1 liter of water. If the organic is dried then use 16 ml in a liter of water. Soak in the solution for at least one minute use soft brush cloth if desired. Thoroughly rinse dry and send for high-level disinfection. Cleaning process is same as above.
Used for mopping of floors across the hospital.
Used for cleaning of floors across the hospitals.
Used for environmental disinfection after thorough cleaning. Now rarely used, becoming outdated.
Used for disinfection of kinds of instruments.
Used for disinfection of kinds of instruments.
Body and hand wash liquid
Used in Apollo for body sponging
Skin preparation & Before PVE
Alcohol based hand rub [quick disinfectant for hands]
Hand wash liquid
Surface & environment disinfection. Ideal for OT,ICU & patient room cleaning when required disinfection.
Surface disinfection 7 cleaning. Can be used where high level disinfection is required; OT,ICU isolation room, transplant unit etc.
Skin disinfection

Note : It is advised that staff should read and follow manufacturer's instructions printed on the labels of the products.

Eo and autoclave
There are two main methods of sterilization or else called high level disinfection.

PURPOSE
The purpose is to sterilize the instruments and required material for invasive and non invasive procedures.

SCOPE
Covers autoclaving and EO sterilizing of various articles used for invasive and non invasive procedures.

DEFINITION
Sterilization and Disinfection

Sterilization

It is defined as a process where all microbes are removed from a defined object inclusive of bacterial spores by means of physical, by means of heat or radiation etc.
e.g. Autoclave gamma radiation or By chemical means e.g. 2% Glutaraldehyde and EO.

Disinfection

Most of microbes are removed from a defined object or surface, except bacterial endospores by means of some chemical agents is considered to be intermediate or low level.
The latest and safest method is Plasma Sterilization, which is highly expensive.
Disinfectants are classified according to their ability to destroy microbes. The agents which are able to destroy vegetative bacteria is termed as low level disinfectants, the agents rendering mycobacterium non viable is termed as intermediate disinfectants and whereas all microbial life is destroyed including end spores are termed as high level disinfectant.

ABBREVIATION
CSSD : Central Sterilization Supplies Department
EO : Ethylene Oxide

AUTOCLAVE
121 degree Centigrade, 20 pounds pressure for 40 minutes. There are pre vacuum autoclave, its holding time is just 4 minutes at 132 degrees centigrade, the other autoclave is gravity displacement, it requires a holding time of 30 to 40 minutes at 121 degree centigrade. Autoclave efficiency should be checked by using biological indicator at every cycle, but we are doing it ever week.

SHELF LIFE
As per Apollo Policy, it’s 7 days. Shelf life depends on kind of storage, away from water source, packaging material used, autoclave reliability etc.

EO STERILIZATION
Those who are packing the items should remember the following points :

Items which are reused should be washed, dried thoroughly before sending to EO unit.
Scrupulous cleanliness and dryness of the object - otherwise a toxic layer of ethyl glycol forms of free toxic gas which can be used for heat sensitive articles.
Requirements 20 - 40% relative humidity.
Concentration of 540 mg - 900 mg/Lt
Temperature of 50 degrees C
Cooling and aeration time of 16 hours.

Shelf life of an EO gaseous item should be 5 years and it can be used immediately since our machine has an inbuilt aeration chamber.
Always double pack the items, place the chemical indicator on the first cover, and seal it properly. It works on EO gas and humidity.

POINTS TO REMEMBER

For EO improper packing affects the efficacy of the process.
EO if the pack is damaged, then it is not fit for use.
Autoclaved items should be stored in closed cupboard protected from moisture.
Shelf life of autoclaved items is 7 days in wards and in OT.
Each individual pack should have indicator top stating the sterility status.

Organogram of Human Resource Department

hospitalmanagement24@gmail.com (Anonymous) — Sun, 29 Nov 2015 21:07:00 +0000

Human Resources Department

Note : H.R = Human Resource; DD = Deputy Director; HRP & M = Human Resource Planning & Management; T & D = Training & Development; AD = Assistant Director; P = Planning; and M = Management.

1. Introduction

Human Resource Management (HRM) module deals with all the activities related to Human Resource Management including maintaining employee’s information, duty schedules, detailing attendance information, leave management and recruitment process, etc.

2. Purpose

This document provides a description of the process involved in Human Resource Management and features allocated for Hospital.

3. Process Description

HRM module contains the following four sections

Maintain Employees Information
Manpower Requirement Analysis
Recruitment
Reports

3.1 Maintain Employees Information
This section describes the processes involved in maintaining employee records; Duty Schedule, Attendance Information, Penalty, Leave Management, Transfer etc.

3.1.1 Employees Information
Steps to be followed in this process :
3.1.1.1 An authorized user enter employees’ basic information like Name, Address, Sex, Date of birth, Grade, Position, TIN, Voter ID no. etc. as well as other information like educational information, job experience(s), salary information and personal information into the system. This input will be treated as the basic information needed for an employee throughout the system.
3.1.1.2 System will generate an ID for every recorded employee and this ID will be used in all over the system as employee’s reference and ID will be used on the ID card.

3.1.2 Attendance Information
Steps involved in this process
3.1.2.1 Every employee scans his/her ID card to the proximity readers.
3.1.2.2 System import employee’s ID, date and scanning time from the proximity reader and records this information in the system’s database.
3.1.2.3 While recording attendance information the following conditions will be considered by the system

Check In-time, out-time and date with employee’s schedule.
According to the employee’s schedule system keeps track of late attendance, early leave, and invalid attendance.

3.1.2.4 An authorized user can see and reconcile employee’s attendance information as and when needed.

3.1.3 Penalty
3.1.3.1 Penalty information will be put and recorded into the system by an authorized user.
3.1.3.2 Penalty can be imposed for absence and/or for disciplinary purpose
3.1.3.3 Penalty is deducted from the current month’s salary based on absent days or for a fixed amount which is decided by the authority

3.1.4 Duty Roster
Steps involved in this process
3.1.4.1 Calendar setting is done at done at the beginning of a financial year. Working days, holidays, duty hours per day, etc. will be set up for the whole years.
3.1.4.2 Duty slot (service hours) to be assigned to employees is setup according to the service provided. This will be treated as the default working schedule for all employees.
3.1.4.3 An authorized user (Department Head) sets/creates for employees and category-wise duty type (fixed or rotation) employees and sets duty slots for each category.
3.1.4.4 An authorized assigns category to the employees and detailed working schedule (working hours, working days, duty type etc) for any specific employee.
3.1.4.5 Detailed Duty Roster is prepared for an individual employee according to the department, employee category and employee type for a certain period. If and when necessary, the duty roster can be modified by the authorized user.

3.1.5 Leave Management
Steps to be followed by this process :

3.1.5.1 Leave type information will be put into the system by an authorized user. Leave types are like Casual leave, Maternity leave, etc which type of leave an employee can enjoy will be prefixed and set into the system.
3.1.5.2 Leave Application: An employee can submit his/her leave application to the authority through this system. A superuser who has no access to the system.
3.1.5.3 Employees of any department forward the application to the respective department head (the system will provide facilities to configure the person to whom one is to send his/her to leave application, which is defined and set by the feature available under “System”)
3.1.5.4 To apply for leave one has to enter following information into the system :

Employee ID (auto-filled by the system for the user logged in, for another employee who does not have access to the system, this ID should be entered).The system shows other information about the employee.
Leave type (casual, Earned, Sick, Maternity leaves, and others)
Starting date of the intended leave
Ending date of the intended leave
Place of stay during leave
Cause of the leave

3.1.5.5 Department Head can see, approve or cancel the leave application only for his/her respective center’s employees.
3.1.5.6 If the Department Head cannot take a decision about any application, then he/she will forward the application to the next higher authority for approval.
3.1.5.7 Director, HR can see, approve or cancel only the application those come from department head(s).
3.1.5.8 If any application gets approved then the respective user (Department Head, and Director, HR) has to modify the applicant’s duty schedule and if necessary assign applicant’s duty to another employee.
3.1.5.9 Director FIR can assign the duty to an employee of another department also.

3.1.6 Transfer
Employee transfer is done centrally under the situation described below :
3.1.6.1 First of all, after recruitment all employees join the department are deployed to different departments.
3.1.6.2 Whenever any employee goes on leave for a few days and if needed, an employee another department may be transferred to that department for a temporary period by Director, HR. When the employee who was on leave joins his/her duty, the temporarily transferred employee joins back at his/her previous department.
3.1.6.3 When a requisition for manpower is submitted from any department to the authority may transfer an employee from any of the departments so that requirement is fulfilled.

3.2 Manpower Requirement Analysis
Administrative or any authorized person can see position wise number of existing employees, required to be recruited and sanctioned a number of employees for any department. Director HR can see a list of all departments, but Department Head can only view his/her department’s employees list. The required and to be recruited numbers can be modified. By viewing this information, Director, HR and/or department head(s) can decide whether manpower recruitment is necessary or not in a certain period of time.

3.3 Recruitment
The step by step recruitment process is described below :
3.3.1 Department head(s) submit a requisition for manpower recruitment. Before doing this he/she should consider things like available manpower, sanctioned manpower, required manpower, allocated budget for the position in the current financial period, already used the amount of the budget, the remaining amount of the allocated budget. After considering all these things, if the Departmental Head deems it necessary to recruit the manpower for a position or some positions, he/she then submits the requisition to the Director, HR.
3.3.2 Director, HR verifies the reason and other information for the submitted requisition and can cancel the requisition. Otherwise, he checks two options available at his discretion.

He/She sees whether it can be fulfilled by transferring required employee(s) to the requesting from any department; or,
If he/she is unable to fulfill the requirement by transferring employee(s) from any department (s) to the requesting department, he/she can go for recruitment.

3.3.3 Director HR will then takes initiative and make formalities for recruitment.
3.3.4 Director HR verifies requisition information and prepares requisition proposal. He/she then forwards the proposal to the authority for according clearance and approval for recruitment.
3.3.5 Director HR decides to recruit or not to recruit new manpower. If he decides not to recruit at the moment, the recruitment process is halted. Otherwise, he/she can suggest alternate recruitment mode(s) and forwards the information to the Finance and Accounts department.
3.3.6 Finance and Accounts department cross checks budget allocation information and also analysis the recruitment mode in terms of cost and finance. It can; if possible, relocate the budget for new recruitment for certain position(s). Finance and Accounts department then sends all the information with its remark(s) to the Director of HR.
3.3.7 Director HR now checks suggestion(s) given from Finance and Accounts Department can also suggest recruitment mode with the remark(s). He/she then forwards the information to the Syndicate.
3.3.8 If the University Syndicate approves the recruitment, Director HR forwards the information to the Deputy Director, HR Division.
3.3.9 Deputy Director, HR Division sends appointment letter(s) and agreement document(s) to the selected candidate(s).
3.3.10 Selected candidate(s) then comes to the Deputy Director, HR and submit joining letter(s).
3.3.11 Acceptance of new joined candidate(s) is done after assumption of duties.
3.3.12 Deputy Director will arrange orientation program for that employee before taking over the charge.

4. Promotion

It is a vertical movement of an employee within the organization. In other words, it refers to the upward movement of an employee from one job to another higher one, with an increase in salary, status, and responsibilities. The promotion will be made when a post-fallen vacant due to any reason or creation of new post(s). The HR department will initiate promotion formalities depending on the requirement of the departments. No approach or application will be required from any individual.

4.1 Types of Promotion

Horizontal Promotion
Vertical Promotion
Dry Promotion

4.2 Purpose

To recognize an employee skill and knowledge.
To reward and motivate employees.
To develop competitive spirit.
To promote employees satisfaction.
To build loyalty among the employees.
To promote good human relations.
To increase the sense of belongingness.
To retain skilled and talented people.
To attract trained, Compete tent and hard working people.
To impress the opportunities are available to them too they also perform well.

4.3 Policy
The following characteristics make a promotion policy as sound and good policy :

It must provide equal opportunities for promotion across the job, department, and region.
It must be applied uniformly to all employees irrespective of their background.
It must be fair and impartial.
The basis of promotion must be clearly specified and made known to the employees.
It must be correlated with career planning.
Appropriate authority must be entrusted with the task of making the final decision.
Promotion must be made on trial basis.
The policy must be a good blending of promotion made from both inside and outside the organizations.

4.4 Different basis of Promotion

Seniority i.e. length of service
Merit, i.e. performance
Educational and technical qualification
Potential for better performance
Career and succession planning
Vacancies based on the organizational chart
Motivational strategies like job enlargement
Training

4.5 Transfer

A transfer refers to as lateral movement of employees within the same grade, from one job to another.
“A transfer is a change in the job of an employee without a change in responsibilities or remuneration”.
Transfer differs from the promotion in the sense that the latter involves a change of job involving an increase in salary, authority, status, and responsibilities, while all these remain unchanged /stagnant in the case of former.
In practice, her company may transfer the employee to the place where he/she can prove more useful and effective. Similarly, the employee may initiate a transfer to a location where he/she is likely to enjoy the greater satisfaction.

4.6 Need
The need for making a transfer is left for various reasons as listed below :

To meet Organizational Needs.
To satisfy Employee Needs.
To Better Utilize Employee.
To make the Employee More Versatile.
To adjust the Workforce.
To provide relief.
To punish Employee.

