Infection Control Transmission-Based Precautions Lecture 5 PDF

49 ‫المحارضة‬ ‫المحارضة‬ ‫حضور‬ ‫حضور‬ ‫عن عن‬ ‫يغين‬...

49 ‫المحارضة‬ ‫المحارضة‬ ‫حضور‬ ‫حضور‬ ‫عن عن‬ ‫يغين‬ ‫يغين‬ ‫العمل ال‬ ‫العمل ال‬ ‫هذاهذا‬ Infection Control ‫هذا العمل ال يغين عن حضور المحارضة‬ 05 Transmission based Precautions Transmission - based precautions (TBPs)  They are the second level of the basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission. transmission based ‫ هنتكلم المحاضرة دي إن شاء هللا عن الـــــ‬standard precautions ‫ اتكلمنا المحاضرة اللي فاتت عن الـــــ‬ standard precautions ‫بستخدمها بعد مااكون خالص طبقت الـــ‬second level of infection control ‫ ودي هي الـــ‬precautions mode of transmission of the the infectious agent ‫ولسة فيه انتقال للعدوى جوه المستشفى وهي بتعتمد على الـ‬  The type of TBPs applied is based upon the mode of transmission of the pathogen.  For diseases that have multiple routes of transmission, more than one TBP category is applied. chain of infection or disease transmission cycle ‫ إن فيه عندي كائن‬chain of infection ‫ احنا قولنا قبل كدة الـــــ‬ ‫ وبعد كدة بيطلع منه‬reservoir ‫مســــبع للعدوى موجود جوه‬ ‫ وبعــد كــدة بيــدخــل الـ‬mode of transmission ‫بيبقى فيــه‬ chain of infection ‫ يعني انا عايز اكسر الــــ‬susceptible host ‫ بحذافيرها‬precautions standard ‫دي يعني انا مطبقة الــــــ‬ ‫وعلى اتم و جه و بالرغم من ذ لك في عدوى برده بتنت قل في‬ ‫دي مقفولة فأنا‬chain of infection ‫الم ست شفى ع شان الــــــ‬ ‫دي بحيث امنع انتشار العدوى‬cycle ‫عايز اكسر الـ‬ ‫ دي كافية جدا وبتقضي على معظم‬standard precautions ‫ الـ ـ‬ ‫الميكرو بات بس مثال في نوع معين من االنفكشــــن مزهقني‬ ‫ فأنا‬standard precautions ‫وانتشر برده بالرغم من تطبيق ال ـ‬ level of infection ‫هرجع اشوف طريقة انتقاله وازود بقى الـــــ‬ transmission based precautions ‫ واستخدم الـ‬control Mode of transmission  Infectious micro-organisms are transmitted by five main routes:  Contact (Direct, Indirect)  Droplet  Airborne  Common vehicle  Vector borne  Airborne transmission, e.g. Pulmonary tuberculosis, chickenpox, measles  Droplet transmission, e.g. Influenza, pertussis (whooping cough), rubella  Contact transmission (direct or indirect), e.g. Viral gastroenteritis, Clostridium difficile, MRSA, scabies. aerosol ‫ اللي هي الصغيرة اللي بتنتقل لمكان بعيد‬airborne transmission ‫ دي أمثلة للحاجات اللي بتنتقل عن طريق الـ‬  Using additional barriers to break the cycle is the primary goal for Transmission-Based Precautions.  Diseases that have multiple routes of transmission (e.g., influenza, Middle East Respiratory Syndrome- coronavirus or MERS-CoV, varicella) may require the use of more than one category of Transmission- Based Precautions. ‫ بتاعته‬precautions ‫ هنا على حسع هو بينتقل ازاي هطبق الـ‬route of transmission ‫ فيه امراض بيبقى ليها اكتر من‬ Empiric/Syndromic Use of Transmission Based Precautions  Every effort should be made to diagnose the microorganism responsible for infection; however, laboratory diagnosis is not immediately available and not always available.  In these circumstances, precautions must be based on empiric/syndromic findings. 1  Infection Control Transmission based Precautions 05 ‫ معينة مستمرة في االنتشار جوه‬infection ‫ طيع انا لو عندي‬ standard precautions ‫المستشفى بالرغم من تطبيق الـــــ‬ ‫عشان اعرف هو‬laboratory diagnosis ‫هقعد بقى استنى ال ـ‬ transmission ‫ا يه وبينت قل ازاي وب عد كدة اقرر اطبق انهي‬ ‫؟