BASIC FACTS ABOUT PCI IN Q/A FORMAT[1] What is Infection Control Program & why is it important? ANS: It is health care organisations program for the surveillance, prevention & control of infection. It is important as basically it aims at the prevention & spread of infections amongst patients, health care workers as well as visitors in the health care setting. 1. DOES NMCSH AL AIN HAVE AN INFECTION CONTROL PROGRAM/ MANUAL? Answer: Yes 2. WHERE IT IS LOCATED? Answer: located in the intranet ( www.nmc.aa ) 3. WHO ARE THE CURRENT INFECTION CONTROL CHAIRMAN/DOCTOR AND INFECTION CONTROL NURSE? Answer: PCIC CHAIRMAN & IC DOCTOR: Dr Nayan J. Vasa INFECTION CONTROL NURSE: Ariel Arzadon 4. WHO ARE THE CURRENT REPRESENTIVE/ COORDINATOR FROM YOUR DEPARTMENT AND WHAT ARE HIS/HER RESPONSIBILITIES? Answer: ________ (YOU MUST KNOW WHO IS THE INFECTION CONTROL COORDINATOR IN YOUR DEPARTMENT). He /She is responsible for taking our issues to the committee and to our HOD on the committees actions and reports on a monthly basis. 5. HAVE YOU RECEIVED EDUCATION ON INFECTION CONTROL? Answer: We receive education during orientation, training on a regular basis and annually. [2 ]Who is involved in Infection Control in the hospital? ANS: Everybody or all employees of the hospital. [3] What do you know about the JCI? ANS: JOINT COMMISSION INTERNATIONAL [JCI] is a division of Joint Commission Resources [JCR] , the subsidiary of the Joint Commission on Accreditation of Healthcare Organizations[ JCAHO].These have been dedicated to improving the quality & safety of health care services. They survey nearly 20,000 health care programs through a voluntary accreditation process. [4] What is ACCREDITATION?

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ANS: It is a process in which an entity [like JCI], separate & distinct from the health care organisation , usually nongovernmental , assesses the health care organization to determine if it meets a set of requirements (standards) designed to improve the safety & quality of care. Accreditation is usually voluntary. [5] What do you mean by HAI ? ANS: Health care associated infections[or hospital acquired infections] are acquired during hospitalisation or become more evident after discharge from the hospital. Infections are considered nosocomial if they appear 48 hrs or more after hospital admission or within 10 days after discharge. Health care associated infection control is important not only for hospitalised patient but also for out patient, visitors and the hospital staff. [6] Give examples of some of the HAIs. ANS: Urinary tract infection Wound infection Eye infection Bone and joint infection Ventilator associated Pneumonias Surgical site infection Blood stream infection Gastrointestinal infection

Central nervous system infection [7] How does infection spread in the health care setting?

ANS: The chain of transmission of infection is a model that describes the components necessary for transmission of organisms. There are six links in the chain of transmission. Model

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[8] What are the various modes of transmission of infection? ANS: {A} HORIZONTAL TRANSMISSIONFour main routes spread organisms

Contact (direct, indirect, droplet) Airborne Vehicle Vector borne

{B}VERTICAL TRANSMISSION FROM THE MOTHER TO THE FOETUS. [9] How can we take precautions to prevent spread of infections? ANS: Precautions taken are classified in groups as follows: {a} Standard precautions used at all times in the hospital while dealing with all the patients irrespective of their diagnosis for e.g. hand washing , use of personal protective equipments etc.

WHEN WILL WE APPLY THESE STANDARD PRECAUTIONS? While managing the patients regardless of their diagnosis. While managing any contaminated equipment and material used during patient care..3

{b}Transmission based precautions- used while managing specific type of infected patients & therefore are specific for particular mode of transmission as -- contact precautions. -- droplet precautions. --airborne precautions. E.R. OBSERVATION ISOLATION ROOM CRITERIA CONTACT AND DROPLET PRECAUTION FOR FOLLOWING SUSPECTED OR DIAGNOSED DISEASES, FOR OBSERVATION < 6 HOURS. CONTACT PRECAUTIONS BRONCHIOLITIS CLOSTRIDIUM DIFFICILE CONGENITAL RUBELLA DIPHTHERIA (CUTANEOUS) HEPATITIS A (DIAPERED OR INCONTINENT PATIENTS) HERPES SIMPLE-NEONATAL, MUCOCUTANEOUS, DESSIMINATED HERPES ZOSTER (SHINGLES) DISSEMINATED OR IN IMMUNOCOMPROMISED HOSTREQUIRES AIRBORNE PRECAUTIONS AS WELL IMPETIGO LICE (HEAD PEDICULOSIS) MAJOR UNCONTAINED ABSCESS OR DECUBITUS ULCERS, MAJOR WOUND INFECTION MDR-MULTI DRUG RESISTANT GRAM NEGATIVE ORGANISMS-(SUCH AS PSEUDOMONAS, KLEBSIELLA, ACINETOBACTER. RESISTANT TO THREE OR MORE OF THE FOLLOWING ANTIBIOTICS: QUINOLONES, ANTI-PSEUDOMONAL BETA LACTAMS, AMINOGLYCOSIDES, 3RD AND 4TH GENERATION CEPHALOSPORINS, PIPRA-TAZOBACTAM AND CARBAPENEMS). MRSA- METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS PARAINFLUENZA (INFANT AND CHILDREN) POLIOMYELITIS ROTAVIRUS RSV-RESPIRATORY SYNCTIAL VIRUS SCABIES4

VARICELLA (CHICKEN POX)-REQUIRES AIRBORNE PRECAUTION AS WELL VIRAL HAEMORRHAGIC DISEASE- REQUIRES DROPLET PRECAUTION AS WELL VRE-VANCOMYCIN RESISTANT ENTEROCOCCI

DROPLET PRECAUTIONS ADENOVIRUS DIPHTHERIA (PHARYNGEAL) EPIGLOTTITIS DUE TO HAEMOPHILUS INFLUENZA HEAMOPHILUS INFLUENZA TYPE B (KNOWN OR SUSPECTED) INFLUENZA (PANDEMIC AND SEASONAL) MENINGOCOCCAL DISEASE: SEPSIS, PNEUMONIA, MENINGITIS MUMPS (INFECTIOUS PAROTITIS) MYCOPLASMA, MENINGOCOCCAL, ADENOVIRUS NEISSERIA MENINGITIDIS (MENINGOCOCCAL KNOWN OR SUSPECTED) PARVOVIRUS B 19 (ERYTHEMA INFECTIOSUM) PERTUSSIS (WHOOPING COUGH) PLAGUE (PNEUMONIC) PNEUMONIA (MYCOPLASMA, MENINGOCOCCAL,ADENOVIRUS) RUBELLA (GERMAN MEASLES) STREPTOCOCCAL DISEASE (STREPTOCOCCUS GROUP A)

2ND FLOOR IN PATIENT ISOLATION ROOM CRITERIA CONTACT, DROPLET AND AIRBORNE PRECAUTION FOR FOLLOWING SUSPECTED OR DIAGNOSED DISEASES, FOR ADMISSION (CONTACT, DROPLET AND AIRBORNE) + OBSERVATION < 6 HOURS (AIRBORNE) CONTACT PRECAUTIONS AS MENTIONED ABOVE DROPLET PRECAUTIONS AS MENTIONED ABOVE AIRBORNE PRECAUTIONS VARICELLA (CHICKEN POX)-REQUIRES AIRBORNE PRECAUTION AS WELL5

AVIAN INFLUENZA- REQUIRES CONTACT PRECAUTION AS WELL EXTRAPULMONARY TB, DRAINING LESSION MEASLES (RUBEOLA) SARS (SEVERE ACUTE RESPIRATORY SYNDROME)- REQUIRES CONTACT PRECAUTIONS AS WELL SMALLPOX- REQUIRES CONTACT PRECAUTION AS WELL TUBERCULOSIS (PULMONARY OR LARYNGEAL) SUSPECTED OR CONFIRMED MONKEY POX- REQUIRES CONTACT PRECAUTION AS WELL

[10]Give examples of contact / airborne / droplet infections. ANS: A) Infections which need contact precautions are -- MRSA, VRSA,CLOSTRIDIUM DIFFICILE WITH DIARRHOEA, SCABIES, CHICKEN POX ETC. B) Infections which need airborne precautions are T.B., MEASLES ETC. C) Infections which need droplet precautions are DIPHTHERIA, PERTUSSIS, VIRAL HAEMORRHAGIC FEVER, STREPTOCOCCUS PNEUMONIAE ETC.

STOP

Put the Patient in Isolation Room (if possible)

Do Hand Washing Before EntryINCLUDEPICTURE "http://scd.mm-c1.yimg.com/image/1010163999" \* MERGEFORMATINET

Contact PrecautionsPut Gloves OnINCLUDEPICTURE "http://scd.mm-b1.yimg.com/image/839422345" \* MERGEFORMATINET

Wear Protective GownINCLUDEPICTURE "http://scd.mm-c1.yimg.com/image/1213283875" \* MERGEFORMATINET

Remove PPE at Doorway anddo Hand Washing before Leaving

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STOPIn Addition Standard to Precautions)) Only 2 persons per visit allowed, Visitors must report to Nursing Station before entering the room

Isolation Room is a Must

INCLUDEPICTURE "http://scd.mm-b1.yimg.com/image/533130431" \* MERGEFORMATINET

PRECAUTIONS DROPLET Wear a Surgical Mask before EntryINCLUDEPICTURE "http://scd.mm-b1.yimg.com/image/916551229" \* MERGEFORMATINET

Remove the Surgical Mask and do Hand Washing before leaving

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STOP Negative Pressure Room is a Must In Addition to Standard PrecautionsINCLUDEPICTURE "http://scd.mm-a1.yimg.com/image/347434253" \* MERGEFORMATINET Only 2 persons per visit allowed, Visitors must report to Nursing Station before entering the room

The Door Must n Control Dept. Remain Closed

Infectio

AIRBORNE PRECAUTIONSWear N95 Mask Before EntryW

Remove the Mask before LeavingAnd do Hand Washing

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)) Only 2 persons per visit allowed, Visitors must report to Nursing Station before entering the room

Diseases that require these types of precautions are; TB, Measles, Chickenpox

[11] When do you wash your hands or what are the indications for HAND WASHING OR HAND HYGIENE? ANS: Kindly refer to our hospitals hand hygiene policy & procedures. This policy is the most important guideline for prevention & control of infection in a health care organization.

HAND HYGIENE

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THE MOST IMPORTANT Hand Hygiene Indications =

Use antimicrobial soap, OR Alcohol hand rubs Do not use alcohol hands rub if your hands are visibly soiled Duration of hand washing

Two minutes at the beginning of duty, and after duty before going home Two minutes before high-risk procedures, and after heavy contamination.A) Routine washing at least 20 seconds

[12] How can you classify HOSPITAL LINEN? ANS: A) Soiled linen : All linen used while managing patients &/or contaminated linen . B) Clean linen : All unused & uncontaminated linen. C) Sterile linen : All autoclaved clean linen . [13] How soiled linen is sent to the laundry? Answer: We wear personal protective equipment (PPE) WHILE handling staff, dirty/unsoiled and soiled linen, and wash our hands after removing PPE. 1. Linen is segregated on the area of generation. Categories: a. Staff linen (linen trolley for staff linen in the dirty utility room).10

b. Dirty/nonvisibly soiled or used linen (put in a yellow plastic bag , label and place

in the dirty linen trolley in the dirty utility room). c. Soiled linen with biological fluids while managing patients- considered as highly infective (put in a water soluble alginate bag +RED BAG, label and place in the soiled linen trolley in the dirty utility room). 2. Collection 3. Transport[IN A CLOSED TROLLEY/CONTAINER to the site of temporary storage ( use of dirty service lift ). 4. Temporary storage area[BASEMENT OF THE INPATIENT BUILDING] 5. Laundry (outsource) [14] How can you classify HOSPITAL WASTE? ANS: As follows-A) MEDICAL OR HAZARDOUS OR INFECTED

WASTES

CATEGORY OF MEDICAL WASTE Group A Medical Waste

MATERIALS / ITEMS Anatomical or pathological waste, waste contaminated with human blood or other body fluids, excreta, vomit, human tissue, wastes from contagious diseases, dirty bandages, bed sheets, animal remains and all other materials on which animal lay or cloth or used by animal whether contaminated or not and mortuary wastes. Sharps, usually syringes and needles, surgical tools, different medicine and medical equipment vessels, broken glass and all other sharp equipment, tools and materials. Blood, tissue and microbial cultures and microbiology laboratory waste, carcasses of inoculated lab animals, stools from cholera patient or body fluid of highly infectious diseases, and mortuary waste not specified under Group A.

Group B Medical Waste

Group C Medical Waste

Group D Medical Waste Group E Medical Waste Group F Medical Waste

Pharmaceutical and chemical waste to which medical specifications apply. Deposable linings used for patient beds, caps of bottles for receiving and storing blood, urine, urine diapers, bags or vessels used for receiving stomach waste and similar wastes. Waste resulting from treatment with radio active materials and wastes resulting from all operations related to radio active materials.

B) NONHAZARDOUS OR GENERAL OR NONMEDICAL WASTES Non-medical waste refers to garbage (waste from food) and rubbish (paper, plastic, metal , glass, and ashes). It is similar to the domestic waste.11

[15] Where do you place medical waste & how it is disposed? ANS: It is placed in a yellow plastic bag & closed for its disposal. Note that ideally highly infectious wastes [ group A& C especially] are first packed in a red plastic bag at the point of generation & then disposed . [16] What are the basic steps in waste disposal? ANS: The basic steps involved are : 1. Medical waste is segregated on the area of generation. Packaging and color codes for medical waste according to classification/categories. NOTE: All waste bags should not be filled more the 65% of their capacity and sharp object boxes should not be filled more than 75% of their capacity. 2. Collection 3. Transport to the site of temporary storage a. All medical waste yellow bags are collected in closed containers twice a day from all departments by the housekeeping staff and transported in the specific elevator ( dirty service lift ) to the central waste storage area in the basement. b. The service elevator is cleaned and mopped with disinfectant after transportation of clinical waste. c. Sharp objects boxes must not be stowed for more than 75% of their capacity and the boxes for preserving such waste shall be tightly sealed with a cap or lock or any other means so as not to be opened. When the sharp container is full staff in charge is the one responsible to secure and label by which department, date and the person who secure it before calling the housekeeping staff for collection and transport to the site of temporary storage. No full sharp container must be stored on the patient area. d. The medical waste bags and general waste bags are transported separately. e. General waste is discarded by the user into a bin lined with black plastic bag and when 2/3 full removed by the housekeeping staff and taken onsite storage from where it is removed by the municipality daily. 4. Final Disposal by outsource contactor. [17] How do you dispose sharps? ANS: They are disposed in a puncture proof rigid plastic yellow sharp boxes marked with a BIOHEZARD symbol. [18] What you will do if you have a blood/ body fluid exposure accidentally while managing a patient? ANS:a) Not to panic!

b) Wear glove & wash the affected area thoroughly with copious water (first aid). c) Inform to your senior/ in charge d) Attend the employee health clinic[GP] for further advise/treatment in normal working hours or emergency room after normal working hours e) MAKE AN INCIDENT REPORT & THEREAFTER BLOOD/ BODY FLUID EXPOSURE FORM. [19]What are the most common Nosocomial Infections of your unit?12

ANS: (Depends on the unit). [20] What would you check when doing an Infection Control Environmental Check in your unit? ANS: a)cleanliness of the environment b)presence of hand hygiene facilities c)availability of the PPE[ personal protective equipments] d)appropriateness of the waste & linen management e)decontamination methods if being done for your unit.

[21]Name common PPEs. ( PERSONAL PROTECTIVE EQUIPMENT) ANS: PPE CONSISTING OF THE FOLLOWING: a. Gloves, disposable b. Gowns, apron c. Goggles and face shields d. Head cover, shoe cover e. Surgical mask f. N95 Particulate Respirator ( for Airborne precautions; sometimes referred to as a TB mask). All are disposable except the N95 mask, it could be reused

By the same staff FOR TREATING THE SAME PATIENT Label with the staff name, date of opening Kept outside the patient room, in a clean plastic bag Keep max. one week

EVERYBODY MUST KNOW THE LOCATION OF PPE AND ALL PPE SHOULD BE REMOVED BEFORE LEAVING THE CLINICAL AREA.

Recommended Usages of Personal Protective Equipments

Procedur e

Recommended PPEGlov es Eye Goggl es Surgic al Gown0 /apro01 Mask

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Extracting Blood sample Insertion IV cannula Wound dressing Bed making Patient morning care Cleaning patient equipment Handling medical waste Handling any blood or body fluid Handling clean linen Suctioning Changing diapers

Checking blood sugars Examining the patient Cleaning & disinfection Feeding baby

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+/-

Preparing Patient for OR-or Shaving Preparing food

Cleaning hospital environment Insertion of urinary catheter

Handling the corpse or dead body Handling body part Collecting contaminate d (soiled) linen Collecting used linen Cleaning Enema

References:

http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/ppe/index.ht ml http://www.cdc.gov/ncidod/dhqp/gl_isolation.htmlhttp://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf

http://www.orcbs.msu.edu/chemical/programs_guidelines/ppe_program/ppe_ma nual/ppe_01_toc.htm www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf

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[21]What is Decontamination? ANS: It is a process which removes or destroys microorganisms to render an object safe for use. Decontamination includes a] cleaning which removes foreign material from an object. b]disinfection which reduces the number of majority of pathogens except bacterial spores. c]sterilization which destroys all pathogens including spores.

[22] What is isolation/ anteroom/cohorting? ANS: Isolation is physically separating the infected patient from other patients in specific single rooms to prevent spread of infection. Anteroom is the place attached to the isolation room to support use of PPEs. Cohorting means for infection control purposes, if single isolation rooms are not available/ shortage of isolation rooms, patients infected or colonized by the same organism can be kept in a sharing room.[ 23A]What is C.S.S.D? How is it divided into separate areas? ANS: C.S.S.D. means Central Sterile Supply Department of the facility. It should have the following areas a)decontamination ( mainly cleaning) area b)packaging area c)sterilization area & d)storage area. [23B]How can you monitor sterilization methods in the C.S.S.D.? ANS: Sterilization processes are routinely monitored with a) Physical(mechanical) techniques for e.g. daily assessment of the cycle time/temperature & pressure gauge. b) Chemical methods like change of colour of chemical indicator strips.

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c) Biological indicators e.g. spores of Bacillus geothermophilus are used to monitor steam & dry heat sterilization processes.

[24]What is the latest classification of the Infectious Diseases on the basis of their acquirement? ANS: a)Hospital Acquired Infection, b)Community Acquired infection & c) Occupationally Acquired infection e.g. needle prick injuries.

FEW MORE POINTS1. HOW IS THE INFECTION CONTROL TEAM NOTIFIED OF

INFECTIONS? Answer: By completing Notification of Infectious Disease Form and forwarding it to the infection control nurse. ICN reviews all notifications received. 2. HOW IS THE PREVENTIVE MEDICINE DEPARTMENT NOTIFIED OF COMMUNICABLE DISEASES? Answer: The treating doctor completes the notification of communicable disease form according to the federal law of the UAE and forwards the original copy to the MRD, and they will do the needful. Copy of the original with the notification of infectious disease for by the infection control will forwarded to the ICN. ICN reviews all notifications received. 3. What kind of precautions do you apply in case of? 1. 2. 3. 4. 5. Mumps, Rubella Pulmonary TB Whooping cough Wound infection with Pseudomonas meningococcal meningitis, 6. Chicken Pox 7. Influenza viruses 8. Measles Answer: For 1, 3, 5, 7 Droplet precautions For 2, 8 For 4 For 6 Airborne Contact Airborne & contact

4.What are the precautions taken pre-operatively to prevent surgical site infection? Infections to be treated, DM to be controlled Showering the patient the night before the operation if admitted , otherwise after

admission if patient fit for the bath Hair removal with electric clipper not razors17

Before skin antisepsis; gross contamination should be cleaned with detergent Prophylactic antibiotic during induction of anaesthesia Hand scrub for the staff (3-5 min)

5. What type of incidents you should report to Infection Control Department? A) B) C) D) Needle stick injury Exposure to a case open Pulmonary TB Exposure to any vaccine preventable disease (measles, mumps, rubella) Suspected or confirmed case of H1N1 influenza A virus

6. If you have an immune-compromised patient , how can you protect him? 1. 2. 3. 4. 5. 6.

Protective isolation[ 2 nd floor isolation room] The door of the room shall be kept closed Hands Hygiene & don gloves before touching the patient. Surgical masks are indicated for all persons entering the room. Limit the number of staff or Visitors entering the room. Staff or visitors with Infection e.g. influenza; are not allowed to enter. Staff who is nursing patients with infections should avoid nursing patients in protective isolation during the same span of duty.

7. Take care, Common mistakes with the use of gloves Not performing hand hygiene Touching clean surfaces and objects with contaminated used glove. Keeping gloves when moving from contaminated to clean area. Wearing same glove with different patients. Wearing torn or damaged gloves Wearing non sterile gloves with invasive procedure. (Conditions for use of multi dose vials ( MDVs .8 MDVs due date within 30 days or within due date stated by manufacturer after opening or upon sign of contamination whichever is less The vial should be label with open date & due date. Change syringe and needle with each use of multi-dose

Multiple choice questions, the right answer is underlined9. Airborne transmission occurs by dissemination of airborne droplet nuclei sized:18

< 5 microns 10. Pregnant women should not visit: A) B) C) D) MRSA colonized patient Patient with urinary stones Rubella patient Patient with Hepatitis B

11. A blood spill kit should contain the following except: A) PPE B) Sprayer bottle filled with 10% hypochlorite C) Yellow biohazard waste bags D) C- Fold tissue papers 12.For discarding a used contaminated needle the following is the correct method A) Use scoop method to recap needle and throw in sharp container B) Remove needle and throw in sharp container, then throw cylinder in medical waste bag C) Recap the needle then throw the whole needle in medical waste bag D) Dont recap needle, throw syringe altogether in sharp container 13. In case you get a needle prick with a used needle which of the following is correct: A) B) C) D) Serology screening for the injured staff Incident report is submitted to ICD Serology screening for the source patient. All of the above

15. The following statements about sharp containers are correct except: A) B) C) D) Should be puncture proof with tight lid Should be closed and discarded when full Should be of uniform size for all hospital Should have biohazard sign and labelled before disposal

16. The following are among safe injection practices except: A) B) C) D) Use of single dose vials whenever possible Do not use of IV bottle as common source of supply to multiple patients With multi-dose vials change the needle of the syringe with change of patient. Store MDV as per manufacturer instruction

17. The following statements about linen are correct except:19

A) B) C) D)

Soiled linen are well agitated before being collected Soiled linen is kept in yellow plastic bags, inside blue or green hamper Linen bags are stored in hampers in utility room until collected Hand hygiene is mandatory before handling clean linen

18. Check the single correct statement:A) All hospital staff must receive BCG vaccine B) MRSA patient should be isolated in negative pressure isolation room C) Perform Hand hygiene & change of gloves when shifting from contaminated

to clean body site. D) Under pad contaminated with cytotoxic drugs is discarded as highly infectious waste.

FINALLY,,,,,,REGARDING INFECTION CONTROL No eating in working area, do not go to other areas wearing potentially contaminated gloves; nor answer the telephone while wearing gloves, use a computer keyboard or open doors while wearing the gloves. Mask shall not be lowered and worn around the neck. They should be change when sneezing occurs, when damp and between patients. The maximum time for wearing the same mask should be 1 hour, since it becomes dampened from respiration, causing filterability to be degraded. N95 mask shall be use 7 continuous hours in the same patient, therefore can be worn for seven days if not worn continuously. Label your name and put it on a plastic bag and hang it in the ante room of the isolation room. Do not recap, bend, clip or remove needles from syringes prior to disposal. Needles, syringes and other sharps should be discarded in the designated sharp object boxes containers with a little manipulation as possible. Never recap but if it is really necessary SCOOP METHOD should be applied.

NO..FROM PCI IN THE HOSPITAL. NO Bar Soap NO Sponge NO Plants in medical areas NO Long nails NO Nail paint No house-hold soap in medical departments

PLEASE REVIEW THESE Q/A AS THEY REFRESH YOUR KNOWLEDGE ABOUT THE INFECTION CONTROL AS WELL AS THEY MAY WELL BE ASKED TO ANY UNIT BY VARIOUS INSPECTION TEAMS VISITING OUR HOSPITAL! For any assistance please contact the undersigned.20

THESE Q/A ARE PREPARED BY THE PCIC CHIARMAN DR.NAYAN J.VASA & MR.ARIEL [PCIN] OF THE NMCSH, AL AIN. APPROVED BY DR.IAJAZ AHMED M.D. NMC SPECIALTY HOSPITAL AL AIN. Dr. Nayan J.Vasa H.O.D. General Surgery PCI Committee Chairman NMC Specialty Hospital PO Box. 84142, Al Ain, UAE Tel: +971-3-7555999 Fax: +971-3-7553366 Email: dr.nayan@nmc.ae

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