4.7 Transfer Policy
A good transfer policy should satisfy the following requirements :

Specify the circumstances under which transfers will be made.
Specify the basis for the transfer.
Decide the authority which would handle the transfer.
Intimate the fact the transfer to the person concerned well in advance.
Specify the jobs to which will be made.
Indicate whether the transfer can be made within a department or between departments or between units.
Clarify whether the transfer is permanent or temporary.
Not to be made frequent and not for the sake of transfer only.

4.8 Types of Transfer
Employee transfers may be classified into following types :

Production transfer
Remedial transfer
Replacement transfer
Versatility transfer
Shift transfer
Penalty transfer.

4.9 Demotion
Demotion is just the opposite of promotion. It is the downward movement of an employee in the organizational hierarchy with lower rank/status. According to D.S ‘Demotion is the assignment of an individual to a job of lower rank and pay usually involving a lower level of difficulty and responsibility. Demotion affects the status, pride, career, and income of the employee.

4.10 Factors for Demotion
Demotion may be caused by several factors which may be beyond an employee’s control. Following are the important ones :

Incompetence
Adverse Business Condition
Disciplinary measures

4.11 Policy for Demotion
A systematic policy on dimension should contain the following five points :

A clear and reasonable list of rules should be framed, violation of which would subject an employee to donation.
This information should be clearly communicated to employees.
There should be a competent investigation of any alleged violation.
Once violations are proved, there should be a consistent and equitable application of the penalty, preferably by the immediate supervisor.
There should be a provision for review.

4.12 Separation
Separation is a situation when the service agreement of an employee with his/her organization comes to an end and employee leaves the organizations. In other words, Separation is a decision that the individual and organization part from each other.

4.13 Retirement
Retirement is the major cause of separation of employees from the organizations. It can be defined as the termination of service of an employee on reaching the age of superannuation.
Types of Retirement :
4.13.1 Compulsory Retirement: This is the retirement when employees retire compulsorily from service on attaining the age of superannuation.
4.13.2 Voluntary Retirement: Employees in return for voluntary retirement are given lump sum payment. This type of retirement is also called “Golden Handshake”.

4.14 Resignation
Resignation is termination of service by an employee by serving a notice, called “resignation” on the employer. Resignation may be voluntary or involuntary. A voluntary resignation is when ban employee himself/herself decides to resign on the grounds of ill health, marriage better job prospects in other organizations etc. It is considered involuntary or compulsory when the employer directs the employee to resign on grounds of duty and indiscipline or face the disciplinary action.

4.15 Dismissal
Dismissal is termination of service of an employee as a punitive measure. This may occur either on account of unsatisfactory performance or misconduct. Persistent failure on the part of the employee to perform up to the expectations or specified standard is considered as unsatisfactory performance. Dismissal is a drastic step seriously impairing the earnings and image of the employees.

5. Reports :

The following reports will be generated by the system :
5.1 Employee’s detailed information
5.1.1 Name, Age, Sex, Educational qualification, Experiences, Length of service etc.

5.2 Attendance
5.2.1 Daily attendance report
5.2.2 Monthly attendance report

5.3 Leave
5.3.1 Department wise leave report
5.3.2 Employee wise leave report

5.4 Department wise employee gap list

5.5 Duty Roster
5.5.1 Employee’s monthly time schedule
5.5.2 Department-wise daily time schedule

5.6 Recruitment
5.6.1 Department wise requisition report
5.6.2 Recruitment proposals

5.7 Employees transfer report

6. System

This feature includes facilities to switch and log in to the system using different username and password, set up reporting authority and its hierarchy; and get out of the system.
6.1 Change User
So, this feature helps the user to change his/her username and provide a password to get into the system to get into the system to get the features he/she is given privilege on.

6.2 Reporting authority
Which employee will report to which higher official will be set up using this feature of the module? This reporting hierarchy will be needed in cases of submitting manpower requisition, recruitment proposal, candidate selection, leave application and leave a recommendation.

7. Process allocation

All the features will not be available in all the departments. Features under this module will be selectively available in different.

Following is the tabular presentation of process allocation displaying which features of the module will be available in which department(s) and which are not available :
View Process

8. TRAINING Proposal for Human Resource Development

8.1 Hospital Management

Short-term Training Course (3 months)
Long-term Training Course (6 months)
Diploma
Master
Ph.D.

8.2 Hospital Services Management

Short-term Training Course (3 months)
Long-term Training Course (6 months)
Diploma
Master
Ph.D.

8.3 Financial Management

Short-term Training Course (3 months)
Long-term Training Course (6 months)
Diploma
Master
Ph.D.

8.4 Technical Courses

Short-term Training Course (3 months)
Long-term Training Course (6 months)
Diploma
Master
Ph.D.

8.5 Teaching Methodology

Continuing Medical Education
Research Methodology
Statistical Analysis (SPSS, EPI info, etc)
Thesis/Dissertation writing

8.6 Bio-medical

Short-term Training Course (3 months)
Long-term Training Course (6 months)

8.7 Quality Assurance Programme

Short-term Training Course (3 months)
Long-term Training Course (6 months)
Diploma
Master
Ph.D.

8.8 Office Management

Short-term Training Course (3 months)
Long-term Training Course (6 months)

9. SUBJECT AND DURATION OF TRAINING

Bonus Tips!

Severely injured? Looking for long-term crutches minimizing side risks? Visit here to know best crutches prices.

Sterilization and Disinfection Policy for Hospital

hospitalmanagement24@gmail.com (Anonymous) — Wed, 25 Nov 2015 19:23:00 +0000

Sterilization and Disinfection Policy

DEFINITIONS

Cleaning
This is physical removal of organic material or soil from an object. It is usually achieved by applying water with or without a detergent.

Disinfection
A procedure that achieves killing of vegetative organisms and reduction of microbial load to safe levels, spores Will not usually be destroyed.

Disinfectant
A chemical agent used for disinfection.

Antiseptics
These are types of non-toxic disinfectants that may be applied to the skin and other living tissues. An antiseptic should not be used to disinfect instrument or the environment.

Sterilization
A procedure that achieves completes killing or removal of all types of microorganisms, including resistant spores.

Chemical Sterilants
These are a small range of chemical compounds, which under controlled conditions can kill all living organisms including spores, e.g. glutaraldehyde, ethylene oxide.

Note : Cleaning with detergent and water removes above 80% while chemical
disinfectants remove up to 99% of microorganisms.

Methods of Sterilization

Sterilization can be achieved by any of the following methods.

1. Steam under Pressure [Autoclaves] : This is applied at high temperature [134oC for 3 minutes] or low temperature [121oC for 15 minutes]

2. Dry heat [hot air sterilizes] : This is applied at 160oC with holding time 60 minutes. The total cycle time takes 2-2 ½ hours.

3. Chemical methods, (use of sterilant) : This is applicable for heat sensitive materials at a temperature of 55°C [30-55°C]. The following chemical sterilants are used.
a. Ethylene oxide gas : chamber pressure is usually maintained at 5 - 10 psig. Exposure time varies from 3 hours to 16-36 hours depending on temperature [longer at lower temperature].
b. Glutaraldehyde 2% solution : This preparation sterilizes reliably in 10 hours, but 3 hours should provide adequate sporicidal effects. Treatment for 20 minutes will only disinfect.
c. Low temperature steam and formaldehyde : This utilizes steam at sub-atmospheric pressure. Usual temperature 71 — 75°C 1-3 hours is required for sterilization’s. Sporicidal activity with low temperature steam is less than for steam at high temperature, but the process is reasonably efficient if conditions are strictly controlled.

4. Filtration : It uses suitable bacteria proof filter to remove the organisms. It is aqueous solutions particularly suitable for thermolabile ingredient infiltration of air removes dust particles and bacteria.

5. Radiation : The following methods of radiation are used for sterilization :
a. Ultraviolet radiation : It has a poor penetrating power and is absorbed extensively by glass, plastics and turbid liquids. It is suitable only for sterilizing air and water in thin layer, and hard impermeable substances.
b. Gamma radiation : It is highly penetrative and does not leave residual radioactivity on object being sterilized. It produces negligible temperature rise in the irradiated object at normal dosage. It is used for sterilizing some thermolabile pharmaceuticals and surgical products.

Methods of Disinfection

Cleaning alone.
Exposure to steam of boiling water at atmospheric pressure above 100°C For 5 — 10 minutes.
Pasteurization at 75°C for at least 10 minutes.

Factors determining the effectiveness of chemical disinfection :

Is the correct type of chemical agent being selected for the purpose required?
Has a suitable concentration of the chemical agent been used?
It the time of exposure to disinfectant sufficient and had adequate prior cleaning been carried out?
Has the correct pH been used?
Are in activating materials present?
What is the temperature and volume of the disinfectant in use?
Are the containers for the only disinfectant cleaned adequately?

1. Disinfection policy
It is necessary that all members of staff know the correct and approved agents for disinfection in the Hospital. This is important for the prevention of infection in the hospital environment. The effective use of antiseptics, disinfectants and sterilization procedures constitutes and important factor in preventing nosocomial infections.
a. Disinfectants must be used at the recommended concentrations neither to neither strong nor too weak.
b. The correct disinfectants must be used for the particular purpose for the recommended exposure time.
c. Disinfectants must be used within the expiry date and be freshly prepared.
d. For the disinfectants that are dispersed undiluted there should be :

Complete instructions for accurate dilution and use.
Labels must include the name of preparation, in use concentration, expiry date of unopened product, storage requirements, date of issue and date after which the solution should not be used.
Containers with no labels that are broken or leaking must be returned to the stores.

1.1 Where sterility is not required, disinfecting is sufficient.
1.2 Chemical disinfectants should be used only where :
a. Sterility is not essential
b. Cleaning is not sufficient
c. Disinfection by heat is not possible
d. Disposable equipment cannot be economically used.
1.3 Use dilutions of disinfectants should be freshly prepared. Any remaining disinfectant should be discarded and the container washed thoroughly before refilling. Containers should have glass or plastic closures (not cork) which can be cleaned.
1.4 It is mandatory to display the expiry date on disinfectant containers.
1.5 Instruments should not be stored in disinfectant solutions.
1.6 Disinfectant solutions must not be mixed or detergents added unless they are compatible.
1.7 Manufactures instructions must be consulted on compatibility of materials with the method of sterilization or disinfection.
1.8 Disinfectants that are reconstituted at ward level must be dated and discarded after 24 hours.
1.9 Disinfectants must never be topped up.
1.10 Each Supervisor must ensure that decontamination of all items / equipment in their departments, are carried in accordance with the guidelines provided in this policy.
1.11 New items of equipment that are not included in this policy should have a written protocol that complies both with the manufacture’s recommendations or disinfection and Infection Control requirement.

NOTE : It has been observed that cleaners of the House Keeping Unit of the hospitals do not have any idea on the above factors and they should be trained and educated on this aspect of Chemical Disinfection cleaning process of floors, walls etc.

2. Disinfection principles
2.1 Choice of method :
The choice of method of disinfection or sterilization depends on a number of factors that include.
a. Risk of patients and health care workers from equipments
b. Microorganisms involved.
c. Type of material to be disinfected.
d. Level of Contamination required for the procedure.

2.2 Risk
The risk of patients from equipment may be classified into four
categories :
a. High risk : This includes item in close contact with a break in the skin, mucous membrane of introduced into a sterile body area. Items in this category should be sterilized by heat if possible or if heat liable may be treated with low temperature steam and formaldehyde or liquid chemical disinfectant [Cidex]. Aim is sterilization.
b. Intermediate risk : this includes items in close contact with mucous membranes, body fluids or contaminated with particularly virulent or readily transmissible micro-organism or if the items are to be used on a highly susceptible patients or sites. Aim is sterilization.
c. Low risk : This includes items in contact with normal and intact skin, e.g. stethoscopes, crockery and cutlery. Aim is cleaning with detergent and water.
d. Minimal risk : Items in close contact with the patient or his/her immediate surroundings e.g. bed frames, lockers, walls, and ceilings. Aim is cleaning with detergent and water.

2.3 Cleaning and Drying
Cleaning is a process which removes soil e.g. dust, dirt, and organic matter along with a large portion of micro organisms a further reduction will occur in drying as microorganisms cannot multiply on clean dry surfaces. Thorough cleaning with detergent and water is adequate for most surfaces in the hospital environment. Cleaning is a prerequisite of disinfection or sterilization.

2.4 Disinfection
Disinfection is the destruction of pathogenic micro organisms but not usually bacterial spores. The process does not kill all micro - organisms but reduces them to a level, which is not harmful to health. Chemical disinfection should only be used if heat treatment is impractical or may cause damage to the equipment.

3. Recommended uses of chemical disinfection
The disinfectants commonly used are : Phenolics, Glutaraldehyde, Hypochlorites.
3.1 Antiseptics : An antiseptic is a non-toxic disinfectant, which can be applied to the skin or living tissues. An antiseptic should not be used to disinfect instrument or the environment. Antiseptics include : Savlon, Betadine, Microshield Rub.

