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2. Infection Prevention and Waste Disposal
2.1 Introduction
Nosocomial infections (hospital-acquired infections, healthcare-associated infections) are a significant cause of morbidity and mortality. They are defined as those infections acquired by a person in a healthcare unit which are secondary to the patient’s original condition. These infections also include infections acquired by the patient but appearing after discharge. The symptoms usually appear after 48 h of admission. It is estimated that 5–10% of patients admitted for acute care and emergency procedures acquire healthcare-associated infections (HAI). Of more concern is that more than 70% of infections are due to antibiotic-resistant organisms.
Pregnant females and their foetuses are at an increased risk of acquiring HAIs. All labour rooms, obstetric emergency evaluation areas and operation theatres should have facilities for infection control as they can get puerperal sepsis, neonatal sepsis and other infections acquired during delivery. HAIs also include occupational injuries and infections which a healthcare worker (HCW) can get by virtue of his/her occupation. Needle-stick injuries and injuries from other sharps results in approximately 400,000 cases each year. So, infection control measures should be of top most priority for all HCW (doctors, nurses, midwifes, safai karamcharis, etc.).
2.2 Importance of Infection Control in Obstetrics
India accounts for about 1/5 of all maternal deaths and 1/3 (approximately 30%) of all neonatal deaths. Puerperal sepsis is a fairly common entity especially in the rural and backward areas of India. Most maternal and neonatal deaths occur in the first 7 days after delivery. It accounts for about 19.2% deaths, and it is the second leading cause of death in mothers after haemorrhage and anaemia. In the mother sepsis may lead to blood stream infections, endotoxic shock, peritonitis and abscess formation.
Infections in neonates include neonatal septicaemia, decreased Apgar score and pneumonia. Increased susceptibility of sepsis is more marked in low birth weight neonates (<2500 g) and very low birth neonates (<1500 g). This is due to their poor immune defences and weak cellular and humoral immunity. Vascular or urinary catheters, other indwelling lines or contact with care givers who have bacterial colonization are additional factors contributing to neonatal septicaemia.
Differentiating features of EOS and LOS
Feature | EOS | LOS |
|---|---|---|
Time of appearance | Infection within 72 h of birth | Infection after 72 h of birth |
Mode of transmission | Vertically from mother to infant before or at time of birth (i.e. HBV,HIV, TORCH) | At time of birth or during hospital stay |
Microorganisms | Includes organisms harboured in genital tract or which can cross the placenta (e.g. group B streptococcus, E.coli, CONS, H. influenzae, Listeria monocytogenes) | Includes mainly organisms acquired from the environment (e.g. Staphylococcus aureus, CONS, E.coli, Klebsiella spp., Pseudomonas spp., Candida spp., Acinetobacter spp.) |
2.3 General Measures to Prevent Spread of Infections in Emergency Obstretic Care
- 1.
Infection control measures during admissions.
- 2.
Availability of clean environment, clean equipment and other supplies.
- 3.
Availability of trained and skilled staff.
- 4.
Hand washing.
- 5.
Biomedical waste management.
- 6.
Safety from sharps.
- 7.
Safe blood transfusion.
- 8.
Measures to prevent tetanus.
- 9.
Neonatal resuscitation facilities.
2.4 Infection Control Measures During Admissions
- 1.
Proper initial assessment of every patient should be done very carefully. If any patient is assessed to be suffering from contagious illness (measles, rubella, chicken pox, etc.), separate room for delivery should be made available. The staff of nursery/NICU (neonatal intensive care unit) should be notified simultaneously so that adequate neonatal facilities are arranged well in time.
- 2.
Isolation facilities are also necessary for both mothers and neonates suffering from puerperal sepsis, gastrointestinal infections, breast abscesses and skin sepsis.
- 3.
All the items which have been supplied/bought by the patient should be marked carefully.
- 4.
Avoid overcrowding in labour rooms and other procedural rooms to reduce cross infection. Limit the visitors inside these areas.
2.5 Availability of Clean Environment, Equipment and Other Supplies
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Clean environment to be ensured by:
- (a)
Operation theatres and labour rooms should ideally be cleaned after each operating session. Routine cleaning and mopping with water and detergent is required. A disinfectant should be used after known contamination of floors with material from infected patients.
- (b)
An interval of at least 10 min should be there between two patients.
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- (a)
