Infection Control in the Hospital - Rodriguez PDF

INFECTION CONTROL IN THE HOSPITAL: PREVENTING THE TRANSMISSION OF INFECTION Presenter: C. Thoms-Rodriguez BMed Sci; MBBS; DM; PDipIPC OBJECTIVES The Five Pillars of Infection Control Importance of Infection Control The Chain of Infection Strategies that Interrupt the Spread of Infection INFECTION CO...

INFECTION CONTROL IN THE HOSPITAL: PREVENTING THE TRANSMISSION OF INFECTION Presenter: C. Thoms-Rodriguez BMed Sci; MBBS; DM; PDipIPC OBJECTIVES The Five Pillars of Infection Control Importance of Infection Control The Chain of Infection Strategies that Interrupt the Spread of Infection INFECTION CONTROL IMPORTANCE OF INFECTION CONTROL IMPORTANCE OF INFECTION CONTROL During the delivery of healthcare there is the risk of infection through the transfer of infectious body fluids:  Blood  Saliva  Other e.g. aerosols IMPORTANCE OF INFECTION CONTROL Transmission of infection can happen in the following ways:  Patient → healthcare professional (HCP)  HCP→ Patient  HCP→HCP  Patient→Patient IMPORTANCE OF INFECTION CONTROL Education and the use of proper infection control procedures can break the chain of infection. THE CHAIN OF INFECTION THE CHAIN OF INFECTION SOURCES OF HEALTHCARE ASSOCIATED INFECTION oENDOGENOUS oAcquired from microorganisms transferred from another site on the same host oEXOGENOUS oAcquired from transfer of micro-organism from another person to the environment TRANSIENT FLORA oAcquired through contact with other sites people and environment oEasily acquired by touch and readily lost on the next thing touched oMany unable to survive for long on the skin oMay accumulate under rings EXOGENOUS SOURCE OF INFECTION List the major reservoirs in your ward/ department. How could these become a source of infection? 1Standard Precautions and Transmission Based Precautions(2includes hand hygiene) Personal Health Elements Sterilization and Disinfection(includes decontamination of 3equipment and 4environment) Waste Management Special Considerations(5includes the prudent use of antibiotics) (* Recall the Five Pillars of Infection Control)) INFECTION CONTROL STRATEGIES THAT BREAK THE CHAIN OF INFECTION STANDARD PRECAUTIONS AND TRANSMISSION BASED PRECAUTIONS (TBP) Hand Hygiene-Most Imp. Failure to perform Hand Hygiene is the leading cause of HAI STANDARD PRECAUTIONS AND TRANSMISSION BASED PRECAUTIONS STANDARD PRECAUTIONS AND TRANSMISSION BASED PRECAUTIONS Presume every patient is infectious. Use standard precautions at all times:  Hand Hygiene  Personal Protective Equipment (PPE).  Safe Injection Practices  Respiratory Hygiene/Cough Etiquette Sometimes additional isolation precautions are needed. Three main transmission based precautions are usually implemented HAND HYGIENE: HAND WASHING; ABHR EFFICACY OF HAND HYGIENE PREPARATIONS IN REDUCTION OF BACTERIA Good Better Best Plain Soap Antimicrobial soap Alcohol-based handrub Source: http://www.cdc.gov/handhygiene/materials.htm ALCOHOL-BASED PREPARATIONS Benefits Limitations Rapid and effective antimicrobial action Cannot be used if hands are visibly soiled Improved skin condition Does not eliminate spores More accessible than sinks Store away from high temperatures or flames Hand softeners and glove powders may “build-up” Some associated with ? increased absorption of Bisephenol A Please perform hand hygiene using the hand sanitizer provided! HOW DID YOU DO? HAND HYGIENE HAND HYGIENE AT THE UHWI 2010 Nicholson TRANSMISSION BASED PRECAUTIONS CONTACT PRECAUTIONS HIGH OUTPUT OF BODY FLUIDS? DROPLET PRECAUTIONS AIRBOURNE PRECAUTIONS TB SUMMARY OF ISOLATION PRECAUTIONS- CDC PRECAUTIONS→ STANDARD CONTACT DROPLET AIRBORNE EXAMPLES OF INFECTIONS FOR WHICH IT IS IMPLEMENTED USED FOR ALL PATIENTS REGARDLESS OF DIAGNOSIS MULTIDRUG RESISTANT ORGANISMS INFLUENZA CHICKEN POX/SHINGLES (VZV) TUBERCULOSIS ETC. PATIENT PLACEMENT NO RESTRICTIONS PRIVATE ROOM / COHORT PATIENTS PRIVATE ROOM (DOOR CLOSED)/ COHORT PATIENTS AIIR WITH NEGATIVE PRESSURE VENTILATION GLOVES FOR CONTACT WITH BLOOD AND OR BODY FLUID WEAR UPON ENTERING ROOM; DISCARD UPON LEAVING FOR CONTACT WITH BLOOD AND OR BODY FLUID FOR CONTACT WITH BLOOD AND