3.2 Sterilization : Sterilization is the process, which achieves the complete destruction or removal of all micro — organisms including bacterial spores. Equipment and materials used in procedures involving a break in the skin or mucous membranes must be sterilized.
Sterilization include the following methods :
a. Steam under pressure [autoclaving] at e.g 132°C
b. Dry heat in the oven at 160 degree C
c. Exposure to Ethylene oxide gas. (EO)
d. Plasma sterilization.
e. Immersion in glutaraldehyde for a prolonged period.

4. Chemical disinfectants - agents
Cleaning with detergent and water removes about 80% while chemical disinfectants remove up 99% of micro — organisms.
4.1 individual agents
The Most Common Used disinfectants in the Hospital are :

4.1.1 Clear Soluble Phenolics
a. Characteristics : This group can be used at a dilution of 1% for routine cleaning and at 2% for dirty and contaminated materials and 5% for laboratory purposes. They have a wide range of bactericidal and fungicidal activities including tuberculosis activity but poor action against spores and virus. They are usually combined with detergent to aid the cleaving process.

Organic matter does not readily inactivate them.
Rubber and plastics absorb them.

b. Use : Phenolics are used for environmental disinfection. They are the agents of choice for Mycobacterium tuberculosis and MRSA and other multiple resistant bacteria. They are used in a theater after a “dirty case”.
c. Precautions

Respiratory irritation may occur if used at concentrations above those listed in this policy.
Appropriate protective clothing must be worn when handling phenolic disinfectants - they can be absorbed through the skin, therefore skin must be protected during use. Latex/Rubber gloves must be worn.
Phenolic solution must not be used on equipment that comes into contact with skin or mucous membranes.
Phenolic solution may taint food. Therefore it must not be used on food preparation surface or Equipment.

4.2 Halogens
These are chlorine-based disinfectants that include :

Sodium hypochlorite / Dichlorisocyanurates.
Hypochlorite / Hypobromite

a. Characteristics

The activity of the compound is due to chlorine.
They are bactericidal against bacteria, some fungal protozoa, algae & viruses and are specially recommended if there is hazard of infection.
They act rapidly by the release of available chlorine.
Solutions are unstable after dilution and therefore must be stored according to Pharmaceutical recommendations and used before the expiry date. They must be freshly prepared daily — light heat and heavy metal accelerates decomposition.
Chlorinated disinfections are corrosive to metals, damage plastic, rubber and similar components on prolonged contact or if used at the incorrect dilution.
Chlorinated disinfectants bleach fabrics, carpets and soft furnishings
Activity is pH—dependent : organic matter inactivates them.

b. Use

It is the disinfectant of choice for dealing with viral infections. e.g. Hepatitis B.C. HIV for environmental disinfection of blood spillage, body fluid spillage.
It is used for laboratory discard jars.
It is non-abrasive cleaning agents which may be used for environmental disinfection of hard surfaces i.e baths, sinks.
It is used to disinfect baby bottles / teats / spoons/ catering surfaces/equipment.

c. Precautions

Chlorinated disinfectants can cause irritation of the skin, eyes and lungs if used frequently in a poorly ventilated area.
Appropriate protective clothing must to worn when handling
Hypochlorites, Latex gloves disposable plastic aprons.
Do not mix strong acids or acidic body fluids [urine] with chlorine based disinfectants as chlorine gas will be released. Urine spillage should be cleaned first them disinfected with hypochlorite.
Do not submerge animal fibers [e.g wool or silk] due to strong proteolytic action.
Prolonged contact with stainless item should be avoided otherwise corrosion will result.

4.3 Glutaraldehyde [ Cidex 2% ]
a. Characteristics

It is an alkaline solution. It requires activation with 2% Buffered solution, once activated remains active for 14 days depending on the brand or preparation used and the frequency of use. It is less irritant than Formaldehyde.
Glutaraldehyde has a wide range of activity. It is bactericidal, sporicidal, virucidal, [Hepatitis B, C and HIV]. Prolonged immersion in Glutaraldehyde [60 minutes] is required to kill Mycobacterium tuberculosis and related organisms.
It has little inactivation effect by organic matter.
To ensure sporicidal activity exposure period of at least 3 hours is required. Up to 10 hours may be necessary in some cases.
It is non — corrosive to metals and other materials.

b. Use
It is used to disinfect heat sensitive items i.e. Endoscopes.
c. Precautions

Glutaraldehyde is an eye and nasal irritant and may cause respiratory illness [asthma] and allergic dermatitis.
2. It should be used in a well-ventilated place.
Eye protection, plastic apron and gloves must be worn when Glutaraldehyde liquid is made up, disposed of or when immersing instruments.
Aldehydes should be stored away from heat source and in containers with close fitting lids.

4.4 Formaldehyde [Formalin]
a. Characteristics

It is active against vegetative bacteria fungi and many viruses. It is very slowly effective against spores and acid — fast bacteria [e.g. Mycobacterium tuberculosis].
It is irritant and activity is reduced in the presence of organic matter. It does not penetrate organic matter well.
It is used for preservation of tissue specimens.
Aldehydes should be stored away from heat sources and in containers with close fitting lids.

b. Uses
Formaldehyde is used mainly as a gaseous fumigant to disinfect safety cabinets in the laboratory and to fumigate rooms of patients with a highly dangerous and transmissible infectious disease who are kept in strict isolation.

UPDATE

Though still practiced in many Hospitals, “Fumigation” is now an outdated practice and should not be used to sterilize rooms etc. Scrubbing with disinfectant has replaced fumigation world wide.
c. Precautions
Formaldehyde is a potent eye and nasal irritant and may cause respiratory distress and allergic dermatitis. Gloves, goggles and aprons should be worn when preparing and disposing of formaldehyde solutions.

4.5 Alcohols [70% ethyl alcohol, 60-70% Isopropyl alcohol]
a. Characteristics

This agent does not penetrate well into organic matter especially protein based and should only be used on physically clean surfaces.
It is rapidly bactericidal & fungicidal and it is used for disinfection of smooth surfaces e.g. trolley tops, incubators, and skin [needle puncture site].

b. Use

It is used for its rapid action i.e. alcohol impregnated wipes to disinfect the skin prior to injection.
May be used for hand disinfection after the addition of 0.1 - 1.0% glycerin [should be applied to physically clean hands].
It can be used with other bactericidal agents such as chlorhexidine and Povidone iodine for pre-operative skin disinfection prior to invasive procedures. It can also be used to disinfect some instruments in laboratory work e.g. probes.

c. Precautions

It must be stores in a cool place.
Alcohol mixtures are flammable. Do not allow coming in contact with hot surfaces, flames, electrical equipment or other sources of ignition.
Do not leave bottles uncapped as alcohol vapours irritate mucous membranes especially in an enclosed space and evaporates also.

4.6 Biguanides [Chlorhexidine]
Characteristics
Soap and organic matter inactivate these agents. They are highly active against gram - positive organisms but less so against gram — negative bacilli, esp Ps. Aeruginosa and Proteus spp.

4.7 Iodine and Iodophors [Povidone iodine/Betadine iodine]
a. Characteristics

This group has a wide range of bactericidal, virucidal, fungicidal and some Sporicidal activities and also active against some viruses and fungi.
They are inactivated by organic material and may corrode metal.
They have very rapid action.
1% w/v solution in 70% alcohol is an effective skin antiseptic, but might cause skin reaction.

b. Use
It is used exclusively as an antiseptic for skin and mucous membranes. It is available as :

Iodine : Aqueous iodine and Tincture of iodine.
Povidone iodine 10% — for skin disinfection [Microshield]. This is less irritant that iodine and does not stain the skin.
Povidone iodine 7.5% — Microshield scrub for hand/ skin disinfection.
Povidone iodine 10% with 70% Spirit Microshield alcoholic solution] for pre—operative skin preparation and skin disinfection prior 10 invasive procedures.

c. Precautions
Tincture and iodine and aqueous iodine solutions can cause skin irritation, while iodophors [Betadine] do not stain and have in most cases non—irritant skin activity.

Potassium Permanganate

a. Characteristics
It has a limited topical efficacy against bacteria and fungi.
b. Use
1:5000 concentrations have effective bactericidal actions, but is irritant to tissues. So 1:10,000 concentration is usually used.

Role of Nursing Services in Healthcare

hospitalmanagement24@gmail.com (Anonymous) — Sat, 21 Nov 2015 22:31:00 +0000

Role of Nursing Services in Healthcare

The role of the Nurse can be grouped into the following categories

Role of Nursing Service

General Role

Round the clock nursing services
Monitoring and coordinating nursing care
Assisting medical personnel in rendering medical care to the patients

Specific Role

Assessment of patients nursing need
Planning and providing of nursing care
Prevention of complication
Documentation of care provided to the patient
Assist hospital administration in measurement of the performance

Role of nursing executive

Designing and proving nursing care by allocating sufficient number of nursing manpower for patient care
Ensure continuous and timely availability of nursing personnel for the patient care
Implementation latest advances for nursing care
Measurement, monitoring and evaluation of the nursing care, thus helping in the control and administration of the nursing services of the hospital
Organize continuing nursing education performance
Organizing nursing audit

Universal Precautions Infection Control Guidelines

hospitalmanagement24@gmail.com (Anonymous) — Thu, 19 Nov 2015 13:38:00 +0000

Universal Precautions Infection Control Guidelines

1. Hand Washing
Hands must be washed:
a. Before and after coming in contact with any patient
b. After handling clinical specimens
c. After handling any contaminated material or surfaces
d. Before leaving the work place
e. Immediately after removing surgical gloves

2. Protective Clothing
a. Gowns / Aprons
A surgical gown/ plastic apron is used for procedures where excessive dissemination of blood and body fluids is unlikely to occur. However, in procedures likely to result in excessive dissemination of blood for example, major arterial surgery a gown with non permeable front and sleeves is used. Surgical gowns must be worn while performing the following procedures:

All surgical operations
Intubation
Haemodialysis
Endoscopy
Bronchoscopy
Dental Procedures
Child birth
A gown with non permeable front and sleeves is used while performing these procedures:
Procedures that produce splattering of blood and body fluids
Inserting arterial access
A plastic apron may be used while performing these procedures:
Suctioning and extubation
Handling soiled linen waste or equipment
CPR

b. Gloves
Gloves must be worn when performing a procedure on a patient or handling any contaminated material.
Sterile gloves are worn when performing aseptic procedure. In the operating theatres, the scrubbed team wears sterile disposable gloves, but when performing procedures in high risk patients, it is advisable to wear two pairs of gloves (double). Cuts or lesions on hands are covered with a waterproof dressing.

Wear sterile gloves while performing:
All surgical operations
Inserting arterial access
Haemodialysis
Endoscopy
Bronchoscopy
Intubation
Childbirth

Wear non sterile gloves when handling blood, body fluids or non intact skin of all patients and also when handling items or surfaces contaminated with blood and body fluids.
Non sterile gloves are used when performing the following procedures:

Contact with blood] body fluids, mucous membranes or non intact skin
Drawing blood
Suctioning and extubation
Handling soiled linen waste or equipment
CPR
Dental procedures

c. Masks
A surgical mask should be worn during procedures where splashes of blood or body fluids are expected. Masks must be worn with all of the following procedures:

Inserting arterial access
Suctioning and extubation
Handling soiled linen, waste or equipment
Intubation
CPR
Haemodialysis
Endoscopy
Bronchoscopy
Dental procedures
All surgical operations
Childbirth

d. Face shield or goggles
Face shields or the operators and their assistants to protect the eyes, whenever they perform procedures where aerosols or splashes of blood and body fluids may occur should wear goggles. When blood stained, goggles must be cleaned using paper cloths soaked in 0.1% hypochlorite solution (1000 ppm available chlorine). A face shield or goggles must be worn while performing the following procedures:

Inserting arterial access
Suctioning and extubation
Handling soiled linen, waste or equipment
Intubation
CPR
Haemodialysis
Endoscopic
Bronchoscopy
Dental procedures
Operative procedures that produce splattering of blood and body fluids
Child birth

3. Waste Management
a. Infected Waste
Infected waste is places in double yellow bags and disposed of according to laid policies
b. Disposal of sharps
All needles, syringes, scalpel blades and other sharps should be discarded immediately by the user, without re-sheathing into sharps disposable bin. The sharps bin should be handled and disposed of, according to the laid policy.
c. Non disposable linen and theatre clothing
Contaminated or infected linen should be placed in hot water soluble bags, into red/green linen bag, sealed and sent for washing. It is washed at very high temperature (80 degrees C for 30 minutes)
d. Laboratory specimens
Specimens must be collected into securely capped, leak proof specimen containers. The outside of the specimen container should be free of contamination by blood or other body fluids. The specimen should be placed in the specimen bag separate from the request form.
e. CSSD Equipment and Instruments
Reusable items should be places in the CSSD bin and sent directly to the CSSD. If heavily blood stained it should be sent to the CSSD in a polythene plastic bag.
f. heat sensitive Equipment
Heat sensitive equipment such as flexible endoscopes, should be cleaned carefully and rinsed with a detergent and water. Gloves must be worn and care taken to avoid splashing. The equipment should then be soaked in 2% glutaraldehyde for 20 minutes.
g. Anesthetic Equipment
Anesthetic equipment that has been in direct contact with the patient’s upper respiratory tract, such as facemasks and endotracheal tubes (if not disposable) must be disinfected after use for each patient according to laid policies.
h. Diathermy Equipment
The surfaces of diathermy machine, the leads and the diathermy plates should, if blood stained, be cleaned with sodium hypochlorite solution 0.1 % (1000 ppm available chlorine)
i. Spillage of Blood
Wear gloves and apron. Cover with a paper cloth, 1% hypochlorite solution (10,000 ppm available chlorine) and leave for 5 minutes clear using paper cloth and place soiled material into a disposable yellow bag.

