ﺑﺴﻢ ﺍﷲ ﺍﻟﺮﺣﻤﻦ ﺍﻟﺮﺣﻴﻢ
Pasteur, Semmelweis, Lister
The risk of infection is always present.
1877 Separate facilities 1910 Antisepsis and disinfection 1950-60 Closure of Infectious disease and TB hospitals. 1970 CDC “Isolation Techniques for use in Hospitals”
Ignaz Philipp Semmelweis
Joseph Lister
1983 CDC Guideline for isolation precautions in Hospitals (Disease-specific and category-based precautions including blood and body-fluids)
1985 Universal Precautions 1987 Body Substance Isolation
(Mostly focused on worker protection)
1996 Publication of CDC/HICPAC revised guidelines
definition
Patient may acquire infection before admission to the hospital (Community acquired infection). Patient may get infected inside the hospital ( Nosocomial infection = HCAI)
It includes infections
not present nor incubating at admission, infections that appear more than 48 hours after admission, those acquired in the hospital but appear after discharge also occupational infections among staff.
Nosocomial infections occur worldwide. The incidence is about 5-8% of hospitalized patients, 1/3 of which is
preventable. The highest frequencies are in East Mediterranean and South-East Asia. A high frequency of N.I. is evidence of poor quality health service
delivered. East Mediterranean and South-East Asia: 10- 11.8% Europe and west of Pacific ocean: 7.7- 9 % An estimated 1 to 4 extra days for a urinary tract infection, 7 – 8 days for a
surgical site infection, 7 – 21 days for a blood stream infection, and 7 – 30 days for pneumonia.
Reduce the risk of hospital-acquired infection,thereby protecting the :
Patients Employees Health care student Visitors
Contact indirect: infected pt staff & env another pt
direct: infected pt another pt
Autoinfection Air borne Droplet Common source spread
food salmonellosis
Humans Cross-infection
Environment
clinical case e.g. chickenpox streptococcal pharyngitis wound infection
symptomless carrier e.g. MRSA gent-resistant GNRs
auto-infection e.g. some
Staph aureus wound infections
IVI e.g. Staph aureus, diphtheroids, staph epidermidis
ventilator e.g.Pseudomonas
air/dust Staph aureus , legionella disinfectants, solutions etc
e.g.. Pseudomonas
endoscopes e.g. mycobacteria
H. pylori
Humans
Indirect contact transmission Autoinfection Direct contact transmission Air borne & droplet transmission Common source transmission
Urinary tract infection: most common type of N.I. (30-40% of reported cases), associated with an indwelling urinary catheter or instrumentation.
Lower respiratory infection: mostly in ICU (about 15%). surgical wound infections: about 1-18 %. Bacteraemia: (5%) Less frequent include intravenous site infection,
gastrointestinal tract and skin infections.
LOWER RESPIRATORY TRACT INFECTIONS Mechanical ventilation Aspiration Nasogastric tube Central nervous system depressants Antibiotics and anti-acids Prolonged health-care facilities stay Malnutrition Advanced age Surgery Immunodeficiency
13%
BLOOD INFECTIONS Vascular catheter Neonatal age Critical care Severe underlying disease Neutropenia Immunodeficiency New invasive technologies Lack of training and supervision
5%
SURGICAL SITE INFECTIONS Inadequate antibiotic prophylaxis
Incorrect surgical skin preparation Inappropriate wound care
Surgical intervention duration Type of wound
Poor surgical asepsis Diabetes
Nutritional state Immunodeficiency
Lack of training and supervision 17%
URINARY TRACT INFECTIONS Urinary catheter
Urinary invasive procedures Advanced age
Severe underlying disease Urolitiasis
Pregnancy Diabetes
34%
Most common sites of health care- associated infection and the risk factors
underlying the occurrence of
infections
LACK OF HAND
HYGIENE
Bacteria are the most common pathogens. 1. Commensal bacter ia: found in normal flora of healthy humans, prevent pathogenic bacterial colonization on skin, colon, vagina. 2. Pathogenic bacter ia: have great virulence and cause
infection as : - Anaerobic gram +ve rods e.g Clostridium causing
gangrene. - Gram (+) bacteria: Staph. aureus found on skin & nose. - Gram (-) bacteria as E.coli, Proteus, Klebsiella, legionella
species.