‬based precautions ‫ الصـــن ان انا اطبق اعتباريا كدة اللي انا شـــايفاه مااســـتنا‬ ‫ ايام انا شــــايفة إن هو‬١٠ ‫نتيجة المعمل اللي بتاخد تقريبا‬ contact based ‫اطبق ال ـ‬contact ‫مثال بينتقل عن طريق ال ـ‬ ‫اطبق‬droplet ‫ شايفة مثال بينتقل عن طريق الـــــ‬precautions ‫ لحد مانتيجة المعمل تظهر‬droplet precaution ‫الـ‬ ‫ بعد كدة اعيد حســاباتي تاني هشــوف انا الــن وال غل الــن‬ ‫خالص هكمل غل خالص هعدل ال هو بينتقل مثال عن طريق‬ contact based ‫ وأنا كنت مطبقة الــــ‬contact , droplet ‫الــــ‬ droplet based ‫ هــزود بــقــى واطــبــق الـــــــــ‬precautions precautions  If there is any question about whether a patient without a known diagnosis has a specific infection, implement Transmission-Based Precautions based on the patient’s signs and symptoms until a definitive diagnosis (i.e., laboratory test results) can be made. ‫ تظهر اعيد حســــاباتي‬definitive diagnosis ‫ فأنا هنا زي مااتفقنا بطبق بناء على اللي انا شــــايفه وبعد كدة لما نتيجة المعمل‬.‫تاني‬  In all situations, Transmission-Based Precautions must be used in conjunction with Standard Precautions. ‫ ال يلغي‬transmission based precautions ‫طبعا تطبيق الــــ‬  ‫ الزم دي تتطبق على طول بتقضي‬standard precautions ‫تماما الــــ‬ ‫ من العدوى جوه الم ستشفى يبقى دي مينفعش‬%99 ‫ا سا سا على‬.‫ماتتطبقش‬  Empiric Use of Transmission-Based Precautions (Based on Signs and Symptoms) for Isolation of Patients in Hospital Settings Contact:  Acute diarrhea ‫ بيبقى‬transmission based precautions ‫ التطبيق األولى للــــــ‬  Upper respiratory tract infection ‫بناء على اللي انا شـــايفه على العالمات واألعراض اللي راهرة‬  History of infection with multidrug resistant mode of transmission of ‫على المريض بعرف من خاللها الــــــ‬ microorganism infectious agent  Abscess and infected wound ‫ يعني انا برده معنديش خبرة اوي فيه بعض الحاجات أو األمراض‬ contact ‫ واول حاجة الـ‬mode of transmission ‫كدة هتعرفك الـ‬ ‫واألمثلة مهمة أعرفها‬ Droplet: Airborne:  Upper respiratory tract infection  Chronic cough and fever  Suspected meningitis (fever, vomiting, stiff  Vesicular rash neck)  Acute respiratory distress syndrome  Haemorrhagic rash with fever. ‫ يبقى كدة هطبق الحاجتين‬contact , droplet ‫ شوفتها في الـ‬upper respiratory tract infection ‫ طيع الـ‬ 2  Infection Control Transmission based Precautions 05 Contact precautions:  Used to prevent and control infections that spread via direct contact with the patient or indirectly from the patient’s immediate care environment (including care equipment).  This is the most common route of cross-infection transmission. direct or indirect ‫ ول سه موجود انفك شن فى الم ست شفى سببها‬standard precautions ‫ ب ستخدمها لما اكون طبقت الــــــ‬ contact 1. Ensure appropriate patient placement  in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients.  In multi-patient rooms, ≥one meter spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients.  A single-patient room is preferred for patients who require Contact Precautions. ‫لكن لو مش متاح ممكن‬، ‫ ان كل مريض يكون فى غرفة لوحده‬contact transmitted infections ‫ افضل حاجه عشان تتجنع ال ـ‬ ‫اخليهم فى العنابر عادى بس المســافه بينهم تكون أكبر من أو تســاوى واحد متر يعنى أقل حاجه الزم تكون المســافه بين كل‬.‫مريض والتاني متر‬ 2. Use personal protective equipment (PPE) appropriately  including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with the patient or the patient’s environment. ‫ عشان امنع انتشار العدوى‬PPE ‫ إللى عنده االنفكشن دى الزم اكون البس‬patient ‫ طبعا وانا بتعامل مع‬.