4. Vaccination
The infection control team implements a programme of Hepatitis B vaccination of all staff that may come into contact with blood or body fluids. Response to vaccine is checked after vaccination. Anti HbsAg titre is expected to be >100 mlU/ml.

5. Inoculation injuries and splashes
Particular care must be taken to avoid at all cost accidental inoculation with blood/ body fluids contaminated sharps. Accidental inoculation injury must be treated immediately by encouraging bleeding under running water plus liberal washing with Betadine or Hibiscrub as follows:

Squeeze the wound to make it bleed.
Wash the injury site for five minutes in running water, and then wash with Betadine or Hibiscrub.
Splashes on eyes are thoroughly irrigated with water or normal saline.
Splashes in the mouth should be washed out using copious amounts of water.
Splashes on skin should be washed with water and Hibiscrub or Betadine.
Accidents have to be reported to the infection control doctor and the nursing officer on duty. The infection control doctor can be contacted at Bleep No. 247 and the Infection Control Nursing Officer Bleep No. 175. Outside normal working hours the Nursing Officer in duty at Bleep 009 may be contacted.
Fill in the All report form.
Proceed to staff health clinic ( SHC ) or accident & emergency (A&E) for further action.
All reports to be sent to the D.G.
Blood is collected from the victim for — HIV antibodies, HCV antibodies, HbsAg antibodies, VDRL.
Blood is collected from the patient for HIV antibodies, HCV antibodies, HbsAg antibodies, VDRL.

Note: The Incidence Report is kept confidential by the infection Control Nursing Officer in coordination with the Infection Control Doctor.

If the patient is found to be

HIV positive:
The victim should be referred to the appropriate clinic.
HbsAg positive:
Victim is immune = give a booster vaccine
Victim is not immune = give immunoglobulin and HBV vaccine.

If the victim was found to be

HIV/HBV or HCV positive:
Refer to the appropriate clinician.
HIV/HBV or HCV positive:
Repeat the tests three and six months later
VDRL positive:
Do confirmatory tests and if positive, refer to the appropriate clinician.

6. Patients with Inoculation — Risk Infections
a. Identification:
The clinician care for the patient will determine whether there is a definite or high probability of an infection risk requiring precautions. The following are considered high risk patients. They should be treated as if they harbour a blood borne pathogen, regardless of serological results.

Patients known to have a blood borne infectious disease.
Suspected clinical cases
Patients who had multiple blood transfusions
Homosexuals
Heterosexuals with multiple partners
Patients with sexually transmitted diseases
Prisoners
Drug addicts
Patients coming from countries where HIV is highly prevalent and undiagnosed jaundice patients.
Children of HbsAg, HCV or HIV positive mother.

b. Policy
The surgeon must notify the person in charge of the operating theatre that a patient with an inoculation risk infection requires operative procedure. Of heavy blood spillage is anticipated, the patient should be placed at the end of the operating list.
c. Operating theatre procedures

All staff working in the theatre is made aware that the patient has an inoculation risk infection
Only the minimum numbers of staff are present in the theatre
The staff appropriate protective clothing (see below)
Disposable linen is used wherever possible
Disposable waste is carried out in accordance with this policy.
Accidents or injuries to staff are reported promptly according to this policy.

d. Protective Clothing
The normal theatre outfit with boots must be worn.
Circulating Staff
They should also wear disposable plastic apron and disposable gloves.
Scrubbed Team
They should also wear disposable sterile gowns with non permeable front and sleeves. Gloves (two pairs), goggles and mask.
e. Non Disposable Linen and the theatre clothes
Contaminated or infected linen should be placed in the appropriate water soluble laundry bag, which is then placed in an ordinary red bag and labeled “Danger of Infection” and sent for laundry. It is washed at very high temperature (80 degree C). Grossly contaminated, heavily blood soaked linen must be placed in double yellow bags and sent for incineration.
f. CSSD Equipment and Instruments
Reusable items should be rinsed and placed in the CSSD bin. If heavily blood stained it should be placed in a CSSD bag.
g. Suction Apparatus
Tubing should be incinerated. Use a closed system suction apparatus whenever possible. If a closed system is not available, jars should be carefully emptied into the sluice and then filled with 1% hypochlorite and left overnight. The contents should then be emptied into the sluice, rinsed and sent to CSSD.
h. Heat Sensitive Equipment
Heat sensitive equipment such as flexible endoscopes, should be cleaned carefully and rinsed with a detergent and water. Gloves must be worn and care taken to avoid splashing. The equipment should then be soaked in 2% glutaraldehyde for 60 minutes.
i. Anesthetic equipment
Anesthetic equipment that has been in direct contact with the patient’s upper respiratory tract, such as facemasks and endotracheal tubes must be disinfected after use for each patient according to laid policies.
j. Diathermy equipment
The surfaces of the diathermy machine, the leads and the diathermy plates should, if blood stained, be cleaned with sodium hypochlorite solution 0.1% (1000 ppm)
k. Laboratory Specimens
Specimens taken during surgery must be collected into securely capped, leak proof specimen containers. The outside of the specimen container should be free of contamination by blood or other body fluids. The specimen must be placed individually in self sealing plastic bags; the request form should indicate the diagnosis and bear a “Danger of Infection” label and must be kept separate from the specimen in a double compartment bag.
l. Spillage of Blood
Wear gloves and apron. Cover with a paper cloth, gently tour 1% hypochlorite solution (10,000 ppm available chlorine) and leave for 5 minutes. Clear using paper cloth and place soiled material into a disposable yellow bag.

Aseptic technique

Purpose

To prevent contamination of wounds and other susceptible sites by ensuring that only sterile objects and fluids come into contact with these sites thus minimizing the risk of infection.
To maximize patient comfort by limiting / preventing the iatrogenic effects of hospitalization.
To reduce the cost of hospitalization.

Policy

The risk of nosocomial infection should be minimized, if not prevented, for patients receiving health-care. Special care must be taken when attending to patients who are immunocompromised. Those susceptible are neonates / elderly, patients with severe debilitating or malignant disease, and those receiving immunosuppressive drugs / the use of broad — spectrum antibiotics.
Aseptic Technique should be implemented in any surgical / invasive procedure that by passes the body’s natural defenses, e.g. the skin and mucous membranes; or when handling equipment such as intravenous cannulae and urinary catheters during the procedures.
Hand washing should be performed according to policy and procedure on Hand Washing.
Bactericidal alcohol hand-rub should be used as an additional measure, when necessary, in eliminating performer’s resident skin flora. E.g. Staphylococcus aureus, immediately before/during the procedure.
A non-touch technique is essential to ensure that hands, even though they have been washed, do not contaminate the sterile equipment or the patient. This can be achieved either by the use of forceps or sterile gloves.
Sterile packs should be checked for integrity, i.e. undamaged, intact and dry; and observe the recommended shelf life [expiry date]. If autoclave tape is used check that it has changed colour from blue to black. (Please check the autoclave tape manufacturers any other colour code instructions on this)
All fluids and materials to be used must be sterile. Manufacture’s instructions on solutions/disinfectants should be followed.
The trolley used for aseptic procedures should not be used for any other purpose. Unless the surface becomes physically contaminated, daily washing cleaned with spirit before and after each use.
An impermeable disposable apron should he worn as to prevent nurses’ clothing becoming contaminated with pathogenic microorganisms, which may subsequently be transferred to other patients in their care; and to avoid the transfer of potentially pathogenic microorganisms from nurse to patient.
Air movement should be kept to a minimum before and during the procedure in order to minimize airborne contamination.
The spread of airborne infection is most likely to occur in a open space and, ideally, the procedure should be performed in a properly large, ventilated room.

a. If the procedure is to be carried our at the patient’s bed-side, time should be given for dust to settle i.e. ward cleaning should have ceased at least 30 minutes before, and the curtains drawn at least 10 minutes before the dressing is begun.
b. During the procedure, no non-sterile equipment or outreached arm should cross the sterile field.
c. Wounds should be exposed for the shortest time possible; and wounds should be dressed before contaminated wounds; Colostomies and infected wounds should be dressed last.
Equipment

Trolley washed with soap & water & wiped with 70% spirit.
Sterile dressing pack
Sterile drape, if necessary
Appropriate sterile cleaning solution, as required.
Bactericidal hand-rub solution.
Adhesive tape.
Disposable sterile gloves.
Disposable plastic apron.
Disposable bag.

Procedure

Explain the procedure to the patient. If the patient is a child, explain the procedure to the parents also and ask them to wait away from the areas until the procedure is over.
Screen the bed area and position the patient comfortably.
Assemble all equipment needed on the bottom shelf of the trolley.
Attach disposable bag on side of trolley, below the level of the top shelf,
Put on a disposable plastic apron.
Wash and dry hands.
Open the outer wrap of the sterile dressing pack and slide the contents on to the top shelf of the trolley.
Ensure that outside wrapper is not in contact with the sterile field.
Open the sterile field touching only the corners of the wrapper.
Using a pair of forceps from the pack, arrange the contents within the sterile field.
Place the forceps at the edge of the sterile field.
Check solution concentration, and expiry date.
Pour cleansing solution into gallipot.
Avoid splashing solution that may contaminate the underlying sterile field.
Use the hand - rub
If appropriate, put on sterile gloves, touching only the inside wrist cuff.
Carry out the procedure, as required. Should sterile fluid/instrument become contaminated during the procedure, it must be replaced.
On NO account should it be used/ returned to the sterile field.
Make the patient comfortable. Draw back the curtains as applicable.
Place non - disposable equipment in the polyethylene bag and send to CSSD.
Dispose of Waste in appropriate colour coded clinical waste bag for incineration.
Clean the trolley with 70% sprit. Ensure it remains dry and physically clean.
Wash and dry hands.
Document the procedure in the patient’s notes.

Emergency and Disaster Management in Hospital

hospitalmanagement24@gmail.com (Anonymous) — Thu, 12 Nov 2015 11:41:00 +0000

Emergency and Disaster Management in Hospital

1. Introduction
Disasters in the communities occur in all shapes and sizes. Some impact a small number of people and put intense demands on the health system for a short period. Others may involve a large number of casualties but reach a plateau only after a latent period, placing heavy continuing demands on the health system. For some natural disasters like hurricanes, floods and volcanoes-hospitals ace likely to receive advance warning and be able to activate their disaster plan before the event. For other natural disasters, such as earthquakes and tsunami, there is no advance warning, as of now. Many man-made disasters also provide no advance warning; these include chemical plant explosions, industrial accidents, building collapses and acts of terrorism

The emergence of slate-sponsored terrorism, proliferation of chemical and biological agents, availability of materials and scientific weapons expertise all point toward a growing threat of a mass casualty incident (MCI). Preparing for MCIs is a daunting task, as unique issues must be considered with each type of event.

For example, the systemic stress of a bio-threat is entirely different from that of a chemical disaster. These differences hold challenging implications for the hospital preparedness and training. The hospital disaster preparedness has therefore assumed on an increased importance at local, state and national levels.

Disaster plan is a must for every hospital as a disaster can occur anywhere, any lime. The drill of the plan should be practiced periodically. No master plan can be evolved to fit every emergency. But, if executed in a coordinated and disciplined fashion, a general plan of emergency activity could prove extremely helpful in times of stress.

2. Definition
Hospitals would be among the first institutions to he affected after a disaster, natural or man-made. Because of the heavy demand placed on their services at the time of a disaster, hospitals need to be prepared to handle such an unusual workload. This necessitates a well documented and tested disaster management plan (DMP) to be in place in every hospital. To increase their preparedness for mass casualties, hospitals have to expand their focus to include both internal and community-level planning. The disaster management plan of a hospital should incorporate various issues that address natural disasters; biological, chemical, nuclear-radiological and explosive-incendiary terrorism incidents; collaboration with outside organizations for planning; establishment of alternate care sites; clinician training in the management of exposures to weaponizable infectious diseases, chemicals and nuclear materials; drills on aspects of the response plans; and equipment and bed capacity available at the hospital. The most important external agencies for collaboration would be stale and local public health departments, emergency medical services, fire departments and law enforcing agencies. The key hospital personnel should be trained to implement a formal incident command system, which is an organized procedure for managing resources and personnel during an emergency. The hospitals should also have adequate availability of personal protective hazardous materials suits, negative pressure isolation rooms and decontamination showers. A hospital’s emergency response plan has to be evaluated whether that plan addresses these issues. The hospitals in USA are required to have disaster response plans to be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In India and probably in many other countries, there is no statutory body to regulate and accredit this requirement.

A disaster is defined as ‘a serious disruption to community life which threatens or causes death or injury in that community, and damage to property which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilizations and organization of resources other than those normally available to those authorities’.

