Introduction to Health Care (Lab) - Infection Control - PDF

INTRODUCTION TO HEALTH CARE (LAB) INFECTION LESSON 1: INFECTION CONTROL - the entry and multiplication of an infectious agent in the tissues of the host...

INTRODUCTION TO HEALTH CARE (LAB) INFECTION LESSON 1: INFECTION CONTROL - the entry and multiplication of an infectious agent in the tissues of the host PATHOGEN ASEPSIS - infectious agent absence of germs, such as SYMPTOMATIC bacteria, viruses, fungus, parasites, and - the infection is called Symptomatic other microorganisms that can cause if the pathogens multiply and cause clinical disease. signs and symptoms COMMUNICABLE - the infectious disease can be transmitted directly from one person to another CONTAMINATION - a process by which something is rendered unclean or unsterile. DISINFECTION - a process that eliminates some pathogenic TYPE OF ASEPSIS microorganisms, except bacterial spores on inanimate 1. MEDICAL ASEPSIS/ CLEAN TECHNIQUE objects involves practices or procedures that STERILIZATION reduce the number and transmission of - a process by which all microorganisms, pathogens. including their spores, are destroyed. 2. SURGICAL ASEPSIS/STERILE TECHNIQUE Involves practices or procedures that render and keep objects and areas free from all pathogens. MEDICAL ASEPSIS SURGICAL ASEPSIS Clean technique Sterile technique Minimize/ reduces Eliminate/absence of microorganisms microorganisms Basic Handwashing Surgical/ sterile hand scrubbing Clean equipment and Sterile equipment and supplies supplies Clean Field Sterile Field DEFINITION OF TERMS SEPSIS - presence of infection. NOSOCOMIAL INFECTION - hospital-acquired infection. CARRIER - person or animal who does not manifest signs of illness but harbors pathogens within his body that can be transferred to others. ISOLATION - separation of persons with communicable diseases from other persons so that either direct/indirect transmission to susceptible persons is prevented.  INFECTION CHAIN STAGES OF INFECTIOUS PROCESS 1. INCUBATION PERIOD - extends from the entry of microorganisms into the body to the onset of non-specific signs and symptoms. 1. ETIOLOGIC/INFECTIOUS AGENT - a viable microorganism, that causes or may cause 2. PRODROMAL PERIOD disease - extends from the onset of non-specific signs and in humans or animals symptoms to the appearance of specific signs and symptoms. 2. RESERVOIR - natural habitat for the growth and multiplication of 3. ILLNESS PERIOD microorganisms. - specific signs and symptoms develop and become - Humans (clients, visitors, health care personnel. severe. - Animals (insects, rats) 4. DECLINE 3. PORTAL OF EXIT - the body begins to recover from the infection, - any route which enables a pathogen to leave the Symptoms that were prominent during the illness reservoir stage start to diminish Respiratory Tract: droplets, sputum Gastrointestinal Tract: vomitus, feces, saliva, drainage 5. CONVALESCENT tubes - Recovery phase-regaining Urinary tract: urethral catheters health and strength gradually after sickness or Reproductive Tract: semen, vaginal discharge weakness Blood: open wound, needle puncture INFECTION CONTROL 4. MODE OF TRANSMISSION According to the WHO (World Health Organization) - various ways infectious agents spread from one host Infection prevention and control (IPC) is a practical, to another evidence-based approach preventing patients and A. Contact Transmission health workers from being harmed by avoidable 1. Direct contact infections. - body surface to body surface skin to skin, mucosa to mucosa, mucosa to skin PRINCIPLES OF INFECTION CONTROL 2. Indirect contact 1. Assume everyone if potentially infectious - transmission occurs when there is no direct human- 2. Practice good personal hygiene especially to human contact handwashing 3. Keep the workplace clean and disinfect surface B. Droplet Transmission regularly - Maybe considered a type of contact transmission. 