Infection Prevention & Control.pdf

INFECTION PREVENTION & CONTROL REVIEW  The goal of IC program to reduce the risk of healthcare-associated infections which involves patients, families, staff, and visitors. Infection The program applies to all center. Control The program is...

INFECTION PREVENTION & CONTROL REVIEW  The goal of IC program to reduce the risk of healthcare-associated infections which involves patients, families, staff, and visitors. Infection The program applies to all center. Control The program is guided by an annual infection control plan and based on: Program 1- Risk asessment. 2-Current scientific knowledge 3-Referenced practice guidelines. 4- Applicable laws and regulations.  Infection Control Program *A comprehensive, effective and supported program is essential for reducing infection risk and increasing center safety. *It is including surveillance, preventive activities and staff training… Infection control program Infection control team Infection control committee Infection control manual  Essential Safety Requirements ESR IPC 4 There is a designated multidisciplinary committee that provides oversight of the infection prevention and control program. The membership of the infection prevention and control committee includes representatives from the medical staff, nursing staff, operating room, central sterilization service, pharmaceutical care, housekeeping, infection prevention and control staff, and other departments as needed. The infection prevention and control committee meets on a regular basis (at least quarterly).  Essential Safety Requirements ESR IPC.15 Facility design and available supplies support isolation practices. Air is exhausted to the outside and is not re-circulated unless it is filtered through High-Efficiency Particulate Air (HEPA) Filter. There is evidence of daily air exchange monitoring (12 air changes per hour) when a patient is isolated. Weekly monitoring of the air exchange is needed when no patient is isolated.  plan includes measures for staff safety , (e.g., staff immunization and post exposure management). infection prevention patient safety (standard precautions, and control transmission based isolation, different care annual bundles). plan. staff, and patient/family education  IPC Education Plan New staff receive an orientation to the center's infection prevention and control policies and procedures upon hiring. Training records are maintained in their files. continuing education on infection prevention and control practices to staff, patients, families.  Health Care Associated Infection Is an infection , that acquired in the hospital After admission( 48 to 72 hr.) Definitions A community – Acquiredinfection: Is an infection that is present or might be incubating at the time of admission to the hospital what are health care associated infections: Catheter Associated Urinary Tract Infection (CAUTI ) Ventilator-Associated Event ( VAE ) Central Line-associated Bloodstream Infection( CLABSI) Surgical Site Infection( S.S.I ) Multi Drug Resistance Organism ( MDRO) HAIs are the infections acquired in the hospital after admission Other Environment patient Patient’s Medical Staff member own flora equipment  Chain of Infection Susceptible Host Pathogen Reservoir Portal of Mode Portal of of Entry Exit Transmission  Types of Isolations Precaution Standard precautions Designed for the care of all patients in There are hospitals regardless of diagnosis or suspected two levels of infection status Is the primary strategy for successful HAIs isolation control precautions Transmission precautions Are designed : only for specified patients who are known or suspected to be infected by epidemiologically important pathogens  HAND HYGIENE Five logical steps towards understanding the need and importance of hand hygiene The health care environment is Hands spread contaminated germs Hands are Patients are All health care vulnerable to work involves contaminated infection hands  What are the Methods of Hand Hygiene? Hand hygiene can be done by several methods 1. Hand washing by: a. Plane soap and water to remove the dirt from our hands. b. Antimicrobial soap and water to remove soil and remove or destroy transient microorganisms. 2.Hand sanitizing by: c-Using alcohol based hand rub to destroy transient and resident microorganisms on UNSOILED hands. d. Hand surgical scrub (before surgery) to remove or destroy transient microorganisms and reduce resident flora by: i. Antimicrobial soap and water ii. Alcohol hand surgical scrub  Hand-Hygiene-MOH Hand What-are-the-5-moments- Hygiene GDIPC- video How-and-When-to-Practice-Hand- Hygiene-  It is important to use the appropriate personal protective equipment (PPE) for the job to be done Personal Wear PPE when CONTACT with bloodborne pathogens (BBP) is anticipated Protective When removing PPE, avoid exposure by Equipment removing most contaminated PPE to least contaminated PPE Dispose of PPE properly and ALWAYS wash hands after removing PPE. Protect clothing, skin, and especially mucous membranes of the eyes, nose and mouth from BBP  Personal Protective Equipment Personal protective equipment (PPE) is available to you to reduce your risk of exposure. The PPE includes: Masks Gloves Goggles Mask/goggle combo Gowns Contaminated – outside front that have or are likely to have been in contact with body sites, materials, or environmental surfaces where “Contaminated” the infectious organism may and “Clean” reside Areas of PPE Clean – inside, outside back, ties on head and back  Sequence for Donning PPE 1 Hand Hygiene 4 Goggles or face shield 2 Gown 5 Gloves 3 Mask or respirator  Keep gloved hands away from face How to Avoid touching or adjusting other PPE Safely Remove gloves if they become torn; Use PPE perform hand hygiene before donning new gloves Limit surfaces and items touched  At doorway, before leaving patient room or in anteroom* Where to Remove respirator outside room, Remove after door has been closed* PPE * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub  Sequence for Removing PPE 1 Gloves 4 Goggles or face shield 5 Mask or respirator 2 Gown 6 Hand Hygiene 3 Hand Hygiene  Removing Isolation Gown 1 Unfasten ties 2 Peel gown away from neck and shoulder 3 Turn contaminated outside toward the inside 4 Fold or roll into a bundle 5 Discard  Removing a Mask 1 Untie the bottom, then top, tie 2 Remove from face 3 Discard Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard Respirator (high filtration) masks (N95, N-99) can be reused by the same patient care giver as per the period specified by the manufacturer For one shift and keep it in paper bag  It is important to use personal protective equipment effectively, correctly, and at all times where contact with patient’s blood, body Remember… fluids, excretions and secretions may occur. PPE-Donning-and-Doffing- Respiratory Hygiene & Cough Etiquette In waiting areas, signage should be posted requesting Patients to inform caregivers of respiratory signs/symptoms It is recommended that asymptomatic visitors not stay in the same area and that symptomatic patients be at least 3 feet from patients without respiratory symptoms Patients with symptoms should be provided a mask, tissues, and alcohol hand gel and be asked to use clean hands, cover mouth when coughing and dispose of tissues properly Healthcare workers should use mask and use hand gel before and after caring for respiratory patients.  COVER YOUR nose and mouth Cover your nose and mouth with a tissue Or cough/sneeze into your upper sleeve, NOT your hands. Dispose used tissue in the nearest waste receptacle. Perform hand hygiene after coughing, sneezing, or wiping or blowing your nose. You may be asked to wear a mask to protect others. The physical space requirements for patient care areas set by MOH mandate adequate spacing Patient between patients to prevent crowding and reduce the risk of Placement microorganism transmission.  Handle patient care equipment soiled with blood, other body fluids, secretions, or excretions in a way that prevents contact with skin and mucous Handling membranes Patient Care Handle patient care equipment in a way Equipment that prevents contamination of clothing and the spread of microorganisms to other patients Appropriately dispose of single use equipment (suction catheters, etc) Clean and disinfect reusable equipment.  Routine Environmental Disinfection and Cleaning Routine disinfection and cleaning of environmental surfaces with approved sanitizers is crucial in preventing spread of contaminants and pathogens Staff who do environmental cleaning should wear the appropriate PPE during cleaning  Control access to the area (using wet floor sign) Locate the “spill kit“ Wear appropriate PPEs. Contain spill ( Sprinkle the SoChlor over the spill and leave for 2 minutes, Allow the spill to solidify before removing ) Meanwhile place SoChlor 7 tab + 1 liter of water (10,000ppm) Use plastic scoop or other mechanical means to remove How to Clean any broken glass or other sharp objects from the spill area, and dispose into the sharp container a Blood Spill Remove the solidified waste material using the scoop and scraper and carefully dispose all contaminated materials into the infectious waste bag. Use the paper towels and SoChlor solution to clean the area of the spill and remove any smears. Remove PPEs and place in a yellow bag for disposal. Wash hands thoroughly with soap and water Contact housekeeping to clean the affected area with approved disinfectant.  LINEN MANAGEMENT To prevent the spread of infection to patients and staff through proper handling of linen To prevent occupational exposure to blood and body fluids Safe Injection Practices Special care should be taken to prevent injuries caused by needles, scalpels and other sharp instruments, and when cleaning sharp reusable instruments or equipment Needles should not be recapped, bend or broken All used sharps should be disposed into puncture-resistant sharp box. Dispose of contaminated items into appropriate containers, avoiding contact with clothing and environmental Body surfaces. Consider all needles and catheters and Substance sharps and dispose of into yellow rigid & Sharps Handling biohazard sharps containers; dispose container when the content reaches the ¾ marked on the container.  Immediate first aid: 1. Wash needle sticks and cuts with soap and water 2. Flush splashes to the nose, mouth, or skin with water What to do if exposed to 3. Irrigate eyes with clean water, saline, or sterile irrigants. 