‫ليا والى مكان اروح له بعد كده‬  Donning PPE upon room entry and properly discarding before exiting the patient room is done to control pathogens. ‫ اللي البسها دى قبل ما اخرج من االوضه إللى فيها المريض مباشرة عشان امنع انتقال‬PPE ‫ بشيل الـــــ‬.‫العدوى‬ 3. Limit transport and movement of patients  outside of the room to medically-necessary purposes. ‫ دا كتير‬patient ‫ مهم انى مخرجش الـ‬  When transport or movement is necessary, cover or contain the ‫ الخروج يبقا للضــــرورة فق غ واغطى المكان‬ infected or colonized areas of the patient’s body. ‫ عشان‬PPE ‫اللى فيه االنفكشن واهتم بالــ‬  Remove and dispose of contaminated PPE and perform hand contact transmitted ‫امنع انتقــال الـــــــــ‬ hygiene prior to transporting patients on Contact Precautions. ‫ أثنــاء التعــامــل معــاه وبعــد مــا‬Infection  Wear clean PPE to handle the patient at the transport location..‫ كويس‬hand hygiene ‫تشيلها اعمل‬ 4. Use disposable or disinfected patient-care equipment.  If common use of equipment for multiple ‫ االفضـــل اســـتخدم األدوات إللى بتســـتخدم مره واحده بس‬ patients is unavoidable, clean and disinfect such ‫ لكن فى االجهزه إللى مش بت ستخدم مره‬، ‫وبعد كده ارميها‬ equipment before use on another patient. ‫واحده بس وبتســــتخدم كذا مره الزم تنظيفها وتعقيمها بعد‬.‫االستخدام‬ 3  Infection Control Transmission based Precautions 05 5. Prioritize cleaning and disinfection of the rooms of patients on contact precautions  ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by another patient if outpatient setting) focusing on frequently-touched surfaces and equipment in the immediate vicinity of the patient. ‫ تتنظف وتتعقم مره يوميا على األقل وبالذات‬patients ‫ الزم الغرفه بتاعة الـــــــــ‬ ‫االسطن إللى غالبا المريض بيلمسها زى مقابض األبواب‬ Droplet precautions:  Used to prevent and control infections spread over short distances (at least 3 feet or 1 metre) via droplets (greater than 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Droplets penetrate the respiratory system to above the alveolar level. ‫ كويس جدا‬standard precautions ‫ فى حاله لو طبقت الـــــ‬droplet precautions ‫بستخدم الـــــ‬  ‫ اللى خدنا قبل كدا ان حجمها‬droplets ‫وبرضــو لســه فى انفكشــن فى المســتشــفى بتنتقل عن طريق ال‬.) ‫ ميكرو ) وبتنتقل خالل مسافة الغيره (أقل من متر‬٥ ‫بيكون كبير ( أكبر من‬ 1. Source control: put a mask on the patient..‫ دى‬droplet ‫ دا يلبس ماسك عشان امنع انتشار الـ‬patient ‫ الزم الـ‬respiratory tract ‫ فى حاله االنفكشن دى بما انها من الـ‬ 2. Ensure appropriate patient placement  in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients.  In multi-patient rooms, ≥ one meter spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients..‫ والتانى واحد متر‬patient ‫ فى غرفة لوحده أو لو مش متاح اخلى المسافه بين كل‬patient ‫ اعزل كل‬ 3. Use personal protective equipment (PPE) appropriately  Don mask upon entry into the patient room or PPE ‫ الزم مهم جدا ان اى حد بيتعامل مع المريض يرتدى الـ‬ patient space. ‫ أو المحي‬patient ‫ وهو داخل غرفة الـــــ‬mask ‫وبالذات الـــــ‬ ‫إللى حواليه‬ 4. Limit transport and movement of patients outside  of the room to medically-necessary purposes.  