OR BODY FLUID GOWN TO PROTECT CLOTHING WHEN SPLASH/SPRAY LIKELY WEAR UPON ENTERING ROOM; DISCARD UPON LEAVING TO PROTECT CLOTHING WHEN SPLASH/SPRAY LIKELY TO PROTECT CLOTHING WHEN SPLASH/SPRAY LIKELY PERSONAL PROTECTIVE EQUIPMENT (PPE) ESP FOR VZV-WEAR UPON ENTERING ROOM; DISCARD UPON LEAVING EYE/ MASK WHEN SPLASH/SPRAY LIKELY WHEN SPLASH/SPRAY LIKELY SURGICAL MASK N95 OR HIGHER RESPIRATOR HAND HYGIENE SOAP AND WATER OR ALCOHOL BASED HAND RUB (ABHR) SOAP AND WATER OR ALCOHOL BASED HAND RUB (ABHR) SOAP AND WATER OR ALCOHOL BASED HAND RUB (ABHR) SOAP AND WATER OR ALCOHOL BASED HAND RUB (ABHR) PATIENT-CARE EQUIPMENT CLEAN AND DISINFECT AFER USE USE DESIGNATED EQUIPMENT WHENEVER POSSIBLE CLEAN AND DISINFECT AFER USE CLEAN AND DISINFECT AFER USE CLEAN AND DISINFECT AFTER USE PERSONAL HEALTH ELEMENTS PERSONNEL HEALTH ELEMENTS Education and training Immunizations Exposure prevention and post exposure management Medical condition management and work-related illnesses and restrictions Health record maintenance DECONTAMINATION OF THE ENVIRONMENT AND EQUIPMENT STERILIZATION AND DISINFECTION RATIONALE FOR USING DIFFERENT TECHNIQUES INVOLVED IN STERILIZATION AND DISINFECTION IN DIFFERENT CLINICAL SCENARIOS Earle Spaulding believed the nature of disinfection could be understood readily if instruments and items for patient care were categorized as:  Critical → enter sterile sites → sterilize  Semicritical→ contact mucous membranes (no penetration of soft tissue)→ sterilize if not high level disinfection  Noncritical (environmental or pt care)→intact skin→ most times low level disinfection Use disinfectants according to manufacture’s instructions; Use PPE SNAPSHOT(S) OF STERILIZATION AND DISINFECTION STERILIZATION USING THE AUTOCLAVE CLEANING Cleaning - Cleaning means the removal of dirt or of any other unwanted material (blood, food residues, etc.). This removes visible contaminants. Floors should be cleaned with environmentally friendly all-purpose cleaners at the end, or before the start, of the working day. All surfaces should be cleaned at the beginning of a shift or more frequently if visibly soiled. CLEANING Always start from the cleanest area to the dirtiest area. For example start from the bedside table to the bed and then the patients’ bathroom at the end. Do not use the same rag or cloth that is used on the patient’s bathroom to clean the bed or bedside table Do not use the same rag on the staff workstation. TERMKINAL CLEANING TERMINAL CLEANING Remove all dirty/used items from the room before cleaning the room (e.g., suction container, wheelchairs, medical supplies, disposable items). Items which can be cleaned must be cleaned before removing from the room. Medical supplies which can be reprocessed should be bagged and sent for reprocessing. TERMINAL CLEANING Discard disposable items and items that cannot be reprocessed. Remove Bed sheets and send for laundering. Work from top to bottom and from clean area (e.g., windows) to dirty area (e.g., bathroom). Walls – check for visible soiling. TERMINAL CLEANING The only difference between terminal cleaning and cleaning after an infectious case is the chemical, concentration, and standing time. WASTE MANAGEMENT MEDICAL WASTE Non-infectious waste → regular trash Infectious waste→ dispose of according to local guidelines→ processing usually includes autoclaving or incineration  This should be properly contained  Clearly marked USE A PROPER SHARPS CONTAINER DON’T! INFECTIOUS WASTE SHOULD BE PROPERLY PACKAGED IN APPROPRIATE BAGS! PROPER DISPOSAL OF SLUICE Don’t dispose of medical waste in the hand washing sink SPECIAL CONSIDERATIONS PRECAUTIONS FOR PARENTERAL MEDICATIONS Use single use disposable items such as needles, and syringes ONCE! Single dose vials  Do not administer to multiple patients even if the needle on the syringe is changed  Do not combine leftover contents for later use REGULATORY BODIES/RESOURCES The Ministry of Health; CDC; OSAP (Organization for Safety and Infection Control Procedures); OSHA (Occupational Safety and Health Administration); Others ACKNOWLEDGEMENTS Colleagues  Special for the support given. REFERENCES  Available upon request.