4. Properly dispose of infectious waste Occurs when the mucous membrane of the nose, 5. Use of personal protective equipment (PPE)when mouth, or conjunctiva is exposed to the secretions of needed an infected person who is coughing, sneezing, or talking usually within a distance of 3 feet. C. Vehicle-borne Transmission ASEPTIC TECHNIQUE - Transfer of microorganisms through inanimate - Refers to the practices or procedures used by objects contaminated items that transmit pathogens. nurses/midwives and other health care professionals Examples: food, water, milk, blood, eating utensils, to help prevent infection or interrupt the infection pillows, mattress, clothing, medical instruments. chain. D. Airborne Transmission PRINCIPLES UNDERLYING ASEPSIS - spread of infectious pathogens through the air via - The patient is a source of pathogenic small particles or droplets suspended in the air. microorganisms. inhalation of contaminated air leads to infection - The patient’s microorganisms leave through specific (influenza, tuberculosis, whooping cough) routes. - There are always microorganisms in the environment E. Vector-borne Transmission that in some individuals and under certain - transmitted through vectors, primarily blood sucking circumstances can cause illness. organisms (dengue, chikungunya, malaria) - Microorganisms harmful to man can be transmitted by direct and indirect 5. PORTAL OF ENTRY contact. - infectious agent enters a susceptible host and causes - The spread of infection from one source to others can an infection. be prevented by various methods to stop the spread as Inhalation (via Respiratory Tract) close to the source as possible. Absorption (via mucous membranes such as the eyes) - The effectiveness of medical/surgical asepsis is Ingestion (via the gastrointestinal tract) dependent on the conscientiousness of those carrying Introduction (via the insertion of medical devices) them out. 6. SUSCEPTIBLE HOST HANDWASHING - person who is at risk of infection (weak immune - also known as hand hygiene system, malnutrition, poor hygiene) - most important methods in the reduction of the transmission of infection in healthcare settings To break the chain of infection, its essential to interrupt (decrease pathogens responsible for nosocomial or any of its six links hospital acquired infections) - the act of cleaning hands with soap and water for at least 10-30seconds with a vigorous motion to cause friction and making sure to include all surfaces of the hands, fingers, and wrist. 5 moments for Hand Hygiene (WHO): 1. Before touching or coming into contact with a patient. 2. Before performing a clean or aseptic procedure. 3. After an exposure to bodily fluids and glove removal 4. After contact with a patient and their immediate surroundings 5. After touching an inanimate object in the patients immediate surroundings even if no direct patient contact. Purpose: - To avoid the spread of infection - For cleanliness - To serve as an example to the patient Materials: SEQUENCE: (PUTTING ON) 1. Soap/Liquid soap MASK (with ear loops) 2. Soap dish CAP 3. Hand towel GOWNING 4. Paper towel GLOVING (Note: First in last out in removing) PROCEDURE: HANDWASHING PUTTING ON DISPOSABLE MASK (ear loops) CAP 1. Prepare equipment, Perform handwashing 2. Hold both strings, find top edge, spread over the nose and fit snugly over the ears. 3. Pull the lower part until snugly fitted under the chin. 4. Put on cap, touching inside part only until hair is fully covered. GOWNING (clean gown) 1. Unfold gown by touching wrong-side part only. 2. Put arms in the sleeves, avoid touching the outside part of the gown. 3. Pull neck band and fasten at the nape. 4. Pull waist band around the waist and tie at the back. STERILE GLOVING TECHNIQUE MASKING, CAPPING, GOWNING, GLOVING Equipments: 1. MASK (ear loops) 2. CAP 3. GOWN 4. STERILE GLOVES 5.DEMONSTRATION TABLE 6. RECEPTACLE (FOR SOILED MATERIALS) 7. LAUNDRY HAMPER SEQUENCE: (TAKING OFF) GLOVES GOWN CAP MASK (EAR LOOPS) REMOVAL OF GLOVES 1. Remove gloves, turning each