If transport or movement outside of the room is necessary, instruct patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette. ‫ ولو اضطريت أخرجه الزم اخليه يلبس الماسك واخليه يتبع‬، ‫ من مكانه إال للضرورة القصوى‬patient ‫ مهم جدا انى مخرجش الــ‬ respiratory hygine & cough etiquette. Airborne precautions:  Used to prevent and control infections spread without necessarily having close patient contact via aerosols (less than or equal to 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Aerosols penetrate the respiratory system to the alveolar level. ‫ كويس ولسه فيه انفكشن فى المستشفى‬standard precautions ‫ دى يستخدمها لو طبقت الـــــ‬airborne precautions ‫ الـــــ‬ ) ‫ ميكرو‬٥‫ وخدنا قبل كدا انها بتكون الغيرة فى الحجم ( أالغر من أو تساوى‬airosoles ‫وبتنتقل من خالل الـ‬.)‫ وبالتالى هتنتقل خالل مسافات كبيرة ( أكبر من متر‬ 4  Infection Control Transmission based Precautions 05 1. Source control: put a mask on the patient..‫ عشان امنع انتشارها‬mask ‫ يلبس‬patient ‫ الزم الـ‬respiratory infection ‫ بما انها‬ 2. Ensure appropriate patient placement in an airborne infection isolation room (AIIR)  Constructed according to the Guideline for Isolation Precautions. In settings where Airborne Precautions cannot be implemented due to limited engineering resources, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned home.  AIIR is a single-occupancy patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease.  Environmental factors are controlled in AIIRs to minimize the transmission of infectious agents that are usually transmitted from person to person by droplet nuclei associated with coughing or aerosolization of contaminated fluids.  AIIRs should provide negative pressure in the room (so that air flows under the door gap into the room); and direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before retruning to circulation. ‫ دا فى غرفة لواحده وبتمنع خروج‬patient ‫ الزم هنا اخلى الـ‬ ‫ دا‬patint ‫ ودا من خالل انى هعزل الـ‬، ‫الهوا الملوث دا منها‬ ‫ ودى غرفة بيكون فيها ضغ‬AIIR ‫فى غرفة لوحده اسمها‬ ‫الهوا منخفض عشان الهوا يدخلها من بره وميخرجش منها‬ ‫وبالتالى هيكون اتجاه الهوا زى ما واضن فى الصوره دى‬ ‫ عشان يعقم اى هوا‬HEPA filter ‫وفى االخر بيكون فيه‬.‫بيخرج‬ 3. Restrict susceptible healthcare personnel from entering the room of patients  known or suspected to have measles, chickenpox, disseminated zoster, or smallpox if other immune healthcare personnel are available. ، ‫ م صاب باألمراض دى من التعامل مع المر ضى فى الم ست شفى ع شان مينقلش العدوى دى‬helth care worker ‫ امنع اى‬.‫ المعافين هما إللى يتعاملوا مع المرضى فى المستشفى‬HCWs ‫واألفضل الـ‬ measles, chickenpox, disseminated zoster, or smallpox : airborne transmission ‫ االمراض دى بتنتشر خالل‬ 4. Use personal protective equipment (PPE) appropriately  including a fit-tested N95 masks for healthcare personnel..‫ألنه بيكون ثابت جدا‬. fit-tested N95 mask ‫ خصوالا الـ‬، ‫ أثناء التعامل مع المريض‬PPE ‫ مهم ارتداء الـ‬ 5  Infection Control Transmission based Precautions 05 5. Limit transport and movement of patients outside of the room to medically- necessary purposes.  If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette surgical mask ‫ يلبس‬patient ‫ ولو اضطريت انقله الزم الـــــ‬، ‫ غير فى الضرورة القصوى‬AIIR ‫ اتجنع برضو نقل المريض من الـــــ‬.‫ إللى خدناها قبل كدا‬respiratory hygiene & couh etiquette ‫ويتبع الـ‬ 6. Immunize susceptible persons as soon as possible  following unprotected contact with vaccine-preventable infections (e.g., measles, varicella or smallpox) ‫ إللى قلنا عليها دى أكيد‬precautions ‫ بدون أخذ ال ـ‬infected patients ‫ لو حد اتعرض لل ـ‬ ‫ دى فى‬infection ‫ ولذلك الزم ياخد المصل بتاع الـ‬، ‫هيكون معرض جدا للعدوى بالمرض دا‬.