3. Disaster management concepts

All Agencies (or integrated) approach
Comprehensive approach embracing strategies in prevention, preparedness, response and recovery
All Hazards
Prepared Community

A range of disaster management concepts and the Hospital Incident Control System (HICS) have been adopted and implemented to assist in ensuring the Hospital’s preparedness in the particular area.

HICS provides a predictable chain of management, a flexible response as required for the event, accountability of position functions, and a common language to promote communication and facilitate outside assistance.

4. Aims and Objectives
To save as many lives as possible by providing best possible medical care under prevailing circumstances.

5. Types of Disaster
Disasters can be of various types as follow:
5.1 Vehicular train accident
5.2 Air crash
5.3 Fire in a big multi-storeyed building
5.4 Floods
5.5 Building collapse
5.6 Food poising, liquor poisoning and toxic gas poisoning
5.7 Earthquake
5.8 Explosions, blasts or ballet injuries
5.9 Mine accidents
5.10 Air raids
5.11 Storms and tornadoes
5.12 Atomic explosions

6. Training
A wide range of training of hospital staff is needed so ensure an effective health and medical response to a mass casualty event. Training should include, but not limited to,
6.1 General disaster response, including an. introduction to altered standards of care;
6.2 Legal and ethical basis for allocating scarce resources in a MCI;
6.3 Orientation to how an incident commands system would work in a mass casualty event;
6.4 How to recognize the signs and symptoms of specific hazards and treat specific conditions;
6.5 Basic and advanced life support; hazardous materials (HAZMAT) life support;
6.6 Decontamination and isolation protocols, triage protocols; personal protection gears; and
6.7 Use and maintenance of emergency equipment.

7. Disaster Management Preparedness
Preparedness for disasters is a dynamic process. In addition to having a well documented DMP in place, it is prudent to have regular drills to test the hospital’s DMP. The drills may be hospital disaster drills, computer simulations and tabletop or other exercises. In Bangladesh and India, hospitals rarely have a documented DMP and even rarely conduct disaster drills or publish the reports of such drills. The JCAHO actually requires hospitals to test their emergency plan twice a year, including at least one community-wide drill.

8. Purpose of Hospital Disaster Drill
The purpose of the hospital disaster drills is to train hospital staff to respond to an MCI, to validate the readiness and effectiveness of the hospital’s DMP. to make new hospital staff to become aware of procedures in disaster response, to incorporate advancements in knowledge and technology into the DMP and to use the reports from the drill to reinforce the DMP. Hospital disaster drills should test various components viz incident command, communications, triage, patient flow, drugs and consumables stock, reporting, security and other issues.

9. Procedure for Hospital disaster Preparedness
Survey of some published articles on disaster drills have highlighted that internal and external communications were the key to effective disaster response; a well-defined incident command center reduce confusion; conference calls were an inefficient way to manage disaster response; accurate phone numbers for key players were vital and regular updating was necessary; disaster drills appeared to be an effective way to improve clinicians’ knowledge of hospital disaster procedures;
9.1 Computer simulation is an economical method to educate key hospital decision makers and improve hospital disaster preparedness before implementation of a full-scale drill;
9.2 A tabletop exercise can help to motivate hospital staff to team more about disaster preparedness and can help to teach staff about aspects of disaster-related patient care in a way that simulates the practice setting;
9.3 A regional exercise involving top government officials can help to increase awareness of the need for better disaster response planning; and
9.4 Video demonstrations may be an inexpensive, Convenient way to educate a large number of staff about disaster procedures and equipment use in a short time.

10. Problems to be handled
10.1 Transportations of victims to the hospital
10.2 Provision of prompt medical attention
10.3 Advice on prevention of outbreak of epidemics.

11. Organization and Operation
Disaster Committee: There will be a standing committee of the Hospital Management Board. It consists of:

Head of the Dept. of Orthopedics
In-charge, Accident and Emergency Services
Head of the Dept. of Surgery
Head of the Dept. of Medicine
Head of the Dept. of Forensic Medicine
Head of the Dept. of Anesthesiology
Head of the Dept. of Radio-Diagnosis
Head of the Dept. of Gastroenterology

The Nursing Superintendent
It also consists of the Head of the Department of Hospital Administration if available to co-ordinate all the hospital supportive services DD/Deputy Medical Superintendent acts as the Officer-in-charge. The Director/ Medical Superintendent acts as the Chief Co-ordinator.

12. The Actual Operation Plan
12.1 Control Center: A control center for disaster operation is set up in open location (Room no-1) Ground Floor, of the Hospital, which functions with the Director/ MS as its chief organizer. The telephone numbers are: 0000000 / Ext. 000 and internal 000. The Director/ MS clearly identify the duties of his assistants and depute a standby for himself as well as for his assistants.
12.2 Alert: The moment information regarding a disaster reaches the Director/ MS, he alerts all those who are involved in the operation of the plan through a well-defined channel. The Mobile phone sod intercom play an important role at this stage. The operator, as informed by the Director/ MS informs all these persons shoot the disaster.

13. Reception Center

a. For moderate load:

The present casualty O.P.D / Emergency will function as the reception area.

b. For heavy load:

Main Hall of Ground floor O.P.D will be converted into reception center.

⇢

Police and Security personnel of the Hospital will act as Traffic Controllers directing the patient and relatives to the respective reception centers on the orders of the co-ordinator.

14. First-Aid and Sorting

a. For moderate load:

Existing casualty medical team will function for first aid and sorting.

b. For heavy load:

The center will be manned by 4 teams, each consisting of:

One General Surgeon
One Orthopaedic Surgeon
One Physician
One Anesthetist
Two Sisters
Two Nursing Orderlies
One Sweeper/Cleaner
Two Teams of stretcher — bearers each having one stretcher and two Stretcher Bearers.

The responsibilities of First-Aid Center will be:

a. Quickly sorting out casualties into
i. Priority one: Needing immediate resuscitation
ii. Priority two: Immediate surgery
iii. Priority three: Needing first-aid and possibly surgery
iv. Priority four: Needing only First-Aid

b. Action
i. Priority one will be attended to in the Casualty Department and if need arises will be sent to intensive care.
ii. Priority two will be transferred immediately to casualty O.T. or Main O.T.
iii. Priority three will be given first aid and admitted if bed is available or transferred to other hospital.
iv. Priority four patients will be given first aid and discharged home.

The area marked for conversion into ward: Corridors of Ground and first floor
Brought in dead or those who stay die while receiving resuscitation will be segregated. Temporary morgue for keeping dead bodies will be created in the long verandah of Ground Floor. Necessary identification and handing over of bodies to the relatives after medico legal clearance will be done in this area. This will function under care of the Department of Forensic Medicine.

Additional Bed Space
In Addition to the area marked on first floor, extra bed will be created as follows:
1. Any vacant beds will be requisitioned by the Director / M.S. for this purpose.
2. By discharging following categories of patients:
a. Convalescing patients needing only nursing care
b. Elective surgical cases
c. Patients who can have domiciliary care or OPD advice
3. Ward side-rooms and Seminar rooms of the wards may have to be used temporarily.

15. Linen Stores
A room of second floor is earmarked for this purpose. Following stores will be transferred to that room.

Mattresses — 40
Bed Sheets — 120
Blankets — 80
Pillows & Covers — 60
Patient clothing (female) — 30
Patient clothing (male) — 30
I.V. stand — 60
O₂ Cylinder — 20

16. Drugs and Equipments
The Medical Store Keeper and the Surgical Store Keeper will be called at once to open the store. As an immediate measure the buffer stock earmarked in the Casualty will be utilized. All essential drugs will be stocked in the medical stores and will he issued on order of the Director/ M.S/ DMS/ Duty Officer.

Dressing material and items of surgical stores are similarly kept in reserve. A dozen emergency trays containing life saving drugs will be kept ready in medical stores. For the first few hours the drugs will be requisitioned from emergency stock lying with Sister-in-charge at the Casualty. Approximately 400 bottles of different types of saline/crystalloids are kept available at the saline/crystalloids stores for use in such emergencies.

17. Emergency Blood bank
Efforts shall be made for blood of all the available groups to he stocked in plenty. Volunteers and voluntary organizations will be approached to donate as much blood as possible. The responsibility for this will be that of the B.T.O. / the Asst. B.T.O.

18. Staff
Medical Staff: In addition to members of regular clinical units the faculty members of para and pre-clinical disciplines will be asked to render help to assist the clinical staff in managing the causalities. The duty roster of regular consultants and stand-by doctors is to be made available in control room.

Nursing Staff: A pool of nurses will be created by the Nursing Superintendent. So that nursing staff is available at short notice. This pool should consist of nurses staying in the hostel for operational reasons. Duty roster will be sent to Duty Officer by the Nursing Superintendent. One sister will be detailed to take charge of personal belongings of the patients.

Class IV Staff: All the available class IV staff will be utilized except for those who are already on duty in emergency areas. DD/DMS/Sanitary Superintendent will create a pool from amongst the staff residing in the campus. Duty roster will be sent to Duty Officer by DD/DMS /Sanitary Superintendent.

Volunteers: Volunteers will be invited by coordinated effort of the DD/ Deputy Medical Superintendent.

19. Documentation Center
a. For small load of casualty: Documentation shall be done at the casualty OPD itself.

b. For large load of casualty: It is to be established in Ground Floor OPD at the Central Registration Office of OPD. The staff working at registration counters and Nursing staff will be utilized for documentation and identification. Volunteers may also be engaged for this purpose.

20. Hospital Security
Security of staff, patients and hospital building and equipment being of paramount importance. Daring such disasters, Security Officer is required to tune up and organize the security arrangements for this purpose.

21. Food Service
Supply of nourishment to the patients and emergency duty staff will start immediately by the staff of the Dietary Services under direct supervision of the Head of Dietary-in-Charge of Kitchen. Most of she patients for first 24 — 48 hours will be using only liquid or semi-solids. During this time arrangement can be made for supply of proper meals.

22. Ambulances
All the available ambulances will be kept in first rate operational condition and shall be available at casualty department along with drivers as soon as the state of emergency/Disaster is declared.

23. Information Services
The Public Relation Officer (PRO) of the Hospital will function as Information Officer. All information to Press, Radio and other media, to individuals and organizations, Governmental or otherwise, will be issued by him. He will get prior clearance from component authorities before issuing such information.

24. Engineering and Maintenance Services
The engineering section will make sure that water and electricity is made available without interruption. All the standby electric power generators will he regularly checked, inspected and maintained in excellent serviceable condition.

25. Discharge Procedure
After appropriate treatment the patients fit to be discharged shall be discharged to go home or to other hospital for convalescence. For all cases discharged the destination will be noted by the hospital and police informed.

26. Success of Plan
Disaster in an emergency situation. Timely help of every individual is needed to make this plan a success to reduce the Mortality and Morbidity. In such state of affairs the individual and personal consideration take low priority in the face of duty to the profession for the sake of amelioration of human suffering.

Hand Washing Techniques Infection Control Management

hospitalmanagement24@gmail.com (Anonymous) — Fri, 06 Nov 2015 13:20:00 +0000

Hand Washing Techniques

Hand washing is the most important and effective universal precaution for infection control
Purpose

To remove dirt and/or to reduce the level of organisms present on the hand.
To prevent hospital-acquired infection.

Policy
Hand washing technique should be adhered to for following

Prior to and after handling patient, particularly those infected or colonized with highly resistant bacteria.
Prior to and after performing aseptic techniques or any nursing procedure.
After handling contaminated material/substances such as secretions/excretions and blood and body fluids.
On arrival for, and prior to departure from duty.
Before and after using the toilet/bathroom, before going to the cafeteria and after completing duty.
Before and after touching wounds and dressings of any type.
Before preparing or serving food.
After touching hair, nose, mouth or handkerchief.
Prior to and after contact with patients susceptible to infections.
After touching sources likely to be contaminated with significant microorganisms such as urine measuring devices, suction bottles, and sputum collection pots.
Before and after wearing gloves. Gloves should not be used as substitute full hand washing.
Attendants and visitors to specialized areas should be instructed on the importance of hand washing and should be encouraged to do correctly.

Equipment

Sink with elbow operated taps.
Liquid soap or antiseptic solution in the dispenser — CHLORHEXIDINE GLUCONATE 0.5-2.5 % E T H Y L ~~A L C O H O L~~ 70% (MICROSHIELD HAND RUB).
Disposable paper towels in the dispenser.
Waste container with a foot pedal.

Procedure

Roll up sleeves well above elbow particularly in critical care areas and remove wristwatch and rings.
Turn on the taps with the elbows to reduce the risk of contamination, and adjust Water to a comfortable temperature.
Wet hands and forearms with running water.
Use elbow to depress the arm of the soap / antiseptic solution Dispenser. and allow a sufficient quantity of solution onto the hand to produce visible lather on all surfaces.
Allow the water to run continuously and do not allow hands to touch any part of the taps or sink throughout the procedure.

Lather hands using a friction motion ensuring that all parts of the hands and wrists are covered.
Palm to palm
Right palm over left dorsum and left palm over right Dorsum.
Palm to palm fingers interlaced.
Back of fingers to opposing palms with fingers interlocked.
Rotational rubbing of right thumb clasped in left palm and Vice versa.

Rinse hands thoroughly under running water, starting first with the fingers, palms, and wrists.
Drain excess water by a downward shaking motion from fingers to wrist. Let water drip off well above the washbasin.
Dry hands completely with a paper towel, and then proceed to the wrists.
Turn taps off using either the elbows or the used paper towel. Dispose of the used paper towel in the foot operated pedal bin provided at all sinks.
Care must be taken to avoid excessive splashing on clothes, floor, and adjacent equipment.

Note : An alternative method of hand washing is the application of 3 - 5ml of ~~A L C O H O L I C~~ hand rub [containing 2% glycerin] covering all surfaces. This method provides a convenient, rapid and effective alternative to hand washing in situations where there is no gross soiling of the hands and where no sink is readily available.

The Methods of Hand Washing

A. Social Hand Washing

Social hand washing will render hands socially clean and remove transient microorganisms provided that an effective technique is used. Special attention should be paid to the tip of the fingers, the thumbs and other areas of the hand likely to come in contact with contaminated sites.

Hands should be washed when soiled, after handling patients, after visiting the toilet, before handling food, before starting and leaving work, after cleaning sessions or after handling infected waste.

Use liquid soap or an antiseptic hand wash.
Wet hands and forearms. Rub vigorously to from lather on the surface of hands for at least 15-20 seconds. Rinse thoroughly and dry well using a good quality paper towel.

B. Antiseptic Hand Washing

Antiseptic hand washing should be used before aseptic procedures, before contact with the susceptible patient and after contact with infected patients or contaminated material or equipment.

Use an antiseptic hand-wash preparation — CHLORHEXIDINE GLUCONATE / ~~A L C O H O L~~, skin antiseptic.
Wet hands and forearms, using 3-5 ml of antiseptic solution, rub vigorous to form lather on all surface of the hands and forearms for at least one minute.
Rinse thoroughly and dry well.

C. Surgical Hand Washing

Surgical hand washing requires the removal of transient microorganisms and a substantial reduction and suppression of the resident flora. This is performed prior to surgery to ensure that a high level of skin disinfection is achieved.

Fingernails should be kept short and clean and nail varnish, wristwatch, or jewelry should not be worn.
Turn on the taps using the elbow and adjust the flow and temperature of water. Wet hands and forearms. Apply antiseptic hand wash preparation from elbow operated pump dispenser.
Lather hands, wrist and forearms for the minute keeping them above elbow level and rinse thoroughly. Clean the nails with a sterile nailbrush at the beginning of the operating list.
The hand washing procedure is then repeated for two minutes. The hand's wrists and forearms are then rinsed thoroughly under running water, still keeping the hands above elbow level and the excess water is gently shaken off.
The technique of drying the hands is very important. A separate paper towel is used for each arm, moving from fingertips to elbow using a dabbing action.
The paper towel is discarded and the procedure repeated for the other arm. When hands wrists and forearms are thoroughly dry, the individual is ready to gown and glove.

Note : Hands must be washed after removing gloves. Wearing gloves does not obviate the need for hand washing.

Important
Hand washing agents may give rise to skin irritation or induce sensitivity. To minimize this, it is important that hands are rinsed well and dried thoroughly. Should skin irritation or sensitivity occur, please seek advice from Staff Clinic. Some types of hand creams may interact with antiseptics, both reducing the effect of antiseptic and giving rise to skin irritation only hand cream approved should be used.

INFECTION CONTROL HAND WASHING TECHNIQUE

HAND WASHING IS THE MOST IMPORTANT EFFECTIVE UNIVERSAL PRECAUTION FOR INFECTION CONTROL

The 10 most important carriers of cross infection are your 10 fingers. Practice and Preach Hand Washing

Protection against blood Borne diseases

Introduction
Bloodborne infections such as human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) have caused serious concern to health care workers exposed to blood, body fluids and other potentially infectious material that may contain bloodborne pathogens. The risk of blood-borne infection following percutaneous exposure is >30% for HBV, 3- 10% for HCV and 0.38% for HIV. However, the risk of HBV infection may be virtually zeroed if the victim is immune.

Definitions
A blood or body fluid exposure is defined as a needle stick or sharp puncture wound, a splash to mucous membrane or contact with skin that has an open cut or abrasion. Blood means human blood, its blood products or blood components. Other potentially infectious materials include human body fluids, such as semen, vaginal secretions, saliva in dental procedures and any body fluids visibly contaminated with blood.
The “At Risk” healthcare workers are:

Medical practitioners (Surgeons and physicians)
Dentists and Dental employees
Nurses and Phlebotomists
Laboratory technologists
CSSD workers and technicians
Housekeeping personnel
Laundry workers
Paramedics
Medical Orderlies

Prevention Strategies

Screening patients for blood-borne infections for infection control purposes are no longer acceptable. Most authorities now advise applying universal precautions (UP). when performing a high-risk procedure, because it is impossible to identify many virus carriers on the basis of clinical inquiries.

Detection of infection may be missed while patients are incubating or carrying the HIV, HTLV - 1, syphilis, HBV or HCV or other blood-borne diseases. Furthermore, some blood-borne infections such as Hepatitis other than B and C and HIV - 1 subtype O are not detectable by serology. It has been shown that HIV testing alone would detect only 24% of infected patients.

See Also: How To Take Care Of Feet And Hands?

Therefore, blood and blood containing fluids from all patients should be presumed to be infectious and should be considered an Occupational hazard and a system of universal precautions has to be established when dealing with blood and body fluids. This involves the identification of high-risk procedures rather than high-risk individuals. The universal precautions are designed to protect staff from risks such as sharps injuries and body fluid spillage and patients from cross infection.

Personnel Management in Nursing for In-patient Department

hospitalmanagement24@gmail.com (Anonymous) — Tue, 03 Nov 2015 14:49:00 +0000

Personnel Management in Nursing for In-patient Department

Management of Patient Care

It is the legal responsibility of the nursing administrator/ ward in-charge to provide and ensure quality care to the patients. The administrator/ ward in-charge should instruct his/her employees to be very cordial and sympathetic with the patients and their attendants besides providing the quality care to the patients. She is the spokes person, she is the leader and responsible for the liaison with the staff, patients, visitors, VIPs, press and everybody coming to the ward. The importance becomes even more in the crisis situation.

Management of Personnel

Management of personnel is not an easy job. The nursing administrator / ward in-charge has to create a working environment providing facilities and services within the reach of all categories of staff. He/she has to motivate the subordinates to achieve the organizational goals. She has to communicator, motivator, leader and counsellor and disturbance handler in the ward; most of the time her presence is felt in the wards. The clinicians come to ward and go back to their perspective department, handling over their responsibility of patient’s care to the nurse.

Coordinating

Coordinating is the integrating process in an orderly pattern of group effort; in any hospital toward the accomplishment of a common objective. To ensure the harmonious and smooth working of an organization with a number of its divisions, departments or units, activities in all areas are required to be pulled together, unified and blended so as to give them a common purpose. Coordination is basically synergy. The diverse departments are brought together to work for a common purpose of rendering quality care to the patients in the wards. Much of the name and fame of the hospital is dependent upon the work of the nurses. Coordination must have time, quantity, and direction dimensions. Coordination is different from cooperation; in cooperation people help each other to accomplish their objectives; in coordination it is the combined and synergistic effort to achieve the common organization objectives. It is a mutually arranged effort of the requisite quality and quantity, arranged at the proper time through deliberate executive action.

Counselling

Counselling in general is defined as helping people to help themselves. It is the process of helping people to help themselves. It is the process of helping a person to solve his problem by himself. Counselling is also defined as a conversation between two people for the purpose of solving the problem.

Strategic Management

The term strategic management has been borrowed much from the military sciences. It is more appropriate in the war like situations. The strategic management has become very popular in the service industries also. This is basically dependent upon the following factors:

To establish long term goals.
To determine the need of the resources to be deployed for achievement of these goals.
To make environmental analysis, meaning thereby to assets the external environment of the ward in relation to the hospital. To weigh the strength and weakness of each.
To select the best course of action to achieve these goals.
Wards also need a strategic management.
Nursing unit of ward is responsible for giving strategic direction to a ward: Person in-charge of the ward should have over all perspective of the resources, constraints, objective and plans of the hospital. There should he a definite image of the ward and the specially treatment aimed for.
The capacity, requirement of the personnel, medical and para-medical, nursing, technical, non-technical and equipment should be determined.
The standards of quality care of the patients should be established.
There should be proper training of the ward personnel and should establish an evaluation system of patient’s care.

Operational Management

The operational management is basically management on short term and day to day basis at the operational level. Strategic management gives a direction, white operational management works towards this strategy. The objectives should be to provide comforts and good quality care to the patients, as a short term, while long term objective should be improvement and establishment of a system for the functioning of the ward.

Monitoring and Evaluation

Monitoring is the observation and recording of the discrete activities; with as objective to evaluate the plan. The evaluation is itself dependent to a large extent on good monitoring process. Functioning of the ward is monitored by various methods. Nursing is a dynamic, therapeutic and educative process in meeting the health needs. The activities undertaken by the nurses are:

Epidemiology and Surveillance of Hospital Infection

hospitalmanagement24@gmail.com (Anonymous) — Sun, 01 Nov 2015 18:40:00 +0000

Epidemiology and Surveillance of Hospital Infection

Hospital Infection Control is based on surveillance which is defined as a continuous process of scrutiny of all aspects of all occurrences and spread of diseases that can be effectively controlled. A proper and scientific surveillance can cut down the infection rate by one third. It also helps to control a threatening outbreak of an infection.

Surveillance is an ongoing day-to-day activity of the Infection Control Team [ICT]. It includes laboratory-based monitoring of microbial isolates from hospitalized patients and correlating with signs of clinical infection. This is usually carried out daily by the Infection Control Nurse in liaison with the microbiology staff and ward nurses. Surveillance also includes early detection, notification and monitoring of particularly transmissible, so-called “alert organisms”. These organisms are Methicillin-resistant Staphylococcus aureus [MRSA]. Vancomycin resistant Enlerococcus [VRE], Clostridium difficile, Acinetobacter baumannii, Multiple resistant organisms, Neisseria meningitidis, Legionella pneumophila. Day-to-day surveillance allows early detection of an “alert organism’, cross infection or outbreak. The ICT can then move to investigate and control the infection.

Surveillance of Infection Control practices and monitoring proper implementation of laid policies is a function of the ICT. ICT performs regular Visits to essential hospital departments such as wards and clinics, operating theaters and the laboratory, housekeeping, catering, engineering and pharmacy. Hospital Infection rate is published monthly and distributed to all hospital wards and departments. Surveillance of hospital-acquired infection is a good measuring tool and indicator that should keep everyone aware of the occurring infection and ways to control it.

Recording & Classification of post-operative wound infection

Surgical operations are classified into four categories, each with a permissible infection rate. These categories are:

Clean Wound

A clean wound is a surgical wound with no evidence of inflammation and the gastro-intettinal [G1], respiratory or genito-urinary [GU] systems have not been entered. The expected [permissible] rate of infection of a clean wound is 1-2%.

Clean Contaminated Wound

A clean contaminated wound is a surgical wound giving access to a procedure in which the G1, respiratory or GU systems are entered under controlled conditions without spillage. Biliary, appendix, vagina and oropharynx may be included. There must be no evidence of inflammation. The expected [permissible] rate of infection of a clean contaminated wound is 3-5%.

Contaminated Wound

A contaminated wound is an open fresh accidental wound giving access to a site of acute, non-purulent inflammation or where the G1, respiratory or GU systems are entered and it is known they are infected. Also where there is spillage from one of the systems during the course of procedure. The expected [permissible] rate of infection of s contaminated wound is 5-15%.

Dirty Wound

A dirty wound is an old traumatic wound where there is devitalized tissue present of where there has been faecal contamination or a surgical wound giving access to perforated viscous or free pus is encountered. The expected [permissible] rate of infection of a dirty wound is 15-25%.

Daily incidence report criteria on nosocomial infection

Type of Nosocomial infection

Surgical site infection

Simplified criteria

Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation.

Urinary infection

Positive urine culture [1 or 2 species with at least 10-bacteria/ml] with or without clinical symptoms.

Respiratory infection

Respiratory symptoms with at least to of the following signs appearing daring hospitalization.

- Cough
- Purulent sputum
- New infiltrate on chest radiograph
- Consistent with infection

Vascular catheter infection

Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter

Septicemia

Fever or rigors and at least one Positive blood culture

Nursing Management in the Ward for In-patient Department

hospitalmanagement24@gmail.com (Anonymous) — Wed, 28 Oct 2015 20:08:00 +0000

Nursing Management in the Ward for In-patient Department

Management in the Ward

Management defined in a simple language is to get the work done in a systematic way for accomplishment of defined objectives based on management of men, money and materials, machines, methods and minutes. Management gives us the clue as to how to get best possible services and how to make the ward administration effective and efficient. It is also said that management is a process by which a cooperative group directs action towards common goals. Ward management is facilitated by the development of systematic procedures for dealing with the details of ward functions by adoption of a system of day-to-day tasks. The ward management is basically an operational management. The ward management is the key to success of the hospital. The image of a hospital depends to a large extent upon the patient’s satisfaction. The patient’s satisfaction is dependent upon the effective ward management. The effective ward management depends upon the technical skills and ability of the ward sister. Another important fact about the ward management is, ward is a matrix organization, a very complex organization. It is to be managed on the principles of a project management. The ward sister is under the dual Command, at one hand she is under the command of the physician in—charge of the ward/department at other hand she is under the command of nursing superintendent. This makes management of the ward a very challenging job. While managing a ward, the manager has to apply various managerial skill which differ as per the level of the management. The student is advised to consult the introductory chapter on management in the same book. The nurse manager has to apply the whole management process while managing the ward/unit and to follow all the management principles.

