Best Practices for Infection Control in Hospitals

This guide sets out the best practices for infection control in hospitals that make up a clinical infection prevention and control (IPC) programme: hand hygiene, PPE, sterilisation, isolation, vaccination, antimicrobial stewardship and surveillance, as expected by Indian national guidelines and NABH.

What is Infection Control in Hospitals?

In India, the main reference is the National Guidelines for Infection Prevention and Control in Healthcare Facilities, published by the National Centre for Disease Control (NCDC) under the Ministry of Health and Family Welfare in January 2020. WHO and the US CDC publish widely used guidance too, but for Indian hospitals they are reference material, not regulations.

Importance of Infection Control

Effective infection control is crucial for several reasons:

• Patient Safety: Reducing the risk of HAIs protects patients during their hospital stay.
• Cost-Effectiveness: Lower infection rates can decrease hospital costs associated with prolonged patient stays.
• Public Health: Infection control measures help prevent the spread of infectious diseases in the community.
• Regulatory Compliance and Accreditation: Indian hospitals must follow the Bio-Medical Waste Management Rules, 2016 (as amended), and infection control is assessed under the NABH Infection Prevention and Control (IPC) chapter for accredited hospitals and under Kayakalp and the National Quality Assurance Standards (NQAS) for public facilities.

Best Practices for Infection Control in Hospitals

The practices below follow the NCDC national guidelines and the NABH 6th edition IPC chapter, which expects every hospital to have a documented IPC programme, an infection control committee and team, and a designated infection control officer and nurse.

1. Hand Hygiene

• Wash Hands: Wash with soap and water when hands are visibly soiled. The national guidelines give 40 to 60 seconds for the full handwashing procedure.
• Use Alcohol-Based Hand Rub: When hands are not visibly soiled, use an alcohol-based hand rub, which takes 20 to 30 seconds. Keep hand rub readily accessible at the point of care.
• Follow the Five Moments: Clean hands before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.
• Educate Staff: Regular training sessions should reinforce the importance of proper hand hygiene.

2. Personal Protective Equipment (PPE)

• Gloves: Wear gloves when handling bodily fluids or contaminated materials.
• Masks: Use masks when caring for patients with respiratory infections.
• Gowns and Shields: Employ gowns and face shields for protection during procedures.

3. Environmental Cleaning

Clean high-touch surfaces at least daily with approved disinfectants, and segregate waste at the point of generation into the colour-coded categories of the Bio-Medical Waste Management Rules, 2016. Housekeeping schedules, disinfectants and hygiene routines are covered in our guide to sanitation and hygiene in healthcare, and waste handling in our biomedical waste management guidelines.

4. Sterilization and Disinfection of Equipment

• Single-Use Items: Never reuse items labelled for single use.
• Proper Sterilization: Ensure that reusable equipment is sterilized according to protocols.
• Monitor Sterilization Processes: Run and document regular validation tests for sterilizers, and have a recall procedure for when sterilization fails.

5. Isolation Precautions

• Identify Infected Patients: Quickly identify and isolate patients with known or suspected infections.
• Use Single Rooms or Cohorting: Place infected patients in single rooms where available, or group patients with the same infection together, and follow transmission-based (contact, droplet or airborne) precautions.
• Limit Visitors: Restrict visitor access for infected patients.

6. Vaccination

• Staff Vaccination: Have an immunisation policy for staff, as NABH requires, including hepatitis B vaccination for healthcare workers exposed to blood.
• Protect Staff After Exposure: Have a process for needle-stick and blood exposure, with post-exposure prophylaxis available.
• Patient Vaccination: Offer vaccinations to patients, especially those at high risk.

7. Antimicrobial Stewardship

• Appropriate Prescribing: Ensure antibiotics are prescribed only when necessary.
• Education: Train staff on responsible antibiotic use and the implications of resistance.
• Monitor Use: NABH requires a documented antimicrobial policy and an antimicrobial stewardship programme that monitors the use of antimicrobial agents.

8. Surveillance and Reporting

• Track Infections: Regularly monitor and report infection rates within the hospital, including device-associated infections such as catheter-associated urinary tract infections, ventilator-associated pneumonia, central line infections and surgical site infections.
• Audit Compliance: Include hand hygiene compliance and housekeeping effectiveness in surveillance, as NABH requires.
• Analyze Data: Use data to identify trends and implement targeted interventions.

9. Patient Education

• Inform Patients: Provide information about hygiene practices and infection risks.
• Involve Families: Educate family members on how they can help reduce infection risks.

10. Regular Training and Updates

• Ongoing Training: Conduct regular training sessions on infection control protocols.
• Update Policies: Keep staff informed about the latest guidelines and best practices.

Conclusion

Infection control works when it is run as a programme rather than a set of posters: a committee and named officer, written policies that follow the NCDC guidelines, regular audits of hand hygiene and cleaning, and surveillance data that drives action. For how IPC fits with the hospital's other safety measures, see our guide to patient safety measures in hospitals.

Frequently Asked Questions