‫أسرع وقت ممكن‬ Health care – associated infections (HAI) or Hospital – acquired infections or Nosocomially acquired infections  These infections are typically not present or might be incubating at the time of admission.  These infections are usually acquired after hospitalization and manifest 48 hours after admission to the hospital. ‫ ســـاعة من دخول‬٢٤ ‫ لو انا دلوقتي دخلت مســـتشـــفى وبعد‬HAI or hospital acquired infection ‫ تعالوا بقى نتكلم عن الـــــــ‬ ‫ ؟‬HAI ‫المستشفى حصلتلي عدوى يبقى دي كدة اقول عليها‬ ‫ ساعة من دخول المستشفى‬48 ‫ بتظهر على األقل بعد‬hospital acquired infection or nosocomial infection ‫ ألن الـ‬, ‫ اكيد أل‬ Risk factors for nosocomial infections:  Increasing age  Length of hospitalization  Excessive or improper use of broad-spectrum antibiotics  The number of invasive devices and procedures (for instance: central venous catheters, urinary catheters, surgical procedures, and mechanical ventilation).  Most patients often have accompanying conditions such as diabetes, chronic lung disease, renal insufficiency, or malnutrition. HAI or nosocomial infection ‫ اللي بتزود احتمالية إالابة الناس بالـ‬risk factors ‫ إي بقى الـ‬ ‫ زي مثال الناس الكبيرة في الســن وكل مازادت مدة بقاء المريض في المســتشــفى واالســتخدام الخاطا للمضــادات الحيوية ولو‬ ‫ الرئيسي‬vein ‫القسطرة اللي بحطها في الــــ‬central venous catheters ‫ زي مثال الــــ‬invasive devices ‫المريض ده انا بركبله‬ ‫دول كلهم عوامل‬ventilation acquired pneumonia ‫وبرده اجهزة التنفس الصناعي بتسبع انفكشن زي ماهنشوف دلوقتي الـــــ‬ nosocomial infection ‫بتزود احتمالية اإلالابة بالـ‬ ‫ لما يكون حد عنده مريض بيقلل المناعة أو مرض مزمن مثال زي الســكر أو عنده تقت تغذية دول كلهم بردو بيزودوا فرص اإلالــابة‬ ‫بالعدوى‬ Transmission routes of HAI or nosocomial infections:  Health care staff  Contaminated equipment, bed linens, or air droplets.  The infection can originate from the outside environment, another infected patient, or in some cases, the source of the infection cannot be determined.  In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. HAI or nosocomial infection ‫كل دي مصادر الـ‬ 6  Infection Control Transmission based Precautions 05 ‫ اللي هما الدكاترة الصيادلة الممرضين أو العمال أو األدوات الملوثة‬health care staff ‫ ممكن تنتقل من ال ـ‬HAI ‫ دي طرق انتقال ال ـ‬ ‫عارفة م صدر العدوى دي منين ممكن العدوى تيجي من ال شخت نف سه‬ ‫مثال ممكن من مريض تاني وبعض في االحيان ماببقا‬. ‫يكون عنده جرح في الجلد مثال ويعدي نفسه‬ Types of Healthcare-Associated Infections:  Central line-associated bloodstream infections (CLABSI)  Catheter-associated urinary tract infections (CAUTI)  Surgical site infections (SSI)  Hospital-acquired Pneumonia (HAP)  Ventilator-associated Pneumonia (VAP)  Clostridium difficile infections (CDI)  Multidrug-resistant infections Central line-associated bloodstream infections (CLABSI)  It is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line.  A central line is an IV (intravenous) line that goes into a large blood vessel near the centre of the body. Central lines are used for giving medications, fluids, IV nutrition and drawing blood. The central line is usually placed in the chest area.  Healthcare providers must follow a strict protocol when inserting the line to make sure the line remains sterile and a CLABSI does not occur. Patients who get a CLABSI have a fever, and might also have red skin and soreness around the central line. vein ‫ في الـــــــ‬catheter ‫ زي المرضـــى اللي بيركبوا‬central line ‫ النوع ده من االنفكشـــن بيكون خطير جدا النه بيكون عن طريق‬ ‫ هيدخل علطول للـ‬germs ‫ فلو حصــل اي انفكشــن الـــــــ‬malnutrition ‫ و‬cancer ‫الرئيســي اللي بيكون جنع القلع زي مرضــى‬ bloodstream chest area ‫ بيكون موجود في‬Central line  CLABSI ‫ عشان ميحصلش‬strict protocol ‫ عشان كده الزم وانا بتعامل مع الحاالت دي اتبع‬  Follow recommended central line insertion practices to prevent infection when the central line is placed, including:  Perform hand hygiene  Apply appropriate skin antiseptic  Ensure that the skin has completely dried before inserting the central line  Use all five maximal sterile barrier precautions: o Sterile gloves o Sterile gown o Cap o Mask o Large sterile drape antiseptic ‫ واح‬hand hygiene ‫ الزم اهتم بالـــــ‬central line ‫ للـــــ‬insertion ‫ وانا بعمل‬ ‫وطبعا‬, central line ‫على المكان اللي هشـــتغل فيه واتاكد انه نشـــف قبل ما اح الـــــــ‬ ‫ بتبقى ماليه‬large sterile drape ‫ واســـتعمل‬sterile gloves ,gown ,cap ,mask ‫البس‬ ‫كبيره بغطي بيها الجسم كه ماعدا الجزء الي هشتغل فيه بس زي الصوره كده‬ PPE ‫ البس كل الـ‬health care provider ‫ وبرده الـ‬  Once the central line is in place:  Follow recommended central line maintenance practices (Scrub the access port with friction immediately prior to each use with an appropriate antiseptic like chlorhexidine, povidone iodine or 70% alcohol).  Use only sterile devices to access catheters.  Immediately replace dressings that are wet or soiled.  Wash hands with soap and water or an alcohol-based hand rub before and after touching the line  Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection. 7  Infection Control Transmission based Precautions 05 ‫ واغســل‬, ‫ الي بيبقي فوقيها‬dressings ‫ واالدوات كلها متعقمه واغير الـــــــ‬sterile ‫ بعد ما اتح خالص الزم اي تعامل معاه بيكون‬ ‫ايدي قبل وبعد التعامل‬. ‫ اول ما اكون خالص مش محتاجه‬central line ‫ واشيل‬ Catheter-associated urinary tract infections (CAUTI)  They are infections of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. The definition of CAUTI falls into two groups; symptomatic urinary tract infection and asymptomatic urinary tract infection.  Key Interventions for Prevention of CAUTI:  Insert catheter only for appropriate indications.  Remove catheter as soon as possible.  Ensure that only properly trained persons insert and maintain catheters.  Insert catheters using aseptic technique and sterile equipment.  Maintain a closed drainage system  Maintain unobstructed urine flow.  Comply with Standard Precautions, including hand hygiene recommendations. ‫ ب ستخدمها بس عند ال ضرورة يعني لو المريض ينفع يدخل الحمام من غيرها عادي لكن لو خالص مش قادر والزم احطها له خالص‬ ‫احطها واول ماالمريض يتعافى خالص بشيلها بقى‬ ‫ واألدوات تكون متعقمه و طبعا‬, ‫ مينفعش اجيع اي حد كده يركبها وخالص‬trained ‫ يكون‬catheter ‫ الزم الشخت الي هيركع الـــــ‬ ‫ يبقى مقفول عشان لو مفتوح هيبقى مصدر العدوى‬drainage system ‫ والزم الـ‬standard precautions ‫بطبق الـ‬ ‫ فأقرب وقت ممكن‬catheter ‫ الزم اشيل الـ‬ Surgical site infections (SSI)  They are infections that occur after surgery in the part of the body where the surgery took place.  Surgical site infections can sometimes be superficial infections involving the skin only.  Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.  Symptoms include redness and pain around the area where you had surgery, drainage of cloudy fluid from your surgical wound and fever.  Most SSIs can be treated with antibiotics. The type of antibiotic given depends on the bacteria causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection. ‫ زي‬tissue under skin ‫ وممكن تكون في‬,‫ سطحيه‬superficial ‫ ح صل فيه ممكن تكون‬surgery ‫ بتكون ف المكان الــــــ‬SSI ‫ الــــــ‬ ‫ وده بيكون أكثر خطوره‬organs or implanted material ‫الـ‬ ‫ من الجرح‬cloudy fluid ‫ وممكن يخرج‬redness, pain, fever ‫ االعراض اللي ممكن تظهر‬ ‫ قبل وبعد العمليه‬antibiotics ‫ عشان احل المشكله دي ممكن ادي المريض‬  Key Interventions for Prevention of SSI:  Healthcare providers should:  Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.  Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.  Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.  When indicated, use antibiotics before the surgery starts. In most cases, the antibiotics are administered within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery. ‫واغســـل ايدي بالمياه‬, ‫ قبل الجراحه على طول‬antiseptic ‫ عشـــان اتفادى المشـــاكل دي الزم غســـل االيد والذراع لحد الكوع ب‬ hair cover, masks, gowns, gloves ‫ اثناء الجراحه زي‬PPE ‫والبس الـ‬, alcohol-based hand rub ‫والصابون او‬.‫ ساعه بعد الجراحه‬24 ‫ وزي ما قلنا ممكن ندي المريض مضاد حيوي قبل الجراحه بـ ساعه و اوقفها ف خالل‬ 8  Infection Control Transmission based Precautions 05 Hospital-acquired Pneumonia (HAP)  Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. ‫ طع لو دخل الم ست شفى ورهر عليه االعراض‬, ‫ بيح صل بعد دخول الم ست شفى بيومين او اكتر‬HAP ‫ االلتهاب الرئوي الناتج عن‬ ‫ النه جاي بيها من برا‬CAP ‫ لكن هتبقى‬HAP ‫بعد يوم مثال كده مش هقول عليها‬  Pneumonia that presents sooner should be regarded as community acquired pneumonia (CAP).  Symptoms include Fever > 37.8 °C, Purulent sputum, Leukocytosis > 10,000 cells/μl.  In an elderly person, the first sign of hospital-acquired pneumonia may be mental changes or confusion.  Other symptoms may include: o A cough with sputum o Fever and chills o General discomfort or ill feeling (malaise) o Sharp chest pain that gets worse with deep breathing or coughing o Shortness of breath o Decreased blood pressure and fast heart rate sputum ‫ فيه الديد في الـ‬, leukocytosis , ‫ االعراض الي بتظهر حراره عاليه‬ shortness of breath‫ و‬sharp chest pain ‫ واعراض تانيه زي‬confusion ‫ في الناس الكبيرة هيظهر عليهم‬  Key Interventions for Prevention of HAP:  Healthcare providers should:  Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur.  Isolation of infected patients  Clean their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator.  Clean the inside of the patient’s mouth on a regular basis.  Clean or replace equipment between use on different patients.  Limit hospitalization whenever possible ‫ در جه زي الصــــوره كده ده بيســـــاعد ف حاالت‬30-45 ‫ الزم احافظ على وضــــع المريض ف حدود‬ ‫ ميكونش مستقيم اوي وال نايم اوي‬shortness of breath ‫ نخلي بالنا من الحاجات المميزة دي‬patient’s mouth ‫ وهو اغسل الـ‬HAP ‫ حاجه مميزه للـ‬ Ventilator-associated Pneumonia (VAP)  It is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals.  As such, VAP typically affects critically ill persons that are in an intensive care unit (ICU) and have been on a mechanical ventilator for at least 48 hours.  The most important signs are fever, new purulent sputum, and hypoxemia (decreasing amounts of oxygen in the blood). ‫ ساعه يعني‬48 ‫ لمده على االقل‬ICU ‫ النوع ده بيحصل مع المرضى الي بيكونو على جهاز التنفس الصناعي في العنايه المركزه‬ VAP ‫ساعه بس مينفعش أقول عليه‬24 ‫ لمدة‬ventilator ‫لو حد قعد على الـ‬ fever, purulent sputum, hypoxemia ‫ ومن اهم االعراض‬ 9  Infection Control Transmission based Precautions 05  Key Interventions for Prevention of VAP:  Healthcare providers should:  Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur.  