Ward Management

Objectives

The objectives of ward management can be classified as

Short term objectives: Patient care, treatment and early discharge will be short term tangible objectives.
Long term objectives: Especially treatment, personnel training and advancement are long term objectives.

Main role in ward management is performed by the nursing unit. This unit forms the system, ensures its proper implementation and performs evaluation towards the care and comfort of the patients with full supervision. A nursing unit should be so designed that it can operate at minimum cost and can at the same time also achieve the functional goals of the ward. The nursing unit has to be an efficient unit of the hospital. Much of the care in the hospital is dependent upon the quality output of the nursing services: The person in-charge of a nursing care in the ward is called ward-sister or sister-in-charge.

Management of Ward

Management of personnel
Policy and procedures of IPD
Management of supplies and equipments
Management and control of environment of IPD

Guidelines and Requirements for Intensive Care Unit

hospitalmanagement24@gmail.com (Anonymous) — Mon, 19 Oct 2015 12:23:00 +0000

Guidelines and Requirements for Intensive Care Unit

Guidelines for the Staffing and Equipment Requirements of the Intensive Care Units

I. Medical Staff Organization

A. A distinct medical staff critical care organizational entity (department, division, section, or service) exists

Privileges (both cognitive and procedural) for members of the critical care physician team arc approved by the medical staff credentials committee based on previous training and experience as defined by the medical staff
A section of the medical staff bylaws delineate the regulations governing the implementation of these conditions
Budgetary activities relating to unit function, quality assurance, and utilization review are conducted as joint medical / nursing administrative endeavours
A critical care representative serves on the medical staff Executive Committee

B. The team is organized and led by an intensivist with time, expertise in, and significant commitment to the care of the critically ill patient within the Asian Hospitals.
C. Patient management is directed by an attending level physician who:

Is privileged by the medical staff to have clinical management responsibility for critically ill patients
Certified in critical care medicine or has equivalent qualifications
Supervises the patient as often as required by acuity but at least twice daily directly or through a surrogate physician. Free for service will be half when an ICU patient is seen through a surrogate physicians.
Is either the patient’s attending physician or a consultant who provides direct management of critically ill patients D. Medical Staff members should participate in Bioethical Committee activities.

II. Unit Organization

A. A physician NURSE Unit Coordinator is required.
B. Specific requirement for the Unit Coordinator include:

Training, interest, and the time availability to give clinical, administrative, and educational direction to the ICU
Qualification/ Certification in critical care medicine.
Time and commitment to maintain active and regular involvement in the care of the patients in the unit.
Expertise necessary to oversee the administrative aspect of unit management. Including formation of policies and procedures, enforcement of unit policies, and the education of unit staff.
The ability to assure the quality safety and the appropriateness of care in the ICU.
Availability (either the Coordinator or similarly qualified surrogate) to the unit 24 hrs/day, 7 days/wk for both clinical and administrative matters.
Active involvement in local and/or national critical care societies
Participation in continuing education programs in the field of critical care medicine.
Hospital privileges to perform relevant invasive procedures.
Active involvement as an advisor and participant in the organization of the care of the care of the critically ill patient in the community as a whole.
Participation in the education of unit staff, other physicians, SHOs, and medical staff as indicated.
Participation in scholarly activity.
Active participation in the review of the appropriate utilization of ICU resources Hospital.

C. A nurse manager is appointed to provide precise lines of authority, responsibility. And accountability for the delivery of high-quality patient care. Specific requirement for the nurse manager includes:

An RN with a BSc or preferably a Masters degree.
Certification in critical care or has equivalent graduate education.
At least 3 yrs. of experience working in critical care unit.
Previous management experience, including experience with health information systems, quality improvement/risk management activities, and healthcare economics.
Preparation to participate in the on-site education of critical care unit nursing staff and physicians-in-training.
Ability to foster a cooperative atmosphere with regard to the training of nurses, physicians, respiratory therapists, and other personnel involved in the care of critical care patients.
Regular participation in ongoing continuing nursing education.
Ability to participate in and foster cooperation in, scholarly activity in the ICU.
Knowledge about current advances in the field of critical care nursing.
Participation in strategic planning and redesign effort.

III. Physician Availability

A. A variety of studies suggests that a full time intensivist improves patient care and efficiency.

At least one physician who can manage emergencies, including airway emergencies, and is certified in ACLS. This requirement may be fulfilled by senior SHOs or physician extenders capable of handling emergency situations. An attending physician fully credentialed in critical care medicine must be on call and available within 15 minutes.
Critical care physicians appropriately credentialed to provide dedicated care to the critical care unit patients. Critical care fellows may fulfil this requirement.

B. The following physician sub specialist should be available within 30 minutes:

General Surgeon
Neurosurgeon
Cardiovascular Surgeon
Obstetric-gynecologic surgeon
Urologist
Thoracic surgeon
Vascular surgeon
Anesthesiologist
Cardiologist
Pulmonologist
Gastroenterologist
Hematologist
Infectious disease specialist
Nephrologist
Neuroradiologist/Senior Radiologist
Pathologist
Traumatologist/Emergency Chief
Metabolic/Endocrine Specialist
Neurologist
Orthopaedic surgeon

IV. Nursing Availability

A. All patient care is carried out directly by, or under supervision of, a trained critical care nurse.
B. All nurses working in critical care should have complete a clinical critical care related course/training before assuming full responsibility for patient care.
C. Unit orientation is required before assuming responsibility for patient care.
D. Nurse to patient ratios should be based on patient acuity.
E. All critical care nurses must participate in continuing education.

V. Respiratory Therapy Availability

A. A respiratory therapist available to the unit at all times is required. Ideal levels of staffing are based on acuity, utilizing objective measures whenever possible.
B. A working knowledge of the principles of management of patients with acute respiratory failure is required.
C. The therapist must be familiar with ENDOTRACHEAL INTUBATION mechanical ventilators and with the range of ventilatory modes.
D. Proficiency in the transport of critically ill patients is required.

VI. Pharmacy Services Requirement

A. Unit dosing and intravenous admixture services.
B. Availability of registered pharmacist to monitor drug dosing and administration regiments.
C. Availability of a pharmacist with specialized role in activities such as nutritional support formulations, cardio respiratory resuscitation efforts, and clinical research products.

VII. Other Personnel

A variety of other personnel may contribute significantly to the efficient operation of the ICU. These include unit clerks, physical therapist, occupational therapist, advanced practiced nurse, physician assistant, dietary specialist, and biomedical engineers.

VIII. Laboratory Services

A. A clinical laboratory should be available on a 24 hour basis to provide basic hematologic, chemistry, and blood gas analysis.
B. STAT or “bedside” laboratories adjacent to the ICU or rapid transport system provide an optimum and cost-effective setting for obtaining selected laboratory tests in a timely manner.

IX. Services Provided in the Unit

An ICU has the capability of providing basic monitoring and patient support. In order to do so, the ICU is prepared to provide:

Continuous monitoring of the electrocardiogram (with high/low alarms) to all patients
Continuous arterial pressure monitoring (invasive and noninvasive)
Central venous pressure
Equipment to maintain the airway, including laryngoscopes and endotracheal tube
Equipment to ventilate, including Ambu bags, ventilators, oxygen, and compressed air
Emergency resuscitative equipment
Equipment to support hemodynamics, including infusion pumps, blood warmer, pressure bags, blood filters
Transport policies that address transport monitors, transport ventilators, and resuscitative equipment
Beds with removable headboard and adjustable position
Adequate lighting for bedside procedure
Suction
Hypo-hyperthermia blankets
Scales
Temporary pacemakers
Temperature monitoring devices
Pulmonary arterial pressure monitoring
Cardiac output monitoring
Inspired oxygen monitoring capability for all ventilators
Hemodialysis
Peritoneal dialysis
Capnography
Transcutaneous oxygen monitoring or pulse oximetry for all patients receiving supplemental oxygen
In house availability of a CT scanner, cardiac catheterization lab, echocardiography, nuclear medicine testing, and Venous Doppler techniques.
Fiberoptic and rigid bronchoscopy
Fluoroscopy capability in unit or readily available in radiology
Intracranial pressure monitoring

Infection Control Activities in the Hospital

hospitalmanagement24@gmail.com (Anonymous) — Sat, 17 Oct 2015 13:00:00 +0000

Infection Control Activities in the Hospital

THE COMMAND’S STRUCTURE

INFECTION CONTROL COMMITTEE [ICC]

A committee of experts to develop plans and policies for Infection Control and monitor overall activities.

↓

INFECTION CONTROL TEAM [ICT]

A working body which implements ICC policies and supervises day to day infection control activities and take the remedial measures whenever necessary.

↓

INFECTION CONTROL NURSE [I C N]

A full time senior staff nurse who carry out day to day surveillance activities in infection control and reports to Infection Control Team on daily basis.

↓

MASTER TRAINERS - TRAINERS

A certified group of hospital staff who are responsible to act on infection control activities in their respective work stations and spread awareness on hospital infection control.

Infection control committee [icc] Job description

The ICC is a body of experts responsible to develop policies and procedures related to Infection Control at Apollo Hospitals. It is responsible to the Management Board for assuming authority and resources to implement agreed policies in order to prevent spread of infection to all areas of the hospital.
Prepare and review the progress of the annual programme of activities.
Review the incidences and prevalence of ‘alert’ organisms and important infections diseases.
Review the occurrence and nature of any outbreak of Infection Control standards in the hospital.
Review planning, services, facilities in the hospital on the issues relevant to Infection Control.
To establish policy and monitor and control rational antibiotic prescribing habits among the clinicians.
Monitor and advice on certain specific areas of Infection Control like CSSD, OT’s, Critical Care areas etc.
Monitor programmes for the education of staff about infection control practices and policies.

Infection control team [ict] Job description

Conduct surveillance activities
Review effectiveness of control measures and adapt to changing local circumstances.
Advise on and monitor policies and procedures.
Liaise with concerned consultants to inform him of known suspected cases of notifiable diseases other significant infections.
Discuss with consultants any case of proposed action, which may have implications for infection control in the hospital.
To regularly visit and liaise with hospital departments especially the following.

Catering department [food hygiene]
Engineering dept [equipment, water supply air conditioning and environmental hygiene]
Pharmacy [antibiotics and disinfectant policies]
Wards, Clinics, ICU, OT
House Keeping [cleaning, waste disposal policies]
Laboratory Department [Laboratory hazard waste disposals]
Visit areas surrounding hospital premises and ensure action for proper hygiene and sanitation.

Initiate appropriate responses to incidence or outbreaks of infection and recommend allocation of resources for investigation and control.
Request for on urgent meeting of Infection Control Committee when there is a major incident.
Organize the relevant education of health care staff and encourage reflexive practice of infection control measures.

Infection control nurse [icn] job description

The JCN will be a member of Infection Control Committee and Infection Control Team and will carry out al policies and protocols of day-to-day infection control and submit daily reports to Chief Executive Diagnostic Services and Head of the Department of Microbiology.

ICN will carry out ongoing day to day activities of surveillance of Infection Control by regular visits to essential hospital departments such as wards, clinics, operating rooms, ICU’S, Laboratory, House Keeping, catering, Engineering, Pharmacy, wash areas, toilets etc.
ICN will provide clinical advice and support to nurses and non —clinical personnel on infection control issues.
ICN will explain and interpret microbiology reports to relevant nursing staff and advice on isolation techniques generally and in specific clinical situations.
Identify potential infection hazards and suggests appropriate remedial measures to relevant personnel.
Follow the ICC protocols to identify investigate and control out breaks of infection.
Participate in informal and formal teaching programmes for nurses and other paramedical staff.
Keep abreast with recent advances by reading relevant literature and attending appropriate courses and meetings of infection control.

Master trainer and trainer Job description

To ensure that the Infection Control Activities are fully implemented at their respective working stations and they provide the leadership for the same.
To provide hands on training to 5 nominated nurses each month for next 12 months. The Infection Control team will monitor their training effectiveness by regularly interviewing the nurses they have been training.
To give periodic lectures in future Infection Control Training programmes.
To attend any Workshop, Seminars held locally on Infection Control Programmes.
To regularly update their knowledge on Infection Control and submit to Infection Control Team their views periodically on further improving the Infection Control programmes.
To actively fill in, and update the activity log book provided to them by keeping a record of all their Infection Control Activities. This log book will be periodically checked by the Infection Control Nurse and countersigned by the Chairman, Infection Control Team.