Viruses: HIV, HBV, HCV can be also be transmitted through
blood & B F (transfusion, injections, dialysis) respiratory syncytial virus, rota virus, ebola, infleunza, herpes
simplex viruses. Parasites & Fungi: e.g. Giardia lamblia is easily transmitted
between adults or children, Aspergillus sp. affecting imunocompromised.
Scabies an ectoparasite causing outbreak.
Age: infants and old age have decreased resistance to infection.
Immune status: Patients with chronic diseases as malignancy, leukemia, diabetes mellitus, renal failure or AIDS have increased susceptibility to infection.
Immunosuppressive drugs or irradiation
Healthcare settings are environment where both infected persons and persons at high risk of infection congregate.
Crowded conditions within hospital, frequent transfers of patients between units.
Microbial flora may contaminate objects, devices and materials which subsequently contact susceptible body sites of patients.
- Standard precautions: minimal level of infection control
- Assume that every person is potentially infected or colonized with an
organism( blood-borne pathogens). applied to blood, body fluids, secretions, excretions( except sweat), nonintact skin and mucous membranes. for all patients in the hospital (regardless of suspected or confirmed infection status).
There are 9 elements to Standard Precautions
Hand Hygiene
linen
Clinical waste
Body fluid spills
Accommodation
Clean environment
Preventing exposure
Patient care equipment
PPE
The selection of PPE based on The nature of patient interaction and/or The likely mode(s) of transmission
Designated containers for used disposable or reusable PPE should be placed in a convenient to the site of removal
Hand hygiene is always the final step after removing and disposing of PPE
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Standard precautions – Gloves (PPE)
1. Exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items
3. Perform hand hygiene immediately after glove removal
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2. Change gloves when heavily contaminated
4. Disposable glove should not be reused
Standard precautions – Gown (PPE)
1. When splashes or sprays
of blood and body fluids, secretions and excretions to skin and working clothes are likely
2. When working clothes has substantial contact with patient, environmental surfaces or patient items
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3. Select an appropriate gown for the procedure
Standard precautions – Mask and eye protection (PPE)
Surgical masks and eye protection: When splashes or sprays of blood and body fluid, secretions and excretions are likely Sterile technique Respiratory etiquette
Change PPE promptly if heavily contaminated during the procedure
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Prevent needles and other sharps instrument injuries
Prevent mucous membrane exposures Safe work practices and PPE to protect
mucous membranes and non-intact skin
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Standard precautions: Environmental measures
Clean and disinfect non-critical surfaces in patient-care
areas are part of SP. Clean and disinfect all frequently touched surfaces in
patient-care areas
FDO-registered disinfectants or detergents
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Standard precautions: Patient Care equipment and instruments/devices
Clean and maintain medical equipment and instruments/devices according to the manufacturers’ instructions
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Key principles for handling of soiled laundry:
Don’t shaking items or handle them in any way that may aerosolize infectious agents
Avoid contact with one’s body and personal clothing
Contain soiled items in a laundry bag or designated bin
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Classification of chemical disinfectants. Risk stratification of hospital sections. Classification of medical devices
Cleaning and disinfection of instrument &surfaces
Spaulding classification of chemical disinfectants
Level of disinfection Spores TB Vegetative
bacteria Fungi Nonlipid &
small viruses
Lipid & medium-
size viruses
High + * + + + + +
Inter-mediate - + + + +/- +
Low - - + +/- +/- +
* high-level disinfectants may not be able to kill large numbers of spores
Low risk area : Financial , Official
Moderate risk areas : Hospital ordinarily wards
High risk areas : ICU, NICU, Isolated rooms
Very high risk areas : Operation rooms
Spaulding classification of medical devices
Class of item Use of item Example Decont. level needed
Critical Enter vascular system or sterile body tissues
Hypodermic needle, Scalpels
and other surgical instruments,
Biopsy forceps
Sterilization
Semi-critical Comes in contact with
intact mucous membranes
Vaginal spec., Anaesthetic
equipment, flex. Endoscopes
High-level disinfection (by heat or chemicals)
Non-critical Touches only intact skin
Blood pressure cuff, Baby weigh scale, Examining
table top
Intermediate-level or low-
level disinfection
Classification of Disinfectants High Level
Hydrogen Peroxide Peracetic acid Glutaraldehyde Formaldehyde
Intermediate Level Chlorine Iodine Alcohols
Low level Phenolics Quaternary Ammonium Compounds
Physical: dry heat: 160 c for 1-2 h moist heat:121c for 15min Ionizing radiation :UV & gama Chemical: glutaraldehyde peracetic acid Ethylen oxide