Lecture 5.2 - Infection Prevention .pdf

Infection prevention: ◦The discipline concerned with preventing nosocomial or healthcare-associated infections ◦Similar to public health activities, mainly practiced within a healthcare delivery system ◦Focuses on evidence-based practices and procedures that can prevent or reduce th...

Infection prevention: ◦The discipline concerned with preventing nosocomial or healthcare-associated infections ◦Similar to public health activities, mainly practiced within a healthcare delivery system ◦Focuses on evidence-based practices and procedures that can prevent or reduce the risk of transmission of microorganisms to healthcare providers, patients and visitors Sources of infection: Route of transmission: Basic reproduction number Ro: ◦Ro - the average number of cases one case generates over the course of its infectious period, in an otherwise uninfected, non-immune population ◦If Ro > 1 -> increase in cases ◦If Ro = 1 -> stable number of cases ◦If Ro < 1 -> decrease in cases Factors determining transmissibility: ◦Infectious dose: ‣ Number of microorganisms to cause infection ‣ Varies by: Microorganism Immunity of potential host  Preventing infections in healthcare: ◦Key principles: ‣ Distancing/separation/restriction of movement and of visitors ‣ PPE: gloves, gowns, masks, eye protection (where appropriate) ‣ Hand hygiene ‣ Cleaning, disinfection and sterilisation ‣ Waste management ‣ Staff health management: exposure prophylaxis, health monitoring (occupational health) ‣ Discharge of patients ‣ Care of the deceased Goals of infection prevention: ◦To prevent the spread of infections from: ‣ Patient-to-patient ‣ Patients to healthcare providers ‣ Healthcare providers to patients ‣ Healthcare providers to healthcare providers and to visitors and others in the healthcare environment ◦CONSEQUENTLY: ‣ To protect patients from HAIs, resulting in: Improved survival rates Reduced morbidity associated with infections Shorter length of hospital stay A quicker return to good health The 4 P's of infection prevention and control: Infection control considerations: ◦Patient - improved health/immunity ‣ General: Optimise patient's condition: ◦Immunosuppressed patients ◦Comorbidities (diabetes) ◦Nutrition ◦Smoking Antimicrobial prophylaxis Skin preparation Hand hygiene  ‣ Specific: MRSA screens ◦Mupirocin nasal ointment Disinfectant body wash ◦Pathogens (and/or vector) - reduction or eradication ‣ Reduce/eradicate pathogen: Antibacterials including disinfectants Decontamination Sterilisation ‣ Reduce/eradicate vector: Eliminate vector breeding sites ◦Practice - behavioural change; protective equipment ‣ Infection control at all levels: Awareness Policies Training Leadership (at all levels) Engagement at local and national level ◦Place - environment ‣ Ensuring all premises delivering healthcare are infection control compliant Building (including kitchens, cafes, shops) Wards Consulting rooms Communal areas Toilets Furnishing (including movable items) Flooring Air conditioning/heating system Personal protective equipment (PPE): ◦What is PPE? - examples of PPE are: gloves, aprons, long sleeved gowns, surgical masks, eye goggles, face visors and respirator masks ◦What is PPE used for?: ‣ PPE is used in healthcare settings to create a barrier between healthcare workers and an infectious agent from the patient and to reduce the risk of transmitting micro-organisms from healthcare workers to patient(s) or vice versa ‣ PPE may sometimes be used by the patient's family/visitors e.g. assisting patient with toileting, visiting patient who has a contagious infection, visiting vulnerable patients ‣ Visitors must be fully inducted in the use of PPE and hand hygiene Choice of PPE: ◦The choice of PPE should be based on a risk assessment of potential exposure to blood/bodily fluids/infectious agents ◦PPE should be available at the point of use in both community and acute healthcare settings and staff should receive training on the correct use and disposal of PPE. ◦If used inappropriately, PPE can increase the risk of transmitting infections and put people at risk of acquiring an infection  Prevention of transmission of microorganisms: Inoculation accidents: Handwashing technique: Preventing patient to patient transmission of infection: ◦Halting patient to patient transmission: ‣ Physical barriers ‣ Isolation of infected patients ‣ Protection of susceptible patients Healthcare worker interventions: ◦Healthcare workers: ‣ Healthy Disease free  Vaccinated ‣ Good practice: Good clinical techniques e.g. sterile non-touch Hand hygiene PPE Antimicrobial prescribing Environmental interventions: ◦Built environment ‣ Space/layout ‣ Toilets ‣ Wash hand basins ◦Furniture and furnishings ◦Cleaning: ‣ Disinfectants ‣ Steam cleaning ‣ Hydrogen peroxide vapour ◦Theatres ◦Positive and negative pressure rooms ◦Medical devices: ‣ Single use equipment ‣ Sterilisation ‣ Decontamination ◦Appropriate kitchen and ward food facilities ◦Good food hygiene practice Notifiable diseases: