Hospital Hygiene and Infection Control PDF

HOSPITAL HYGIENE AND INFECTION CONTROL BY DR. YOMNA MOHAMED  IPC (INFECTION PREVENTION & CONTROL) BACKGROUND: Infection prevention and control (IPC) is a practical, evidence-based approach which prevents patients and health workers from being harmed by avoidable infection.  Infection pre...

HOSPITAL HYGIENE AND INFECTION CONTROL BY DR. YOMNA MOHAMED  IPC (INFECTION PREVENTION & CONTROL) BACKGROUND: Infection prevention and control (IPC) is a practical, evidence-based approach which prevents patients and health workers from being harmed by avoidable infection.  Infection prevention and control (IPC) is a major challenge or health care systems around the world. IPC is essential for ensuring patient safety, protecting healthcare workers and reducing the overall burden of healthcare associated infections (HAIs) Standard precautions of infection prevention and control  Standard precautions are the minimum infection prevention and control practices that must be used at all times in any setting where health care is delivered for all patients, regardless of suspected or confirmed status of the patient. They aim at achieving a basic level of infection prevention and control. These practices are designed to both protect health care providers and prevent health care providers from spreading infections among patients  Transmission-based precautions * are used when standard precautions alone are not sufficient to prevent the spread of an infectious agent. * are based upon the mode of transmission of the infectious agent. Before encountering any patient, for any procedure, you should commit to the standard precautions as the basic for patient care, they include; I. Standard precautions of infection prevention and control. STANDARD PRECAUTIONS OF HEALTH CARE WORKERS USED FOR ANY PATIENT CARE:  BEFORE EXAMINING ANY PATIENT, FOR ANY PROCEDURE, YOU SHOULD: 1. Wash Hands properly and thoroughly between patient contact and other contact with body fluids or soiled equipment. 2. Use of personal protective equipment: Wear gloves while handling blood, body fluids, nonintact skin or soiled items. Change gloves between patients. Wash hands after removing gloves. Wear Mask with eye protection or face shield to protect mucous membranes of the eyes, nose and mouth when likely to be splashed. Wear Gown to protect skin and prevent soiling of clothing when likely to be splashed or sprayed. Wash hands after removing gown. 3- Respiratory hygiene and cough etiquette: Do not cough or sneeze in the face of others or in your hand, but into a tissue and immediately throw it in the trash. If you do not find a tissue, do it in the sleeve of your upper arm. 4- Sharps safety: Dispose of syringes and other sharps into a designated closed container. Do not recap, break or bend needles. 5-Decontamination of patient care devices and instruments. 6- Management of soiled linen, clinical waste, blood and body fluid samples. 7- Environmental hygiene: clean and disinfected environmental surfaces. 8- Patient placement: Follow established policies and procedures to assess patients for infection risk and ensure they are cared for in a safe place.  WHY TO PERFORM IPC: In health care settings, the most common mode of transmission of pathogens is via hands. Healthcare workers can contaminate their hands by doing simple tasks, including: o Taking a patient’s blood pressure or pulse. o Touching the patient’s gown or bed sheets. o Touching equipment like bedside rails, over-bed tables, IV pumps. HAND HYGIENE  Good hand hygiene is the simplest, most effective measure for preventing HAIs. It is worthy for all HCP to be very well aware about: the "Standard Precaution" especially hand hygiene before getting contact with any patient. Public Health and community Medicine Department, Faculty of Medicine Cairo University 2 020/2021 According to the CDC, healthcare professionals should avoid wearing artificial nails and trim natural nails to less than one-quarter inch. I. HAND HYGIENE: A. Routine. B. Antiseptic. C. Alcohol-based D. Surgical. When to perform hand hygiene: ENVIRONMENTAL CONTROL Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces. CLEANING, DISINFECTION AND STERILIZATION Cleaning : Prior to any reprocessing to achieve disinfection or sterility all instruments and equipment MUST be cleaned. If not cleaned properly, organic matter may prevent the disinfectant or sterilant from having contact with the instrument/equipment and may also bind and inactivate the chemical activity of the disinfectant. If an instrument/equipment is unable to be cleaned then it is unable to be sterilized or disinfected. After an instrument has been used, prior to it drying, it should be washed to remove any gross soiling. At this stage, detergent and water is appropriate to use. DISINFECTION Disinfection removes micro-organisms without complete sterilization. Disinfection is used to destroy organisms present on delicate or heat-sensitive. Instruments which cannot be sterilized or when single use items are not available. Disinfection is not a sterilizing process and must not be used as a convenient substitute for sterilization. Disinfection is not appropriate for instruments that will be used in critical sites as these instruments must be sterile. The two methods of achieving disinfection are thermal and chemical disinfection: THERMAL DISINFECTION: If an instrument can withstand the process of heat and moisture and is not required to be sterile, then thermal disinfection is appropriate. By using heat and water at temperatures that destroy pathogenic, vegetative agents, is a very efficient method of disinfection. CHEMICAL DISINFECTION The performance of chemical disinfectants is dependent on a number of factors including: temperature, contact time, concentration, PH, presence of organic or inorganic matter and the numbers and resistance of the initial bio burden on a surface. LEVELS OF DISINFECTION High-level disinfection: can be expected to destroy all microorganisms, with the exception of large numbers of bacterial spores. Intermediate disinfection: inactivates Mycobacterium tuberculosis, vegetative bacteria, most viruses, and most fungi; does not kill bacterial spores. Low-level disinfection: can kill most bacteria, some viruses, and some fungi; cannot be relied on to kill resistant microorganisms such as tubercle bacilli or bacterial spores. STERILIZATION Sterilization is the destruction of all micro-organisms and can be achieved by either physical or chemical methods. Sterilization is necessary for medical devices penetrating sterile body sites. HEALTHCARE WASTE Management of health-care waste is an integral part of hospital hygiene and infection control. Healthcare waste should be considered as a reservoir of pathogenic microorganisms, which can cause contamination and give rise to infection. If waste is inadequately managed, these microorganisms can be transmitted by direct contact, in the air, or by vectors. Infectious waste contributes in this way to the risk of nosocomial infections, putting the health of hospital personnel, and patients at risk. TRANSMISSION-BASED PRECAUTIONS Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals.  Use personal protective equipment (PPE) appropriately, including gloves and gown. Limit transport and movement of patients outside of the room to medically- necessary purposes. When transport or movement is necessary, cover or contain the infected or colonized areas of the patient’s body. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. INFECTION CONTROL COMMITTEE An infection control committee provides a forum for multidisciplinary input and cooperation, and information sharing. This committee should include wide representation from relevant departments: e.g. management, physicians, other health care workers, clinical microbiology, pharmacy, sterilizing service, and maintenance, housekeeping and training services. The committee must have a reporting relationship directly to either administration or the medical staff to promote programed visibility and effectiveness. INFECTION CONTROL TEAM The infection control team is responsible for the day-to-day activities of the infection control program. Health care establishments must have access to specialists in infection control, epidemiology, and infectious disease, including physicians and infection control practitioners. THE INFECTION CONTROL TEAM SHOULD: Consist of at least an infection control practitioner who should be trained for the purpose; 1. Carry out the surveillance program, 2. Develop and disseminate infection control policies; 3. Monitor and manage critical incidents; 4. Coordinate and conduct training activities. EDUCATION AND TRAINING OF HEALTH CARE STAFF Health administrators should be oriented towards the importance of the infection control program. Health care workers should be equipped with requisite knowledge, skills and attitudes for good infection control practices. THE INFECTION CONTROL TEAM SHOULD: Assess training needs of the staff and provide required training through an awareness program, in-service education, and on-the-job training; Organize regular training programs for the staff for essential infection control practices that are appropriate to their job description; Provide periodic re-training or orientation of staff; and review the impact of training. The hospital setting is a good setting for communication about personal hygiene, such as informing visitors and the general public about hygiene rules such as washing hands.