Evolution of Health Services Management

hospitalmanagement24@gmail.com (Anonymous) — Fri, 16 Oct 2015 11:48:00 +0000

Evolution of Health Services Management

Mesopotamia — Health Services as an ordered form first materialized in the olden part of South-West Asia. The first recorded prescription was made in this section of ancient Babylon.
Greek Hospitals — Today Hippocrates is known as the father of modern medicine, who first used auscultation method to detect diseases and also performed different surgeries. Greeks realized the importance of coherent methods of treatment and started to study natural causes of disease.
Indian Hospitals — during King Ashoka’s period India developed a splendid health care system. Their obstetrics specialty was superb in succession to save mother and child. There was one physician for every ten villages.
Roman Hospitals — Organized by Romans surprisingly could not develop good health care system for general mass. Although they developed infirmaries for the sick slaves and proper hospitalization process was only for the military personnel.
Arabian Hospitals — The development of efficient hospitals was an outstanding contribution by the Arabs, especially during the 7th century. During the time of Prophet (S), a real system of hospitals was developed. Some of the best known hospitals and Medical schools were in Baghdad, Damascus and in Cairo.
Hospitals during the Renaissance — The Renaissance period lasted from the 14th to 16th century. Real health services management started its journey from this period.

Key medical achievements in development of people’s health

The 17th Century — Invention of Microscope
The 18th Century — Discovery of Vaccines
The 19th Century — The four incredible discoveries

Bacteria as the cause of disease
Anaesthesia
Steam sterilization
The legacy of Florence Nightingale

History of Health Services Management in the Sub Continent

Having realized the need to develop the health care services, the British Indian authority made a committee in 1943, which was designated as ‘Health Survey and Development Committee’ headed by Sir Joseph Bhore. This was also known as ‘Bhore Committee’. This committee included doctors, civil surgeons, public health experts, engineers, lawyers and administrators. They reviewed the countries overall health services under-

Public Health
Medical Relief
Professional Education
Medical Research and
International Health.

The first ‘All Pakistan Health Conference’, which was held in 1947, adopted the ‘Bhore Committee’ Report and its recommendations as the basis of planning and development of Health Services Administration.
Bangladesh health care sector started its intrinsic expedition with insignificant health facilities in terms of human resources and hospitals/health centres at the dawn of independence (1971).
For a long time, shortage of doctors and hospitals has been the key words in our health service. The country now has over 33,000 registered doctors — whereas the number of physicians in 1972 was 731 at the 120 hospitals.
By 1986, Bangladesh had about 16.000 physicians and eventually managed expansion of health care facilities through a cross-country network.
There were around 9,000 beds in 1971 most if not all in the government domain. At present the number of hospital beds has risen to more than 50,000 in government and about 52,000 in private hospitals & clinics. Reduction of fertility rate and childhood mortality remains a couple of success stories, however especially in the villages- much remains to be done.
The existing health care system fails in many ways due to lack of proper accountability and client confidence in it. Bangladesh is certainly not poor in human resources, however it remains poor in professional health services management.

Keystones in the history and development of hospitals

Considered to be beginning of modern health care services management.
Thoughts and plans of Florence Nightingale is one of the greatest contributions to the evolution of modern hospitals. She introduced professional nursing services. Eventually this provided empathetic medical treatment and emphasized a hygienic environment. It was a giant step in the history of improved health services management. During the Crimean war Nightingale properly organized support services in an English hospital. They were — (a) Laundry services, (b) Kitchens and (c) Central supply department and it is amazing that in 10 days she reduced the death rate from 38% to only 2%. Being a modernizer she realized the importance of infection control and nursing care. Her capacity in administration was also notable in the expansion of the processes required for successful health services management.
In due course, advances in Human service management skills became a part of the increasing development of modern health care delivery system.
At present, the “technological” era of the computer age has also played a major part in reshaping the face of modern medical practice and care delivery.
In the last two decades rapid and major advances have been made in the field of improved investigation techniques and processes including Imaging with CT and MRI scanning capacities, Nuclear medicine to non-invasive treatment - all contributing to heightened and quickened understanding of disease and its measurement.
Laboratory facilities likewise have rapidly developed with multi field scanners etc and last but certainly not least the introduction of the “Robot to replace the Human” in robotic and minimally invasive surgery.
The human is still needed however to be better skilled in the use of the technologies now and increasingly becoming available.
The ability to transfer electronic data including images across continents has revolutionized the capacity of local environments to benefit from the world expertise in diagnosis and treatment protocols.
Educational development of nursing and paramedical staff role definition and support to 'THE DOCTOR' has also been a qualitative leap for mankind in the 21st Century.
It is no longer a rarity for university graduated Paramedical and nursing personnel taking their place in the team approach to care.
Likewise the development of hospital management programs and syllabi has brought a major new welcome dimension to the effective and efficient management of health care services and in particular hospitals.

Interpersonal Relationship - Both Within and Outside Hospital

hospitalmanagement24@gmail.com (Anonymous) — Thu, 15 Oct 2015 13:39:00 +0000

Interpersonal Relationship - Both Within and Outside Hospital

ISSUE: Co-ordination

Establishment of good and effective interpersonal relationship and co-ordination between different category of personnel and staff.
Regular co-ordination meeting with respect and responsibility may improve interpersonal relationship and co-ordination.
Mass media should be used for information and education of people Unit head and chief of hospital have the main role.

ISSUE: Public Relation

One Public Relations Officer to be recruited in tertiary and district hospital.
Framing volunteer committees through Health Care Development Committee to encourage community participation, viz, of ansars, VDP members, NGOs and students.
For solving visitors problems:

— Strict visiting time
— Use of mass media, especially radio and television to create people’s awareness
— Introduction of counselling service in the hospital
— Assistance from the local influential

Provision for waiting areas for visitors.
Establishment of a good information centre-cum-public relations unit to provide with necessary information for people and also its use for mass awareness, dissemination of ideas as well as news on the contribution of the hospital to the community through press for building mass support.
Available hospital services and supplies are important determinants of visitors’ problem.

ISSUE: Health education

This must be organized with utmost attention and importance in line with primary health care at the OPD and other waiting areas. Proper media propaganda is essential.

Monitoring and Evaluation - Good Governance in Hospitals

hospitalmanagement24@gmail.com (Anonymous) — Sun, 11 Oct 2015 12:11:00 +0000

Monitoring and Evaluation Good Governance in Hospitals

ISSUE: Supervision system (and chain of command)

Mandatory monitoring and evaluation.
Structure of needs to be defined. Job should be defined. Both quality and quantity of work should be accounted.
Implementation of effective methods of supervision both on site and from distance.
Establishment of effective chain of command.
All staff in a single unit must be controlled under the administrative umbrella of unit head.
Exercise of effective control of unit heads over staff.
Accountability of unit heads to higher authority / Director. Director should have full administrative authority over the unit heads.

ISSUE: Checklists and Quality assurance

Medical audit and practice for measuring the hospital services based on certain norms and standards needs to be ensured.
Preparation of supervision check lists for monitoring and evaluation of staff performance together with guidelines for their implementation Knowledge and practice of quality assurance.
Active involvement of the Core group of Hospital Quality Assurance Project of the government.

ISSUE: Hospital manual

Preparation of a comprehensive hospital manual (both service manual and clinical manual) is a must.

Feedback System - Good Governance in Hospitals

hospitalmanagement24@gmail.com (Anonymous) — Thu, 08 Oct 2015 14:04:00 +0000

Feedback System Good Governance in Hospitals

ISSUE: Correction of deviation

Formulation and implementation of effective feed back system to check deviation
Accurate reporting to higher authority and specific rewarding and punishment system for staff
Rewarding and punishment system for staff must be specified
In time remedial measures for correction of identified deviation of hospital or staff performance.

ISSUE: Maintenance of medical records

Understanding needs of proper medical records
Utmost care in organizing effective and useful medical records keeping system
Use of medical records in medical audit, research, medico-legal procedures, legal protection of hospital personnel, future planning and setting objectives
Maintenance of disease codes as per international classification of diseases (ICD)
Full computerized system of record keeping for tertiary hospital by trained personnel to be extended gradually in lower level hospitals.

ISSUE: Reports and returns both ways

Implementation of effective and scientific reporting system to higher authority
More prompt and effective response from higher authority to encourage local authority for undertaking more initiatives.

Discharges and Delivery of Care in Intensive Care Units

hospitalmanagement24@gmail.com (Anonymous) — Tue, 06 Oct 2015 13:03:00 +0000

Discharges and Delivery of Care in Intensive Care Units

Administrative Policies to Facilitate Appropriate Admissions, Discharges and Delivery of Care in Intensive Care Units

A. Personnel

A Physician NURSE Coordinator / Head must be appointed who, on the basis of training, interest, type of practice and availability, can give clinical, administrative and educational direction to the unit. Collaboration with nursing and ancillary staff should be mandatory. The Coordinator/Head should assume responsibility for assuring the quality, safety and appropriateness of care in the ICU. The Directors must work collaboratively with the Directors of other areas so that patient care, triage and patient flow are effective and efficient; the ultimate authority for ICU admission, discharge and triage rests with the ICU Coordinator / Head.
An ICU Coordinator / Head has the responsibility to ensure that the patients meet ICU admission and discharge criteria. Formal recognition of the role of the ICU Coordinator / Head should occur through established hospital guidelines. Knowledge of the various prognostic models is requirement of the ICU Coordinator / Head. A clearly written procedure for conflict resolution as it relates to admission and discharge of patients must be in place.
The multi specialty team of professionals should meet on a regular basis to identify and solve problems through quality assurance and continuous quality improvement activities.

Nursing Staffing for Inpatient Department

hospitalmanagement24@gmail.com (Anonymous) — Sun, 04 Oct 2015 13:07:00 +0000

Nursing Staffing for Inpatient Department

A. Medical

MO

Gen. Medicine
Gen. surgery
Gynae and obstetrics
Peadiatrician
Anesthesia, Dentistry, ophthalmology, ENT, Skin and VD
Psychiatric, Biochemistry,
Microbiology Chest Disease and TB
Forensic medicine

1 MO/12-15 beds

1 specialist/100 beds+ 1 additional/50 beds
1 specialist/100 beds+ 1 additional/50 beds
1 specialist/100 beds+ 1 additional/40 beds
1 specialist/100 beds+ 1 additional/150 beds
1 specialist/200 beds+ 1 additional/150 beds
1 per hospital above 200 beds
1 per hospital above 200 bed+ 1 for additional 200 bed
1 per 1500 bed

B. Nursing

Nursing personnel

Nursing superintendent
Dy. Nursing superintendent
1 assistant superintendent
Ward sister
Teaching hospital
Non teaching hospital
ICU/CCU
Infection Control Nurse

Staffing Nurse

1/hospital
1 up to 400 beds+ 1 additional/200 beds
1 for 100-150 beds and 3-4 wards
1 for 25-30 beds or per ward
1 nurse for 3 beds
1 nurse for 5 beds
1 nurse for 1 bed (+ 30% on leave reserve)
1 nurse/250 beds

Nurse-patient ratio

The nurse patient ratio depends upon the:

Size and layout of ward.
Type of cases, acute, chronic, mental, children.
Type of hospital-teaching, non teaching or research.
No. of important patients (VIPs)
Type of equipments
Average length of stay of patient.
Availability of student nurses.

Nursing hour requirement

1) Critically ill patient needing intensive care
2) Moderately ill patient needing intermediate care
3) Mildly ill patient needing self care
4) Chronic ill patients requiring skilled and prolonged nursing care

1) 8-10 hour
2) 3-5 hour
3) 1-2 hour
4) 30 minutes to 1 hour

1) 1:1
2) 1:3 (Teaching hospital)
1:5 (Non teaching hospital)
3) 1:6 (Teaching hospital)
1:10 (Non teaching hospital)
4) 1:12 (Teaching hospital)
1:18 (Non teaching hospital)

Norms for Gr. D Staff

(1) 30-50
(2) 100
(3) 200
(4) 300
(5) >500

(1) 15-25
(2) 50
(3) 100
(4) 150
(5) 250

(1) 1 Gr. D/2 beds
(2) Do
(3) Do
(4) Do
(5) Do

Definitions of Infection Control Management

hospitalmanagement24@gmail.com (Anonymous) — Sat, 03 Oct 2015 12:32:00 +0000

Definitions of Infection Control Management

Infection

Deposition and multiplication of microorganisms in tissues, where they can cause adverse effects is called an Infection.

Sepsis

Presence of inflammation and other signs of illness in a wound colonized by microorganisms and in tissue to which such infection has spread.

Hospital Acquired (Nosocomial) Infection

Infection acquired by hospital staff or by patients while they are in the hospital. Such infection presents more than 48 hours after hospital admission. It is also know as Health Care Associated Infection" or "Nosocomial Infection"

Cross Infection

Infection acquired in hospital from other people either patients or staff is known as Cross Infection.

Bioload

It is the number of organisms suspended in air. Bioload in a room is dependent upon the number of people in a room and their movements. To lower the bioload in critical care areas like ICU's, the humans (visitors) entry to such high risk areas should be strictly restricted.

Community Acquired Infection

Infection acquired by patients before admission to the hospital. Such infection presents within the 48 hours of hospital admission.

Endogenous Infection

Infection caused by microorganisms, which the patient carries on normal or septic areas of the body.

Exogenous Infection

Infection caused by microorganisms from outside the patient's body. The source of such infection could be other patient, staff, medicaments or the environment.

Endemic Infection

Increase in a commonly occurring type of infection/microorganism.

Epidemic Infection

Outbreak of infection due to a microorganism not normally present in the hospital.