Infection Control PDF

INFECTION CONTROL James Ogutu Department of Pathology Kenyatta University OBJECTIVES Describe the sources of micro-organisms, routes of transmission and key principles of infection control List the essential elements of universal precautions Underst...

INFECTION CONTROL James Ogutu Department of Pathology Kenyatta University OBJECTIVES Describe the sources of micro-organisms, routes of transmission and key principles of infection control List the essential elements of universal precautions Understand the importance of risk assessment and management in infection control Explain the use of the various classes of vaccines in immunization 2 The pre-scientific era Epidemics and plagues throughout history Physicians fear of contagious disease Hippocrates and others suspected an unseen invisible cause Climate and environment blamed - not the ill, dying or dead 3 Microbiology - Scientific era 1. Anton van Leeuwenhoek (1632-1722) Dutch linen draper Amateur scientist Grinding lenses, magnifying glasses, hobby First to see bacteria “little beasties” No link between bacteria and disease 4 Scientific era continued…. 2. Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues 5  Scientific era continued…. 3. Louis Pasteur (1822-1895) French professor of chemistry Studied how yeasts (fungi) ferment wine and beer Proved that heat destroys bacteria and fungi Disproved the theory of ABIOGENESIS Proved that bacteria can cause infection - the “germ theory” of disease 6 Scientific era continued... 4. Joseph Lister (1827-1912) Scottish surgeon Recognised importance of Pasteur’s work Concerned about infection of compound fractures and post-operative wounds Developed carbolic acid spray to disinfect instruments, patient’s skin, surgeon’s skin Largely ignored by medical colleagues 7 Scientific era continued... 5. Robert Koch (1843-1910) German general practitioner Grew bacteria in culture medium Showed which bacteria caused particular diseases Classified most bacteria by 1900 8 How infections occur Chain of Infection Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host 9 How infections occur… Infectious Susceptible Agent Reservoir Host Means of Means of Entry Exit Mode of Transmission 10 Breaking the Chain of Infection Source control measures – Cough etiquette, cleaning, disinfection Modes of transmission – Contact: hand hygiene -Droplet: distance from source >1 m – Airborne: ventilation – Vector: bednets Portal of entry into the host – Adding barriers, e.g., PPE Host – Strengthen host defences, e.g., vaccination 11 What the expert once said… "It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm" Florence Nightingale 12 Why do we need infection control? Hospitals and clinics are complex institutions where patients go to have their health problems diagnosed and treated But, hospitals, clinics, and medical/surgical interventions sometimes introduce risks that may harm a patient’s health 13 Nosocomial Infection Any infection that is not present or incubating at the time the patient is seen in the hospital or clinic Theyare commonly known as hospital-acquired infections (HAI) 14 Consequences of Nosocomial Infections i. Additional morbidity ii. Prolonged hospitalization iii. Long-term physical, developmental and neurological sequelae iv. Increased cost of hospitalization v. Death 15 HAI - common bacteria (Peto, 1998) Staphylococci - wound, respiratory and gastro-intestinal infections Eshericia coli - wound and urinary tract infections Salmonella spp- food poisoningUTI Pseudomonas aeruginosa – wound and Streptococci - wound, throat and urinary tract infections Proteus spp- wound and urinary tract infections 16 HAI - common viruses (Peto, 1998) Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Human immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] Rotavirus – GIT infections 17 Responsibilities of the Infection Control Program i. Surveillance of vi. Education of hospital nosocomial infections staff on infection ii. Outbreak investigation control iii. Develop written vii. Ongoing review of all policies for isolation of aseptic, isolation and patients sanitation techniques iv. Develop written viii. Eliminate wasteful or policies to reduce risk unnecessary practices from patient care practices v. Cooperation with 18 occupational health Universal infection control precautions Devised in US in the 1980’s in response to growing threat from HIV and hepatitis B Not confined to HIV and hepatitis B Treat ALL patients as a potential bio- hazard Adopt universal routine safe infection control practices to protect patients, self and colleagues from infection 19 Components of Universal precautions 1. Hand washing 2. Personal protective equipment [PPE] 3. Preventing/managing sharps injuries 4. Aseptic technique 5. Isolation 6. Staff health 7. Linen handling and disposal 8. Waste disposal 9. Spillages of body fluids 10. Environmental cleaning Risk management/assessment 20 11. 