8. Infection Prevention

Challenge Actions CQI Teams Took to Address the Challenge
Preparation of chlorine solution (disinfectant) not being done correctly; instruments kept in containers that have chlorine solution
  • Develop an SOP for preparing chlorine solution and orient all staffs on the SOP
  • Ensure all staff involved in cleaning are aware and familiar with the mixing of chlorine solution
  • Orient staff on the use of antiseptics and storage of instruments

Not easy to clean the work environment

  • If the floor of theatre is not easy to clean, work with health unit management, IP and district to renovate the floor or change to another room
  • If the team is using a tent, ensure that it has ground cover
Preparation of disinfectant solution is not done correctly; very concentrated or over diluted solutions were being used
  • Develop a guide with instructions on how to prepare disinfectant solutions based on the concentrations
  • Share this guide in a staff meeting
  • Display this guide on the walls in the rooms where the solutions are prepared
Cleaning equipment not decontaminated before storage--only cleaned with water and detergent and then stored
  • Coach the teams on the standard procedure of decontamination and cleaning of the cleaning equipment before storage or reuse
  • Inform the in-charge to request the staff who do cleaning to join the CQI team
Used instruments are kept in the chlorine solution for decontamination for hours before they are cleaned and some instruments are not completely submerged in the solution
  • Organize a site team meeting to train staff on the standard procedure of decontamination of instruments
  • Make requisitions from the stores for timers which are used to time the decontamination stages
Instruments kept with antiseptics
  • Orientation of staff on instrument management (cheatle forceps handling and sterilization)
No wrapping of instruments before sterilization
  • Request wrappers for instruments from the hospital administration or IP
No expiry dates on the sterilized packs of instruments
  • Develop an inventory system for sterilized equipment
  • Put a label on each sterilized set using masking tape and a pen to indicate the dates when the sets were sterilized
  • Use the first sterilized/first out rule for use of the sets
Instruments for sterilization packed in closed position
  • Go through the process of sterilization with an expert
  • Work with the IP and district health office to identify the expert
  • The expert should orient all the staff on the process of infection prevention
No sterilization tape
  • Place requests for sterilization tape from NMS
  • If not available work with the IP to avail the tape
Poor storage of sterile sets of instruments
  • Identify a specific place for storage of sterilized equipment
  • Preferably get a lockable cupboard and place it in theatre away from dust and off the floor
No waste segregation
  • Work with the IP to get a technical person to orient the team on waste management and segregation
  • Request for all the required items including appropriate waste bins and their liners from NMS or IP
Sharps containers are overfilled
  • Obtain adequate number of safety containers from the hospital stores and NMS
  • Place the safety boxes close to the area of operation
  • Dispose them off when they are ¾ full (as labeled on the box)
No disposal of metallic waste
  • Decontaminate all the metallic waste after each procedure and safely store them in a secure place
  • When the waste has accumulated inform the IP to organize for disposal
No utility gloves
  • Identify the amounts required and place an order to NMS
  • Involve the IP and district health office
  • Put in place an inventory system to track the stock and ensure that minimum stock levels are maintained
No color-coded bin liners
  • Requisition for bin liners from the health unit administration
  • Requisition for bin liners from NMS and IP
  • If necessary, improvise with labeled buckets and liners of other colors for waste segregation
Lack of personal protective gear like shoes, masks, and eye shields
  • Identify the amounts of personal protective gear required and place an order to NMS
  • Involve the IP and district health office
  • Put in place an inventory system to track the stock and ensure that minimum stock levels are maintained
There is no interim storage of waste / interim storage area not appropriate
  • Inform the IP about the need for interim storage waste bins
  • Identify a room within the health unit for interim storage of waste with the help of the health unit administration
Open pit disposal of waste; use of burning for disposal of waste
  • Inform all the stakeholders (health unit administration, IP, and district health office) about the challenges of final waste disposal and together develop a plan to solve the problems