Infection Control in the Hospital Setting PDF

MICROBIOLOGY AND PARASITOLOGY INFECTION CONTROL IN THE HOSPITAL SETTING Atty. Maria Theresa Panes, M.D. | Oct 9. 2024 Susceptible Host Burden...

MICROBIOLOGY AND PARASITOLOGY INFECTION CONTROL IN THE HOSPITAL SETTING Atty. Maria Theresa Panes, M.D. | Oct 9. 2024 Susceptible Host Burden of Infections Patients who have an underlying medical condition 1 in 10 patients get an infection while receiving care (diabetes, cancer, transplant patient) More than 50% of surgical site infections can be Patients who are taking medications that can lower the antibiotic-resistant. immune system response Effective infection prevention and control reduces health Invasive procedures that can serve as portal of entry care-associated infections by at least 30%. → foley catheter tubes → IV lines, etc Immunosuppressed individual Health Care Associated Infections “Nosocomial Infection” BASIC MODES OF TRANSMISSION infections that occur while receiving health care 1st 48 hours or more after admission or within 30 days Transmission- refers to the way microbes are moved to after receiving care. the susceptible host It can be: Direct → central line associated bloodstream infection → Direct contact- physical contact between source and → catheter-associated urinary tract infections victim → surgical site infections → Droplet Spread → ventilator-associated pneumonia Indirect → and many more → Airborne → Vehicleborne → Vectorborne (mechanical or biological)refers to host Infection Control contact with the source is a set of practices and procedures that will help prevent the transmission of disease within a health care facility. DIRECT Purposes of Epidemiology Direct contact → physical contact between source (e.g. MRSA on To plan and evaluate interventions and prevention medical student’s hands) strategies more effectively by knowing: → patient/victim (the one who’s being examined) → the distribution of disease → Skin-to-skin contact, kissing and sexual intercourse → its determinants in person, place and time → can also refer to direct contact with soil/vegetation harboring infection organisms Infections: The Basics Droplet Spread Infection requires a “chain” of events → a form of contact transmission Causative agent: causes the infection (the pathogen) → refers to spray with relatively large, short-range Susceptible host: person at risk aerosols Mode of transmission: method of spread → >5 um in size ▪ infectious droplets deposited on mucous membranes of the nose or mouth ▪ Sneezing, coughing, talking PRECAUTIONS CONTACT Used for pathogens that can easily be transmitted by contact with patient and/or items in the patient’s environment Representative Pathogens → Methicillin-resistant S. aureus (MRSA) → Vancomycin-resistant enterococcus (VRE) → C. difficile → Norovirus → Multiply-drug resistant (MDR) gram negative rods (e.g., B. cepacia, P. aeruginosa, Acinetobacter) → Additional: Mpox (Monkeypox) SOURCE Is an infectious agent (bacteria, virus, fungi, etc) patients, healthcare workers, and visitors are source of microbes → healthcare environment → dry surfaces in patient areas → wet surfaces, moist environments → biofils → indwelling medical devices → debris Transcribed by: NMD 2027  Infection Control in the Hospital Setting VECTOR-BORNE TRANSMISSION Animals that are capable of transmitting diseases may carry an infectious agent through purely mechanical means or may support growth or changes in the agent increase the transmission range of a disease AIRBORNE PRECAUTIONS Used for patients with known or suspected disease transmitted by airborne droplet nuclei (≤5 microns) preferred room is an airborne infection isolation room (AIIR) Private room: → negative air pressure in relation to the corridor Personnel: → required respiratory protection DROPLET PRECAUTIONS AIRBORNE INFECTION ISOLATION ROOM Used for diseases spread via large droplets (>5 microns) (AIIR) Private room negative pressure monitoring → Special air handling not required 12 air exchanges per hour Personnel 6 air changes per hour for older existing facilities → Surgical mask upon entering room air exhausted directly to the outside or recirculated Representative Pathogens through HEPA filtration before return → Invasive N. meningitidis → RSV (Respiratory Syncytial Virus) REPRESENTATIVE PATHOGENS → Bordetella pertussis Measles → Rubella SARS → Mumps Varicella → Group A streptococcal pharyngitis → Influenza → M. tuberculosis → Additional: Mpox (can be transmitted via direct contact or via droplets) WHO IS AT RISK? Anyone whose resistance to disease decreases Reasons for lowered resistance: age, existing illnesses, fatigue, and stress INDIRECT ○ The elderly have weaker immune systems Vehicleborne and a lower resistance to pathogens → inanimate objects ○ Elderly are hospitalized more often, → transmit thru food, water, blood, fomites increasing the chance for hospital-acquired Vectorborne (mechanical or biological) infections → living organism ○ Recovery longer in the elderly → mosquitoes, fleas, ticks Airborne WHAT SHOULD WE DO? → Droplet nuclei suspended in air Isolation Precautions to Prevent the Transmission of Infections to Patients and Personnel AIRBORNE TRANSMISSION Occurs when infectious agents are carried by dust or droplet nuclei suspended in air. STANDARD PRECAUTIONS Includes material that has settled on surfaces and become Hand hygiene: before and after each patient contact and resuspended by air currents as well as infectious particles after gloves removed blown from the soil by the wind Hand washing should be performed: Droplet nuclei are dried residue of less than 5 microns in At the start and finish of procedures size - may remain suspended in the air for so long periods After removing a pair of gloves and before wearing of time and may be blown over great distances a new pair of gloves Before and after patient contact VEHICLE-BORNE TRANSMISSION After contact with a contaminated instrument or Inanimate objects that can carry the infectious agents surface contaminated food, water, etc 2 of 4  Infection Control in the Hospital Setting ★ Handwashing is the single most effective method in PERSONAL PROTECTIVE EQUIPTMENT preventing the spread of infection (PPE) ★ Artificial nails and nail extenders are prohibited for Gown, Eyewear, Mask, Gloves direct patient care providers. Variety of barriers and respirators used alone or in combination HANDWASHING protect mucous membranes, airways, skin, and clothing What is the most effective and simplest method to protect from contact with infectious agents. your health and to help prevent HAIs? HANDWASHING selection of PPE is based on the nature of the patient interaction and/or the likely mode(s) of transmission Steps: 1. Remove all jewelry. PPE: GLOVES 2. Wet hands with water Used to prevent contamination of healthcare personnel 3. Rub hands palm to palm hands when: 4. Right palm over left dorsum with interlaced fingers ▪ anticipating direct contact with blood or body fluids, and vice versa mucous membranes, non intact skin and other 5. Palm to palm with fingers interlaced potentially infectious material 6. Back of fingers to opposing palms with fingers ▪ having direct contact with patients who are colonized interlocked; or infected with pathogens transmitted by the contact 7. Rotational rubbing if left thumb clasped in right palm route and vice versa; do in each of the fingers. ▪ handling or touching visibly or potentially 8. Rotational rubbing, backwards and forwards with contaminated patient care equipment and clasped fingers of right hand in left palm and vice environmental surfaces versa 9. Rinse hands with water 10. Dry hands thoroughly with a single use towel PPE: ISOLATION GOWNS 11. Use towel to turn off faucet. Protect the arms and exposed body areas Prevent contamination of clothing with body fluids and From the 2009 WHO From the 2009 WHO Guidelines on infectious material Hand Hygiene in Heath Care Always worn in combination with gloves, and with other The consensus recommendation is to strongly PPE when indicated discourage the wearing of rings or other jewelry during health care PPE: MASK Evidence suggests that wearing artificial naits may Placed on healthcare personnel to protect them from contribute to the transmission of certain health care contact with infectious material from pateints associated pathogens Placed on healthcare personnel when engaged in Freshly applied nail polish does not increase the procedures requiring sterile technique to protect patients number of bacteria recovered from perrungual skin, from exposure to infectious agents carried in a healthcare but chipped nail polish may support the growth of worker’s mouth or nose larger numbers of organisms on fingernails Each health-care facility should develop policies on PPE: GOOGLES AND FACE SHIELD the wearing of jewelry, artificial fingernails or nail necessary when it is likely that there will be a splash or polish by healthcare workers spray of any respiratory secretions or other body fluids eye protection must be comfortable, allow for sufficient peripheral vision, and must be adjustable to ensure a secure fit TRANSMISSION-BASED PRECAUTIONS Contact Methicillin resistant S. Precaution aureus Vancomycin-resistant enterococcus C. difficile SARS-CoV Droplet N. Meningitidis Precaution Rubella Mumps Influenza SARS-CoV M. tuberculosis STANDARD PRECAUTIONS Airborne Measles Hand hygiene: Before and after each patient Precaution Varicella contact & after gloves removed SARS-CoV Gown: Whenever splashes or sprays of body fluids possible Mask, eye protection, face shield: whenever BLOODBORNE PATHOGENS TRANSMITTED splashes or sprays of body fluids possible Gloves: When touching contaminated items (blood, BY NEEDLESTICKS body fluids, secretions, excretions). Hepatitis B NEVER substitute gloves for hand washing Hepatitis C If it is wet and not yours, wear gloves! HIV 3 of 4  Infection Control in the Hospital Setting What can be done to control exposure to bloodborne Adjunctive measures: pathogens? Vaccines used both for pre and post exposure prevention Post exposure chemoprophylaxis with antiviral or antibacterial agents Screening and restricting visitors with signs of transmissible infections Take note: Infections can be transmitted in the hospital setting via contact, droplet, or airborne spread Adherence to Isolation Precautions prevents transmission of disease to you and to other persons Appropriate use of PPE and safe handling of sharp devices can reduce your risk of exposure to bloodborne pathogens Hand hygiene reduces the risk of transmission of Prevention of needlestick and other sharps-related pathogenic organisms injuries Use aseptic technique to avoid contamination of sterile injection equipment IMPACT OF HOSPITAL ACQUIRED Do not administer medications from syringe to INFECTIONS multiple patients Nearly 1.7 million hospitalized patients annually Do not reuse needles, cannula and syringe acquire hospital acquired infections all sharps must be disposed at the sharps container 98,000 patients die due to it Central line-assoc. bloodstream infection COLOR CODING SCHEME FOR WASTE Catheter-assoc. UTI BIN Ventilator-assoc. pneumonia Estimated number of deaths associated with the HAI: 98,987 Pneumonia:35,967 Bloodstream: 30,665 Urinary tract: 13,088 Surgical site: 8,205 Other sites: 11,062 HEALTHCARE ASSOCIATED INFECTIONS (HAIs) Healthcare system components that influence the effectiveness of precautions to prevent transmission: Administrative measures Infection control professionals Infection control nurse liaison Bedside nursing staffing Clinical microbiology laboratory support Institutional safety culture and organizational characteristics Adherence of healthcare personnel to recommended guidelines Education of HCWs, patients, and families Transport of patient: Limiting transport f such patients to essentia; purposes Place appropriate barriers on the patient Notify healthcare personnel in the receiving area of the impending arrival of the patient and of the precautions necessary to prevent transmission Environmental measures: Proper cleaning and disinfection of patient-care areas Use appropriate detergent/ disinfectant Use recommended amount, dilution and contact time For resistant organisms- 1:10 dilution of 5.25% sodium hypochlorite 4 of 4