1. Hand washing Single most effective action to prevent HAI - resident/transient bacteria Correct method - ensuring all surfaces are cleaned - more important than agent used or length of time taken No recommended frequency - should be determined by intended/completed actions Research indicates: – poor techniques - not all surfaces cleaned – frequency diminishes with workload/distance – poor compliance with guidelines/training 21 Hand washing – areas missed Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger- webs, the palms and the thumbs. 22  Hand Washing Method 1. Wet hands with clean (not hot) water 2. Apply soap 3. Rub hands together for about 20 seconds 4. Rinse with clean water 5. Dry with disposable towel or air dry 6. Use towel to turn off faucet 23 Alcohol-based Hand Rubs Effective if hands not visibly soiled More costly than soap and water Method i. Apply appropriate (3ml) amount to palms ii. Rub hands together, covering all surfaces until dry 24 2. Personal protective equipment Used when contamination or splashing with blood or body fluids is anticipated i. Disposable gloves ii. Plastic aprons iii. Face masks iv. Safety glasses, goggles, visors v. Head protection vi. Foot protection vii. Fluid repellent gowns 25 3. Sharps injuries Prevention – correct disposal in appropriate container – avoid re-sheathing needle – avoid removing needle – discard syringes as single unit – avoid over-filling sharps container Management – follow any local policy for sharps injury 26 4. Aseptic technique Sepsis - harmful infection by bacteria Asepsis - prevention of sepsis – Minimise risk of introducing pathogenic micro-organisms into susceptible sites – Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff – Follow any local policy 27 5. Isolation May be single per room or group Source or protective Source - isolation of infected patient – mainly to prevent airborne transmission via respiratory droplets – respiratory MRSA, pulmonary tuberculosis Protective - isolation of immunosuppressed patient  Isolation may lead to significant psychological effects 28 6. Staff health Risks of acquiring and transmitting infection a) Acquiring infection prevented through: immunisation covering lesions with waterproof dressings restricting non-immune/pregnant staff b) Transmitting infection prevented through: seeking advice when suffering from infection Report accidents/untoward incidents Follow any local policy if available 29 7. Linen handling and disposal Bed making and linen changing techniques Gloves and apron - handling contaminated linen Appropriate laundry bags Avoid contamination of clean linen Hazards of on-site ward-based laundering Follow any local policy if available 30 8. Waste disposal Clinical waste - HIGH risk – potentially/actually contaminated waste including body fluids and human tissue – yellow plastic sack, tied prior to incineration Household waste - LOW risk – paper towels, packaging, dead flowers, other waste which is not dangerously contaminated – black plastic sack, tied prior to incineration Follow any local policy 31 9. Spillage of body fluids PPE - disposable gloves, apron Soak up with paper towels, kitchen roll Cover area with hypochlorite solution e.g., Milton, for several minutes Clean area with warm water and detergent, then dry Treat waste as clinical waste - yellow plastic sack Follow any local policy 32 10. Environmental cleaning Recent concern regarding poor hygiene in hospital environments Some pathogens survive for long periods in dust, debris and dirt Poor hygiene standards - hazardous to patients and staff Report poor hygiene to the appropriate authorities “Hospitals should do the sick no harm” (Nightingale, 1854) 33 11. Risk assessment No risk of contact/splashing with blood/body fluids - PPE not required Low or moderate risk of contact/splashing - wear gloves and plastic apron High risk of contact/splashing - wear gloves, plastic apron, gown, eye/face protection 34 Body fluids Cerebrospinal fluid, peritoneal fluid, pleural fluid, synovial fluid, amniotic fluid, semen, vaginal secretions, and Any other fluid containing visible blood e.g., urine, faeces 35 Please ask me… Have u washed your hands? 36 It is the simplest thing to do…the easiest to ignore…yet it carries a lot importance on it… IT IS A METHOD OF SANITATION… bringing down the pathogen numbers to the ‘safe’ levels. HANDWASHING 37 THANK YOU FOR ATTENDING 38