Hospital Hygiene PDF

L7 Hospital Hygiene  Introduction The conservation of a healthy environment at the hospital is very important issue in any national public health system; the hospitals are the meeting places where the medical staffs providing specialized health care services to patients in a professional man...

L7 Hospital Hygiene  Introduction The conservation of a healthy environment at the hospital is very important issue in any national public health system; the hospitals are the meeting places where the medical staffs providing specialized health care services to patients in a professional manner.  Introduction Inside the hospitals the doctors and the health workers perform a professional and technical activities as well as a social conducting with a sick people, therefore the building of the hospital as a health institution required special criteria during construction design, and specific hygienic measures and general rules in order to perform its function.  Introduction Hospital hygiene deals with the recognition and control, but primarily with the prevention of hospital infections. Protecting patients from infections can only succeed if all occupational groups involved in patient care are committed to hygiene. Hygiene is teamwork.  Introduction Good hygiene in hospitals plays a vital role in ensuring that patients do not catch dangerous infections and diseases, while also ensuring that germs and bacteria cannot spread to visitors and out into the general community that is the purpose of hospital hygiene.  Introduction Management of health-care waste is an integral part of hospital hygiene and infection control. Health- care waste should be considered as a reservoir of pathogenic microorganisms, which can cause contamination and give rise to infection.  Introduction The important problem is the bio-medical waste of the hospitals which carries a higher potential for infection and injuries than any other type of waste, it required strict final disposal like incinerator. If waste is inadequately managed, these microorganisms can be transmitted by direct contact, in the air, or by a variety of vectors. Infectious waste contributes in this way to the risk of nosocomial infections, putting the health of hospital personnel, and patients, at risk.  General Hygienic requirement of hospital: Hospital building: Needs daily cleaning, and frequent maintenance of internal and external buildings. Internal areas of the hospital: Classify according to the sanitary importance and the risk of infection (Nosocomial infection); 1) Restricted areas: Such as theatre room, ICU, sterilization room, and labor room. 2) Semi-restricted areas: Such as intermediate room and pre-labor room. 3) Un-restricted areas: General open rooms like out- patient department. Personal hygiene requirement: The medical staff of the hospital must be wearing uniform dressing, personal hygiene, and submitted to a periodic medical examination. Basic sanitation of hospital: Water supply control, vector control, liquid residual control, garbage control, food control, and hospital waste management. Specific hygienic requirements for hospital hygiene: The hygienic requirements at the hospital vary according to the characteristics and function of each department, special hygienic measures should be applied to certain departments, while some rooms may need routine daily cleaning, the hygienic attention should be devoted to following sections: 1) Waiting room. 2) Causality room. 3) Out- patient rooms. 4) Admission room. 5) Rules for infectious diseases. 6) Premature and newborn rooms. 7) Operation and delivery rooms. Nosocomial infections: Nosocomial infections, also called health-care associated or hospital- acquired infections, are a subset of infectious diseases acquired in a health-care facility. To be considered nosocomial, the infection cannot be present at admission; rather, it must develop at least 48 hours after admission. These infections can lead to serious problems like sepsis and even death. Nosocomial infections are infections that are not present in the patient at the time of admission to hospital but develop during the course of the stay in hospital. There are two forms: Endogenous infection, self-infection, or auto-infection. The causative agent of the infection is present in the patient at the time of admission to hospital but there are no signs of infection. The infection develops during the stay in hospital as a result of the patient’s altered resistance.  Cross-contamination followed by cross-infection. During the stay in hospital the patient comes into contact with new infective agents, becomes contaminated, and subsequently develops an infection. While there is no clinically significant difference between the endogenous self-infection and the exogenous cross- infection, the distinction is important from the standpoint of epidemiology and prevention. In fact, many nosocomial infections are preventable through guidance issued by national public health institutes such as the Centers for Disease Control and Prevention (CDC). Nosocomial infections or hospital acquired infections occur at the rate of approximately 5 to 10 per 100 admissions in US hospitals. In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year and there are associated with an extended length stay, substantial morbidity, and prolonged therapy. Factors that increase the risk for a nosocomial infection include increasing age, length of hospitalization, excessive or improper use of broad-spectrum antibiotics, and the number of invasive devices and procedures (for instance: central venous catheters, urinary catheters, surgical procedures, and mechanical ventilation). In addition, most patients often have accompanying conditions such as diabetes, chronic lung disease, renal insufficiency, or malnutrition. Hospital acquired infection may be considered form three angles: 1) Sources: patients, staff, and environment. 2) Routes of spread: direct contact, droplets infection, air borne particles, or hospital procedures. 3) Recipients: All patients in hospitals are potential recipient of cross infection.  Sites of nosocomial infections: Figure (1): Frequency distribution of nosocomial infections at each of the major sites, 1990- 1996 (total number 101821 isolates).  The most common type of nosocomial infection: The various bacteria, viruses, and fungi can all cause nosocomial infections. However, the most common is the bacterium Staphylococcus aureus. Other common pathogens like Escherichia coli, Enterococci, and Candida are common culprits, and all can be normally found on the skin and mucous membranes. Antibiotic-resistant strains such as Methicillin- Resistant Staphylococcus Aureus (MRSA) can be especially dangerous and difficult to treat.  Pathogenic nosocomial infections: Figure (2): Frequency distribution of major nosocomial pathogens causing infection at each of the major sites.  Preventive measures: 1) Isolation: especially infectious diseases which required precaution measures. 2) Hospital staff: 3) Hand washing: 4) Dust control: 5) Disinfection:  Preventive measures: 6) Control of droplet infection: 7) Nursing techniques: Barrier nursing and task nursing have also been recommended to minimized cross infection. 8) Administrative measures: Establishment of “control of infection committee” the main function of this committee is to reduce the incidence of hospital acquired infection problem and decide on steps to taken to tackle the reported cases in order to prevent occurrence of such cases in the future.  Central sterile supply department (CSSD): In order to ensure high standard of sterilization and disinfection, it is important to establish a central sterile supply department (CSSD) in the hospital, the aim is to minimize the incidence of acquired infection, and the department should be incorporated in the hospital design close to operation theatre complex. Thus, sterilization activities of the hospital are better centralized in one single unit or department for efficiency and effectiveness.  Function of CSSD: 1) Receipt: materials are received from operation theatre (OT), labor room, etc. 2) Sorting: material re-sterilized or discarded. 3) Cleaning: By using hot or cold water to remove blood stains, pus, or any material.  Function of CSSD: 4) Processing: repair, packing to be ready to sterile. 5) Sterilizing: using steam in autoclaves, ultraviolet, cleaner ethylene oxide gas for sensitive materials. 6) Storage: unused storage material for more than one week should again check for sterility. 7) Issuing: distribution system from CSSD for sterile material should be pre-planned in advance.  Bio-medical waste (BMW). The waste which generated during the diagnosis, treatment or immunization of human beings. Strategy adopted for hospital waste management: 1) Waste reduction and management strategy. 2) Waste assessment strategy. 3) Waste recycling strategy. 4) Hospital waste disposal. Certain procedures and guidelines are prescribed as follow: 1) Collection of waste. 2) Sources of segregation. 3) Transportation. 4) Storage. 5) Treatment.