Hospital Acquired Infections (HAIs)

• Infections acquired during hospital stay, not present at the time of admission.
• Common types: UTI, Surgical Site Infection (SSI), Ventilator-Associated Pneumonia (VAP), Bloodstream Infections.
• Caused by invasive devices, poor hand hygiene, contaminated environment, or improper procedures.

Bundle Approach

• A set of evidence-based practices performed together to reduce HAIs effectively.

• Focuses on hand hygiene, aseptic technique, device care, environmental cleaning, and staff education.

Prevention of Urinary Tract Infection (Catheter-Associated UTI – CAUTI)

• Use catheters only when necessary and remove early.

• Maintain closed drainage system.
• Perform aseptic insertion and proper perineal care.
• Ensure adequate hydration and monitoring.

Prevention of Surgical Site Infection (SSI)

• Preoperative antiseptic skin preparation and prophylactic antibiotics.

• Maintain sterile technique during surgery.
• Proper wound care and dressing postoperatively.
• Control of blood sugar and temperature during surgery.

Prevention of Ventilator-Associated Pneumonia (VAP)

• Elevate head of bed 30–45°.

• Daily sedation vacation and assessment for extubation.
• Oral care with chlorhexidine.
• Maintain sterile suctioning and closed ventilator circuits

Hospital Acquired Infections (HAI) & Bundle Approach

1. Ventilator Associated Events (VAE)

• Elevate head of bed 30–45°.

• Daily sedation vacation, assess readiness for extubation.
• Oral care with chlorhexidine.
• Maintain sterile suctioning & closed ventilator circuits.

2. Central Line–Associated Bloodstream Infection (CLABSI)

• Hand hygiene before insertion & handling.

• Use maximal barrier precautions during insertion.
• Chlorhexidine for skin antisepsis.
• Daily review of line necessity & remove if not needed.
• Proper hub disinfection & closed infusion system.

3. Surveillance of HAI

• Regular monitoring by Infection Control Team & Committee.

• Collection, analysis & reporting of infection data.
• Feedback to clinical staff to improve compliance.
• Continuous education & audit of infection prevention practices.

Isolation Precautions & PPE

1. Types of Isolation Systems

• Standard Precautions (for all patients):

o Hand hygiene (before/after patient contact).
o Use of gloves, masks, gowns, goggles as needed.
o Safe handling of sharps, waste, and linen.
o Respiratory hygiene/cough etiquette.
• Transmission-Based Precautions (for suspected/confirmed infections):
1. Contact Precaution (Direct/Indirect):
▪ Gloves & gown for all patient/environment contact.
▪ Dedicated patient equipment.
▪ Examples: MRSA, C. difficile.
2. Droplet Precaution:
▪ Surgical mask within 1 meter of patient.
 ▪Patient wears mask during transport.
▪Examples: Influenza, pertussis, meningitis.
3. Airborne Precaution (Indirect via aerosols):
▪ N95 respirator or higher.
▪ Negative-pressure isolation room.
▪ Examples: TB, measles, COVID-19 (airborne spread).

2. Epidemiology & Infection Prevention (CDC Guidelines)

• Infection Transmission Routes: Direct contact, indirect contact (contaminated surfaces), droplet, airborne.
• CDC Principles:
o Early identification & isolation of infectious patients.
o Cohorting patients if single rooms not available.
o Training of healthcare workers in hand hygiene & PPE.
o Environmental cleaning & disinfection.
o Surveillance and reporting of Healthcare Associated Infections (HAIs).

3. Effective Use of PPE

• PPE Components: Gloves, gown, mask/respirator, goggles/face shield.

• Donning Order (CDC):
1. Hand hygiene
2. Gown
3. Mask/respirator
4. Goggles/face shield
5. Gloves
• Doffing Order (CDC – remove carefully to avoid contamination):
1. Gloves
2. Goggles/face shield
3. Gown
4. Mask/respirator
5. Hand hygiene
• Key Practices:
o Perform hand hygiene before and after PPE use.
o Use appropriate PPE based on risk (type of isolation).
o Discard single-use PPE safely, reprocess reusable items properly.

Hand Hygiene
Types of Hand Hygiene

1. Handwashing with Soap and Water

o Removes dirt, organic matter, and transient microorganisms.
o Indicated when hands are visibly soiled, after contact with body fluids, or after restroom use.
2. Hand Rub with Alcohol-based Solution (ABHR)
o Preferred method if hands are not visibly dirty.
o Rapid, effective, and less irritating than frequent washing.
o Kills most germs including bacteria and viruses.

