Infection prevention (IP) in family planning and health care
facilities has two primary objectives:
- To prevent major postoperative infections when providing surgical contraceptive methods
(e.g., IUDs, injectables, implants and voluntary sterilization)
- To minimize the risk of transmitting serious diseases such as hepatitis B and AIDS not
only to clients but also to service providers and staff, including cleaning and
housekeeping personnel
In the following sections, the recommended infection prevention practices are based on
the following principles:
- Consider every person (client or staff) potentially infectious.
- Wash hands—the most practical procedure for preventing cross-contamination
(person to person).
- Wear gloves before touching anything wet—broken skin, mucous membranes,
blood or other body fluids (secretions or excretions)—or soiled instruments and other
items.
- Use physical barriers (protective goggles, face masks and aprons) if splashes and
spills of any body fluids (secretions or excretions) are anticipated.
- Use safe work practices, such as not recapping or bending needles, safely passing
sharp instruments and properly disposing of medical waste.
- Isolate patients only if secretions (airborne) or excretions (urine or feces)
cannot be contained.
Finally, process instruments and other items (decontaminate, clean, high-level
disinfect or sterilize) using recommended IP practices.
Handwashing
- Wash hands before and after examining any client (direct contact).
- Wash hands after removing gloves because the gloves may have holes in them.
- Wash hands after exposure to blood or any body fluids (secretions and excretions), even
if gloves were worn.
Experience has shown that the most effective way to increase handwashing is to have
physicians or other respected individuals (role models) consistently wash their hands and
encourage others to do the same.
To encourage handwashing, program managers should make every effort to provide soap and
a continuous supply of clean water, either from the tap or a bucket and single-use towels.
(Do not use shared towels to dry hands.)
Gloves
Wear gloves:
- When performing a procedure in the clinic or operating room
- When handling soiled instruments, gloves and other items
- When disposing of contaminated waste items (cotton, gauze or dressings)
A separate pair of gloves must be used for each client to avoid cross-contamination.
Using disposable gloves is preferable, but where resources are limited, surgical gloves
can be reused if they are:
- decontaminated by soaking in 0.5% chlorine solution for 10 minutes,
- washed and rinsed, and
- sterilized (by autoclaving) or high-level disinfected (by steaming or boiling).
Glove
Requirements For Common Procedures in Family Planning Settings
TASK OR ACTIVITY
|
ARE GLOVES NEEDED?
|
PREFERRED GLOVES
|
ACCEPTABLE GLOVES |
| Blood pressure check |
no |
|
|
| Temperature check |
no |
|
|
| Injection |
no |
|
|
| Blood drawing |
yes |
Exam |
HLD Surgical |
| Pelvic examination |
yes |
Exam |
HLD Surgical |
| IUD insertion (loaded in sterile package and inserted
using no-touch technique) |
yes |
Exam |
HLD Surgical |
| IUD removal (using no-touch technique) |
yes |
Exam |
HLD Surgical |
| Norplant implants insertion and removal |
yes |
Sterile Surgical |
HLD Surgical |
| Surgery (minilaparotomy, laparoscopy, vasectomy) |
yes |
Sterile Surgical |
HLD Surgical |
| MVA (using no-touch technique) |
yes |
Exam |
HLD Surgical |
| Handling and cleaning instruments |
yes |
Utility |
Exam or Surgical |
| Handling contaminated waste |
yes |
Utility |
Exam or Surgical |
| Cleaning blood or body fluid spills |
yes |
Utility |
Exam or Surgical |
Who Gets Needlestick Injuries
If you handle needles in any way, accidental needlesticks will occur.
- Surgeons are most often stuck by needles in the operating room—by
accidentally sticking themselves during suturing.
- Nurses are most often stuck by needles in the hospital—by accidentally
sticking themselves while handling hypodermic needles and syringes or being accidentally
stuck by surgeons.
- Cleaning staff are most often stuck by needles when processing soiled
instruments.
- Housekeeping staff are most often stuck by needles when disposing of waste
material.
How
to Handle Hypodermic Needles, Scissors and Other Sharp Items
Operating Room
- Use a pan (safe zone) to carry and pass sharp items (e.g., pass suture needles on a
needleholder).
- Do not leave sharps in places other than safe zones.
- Tell other workers before passing sharps.
Safety Tips When Using Hypodermic Needles and Syringes
- Use each needle and syringe only once.
- Do not disassemble needle and syringe after use.
- Do not recap, bend or break needles prior to disposal.
- Decontaminate needle and syringe prior to disposal.
- Dispose of needle and syringe in a puncture-proof container.
- Make hypodermic needles unusable by burning them.
Note: Where disposable needles are not available and recapping is practiced, use
the "one-handed" recap method:
- First, place the cap on a hard, flat surface; then remove hand.
- Next, with one hand, hold the syringe and use the needle to "scoop-up" the
cap.
- Finally, when the cap covers the needle completely, hold the needle at the base near the
hub and use the other hand to secure the cap on the needle.
How to Withdraw
Medication From a Sterile Multidose Bottle
- Wipe the top of the bottle with a cotton swab soaked in 60–90% alcohol or other
locally available disinfectant. Allow to dry.
- If using a new disposable needle and syringe, open the sterile pack.
- If using a sterile or high-level disinfected needle and syringe, remove from covered
container using dry, sterile or high-level disinfected forceps.
Never use a syringe for more than one injection. Studies have shown that changing only
the needle, not the syringe, between clients can result in transmission of hepatitis B
virus, and presumably HIV/AIDS.
- Attach needle to syringe by holding the hub (base) of the needle and the barrel of the
syringe.
- Turn the bottle containing the drug upside down and draw the fluid into syringe using
the same needle you will use for the injection.
- Withdraw needle from bottle.
Do not leave a needle inserted in the rubber stopper of a multiple dose bottle. This
practice is dangerous because it provides a direct route for bacteria to enter the
drug bottle and contaminate the fluid between each use.
Waste Disposal
The purpose of waste disposal is:
- to prevent the spread of infection to clinic personnel who handle the waste,
- prevent the spread of infection to the local community, and
- to protect those who handle wastes from accidental injury.
Medical waste may be noncontaminated or contaminated. Noncontaminated waste (e.g.,
paper from offices, boxes) poses no infectious risk and can be disposed of according to
local guidelines. Proper handling of contaminated waste (blood- or body fluid-contaminated
items) is required to minimize the spread of infection to clinic personnel and to the
local community. Proper handling means:
- Wearing utility gloves
- Transporting solid contaminated waste to the disposal site in covered containers
- Disposing of all sharp items in puncture-resistant containers
- Carefully pouring liquid waste down a utility drain or flushable toilet
- Burning or burying contaminated solid waste
- Washing hands, gloves and containers after disposal of infectious waste
 
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