Infection prevention & control general orientation [compatibility mode]

INFECTION PREVENTION & CONTROLINFECTION PREVENTION & CONTROLGENERAL ORIENTATIONGENERAL ORIENTATION

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• Infection control (IC) is a quality standard• Infection control (IC) is a quality standardthat is essential for the well being and safety ofthat is essential for the well being and safety ofpatients, staff and visitors.patients, staff and visitors.• It affects most departments of the hospital and• It affects most departments of the hospital andinvolves issues of quality, risk management, clinicalinvolves issues of quality, risk management, clinicalgovernance and health and safety.governance and health and safety.• It is a discipline that applies epidemiologic and• It is a discipline that applies epidemiologic andscientific principles and statistical analysis to thescientific principles and statistical analysis to theprevention or reduction in rates of Healthcareprevention or reduction in rates of HealthcareAcquired Infections (HAIs).Acquired Infections (HAIs).

Infection Control Overview

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An infection meeting the following criteria:An infection meeting the following criteria:a)a) Not present or incubating on admissionNot present or incubating on admission..

b)b) An infection incubating at the time of admission that is related to previous hospitalization at the same facility or identified in an admission following performance of a procedure during a previous admission.

Hospital Acquired Infections or

Healthcare Associated Infections( HAIs )

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HEALTHCARE ASSOCIATED INFECTIONS

►►Infection in a hospitalized Infection in a hospitalized patientpatient

►►Not present or incubating on Not present or incubating on admissionadmission

►►Hospital acquired infectionHospital acquired infection

Remember

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Why now the urgent need for Why now the urgent need for Infection Control ProgramInfection Control Program

►►HAIs HAIs are becoming more prevalent, especially are becoming more prevalent, especially with the advent of more invasive procedures & with the advent of more invasive procedures & increase in use of immunosuppresive therapy.increase in use of immunosuppresive therapy.

►►HAIs HAIs are preventable( can kill ) are preventable( can kill ) ►►HAIs HAIs are associated with prolonged morbidity.are associated with prolonged morbidity.►► HAIs HAIs are associated withare associated with increased length of increased length of

stay & increased cost of care.stay & increased cost of care.

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Devices Associated InfectionsDevices Associated Infections Catheter Associated Urinary tract infections Catheter Associated Urinary tract infections (CAUTI)(CAUTI) Central Line Associated Blood Stream Infections Central Line Associated Blood Stream Infections

(CLABSI)(CLABSI) Ventilator Associated Pneumonia Ventilator Associated Pneumonia (VAP)(VAP)

Procedure Associated InfectionsProcedure Associated Infections Surgical Site infections Surgical Site infections (SSI)(SSI)

TYPES OF HAIsTYPES OF HAIs

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Main Types of InfectionsMain Types of Infections

44%

11%10%

18%

17% UTISSIBSIPneumoOthers

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Patient’s Own Flora

Staff Member

Medical Equipment

HAIs

Source Healthcare AssociatedInfections

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KKH INFECTION CONTROL PROGRAMKKH INFECTION CONTROL PROGRAM

KKH Infection Control Program is a KKH Infection Control Program is a coordinated program designed by coordinated program designed by the hospital to reduce the risk of the hospital to reduce the risk of healthcarehealthcare--associated infections in associated infections in patients, visitors, and workers. It patients, visitors, and workers. It describes the structure, authority describes the structure, authority and functions of it.and functions of it.

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The GOALThe GOALThe goal of Infection Control Program is The goal of Infection Control Program is to provide a safe healthy environment to provide a safe healthy environment through identification and reduction the through identification and reduction the risks of acquiring and transmission of risks of acquiring and transmission of HAIs HAIs among patients, medical staff, among patients, medical staff, administration staff, volunteers, students administration staff, volunteers, students and visitors.and visitors.

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1. We have an obligation to reduce the morbidity and mortality of our patients.2. Accreditation requirements demand a strong infection control program.3. The infection control efforts are part of the '' risk management'' efforts of any hospital.4. Hospital outbreaks now occur frequently in the average community hospital.5. Financial deficit control has become a crucial issue for many hospital.

Importance of Infection Control Program

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Prevention of healthcare acquired infections is the responsibility of all individuals and services providing healthcare.

Everyone must work cooperatively to reduce the risk of infection for patients ,staff and visitors.

Infection control programs are effective, provided they are comprehensive and including surveillance and prevention activities, as well as staff training.

There must also be effective support at the national and regional levels. ١٢

Infection Control is Infection Control is EveryoneEveryone’’s Responsibility!s Responsibility!

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HOSPITAL ENVIRONMENTHOSPITAL ENVIRONMENT

HIV

CHIKENPOX

TB ١٤١٤

How are infections transmitted?How are infections transmitted?