inside out, without touching outside surface with bare hands 2. Dispose used gloves REMOVAL OF GOWN 3.Untie waistband and let them drop to the side. 4. Unfasten the neckband and slip off the gown, touching the inside part only. 5. Roll gown inside out and put in the laundry hamper. TAKING OFF CAP AND MASK 1. Remove cap by touching inside part and roll it inside out 2. Remove ear loops on both ears 3. Fold mask inside out by holding inside part only, dispose used cap, mask, properly 4. Wash hands INTRODUCTION TO HEALTH CARE (LAB) A. Dry Heat LESSON 2: STERILIZATION AND DISINFECTION - kills microorganisms by destroying their oxidative processes. Why we need Sterilization and Disinfection? (Simplest method is exposing item to be sterilized to 1. Microorganism capable of causing infection are the naked flame) constantly present in the external environment and on 1. BUNSEN BURNER the human body - for sterilizing bacteriological 2. Microorganism are responsible for contamination loops, knives, blades) and infection 2. HOT AIR OVEN 3. The aims of sterilization is to remove or destroy - expose items to 160 °C for 1 hour. them from materials or from surfaces - Has electric element in chamber as source of heat plus a fan to circulate air for even STERILIZATION distribution of heat in chamber. Oven without fan is dangerous. Used for items - defined as a process of complete elimination or that are lacking water such as: destruction of all forms of microbial life (i.e., both vegetative and spore forms) Metals Glassware Ointment / Oils/ Waxes /Powder DISINFECTION - is killing or removing of harmful B. Moist Heat vegetative microorganisms - Uses hot water. Moist heat kills microorganisms by DISINFECTANT denaturating proteins. - chemical substance used to achieve disinfection 1. AUTOCLAVING ANTISEPTIC - standard sterilization method in hospitals. disinfectant that can be safely - The equipment is called Autoclave and it works under used on living tissues the same principle as the pressure cooker where water boils at increased atmosphere pressure, because of increase pressure the boiling point of water is >100 °C. - The autoclave is a tough double walled chamber in which air is replaced by pure saturated steam under pressure. METHOD OF STERILIZATION 1. PHYSICAL METHOD - Heat (dry heat & moist heat) The usual temperature achieved is 121 °C, exposure - Radiation (U.V. Light & Ionizing Radiation) time of only 15 mins - Filtration 1. HEAT - Most important should be used whenever possible A. Dry heat at temperature of 160˚C for one hour B. Moist heat at 121 or 134 C for 10 or 15 minutes ex. Autoclave DIFFERENT TYPE OF AUTOCLAVE MOIST HEAT: OTHER APPLICATION ADVANTAGES OF AUTOCLAVE 1. PASTEURIZATION 1. Temp. >100C therefore spores killed - Used heat at temperatures sufficient to inactivate 2. Sterilization, Condensation of steam generates extra harmful organism in milk. The temperatures of heat sterilization is not achieved. 3. The condensation also allows the steam to penetrate - Temperature may be 74°C, for 3-5 seconds. (Flash rapidly into porous materials methods or 62°C for 30 minutes. (Conventional method) Note: for all invasive procedures at operating room or clinics, autoclavable equipment should be used. MONITORING OF AUTOCLAVE 1. Physical method - use of thermocouple to measure 2. BOILING accurately the temperature. - quite common especially in domestic circumstances 2. Chemical method - it consists of heat sensitive chemical that changes color at the right temperature and exposure time. Ex. Autoclave tape, Browne’s tube. OTHER PHYSICAL METHOD 3. Biological method - where a spore-bearing organism is 1. RADIATION added during the sterilization process and then a. U.V. Light cultured later to ensure that it has been killed. - Has limited sterilizing power because of poor penetration into most materials. - Generally used in irradiation of air in certain areas such as operating rooms and tuberculosis labs. b. Ionizing Radiation - Gamma radiation: has greater energy than U.V. light, therefore more effective. - Used mainly in industrial facilities ex. sterilization of disposable plastic syringes, gloves, specimen containers and Petri dishes c. Filtration IMPORTANT POINTS - May be done under either negative or positive - Any instrument or item used for sterile body site pressure. should be sterile. - Example; membrane filter made of cellulose acetate. - Any instrument or item used for non-sterile Generally, removes most bacteria but viruses and body site can be disinfected. some small bacteria e.g. Chlamydia & Mycoplasma may - Hand washing is the most important to prevent pass through. hospital acquired infection. - Thus, filtration does not technically sterilize items but is adequate for circumstances under which is used. Main use: for heat labile substances e.g. sera, antibiotics 2. CHEMICAL METHOD - Useful for heat sensitive materials e.g. plastics and lensed endoscopes 1. ETHYLENE OXIDE CHAMBER - Ethylene oxide alkylates DNA molecules and thereby inactivates microorganisms. - Ethylene's oxide may cause explosion if used pure so it is mixed with an inert gas. - Requires high humidity (50-60% ) - Temperature: 55-60°C and exposure period 4-6 hours. 2. CHAMBER ACTIVATED ALKALINE GLUTARALDEHYDE 2% - Immerse item in solution for about 20 mins - If Mycobacterium tuberculosis or spores present then immersion period 2-3 hours. HOSPITAL DISINFECTION METHODS ARTICLE DISINFECTANT Floors, walls Phenolics fluids 1-2% Surfaces, tables Hypochlorite, Alcohol SKIN Surgeon’s hands Chlorhexidine, Iodine alcohol Patient Skin 70% Alcohol, Iodine Endoscopes Glutaraldehyde 2% (Cidex), subatmospheric steam Thermometers 70% Alcohol INTRODUCTION TO HEALTH CARE (LAB) 4. TYPHUS 1918 - 1922 LESSON 3: OUTBREAK MANAGEMENT - Typhus fevers are a group of diseases caused by bacteria that are spread to humans by fleas, lice, EPIDEMIC and chiggers. (from Greek epi "upon or above" and demos "people") - is the rapid spread of disease to a large number of hosts in a given population within a short period of time. PANDEMIC 5. MALARIA - An epidemic that spreads in several countries, - is a serious and sometimes fatal disease caused usually affecting people. by a parasite that commonly infects a certain type of mosquito which feeds on humans. ENDEMIC - The usual level of a disease within a geographic area (hospital) baseline WORST OUTBREAK HISTORY 1. YELLOW FEVER EPIDEMIC-1793 6. AIDS - viral disease of typically short duration. - Human immunodeficiency virus (HIV) is the virus - In most cases, symptoms include fever, chills, that causes acquired immunodeficiency syndrome loss of appetite, nausea, muscle pains (AIDS). - When a person becomes infected with HIV, the virus attacks and weakens the immune system. 2. CHOLERA PANDEMIC 1817 - 1823 - an acute diarrheal illness caused by infection of the intestine with Vibrio Cholerae bacteria. 3 PRINCIPLES OF OUTBREAK - People can get sick when they swallow food or MANAGEMENT water contaminated with cholera bacteria. Detect and investigate outbreaks of Public health importance within a time frame appropriate to the situation. Limit secondary cases/risk to the public. Manage public health outbreaks in accordance with legislation, regulations, standards and protocols. 3. INFLUENZA (SPANISH FLU) 1918 WHY DO WE INVESTIGATE OUTBREAKS? - Flu, also called influenza, is an infection of the 1. Determine cause of disease nose, throat and lungs, which are part of the 2. Identify source of infection respiratory system. The flu is caused by a virus. 