Check the patient’s ability to breathe on his or her own every day so that the patient can be taken off of the ventilator as soon as possible.  Clean their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator.  Clean the inside of the patient’s mouth on a regular basis.  Clean or replace equipment between use on different patients. ‫ وانظف فم المريض كل شوية‬30- 45 ‫ اخلي وضع السرير مش مستقيم مايل بزاوية من‬HAP ‫ بتاع الـ‬key interventions ‫ نفس‬ ‫ ألن كل اما شلته اسرع كل‬ventilator ‫ كل يوم بشوف قدرة المريض انه يتنفس لوحده لو تمام يبقى خالص بشيله من على الـــــ‬.‫اما كان افضل‬ Clostridium difficile infections (CDI)  Clostridium difficile is an anaerobic bacterium.  The clinical spectrum of C. difficile infection (CDI) ranges from mild diarrhoea to severe life threatening pseudomembranous colitis.  CDI is generally associated with previous use of antibiotics.  The transmission of C. difficile can be patient-to-patient, via contaminated hands of healthcare workers or by environmental contamination. antibiotics ‫ نتيجة االستخدام الخاطا للـ‬ ‫ بيقتل البكتريا النافعه فيخلي البكتريا الضاره تتكاثر‬clindamycin(broad spectrum antibiotic) ‫ عندي مثال‬  Key Interventions for Prevention of CDI:  Early diagnosis of CDI  Surveillance of CDI cases  Education of the hospital and cleaning personnel as well as patients and visitors  Appropriate use of isolation precautions  Hand hygiene  Protective clothing  Environmental cleaning and cleaning of the medical equipment.‫ اللي مسبع المشكله‬antibiotic ‫واوقف ال‬, PPE ‫ و‬hand hygiene ‫واهتم بالـ‬, CDI ‫ مهم اني اتابع مع المرضى اللي عندهم‬ Multidrug-resistant infections  Multidrug-resistant organisms are bacteria that have become resistant to certain antibiotics, and these antibiotics can no longer be used to control or kill the bacteria.  Key Interventions for Prevention of Multidrug-resistant infections  Hand washing: This is the single most important way to prevent the spread of MDROs.  Protective clothing  Careful use of Using antibiotics only when needed, and for the shortest time possible, helps Antibiotics: prevent the growth of more MDROs.  Private Rooms: Patients with a MDRO infection are placed in a private room or share a room with others who have the same infection.  Daily cleaning: All patient care items, equipment, and room surfaces are properly cleaned and disinfected every day. 10  Infection Control Transmission based Precautions 05  Vaccinations: like Streptococcus pneumoniae, a type of bacterium that can cause pneumonia, often can be resistant to one or more antibiotics. Vaccination against Streptococcus pneumoniae can prevent these antibiotic resistant infections.  Monitor antibiotic susceptibility patterns for key targeted MDROs (e.g., carbapenem resistant Enterobacteriacae (CRE), methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE). microbiology lab ‫ عن طريق الـ‬monitoring of antibiotic susceptibility ‫ الزم اعمل‬ ‫ ودي أمثلة للميكرواورجانيزم الرخمة في التعامل معاها‬  Strengthen implementation of an antibiotic stewardship program. multidrug-resistant organisms ‫ اختصار‬MDROs  ‫) ألنه لو مطبق كويس مش هوالل للمرحلة دي‬ASP( ‫ مهم جدا اطبق الـ‬ 11