By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society of Infection Control

1. Lack of structure - No ICC - There may be ICP 2. Lacking or inadequate policies 3. Lack of resources Current Status Current status in rural areas & most P.H.C. facilities: Lacking resources: - Running water - Hand.W. facilities - Protective clothes - Steriliz., disinf. facilities - Sharps disposal facilities - Waste disposal facilities - Incineration facilities Organization & Sustainability

4. Lack of knowledge 5. Lack of compliance 6. Lack of concept 7. Lack of control - Loss - Overconsumption Current Status (cont.d) Current status in rural areas & most P.H.C. facilities: Organization & Sustainability

1. Establish a structure - ICC, ICT, ICD, ICN, ICLN - Minimal requirements Who is the ideal IC man? Who is the ideal IC nurse? How to practice Organization & Sustainability

Infection control Personnel The ideal IC man is a combination of: Inf. ds. specialist Teacher Epidemiologist Preacher Microbiologist Economist Psychologist Environmentalist (Never ever be a policeman) Organization & Sustainability

The ideal IC nurse is: The fairy good mother St. Francis assist Margaret Thatcher Infection control Personnel Organization & Sustainability

2. Formulate & monitor policies (Guidelines) - Protective barriers - Ward specific policies - Site specific policies - Disease specific policies 3. Use the existing system (Modify interventions) e.g.a) Cleaning, disinfection & sterilization b) soiled linen mgt 4. Educate all healthcare workers 5. Raise awareness & establish the right concepts How to practice Organization & Sustainability

6. Control & security to control overconsumption & avoid loss 7. Recycling & Reuse Recycling: Most of hosp. waste is of the household type & is recyclable. Reuse: of non critical items, e.g. masks, gloves, etc. (after being cleaned & disinfected). How to practice Organization & Sustainability

- The basic requirement is clean objects - Determine when sterilization is needed & when disinfection is sufficient - 10 min boiling is sufficient to avoid almost 90% of infections - Highly sophisticated equipment is not required - Less costly methods may be used to eradicate many organisms - Proper use of available resources in due time is very important Modify existing systems - basic concepts Organization & Sustainability

What are the basic concepts for education? - Hand hygiene - Personal hygiene - Protective barriers - Cleaning, sterilization & disinfection - Aseptic work techniques - Safe food and water supply - Special skills, e.g. communicology Education of HCW Organization & Sustainability

Who should be educated? - The general population - Special population groups Teachers, parents, medical & non-medical staff, children, pupils,... Who should educate? - Educated experts - IC doctors - IC nurses - Infectious Diseases specialists Education of HCW Organization & Sustainability

How to communicate with IC users? - Handouts; mostly not read: Doctors have no time to read, what they read, they do not believe, What they believe, they do not do - Posters; mostly not noticed - Lectures; mostly not attended - Scientific literature; mostly not understood &/or believed - IC folders; where are they? Education of HCW Organization & Sustainability

- Ward rounds - Quality circles; Group meeting Adequate time With very ltd. no. At work times Different levels Results discussion Regular meetings Role playing From different work areas Discuss self-chosen subjects Education of HCW (How to communicate w IC users) Organization & Sustainability

How to achieve? - Kill all opponents immediately! - Wait until they die! - Try not to convince strong opponents - Collaborate with supporters - Use the top to bottom approach - The hosp. administrator must be your partner - The hosp. IC nurses are the key players Education of HCW Organization & Sustainability

What should be our goal? - Infection rate; not above average - Low rates of MRSA & VRE - No outbreaks - We are partners - We save you Education of HCW Organization & Sustainability

What should not be our goal? - Teach everybody - Reach everybody - Reach 100% achievement or 100% compliance Education of HCW Organization & Sustainability

How to accomplish? - Clearly define your goal - Involve keen staff - Keep it simple - Do not try to reach 100% compliance - Do not try to impose - Do not expect immediate change Education of HCW Organization & Sustainability

How to accomplish? (cont.d) - Go to the ward & talk to the people - Do not wait to approach - Keep regular meetings with sterilization units with ICC with regular ward rounds Education of HCW Organization & Sustainability