Infection Prevention - Jan 27 PDF

Infection Prevention and Control for Medical Students Natalie Bridger MD FRCPC DTM&H Clinical Chief IP&C Pediatric Infectious Diseases Associate Professor MUN Pediatrics January 27, 2025 1 ...

Infection Prevention and Control for Medical Students Natalie Bridger MD FRCPC DTM&H Clinical Chief IP&C Pediatric Infectious Diseases Associate Professor MUN Pediatrics January 27, 2025 1  Case 1 You are seeing a 21 year old college student who lives in a dormitory He developed a headache and fever earlier today, and was discovered by his roommate comatose on his bathroom floor The roommate also noted a purple rash to his limbs What infection control precautions need to be taken? 2  Case 2 You are seeing a 30 year old woman with hemoptysis and respiratory distress and a RUL cavitary lesion on CXR She is a new Canadian who recently arrived from Kenya (originally from Somalia) What precautions must you take when seeing this patient? 3  IP&C Objective To reduce transmission of pathogens between patients, from healthcare workers to patients, and vice versa 4  Objectives for this lecture Provide a historical perspective of IP&C Discuss the modes of transmission of various pathogens Review elements of routine practices and provide a guide for a point of care risk assessment Highlight correct sequence of PPE removal Discuss burden of hospital-acquired infections in Canada 5  This is not new! Holmes (USA, 1809-1894) – Demonstrated direct transmission of infection by healthcare workers Semmelweiss (Austria, 1818-1865) – Demonstrated that hand hygiene can stop transmission of Group A Streptococcus responsible to puerperal sepsis Nightingale (England, 1820-1910) – Used surveillance, data collection, and statistics to break chain of infection Lister (Scotland, 1827-1912) – “Father” of antiseptic surgery (carbolic acid) 6  Major Components of Modern IP&C Program Hand hygiene Cleaning, disinfection, sterilization of equipment Isolation precautions Occupational health Vaccination Surveillance Outbreak investigation Education Policy development Quality assessment and audit Research 7  Team of linkages Antimicrobial Stewardship Infection and Microbiology Lab Prevention control Public Health/CDC 8 The Chain! 9  Mechanisms of Transmission (1) Direct (ie. human to human) Can you give me an example? 10  Mechanisms of Transmission (2) Indirect (ie. unsterile equipment, unclean environment) Can you give me an example? 11  Mechanisms of Transmission (3) Droplet (ie. coughing, sneezing, suctioning procedures) Can you give me an example? 12  Mechanisms of Transmission (4) Airborne (ie. aerosolized particles < 5 microns) Can you give me an example? " Not many. - Chicken PoX - Measles - TB 13 & What are Routine Practices? System of IP&C practices to control transmission of microorganisms in the healthcare setting Used by ALL HCWs, ALL the time, for ALL patients, in ALL settings ALL blood, body fluids, secretions, excretions, drainage, tissues considered potentially infective infectious is Think everything 14  List 5 Key Elements of Routine Practices 1. Hand Hygiene Major Key - 2. PPE 3. Source Control 4. Clean equipment/environment 5. Patient/visitor education 15  But how do we know what to do? Point of care risk assessment! Assess the need for each element of RP 16 1. Hand Hygiene 17  1. Hand Hygiene (2) Other important points: – Can use -soap and water OR alcohol based ↳ Need this for norovirus C diff hand rub +. – Keep fingernails short! – No nail enhancements! – No hand jewelry (including wrist watches) – Roll up your sleeves! – Mechanical is as important as antiseptic 18 19  2. PPE Is there potential for exposure to: – Blood? – Secretions? – Excretions? – Mucous membranes? – Non-intact skin? – Contaminated objects? 20  2. PPE (2) If ‘yes’ to exposure requiring PPE: Gloves – For potential hand contact Gowns – If splashing of clothes is likely Facial protection – If spraying of eyes, nose, mouth likely 21 * 3. Source Control Elements Reservoir Target Respiratory hygiene (cough etiquette) Zoom for Patient placement/accommodation suspected infection Private - to Don't go Patient flow/activitymid-day imaging Aseptic technique Visitor management Assess need for additional precautions 22  4. Clean Equipment/Environment Sharps safety Cleaning of equipment Cleaning of environment Management of waste, linen, and dishes 23  5. Educate Patients/Visitors What do they need to know? Do they know it? is to help Blue machine post-op inflate lungs to prevent pneumonia 24  Additional Precautions Used IN ADDITION to Routine Practices (RP) Extra measures, when RP alone will not interrupt transmission Transmission-based precautions Initiated on syndrome and/or microbiological diagnosis 25  Additional Precautions (2) -Contact: transmitted by direct/indirect touch Gloves and gowns MRSA, C. difficile, diarrhea, VRE, large wounds, other multidrug resistant organisms (ie. ESBLs, CROs) 26  Additional Precautions (3) – Droplet: large droplets land