Moments of Hand Hygiene (WHO’s “5 Moments”)

1. Before touching a patient

2. Before clean/aseptic procedures
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient’s surroundings

WHO Hand Hygiene Promotion

• “Clean Care is Safer Care” campaign

• Global hand hygiene day observed on 5th May each year.
• Promotion includes:
o Education & training for healthcare workers
o Availability of ABHR at point of care
o Visual reminders (posters, stickers)
o Monitoring & feedback on compliance
o Encouraging a culture of patient safety

Disinfection and Sterilization

Definitions

• Disinfection: Process of eliminating most pathogenic microorganisms (except bacterial spores) from inanimate objects.
• Sterilization: Process that completely destroys or eliminates all forms of microbial life, including spores.
Types of Disinfection

1. Low-level disinfection
o Kills most bacteria, some viruses, some fungi.
o Example: Quaternary ammonium compounds.
2. Intermediate-level disinfection
o Kills mycobacteria, most viruses, most fungi (not spores).
o Example: Alcohols, chlorine compounds.
3. High-level disinfection (HLD)
o Kills all organisms except high numbers of spores.
o Example: Glutaraldehyde, hydrogen peroxide.

Types of Sterilization

1. Physical methods
o Heat: Moist heat (autoclaving), dry heat.
o Radiation: Gamma rays, UV rays.
o Filtration: For heat-sensitive fluids.
2. Chemical methods
o Ethylene oxide, hydrogen peroxide gas plasma, peracetic acid.

Environmental Cleaning
• Routine and terminal cleaning of patient-care areas.
• Use of detergents and disinfectants to reduce microbial load.
• High-touch surfaces (bed rails, doorknobs, switches) require frequent cleaning.

Equipment Cleaning
• Non-critical equipment: Stethoscopes, BP cuffs – cleaned with low-level disinfectant.
• Semi-critical equipment: Endoscopes, respiratory therapy equipment – high-level disinfection.
• Critical equipment: Surgical instruments, implants – sterilization required.

Guides on Use of Disinfectants

• Always follow manufacturer’s instructions (dilution, contact time, shelf-life).
• Ensure proper cleaning before disinfection or sterilization.
• Avoid mixing different disinfectants.
• Personal protective equipment (PPE) use when handling.

Spaulding’s Principle
(Classification system for medical instruments based on infection risk)

1. Critical items
o Enter sterile tissue or vascular system.
o Require sterilization.
2. Semi-critical items
o Contact mucous membranes or non-intact skin.
o Require high-level disinfection.
3. Non-critical items
o Contact intact skin only.
o Require low-level disinfection.

Specimen Collection (Review)

1. Principle of Specimen Collection

• The accuracy of laboratory results depends on proper specimen collection.

• Correct patient identification, aseptic technique, and timely transport are essential.
• Avoid contamination and ensure adequate quantity for testing.
• Follow “right test, right patient, right sample, right time.”

2. Types of Specimens

• Blood – venous, arterial, capillary.

• Urine – random, midstream, 24-hour, catheterized.
• Stool (feces) – for ova, parasites, culture, occult blood.
• Sputum – early morning deep cough sample.
• Throat/Nasal swabs – for culture, viral studies.
 • Wound swabs/aspirates – pus, exudate.
• Body fluids – CSF, pleural, peritoneal, synovial.
• Tissue/biopsy samples – for histopathology or culture.

3. Collection Techniques & Special Considerations

• Aseptic technique to prevent contamination.

• Use sterile instruments and gloves.
• Collect at appropriate time (e.g., before antibiotics for cultures).
• Ensure adequate volume as per test requirement.
• Label immediately with patient details (name, ID, date, time).
• Explain procedure to patient and obtain consent when needed.

4. Appropriate Containers

• Blood – vacuum tubes with/without anticoagulant (EDTA, citrate, heparin).

• Urine – sterile wide-mouth container; 24-hour in special bottles with preservatives.
• Stool – clean, leak-proof container.
• Sputum – sterile, wide-mouth screw-cap container.
• Swabs – sterile transport swab with or without transport medium.
• Body fluids/tissue – sterile containers, sometimes with transport medium or fixative (formalin for histology).

5. Transportation of the Sample

• Transport promptly to the laboratory to prevent deterioration.

