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An important part of an ICC or program is the establishment of policies and procedures. These procedures must be comprehensive and written to ensure stepwise control of all issues involving IC. As with the DTC, policies and procedures provide the infrastructure for developing a comprehensive program that is both effective and enforceable. At a minimum, policies and procedures should be in place for hand hygiene and the use of gloves, isolation and universal precautions, insertion of invasive devices, use of urinary catheters, housekeeping, disinfection and sterilization, mechanical ventilators and respiratory equipment, and surgical site care. Policies should focus on (a) making clinical staff aware of all required procedures to control and prevent infections, and (b) monitoring compliance with policies and procedures.
Surveillance activities are an important part of IC, but they must be prioritized. The collection of information that is infrequently evaluated or of little importance should be discouraged in favor of concentration on priority areas. Surveillance should include the following—
• Daily visits to medical wards by the IC nurse (especially high-risk wards such as intensive care units and surgical wards) to observe for infection, and record keeping to document the results of these visits
• Review of results of the microbiological laboratory, including sensitivity patterns to antibiotics (if available) and reporting these findings to appropriate medical staff
• Attention to spontaneous reports from different wards concerning possible occurrence of nosocomial infections.
Hand Hygiene and the Use of Gloves
Hand hygiene is considered to be the most important procedure for preventing nosocomial infections. With the appropriate facilities and supplies, this simple method of infection control will decrease nosocomial infections significantly. Sinks with running clean water and soap are typically necessary, but not essential. Where they are unavailable, waterless hand antiseptics can be used, with comparable results. Commercial preparations are available or can be manufactured locally by using isopropyl alcohol 70 percent with glycerin. The use of disposable towels or single-use washable towels is encouraged in all hospitals. Reusable cloth towels are a source of contamination, and procedures must regulate how they will be used and laundered. Absolute indications for hand hygiene are generally not known because of a lack of well-controlled studies. Touching or significant contact with possibly infected materials (e.g., blood, sputum, wounds, skin) necessitates thorough hand hygiene before after each contact.