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How to Break the How to Break the Chain of Infection????Chain of Infection????

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Standard PrecautionsStandard PrecautionsExpanded PrecautionExpanded Precaution Staff ProtectionStaff Protection

Primary strategy for Primary strategy for preventing transmission preventing transmission

of microorganisms to of microorganisms to patients, They are patients, They are

applied to all patientsapplied to all patientsHand hygiene &Hand hygiene &

Appropriate use ofAppropriate use ofPPEPPE

Transmission Based Transmission Based Precautions for patient Precautions for patient

with suspected orwith suspected orconfirmedconfirmed

communicable communicable diseasedisease

EmployeeEmployeeHealth Health

ProgramProgram

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Practical Issues and Considerations Practical Issues and Considerations for Standard Precautionsfor Standard Precautions

►►Hand Hygiene. Hand Hygiene. ►►Personnel Protective Equipment (PPE).Personnel Protective Equipment (PPE).►► Safe Use of Sharps. Safe Use of Sharps. ►►Monitoring Staff Health.Monitoring Staff Health.►►Cleaning and Disinfecting Patient Care Cleaning and Disinfecting Patient Care

Equipment. Equipment.

►►Disposing of Waste Safely. Disposing of Waste Safely. ►►Cleaning the Environment. Cleaning the Environment. ►►Removing Spills of Blood and Body Removing Spills of Blood and Body

Fluids Fluids ١٨

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Most common mode of transmission of pathogens is via hands!

Infections acquired in healthcare Spread of antimicrobial

resistance

So Why All the Fuss About So Why All the Fuss About Hand Hygiene?Hand Hygiene?

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All health careAll health care’’s works s works involve the handsinvolve the hands

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Handsspreadgerms

Hands are contaminatedHands are contaminated

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The health care environment The health care environment is contaminatedis contaminated

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Colonized or Infected:Colonized or Infected:What is the Difference?What is the Difference?

►►People who carry bacteria without evidence People who carry bacteria without evidence of infection (fever, increased white blood of infection (fever, increased white blood cell count) are cell count) are colonizedcolonized

►►If an infection develops, it is usually from If an infection develops, it is usually from bacteria that colonize patientsbacteria that colonize patients

►►Bacteria that colonize patients can be Bacteria that colonize patients can be transmitted from one patient to another by transmitted from one patient to another by the hands of healthcare workersthe hands of healthcare workers~ Bacteria can be transmitted even if the

patient is not infected ~ ٢٤

The Iceberg Effect

Infected

Colonized

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The inanimate environment is The inanimate environment is a reservoir of pathogensa reservoir of pathogens

~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.

X represents a positive Enterococcus culture

The pathogens are ubiquitous

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The inanimate environment is The inanimate environment is a reservoir of pathogensa reservoir of pathogens

Recovery of MRSA , VRE & ACINITOBACTER.

Devine et al. Journal of Hospital Infection. 2007;43;72-75

Lemmen et al Journal of Hospital Infection. 2004; 56:191-197

Trick et al. Arch Phy Med Rehabil Vol 83, July 2006

Walther et al. Biol Review, 2007:849-869

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Patients are vulnerable to Patients are vulnerable to infectioninfection

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HandHand HygieneHygiene is the simplest, most is the simplest, most effective measure for preventing effective measure for preventing

HospitalHospital--Acquired Infections.Acquired Infections.

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3030%%--4040% of all HAIs are Attributed % of all HAIs are Attributed to Cross Transmission: to Cross Transmission:

Importance of Hand Hygiene?Importance of Hand Hygiene?٣٠

Types of Hand HygieneTypes of Hand Hygiene

►►Normal hand washingNormal hand washing►►Antiseptic hand washingAntiseptic hand washing►►AlcoholAlcohol--based hand rubbased hand rubCan be used instead of hand Can be used instead of hand washing , if hands are not visibly washing , if hands are not visibly soiled with blood or any other soiled with blood or any other patient body fluidspatient body fluids

►►Surgical hand washSurgical hand wash٣١

Routine Hand WashingRoutine Hand Washing

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Antiseptic Hand WashingAntiseptic Hand Washing

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Samples taken before and after Samples taken before and after antiseptic handwashingantiseptic handwashing

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Waterless Hand Rub Waterless Hand Rub “alcohol“alcohol--based hand rubbased hand rub

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Efficacy of Hand Hygiene Efficacy of Hand Hygiene Preparations in Killing BacteriaPreparations in Killing Bacteria

Good Better Best

Plain soap Antimicrobialsoap

Alcohol-basedhand rub

Guideline for Hand Hygiene in Health-Care Settings MMWR,2009. vol. 51, no. RR-16.٣٦

Hand Hygiene OptionsHand Hygiene Options

~ Use soap and water for visibly soiled hands ~~ Do not wash off alcohol handrub ~

Apply to palm; rub hands until dry

Wet hands, apply soap and rub for

>10 seconds. Rinse, dry & turn

off faucet with paper towel.