• Maintain recommended temperature (e.g., blood gas on ice).
• Use biohazard-labeled transport bags/boxes.
• Follow “cold chain” for microbiology/viral samples.
• Avoid leakage and spillage – ensure proper sealing.

6. Staff Precautions in Handling Specimens

• Use standard precautions (gloves, mask, gown if needed).

• Treat all specimens as potentially infectious.
• Avoid recapping of needles; use safety devices.
• Practice hand hygiene before and after collection.
• Dispose of sharps and waste safely (as per biomedical waste guidelines).
• Report and manage any accidental exposure (e.g., needlestick injury).

Biomedical Waste (BMW) Management

Principle

Safe segregation, collection, transport, treatment, and disposal of biomedical waste to protect healthcare workers, patients, community, and environment.

Categories of Biomedical Waste

1. Infectious Waste – contaminated with blood/body fluids.

2. Sharps – needles, blades, broken glass.
3. Pharmaceutical Waste – expired/unused medicines.
4. Pathological Waste – human tissues, organs.
5. Chemical Waste – disinfectants, reagents.
6. Radioactive Waste – radioactive materials.

Segregation & Color Coding (as per BMW Rules, India 2016)

• Yellow bag – human & animal anatomical waste, soiled waste, expired medicines.
• Red bag – contaminated plastic (tubes, bottles, catheters).
• White (translucent, puncture-proof) – sharps (needles, blades).
• Blue bag/box – glassware, metallic implants.

Steps in BMW Management

1. Segregation at source – by healthcare workers.

2. Collection & storage – in labeled, leak-proof containers.
3. Transportation – in closed trolleys to temporary storage.
4. Treatment – autoclaving, incineration, microwaving, deep burial.
5. Final Disposal – as per prescribed norms.

Infection Control Measures

• Proper training of staff.

• Use of PPE (gloves, mask, apron).
• Hand hygiene before & after handling waste.
• Needle-stick injury prevention.
• Immunization (Hepatitis B, Tetanus).
Laundry Management Process
Importance

Hospital laundry can harbor pathogens (MRSA, VRE, fungi, viruses). Proper handling reduces healthcare-associated infections (HAIs).

Laundry Workflow

1. Collection of Soiled Linen

o Segregate soiled vs. infected linen at patient care area.
o Use color-coded bags (usually red/yellow for infected).
o Avoid shaking linen to prevent aerosol spread.
2. Transportation
o In covered, leak-proof trolleys.
o Separate routes for clean & dirty linen.
3. Sorting & Washing
o Pre-wash with cold water to remove organic matter.
o Main wash with hot water (≥70°C for 25 min) + detergent/disinfectant.
o Use chlorine-based disinfectant for infected linen (if fabric permits).
4. Drying & Ironing
o Sunlight drying or hot-air drying.
o High temperature ironing kills residual microbes.
5. Storage of Clean Linen
o Store in clean, dry area.
o Transport in covered trolleys to wards.
6. Distribution
o “First in–First out” (FIFO) method.
o Separate for sterile & non-sterile areas.

Infection Control in Laundry

• Staff to use PPE (gloves, aprons, masks).

• Hand hygiene after handling soiled linen.
• Separate clean & dirty zones in laundry area.
• Regular machine disinfection.

Infection Control & Prevention (Overall)

• Hand Hygiene – 5 moments of WHO.
• PPE Use – gloves, gowns, masks when needed.
• Environmental Cleaning – regular disinfection of hospital surfaces.
• Safe Handling of Equipment – cleaning & sterilization.
• Isolation Precautions – standard + transmission-based precautions.
• Surveillance – monitor HAIs.
• Education & Training – all staff involved in waste & laundry handling.

Biomedical Waste & Infection Prevention

1. Waste Management Process & Infection Prevention
• Segregation at source → waste separated in color-coded containers immediately after generation.
• Collection & Storage → placed in leak-proof, labeled bags/containers; no open handling.
• Packaging & Labeling → barcoding & biohazard symbol on each bag/container.
• Transportation → closed trolleys/vans; avoid manual handling.
• Treatment & Disposal → incineration, autoclaving, shredding, chemical treatment, deep burial (as per waste type).
• Infection Prevention → PPE use, hand hygiene, vaccination (Hepatitis B, Tetanus), needle-stick injury prevention.