3. Determine mode of transmission 4. Understand who is at risk 5. Control/prevention of additional illnesses EFFECTIVE OUTBREAK MANAGEMENT 7. EVALUATE HYPOTHESES - Surveillance and early detection - a study and questionnaire - Case Finding - Post quarantine 8. RECONSIDER HYPOTHESES - Isolation and quarantine - do data make sense, if not may need to do another - Contact tracing study or involve further lab or environment tests. - Evaluation 9. IMPLEMENT CONTROL MEASURES STEPS OF AN OUTBREAK IVESTIGATION - control this outbreak, prevent future outbreaks ESTABLISH THE EXISTENCE OF AN OUTBREAK VERIFY THE DIAGNOSIS 10. COMMUNICATE FINDINGS DEFINE AND IDENTIFY CASES - Share locally, state national and international, write PERFORM DESCRIPTIVE EPIDEMIOLOGY up findings, use media DETERMINE WHO IS AT RISK ORGANISM DEVELOP HYPHOTESIS SOURCE EVALLUATE HYPOTHESES MODE OF TRANSMISSION PERFORM ADDITIONAL STUDIES HOST IMPLEMENT CONTROL AND PREVENTION MEASURES COMMUNICATE FINDINGS 2. CASE FINDING - Detect and investigate outbreaks of public health 1. ESTABLISH EXISTENCE OF OUTBREAK importance within a time frame appropriate to the - Surveillance data, contact health care providers situation. and neighboring countries - Limit secondary cases/risk to the public. REVIEW LITERATURE - Manage public health outbreaks in accordance CONSULT EXPERTS with legislation, regulations, standards, and protocols. 2. VERIFY THE DIAGNOSIS - contact labs, collect laboratory specimens, don’t CASE DEFINITION spread rumors POSSIBLE (SUSPECTED) CONSULT WITH LABORATORIES - fewer of the typical clinical features. WHAT DIAGNOSIS HAS BEEN ESTABLISHED PROBABLE WHAT AGENT (BACTERIAL, VIRAL, OTHER) - Typical clinical features without laboratory HAS BEEN IDENTIFIED? confirmation DEFINITE (CONFIRMED) 3. DEFINE AND IDENTIFY CASES - Laboratory confirmed. - case definition, person, place, time and clinical information. Make a line list 4. PERFORM DESCRIPTIVE EPIDEMIOLOGY - characterize the outbreak in terms of person, place and time 5. DETERMINE WHO IS AT RISK 6. DEVELOP HYPOTHESES - use historical information, mode of transmission, pertinent exposure, talk to patient. RESERVOIR SOURCE OF THE AGENT MODE OF TRANSMISSION EXPOSURE THAT CAUSED DISEASE 2. PERFORMANCE ASSESSMENT - Evaluation assesses how well the response team and public health authorities performed during the outbreak. - This includes evaluating their ability to detect cases, trace contacts, implement control measures, and communicate with the public. 3. EFFECTIVENESS OF CONTROL MEASURES - It examines the impact of various control measures, such as isolation, quarantine, vaccination, and travel restrictions. - Were these measures effective in slowing or stopping the spread of the disease 4. COMMUNICATION AND PUBLIC PERCEPTION - Evaluation also considers how well communication strategies were implemented. - Were messages clear, timely, and effective in engaging the public? - How was public compliance with recommended measures? 5. RESOURCE ALLOCATION - Evaluation assesses how resources were allocated during the outbreak, including medical supplies, personnel, and financial resources. - Were resources used efficiently and effectively? 6. TIMELINESS - The timeliness of the response is a crucial aspect of evaluation. Delays in case detection, contact tracing, or the implementation of control measures can have a significant impact on outbreak containment. 7. LOGISTICS AND COORDINATION Evaluations also focus on logistical aspects of the response, including the coordination of various teams and agencies involved in outbreak management. 8. LESSONS LEARNED - The evaluation process identifies lessons learned from the outbreak response. - These lessons can inform future preparedness plans and responses. 9. RECOMMENDATIONS AND ACTION PLANS Based on the evaluation findings, recommendations are developed to improve outbreak management. - Action plans are created to address shortcomings and enhance the capacity to respond to future outbreaks. 10. CONTINUOUS IMPROVEMENT - Evaluation is an ongoing process, and its findings should be used to continuously improve outbreak management procedures and response strategies. In summary, evaluation in outbreak management is a vital step in the public health response to infectious diseases. It helps in learning from past experiences, refining response strategies, and building greater resilience against future outbreaks.