4. Inform head of the department 5. Fill up an Needle stick form blood / body 6. See Staff Physician fluids 7. Lab investigation 8. Inform IC department 9. Post Exposure Management  Recommended Segregation & Color Coding For Healthcare Waste Waste Category Type of receptacle Characteristics Color Plastic Regular waste No special requirements Black bag or container Non-sharp Container Leak-proof Yellow Infectious waste or plastic bags in holders Sealed Leak-proof Yellow Sharps box or drum or cardboard box & puncture proof & marked “SHARPS” Whether or not sharps are contaminated, they should be collected together & considered highly hazardous Examples: Needles, infusion sets, blades, knives, scalpels, broken glass…  I should do all the following: What you 1 - I will wash the site with soap and water Stop the bleeding by covering the injury site. will do if you 2- I will inform my supervisor 3- I will write OVR. get needle 4- I will go to staff clinic in the working hour or ER outside the working hours. stick injury? 5- 5.Do baseline serology for exposed person..(test for HBV,HCV, HIV) Evaluate exposure source.(test for HBV,HCV, HIV)  Contact Transmission Person to person touch Direct or Indirect contact Transmitted by inanimate objects….needles, unwashed hands… gloves that were not changed between contact…. Examples: MRSA, VRE, Herpes, Impetigo, Scabies, RSV, and C-Diff Use on patients known or suspected to be “infected” or “colonized.” Personal Protective Equipment (PPE) is worn to prevent contact (i.e., Gloves & Gown) Contact Precautions Place in a private room or cohort cases of “same” organism Dedicated patient care equipment Precautions on transport HAND WASHING recommended with C-Diff – alcohol gel is not effective. Contact Precautions For patients infected or colonized with organisms transmitted by contact e.g. Multi-drug resistant organisms, MRSA, Clostridium difficile, scabies, gastroenteritis  WASH HANDS Before and after patient care Before and after using gloves Components of Contact Between patient contact Between handling different sites of the same patient Wash hands with antibacterial agent. Precautions Avoid recontamination of hands Components of Contact Precautions GLOVES Wear clean, non-sterile gloves when entering the room or cubicle. Wear gloves whenever touching the patient’s intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails) MASK/EYE PROTECTION When procedures and activities are likely to generate splashes or sprays of blood and body fluids  WEAR GOWN/APRON Wear a clean, non-sterile gown when entering the Components room When anticipating substantial or close contact with of Contact patient or environment or items in the room in addition to the circumstances under the standard Precautions precautions i.e. during procedures and activities likely to generate splashes or sprays of blood & body fluids Remove soiled gown immediately and wash hands Remove gown before leaving room  PATIENT TRANSPORT Limit transport of patient to essential purposes only During transport, ensure precautions Components are maintained to minimize risk of transmission of organism of Contact Notify area receiving patient Precautions PATIENT CARE EQUIPMENT Dedicate use of non-critical patient care equipment Clean and disinfect any common equipment between patients used to prevent transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host. examples: DROPLET Influenza Neisseria meningitidis ISOLATION some pneumonias vaccine preventable diseases: - rubella, mumps, pertussis  Droplet Transmission Droplets carry infectious organism – propelled through air – 3 feet. Through coughing, sneezing, talking, suctioning, singing. Can involve direct contact or indirect contact….  Examples: Influenza, Meningitis, Pneumonia Use on patients known or suspected to have infections caused by microorganism transmitted in “droplets” (large particles > 5microns) Droplet Droplets are propelled approximately 3 feet - mask should be worn if within 3 ft of the patient. Precautions Dedicated Patient Care Equipment Precautions on transport Special Ventilation is NOT required Place in private room or cohort infections of “same” organism. Droplet Transmission Droplet transmission occurs when there is adequate contact between the mucous membranes of the nose and mouth or conjunctivae of a susceptible person and large particle droplets (> 5 microns). e.g., Neisseria meningitidis, influenza viruses. BASIC COMPONENTS surgical mask within 3 foot DROPLET zone ISOLATION HANDWASHING  Droplets are usually generated from the infected person during coughing, sneezing, talking or when health care workers undertake procedures such as tracheal Droplet suctioning Transmission The distance droplets travel depends on the velocity and mechanism by which respiratory droplets are propelled from the source, the density of respiratory secretions, environmental factors such as temperature and humidity, and the ability of the pathogen to maintain infectivity over that distance Standard precautions PLUS: PATIENT PLACEMENT Place patient in a single room (or in a room with another patient infected by the same pathogen) Maintain a minimum of three feet separation between Components patients Special air handling and ventilation are not required to prevent droplet transmission of infection WEAR MASK of Droplet Precautions Wear surgical mask if within three feet of patient (Wear surgical mask upon entry into patient room) WASH HANDS WEAR PPE such as gloves, eye protection, gowns For indications under Standard Precautions PATIENT TRANSPORT Use surgical mask on patient during transport AIRBORNE ISOLATION used to prevent transmission of microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust) examples: pulmonary Tuberculosis varicella measles  Airborne Transmission Tiny particles (