2. Staff Precautions
• Always wear PPE (gloves, masks, aprons, boots).
• Perform hand hygiene before & after handling waste.
• No recapping of needles; use puncture-proof sharps container.
• Immediate reporting & management of needle-stick injuries.
• Regular training on BMW handling.
• Ensure immunization (Hepatitis B, Tetanus).

3. Laundry Management
• Collection: segregate infected vs. non-infected linen at source, use color-coded bags.
• Transport: in closed, covered trolleys.
• Sorting & Washing:
o Pre-rinse with cold water.
o Main wash with hot water (≥70°C for ≥25 min) + detergent/disinfectant.
o Chlorine disinfectant for infected linen (if fabric safe).
 • Drying & Ironing: sunlight or hot-air drying; ironing at high temperature kills microbes.
• Storage & Distribution: keep clean linen separate, use FIFO method, transport in covered trolleys.
• Infection Control: PPE for laundry staff, separate clean/dirty areas, regular machine disinfection.

Segregation of Wastes

• Done at point of generation into color-coded bags/containers.

Colour-Coded Waste Containers

• Yellow → Human/animal tissues, soiled waste, expired medicines, chemical waste.

• Red → Contaminated plastic (IV tubes, catheters, syringes without needles).
• White (translucent, puncture-proof) → Sharps (needles, blades, scalpels).
• Blue → Glassware, metallic implants.

Waste Collection & Storage

• Collected daily; not stored beyond 48 hours in facility.

• Bags/containers must be leak-proof, labeled, barcoded.

Packaging & Labeling

• Use biohazard symbol.

• Barcoding system for tracking waste.

Transportation

• Within facility: closed trolleys, separate route for waste.

• Outside facility: only by authorized transport vehicles to Common Biomedical Waste Treatment Facility (CBWTF).

Antibiotic Stewardship

Antibiotic stewardship is a coordinated program that promotes the appropriate use of antibiotics, improves patient outcomes, reduces microbial resistance, and
decreases the spread of infections caused by multidrug-resistant organisms (MDROs).

1. Importance of Antibiotic Stewardship

• Ensures appropriate selection, dosing, route, and duration of antimicrobial therapy.

• Improves patient safety by reducing adverse drug reactions and Clostridioides difficile infections.
• Reduces emergence of antimicrobial resistance (AMR).
• Enhances clinical outcomes and lowers mortality in infectious diseases.
• Reduces healthcare costs by minimizing unnecessary antibiotic use and resistance-related expenses.

2. Antimicrobial Resistance (AMR)

• Definition: The ability of microbes (bacteria, viruses, fungi, parasites) to resist the effects of medications that once killed them.
• Causes:
o Overuse and misuse of antibiotics (self-medication, incomplete courses, unnecessary prescriptions).
o Poor infection control practices.
o Inadequate surveillance and monitoring.
• Consequences:
o Increased morbidity and mortality.
o Limited treatment options.
o Prolonged hospital stays and higher costs.

3. Prevention of MRSA & MDROs in Healthcare Settings

• Hand hygiene compliance (soap and water/alcohol-based rubs).

• Contact precautions: use of gowns, gloves, and dedicated equipment.
• Screening & surveillance: identifying colonized or infected patients early.
• Environmental cleaning & disinfection: regular decontamination of surfaces and medical devices.
• Antibiotic stewardship programs: rational prescribing to avoid unnecessary exposure.
• Education & training of healthcare staff.
• Cohorting or isolation of patients with MRSA/MDROs.
• Removal of unnecessary invasive devices (catheters, central lines, ventilators)

Patient Safety Indicators

1. Care of Vulnerable Patients

• Special attention to elderly, pediatric, immunocompromised, and cognitively impaired patients.

• Individualized risk assessment and care planning.

2. Prevention of Iatrogenic Injury

 • Avoid unnecessary invasive procedures.
• Strict adherence to clinical guidelines and aseptic technique.
• Continuous staff training and monitoring.

3. Care of Lines, Drains, and Tubings

• Daily review of necessity.

• Proper labeling, aseptic insertion, and maintenance.
• Prompt removal when no longer required.

4. Restraint Policy and Care

• Physical & Chemical Restraints: Use only when essential for patient safety.
• Regular monitoring and documentation.
• Least restrictive measures first.

5. Blood & Blood Transfusion Policy

• Strict verification of patient identity and blood product.

• Monitoring for transfusion reactions.
• Documentation and reporting of adverse events.

6. Prevention of IV Complications

• Site inspection, timely cannula replacement.

• Use of sterile techniques and secure fixation.
• Monitoring for phlebitis, infiltration, or infection.

7. Prevention of Falls

• Fall risk assessment tools (e.g., Morse Fall Scale).

• Bed rails, non-slip footwear, adequate lighting.
• Staff and patient education.

8. Prevention of DVT (Deep Vein Thrombosis)

• Risk stratification and prophylaxis (compression stockings, anticoagulants, early mobilization).

• Hydration and physiotherapy support.

9. Shifting and Transporting Patients

• Proper communication (SBAR protocol).

• Safe handling with stretchers/wheelchairs.
• Monitoring of vitals and equipment during transfer.

10. Surgical Safety

• WHO Surgical Safety Checklist.

• Correct patient, site, and procedure verification.
• Infection prevention, sterile instruments, surgical counts.

11. Care Coordination & Medication Reconciliation

• Verification of patient’s medication history.

• Avoid duplication, omission, or interactions.
• Clear communication during handovers.

12. Prevention of Communication Errors

• Standardized tools: SBAR, read-back, closed-loop communication.

• Documentation of verbal/telephone orders.

13. Prevention of HAI (Healthcare-Associated Infections)

• Adherence to hand hygiene and isolation protocols.

• Bundle approaches (CLABSI, VAP, CAUTI prevention).
• Antibiotic stewardship.

14. Documentation

• Accurate, timely, and legible records.

• Clear reporting of care plans, interventions, and outcomes.
• Legal and ethical compliance.

Incidents and Adverse Events

Capturing of Incidents

• Establishing incident reporting systems.

• Anonymous and non-punitive reporting culture.
Root Cause Analysis (RCA)

• Identifying underlying system issues.

• Multidisciplinary approach to problem-solving.

Corrective and Preventive Action (CAPA)

•
•
• Implementation of corrective steps to prevent recurrence.
• Continuous monitoring and evaluation.

Report Writing

• Structured format: Incident details, analysis, corrective actions, outcomes.

• Transparent and timely communication with stakeholders.

The International Patient Safety Goals (IPSGs) were developed by the Joint Commission International (JCI) to improve patient safety in healthcare
organizations worldwide.

Here are the 6 IPSGs with their objectives:

1. Identify Patients Correctly

o Use at least two identifiers (e.g., name, date of birth, hospital ID) before providing care, treatment, or services.
o Prevents errors in patient identification during procedures, medication administration, and sample collection.
2. Improve Effective Communication
o Ensure accurate, timely, complete communication among caregivers.
o Standardize critical test results reporting, handover communication, and use of read-back for verbal orders.
3. Improve the Safety of High-Alert Medications
o Proper labeling, storage, and administration of look-alike/sound-alike drugs.
o Reduce errors in prescribing, dispensing, and monitoring high-risk medications (e.g., insulin, anticoagulants, opioids).
4. Ensure Correct-Site, Correct-Procedure, Correct-Patient Surgery
o Implement the surgical safety checklist and "time-out" procedure.
o Mark surgical sites and involve patients in pre-procedure verification.
5. Reduce the Risk of Healthcare-Associated Infections (HAIs)
o Follow evidence-based guidelines for hand hygiene (WHO’s 5 Moments).
o Implement infection prevention protocols for catheters, ventilators, surgical procedures, etc.
6. Reduce the Risk of Patient Harm Resulting from Falls
o Assess patient’s risk of falls and implement prevention strategies.
o Educate staff and patients, use bed rails, non-slip footwear, and environmental safety measures.

These goals are universal standards for patient safety and are applied in hospitals, clinics, and other healthcare facilities accredited by JCI.

International Patient Safety Goals (IPSGs)

1. Identify Patient Correctly

o Use at least two identifiers before care, treatment, or specimen collection.
2. Improve Effective Communication
o Ensure accurate, timely, complete, and clear communication, especially for verbal/telephone orders and critical test results.
3. Improve Safety of High-Alert Medications
o Proper labeling, safe storage, and monitoring of look-alike/sound-alike and high-risk medications.
4. Ensure Safe Surgery (Correct Site, Procedure, and Patient)
o Use surgical safety checklists, “time-out” procedures, and site marking.
5. Reduce the Risk of Healthcare-Associated Infections (HAIs)
o Follow evidence-based hand hygiene and infection prevention practices.
6. Reduce the Risk of Patient Harm Resulting from Falls
o Fall-risk assessments, environmental safety measures, patient/staff education.
7. Reduce the Harm Associated with Clinical Alarm Systems
o Ensure alarms are audible, responded to promptly, and not ignored or silenced improperly.
o Avoid “alarm fatigue” by proper alarm management.

The first 6 are the core JCI IPSGs,

while the 7th (alarm safety) is often added as an expanded safety goal, since alarm-related harm has become a major patient safety issue globally.

Safety Protocol

1. 5S Concept (Workplace Safety & Organization)

o Sort – Remove unnecessary items.
o Set in Order – Organize essential items for easy access.
o Shine – Clean and inspect work areas.
o Standardize – Establish standard procedures.
o Sustain – Maintain and continuously improve practices.
2. Radiation Safety
o Use shielding, distance, and time principles.
o Wear dosimeters, lead aprons, and PPE.
o Follow ALARA principle (As Low As Reasonably Achievable).
3. Laser Safety
o Proper signage in laser-use areas.
o Use protective eyewear.
o Controlled access and trained operators.
o Fire Safety
o Types of Fire (Classification):
▪ Class A – Ordinary combustibles (wood, paper).
 ▪ Class B – Flammable liquids/gases.
▪ Class C – Electrical fires.
▪ Class D – Metals.
▪ Class K – Kitchen (cooking oils/fats).
o Fire Alarms – Smoke detectors, heat detectors, manual call points.
o Firefighting Equipment – Fire extinguishers (water, CO₂, foam, dry chemical), sprinklers, hydrants, blankets.
4. HAZMAT (Hazardous Materials) Safety
o Types of Spill: Chemical, biological, radioactive.
o Spillage Management:
▪ Evacuate & isolate area.
▪ Use PPE.
▪ Contain and neutralize spill.
▪ Dispose safely as per guidelines.
o MSDS (Material Safety Data Sheets): Information on hazards, safe handling, first aid, and disposal.
o Environmental Safety: Proper disposal, pollution prevention, ventilation.
o Risk Assessment & Aspect Impact Analysis: Identify hazards, analyze impact, and mitigate risks.
5. Maintenance of Temperature & Humidity (Department-wise)
o ICU/OT: Strict control to prevent infection.
o Labs: Controlled conditions for sample integrity.
o Pharmacy/Storage: Maintain recommended drug storage conditions.
6. Audits
o Safety audits, fire audits, infection control audits.
o Ensure compliance with protocols and continuous improvement.
7. Emergency Codes
o Code Red – Fire
o Code Blue – Cardiac Arrest
o Code Yellow – Disaster
o Code Black – Bomb threat
o Code Pink – Child abduction
o Code Orange – HAZMAT/Spill
o (Varies by hospital policy)
8. Role of Nurse in Disaster Management
o Early identification and activation of emergency codes.
o Patient evacuation and triage.
o Provide first aid and maintain communication.
o Assist in documentation and coordination with the disaster team.

Employee Safety Indicators

• Vaccination – Ensuring healthcare workers receive recommended immunizations (e.g., Hepatitis B, Influenza, COVID-19, Tdap) to prevent occupationally
acquired infections.
• Needlestick injuries – Monitoring, reporting, and prevention of sharps-related injuries to reduce the risk of bloodborne pathogen transmission (HIV, HBV,
HCV).

Employee Safety – Prevention

• Fall prevention – Safe workplace design, hazard identification, slip-resistant flooring, proper footwear, staff training.
• Radiation safety – Use of lead aprons, thyroid shields, dosimeters, limiting exposure time, shielding, and following ALARA (As Low As Reasonably
Achievable) principle.
• Annual health check – Regular medical check-ups, screening for occupational illnesses, monitoring chronic conditions, and fitness-to-work assessments.
• Healthcare Worker Immunization Program & Management of Occupational Exposure – Ensuring staff are vaccinated against common infectious
diseases; providing immediate evaluation, first aid, and prophylaxis in case of occupational exposure.
• Occupational health ordinance – Compliance with national and institutional policies regarding employee safety, workplace ergonomics, and prevention of
occupational hazards.
• Vaccination program for healthcare staff – Mandatory/ recommended vaccines (Hepatitis B, Influenza, Tdap, MMR, Varicella, COVID-19).
• Needle stick injuries: Prevention & Post Exposure Prophylaxis (PEP) – Safe sharps disposal, use of safety-engineered devices, no recapping, staff
education, immediate reporting, baseline testing, and PEP (HIV, HBV, HCV) as per protocol.