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Surgical Hand Wash

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Areas Most Frequently MissedAreas Most Frequently Missed

HAHS © 1999٤١

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Gloves

Head Covers

Shoes Covers

Face shields

Eye protection

Masks Gowns

Types of PPE used in Healthcare

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Personal Protective Equipment(PPE)

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ProceduresProcedures►►Putting on Gowns, Gloves, and Putting on Gowns, Gloves, and

MaskMask

GownGown: : Put on gown so that its edges overlap in Put on gown so that its edges overlap in back to cover clothing. Fasten closures. back to cover clothing. Fasten closures.

GlovesGloves:: If worn with gown, pull up over cuffs of If worn with gown, pull up over cuffs of gown to protect the wrists. gown to protect the wrists.

MaskMask: : Apply mask over mouth and nose by Apply mask over mouth and nose by securing mask with ties so that it fits tightly over the securing mask with ties so that it fits tightly over the face.face.

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►►Removing Gloves, Gowns, and MaskRemoving Gloves, Gowns, and Mask

Gloves:Gloves: Remove gloves before exiting the patient Remove gloves before exiting the patient room by pulling them insideroom by pulling them inside--out, so that the out, so that the contaminated side is not exposed. Discard in trash contaminated side is not exposed. Discard in trash receptacle lined with red bag. receptacle lined with red bag.

Gown:Gown: Unfasten closures, pull off sleeves and turn Unfasten closures, pull off sleeves and turn gown to the inside so that the contaminated side is gown to the inside so that the contaminated side is not exposed. Place in red bag prior to washing hands not exposed. Place in red bag prior to washing hands and exiting the room . and exiting the room .

Mask:Mask: Remove mask and place in trash receptacle Remove mask and place in trash receptacle lined with a red bag. lined with a red bag.

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ISOLATION PRECAUTIONSISOLATION PRECAUTIONS

Types of Isolation PrecautionsTypes of Isolation Precautions

11-- Standard PrecautionsStandard PrecautionsStandard precaution (SP) is the primary Standard precaution (SP) is the primary

strategy for preventing transmission of strategy for preventing transmission of microorganisms to patients, They are microorganisms to patients, They are

applied to all patients .applied to all patients .

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Practical Issues and Considerations Practical Issues and Considerations

►►Hand Hygiene. Hand Hygiene. ►►Personnel Protective Equipment (PPE).Personnel Protective Equipment (PPE).►► Safe Use of Sharps. Safe Use of Sharps. ►►Monitoring Staff Health.Monitoring Staff Health.►►Cleaning and Disinfecting Patient Care Cleaning and Disinfecting Patient Care

Equipment. Equipment. ►►Disposing of Waste Safely. Disposing of Waste Safely. ►►Cleaning the Environment. Cleaning the Environment. ►►Removing Spills of Blood and Body Removing Spills of Blood and Body

Fluids Fluids ٥٠

Expanded PrecautionsExpanded Precautions

Expanded precautions are designed for patients Expanded precautions are designed for patients with documented or suspected infection withwith documented or suspected infection withcommunicable or epidemiologically important communicable or epidemiologically important pathogens for which additional precautionspathogens for which additional precautionsbeyond SP are needed to interrupt transmission.beyond SP are needed to interrupt transmission.

The aim of isolating a patient is to prevent The aim of isolating a patient is to prevent the spread of communicablethe spread of communicable

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Droplet PrecautionsDroplet Precautions Contact PrecautionsContact PrecautionsAirborne PrecautionsAirborne Precautions

Pulmonary TBMesealsChickenpox

Types of Types of Types of Types of Expanded PrecautionsExpanded Precautions

MeningitisInfluenza A

H1N1Mumps

MDR

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CONTACT PRECAUTIONSCONTACT PRECAUTIONS►► The patient is placed into a private room The patient is placed into a private room

whenever possible. Cohorting patients whenever possible. Cohorting patients with the same organism may be done if with the same organism may be done if needed.needed.

►► A GOWN AND GLOVES MUST BE WORN BY A GOWN AND GLOVES MUST BE WORN BY ALL ENTERING THE ROOM! THIS ALL ENTERING THE ROOM! THIS INCLUDES VISITORS. Dietary staff that INCLUDES VISITORS. Dietary staff that are delivering trays are required to wear are delivering trays are required to wear gloves, not gowns.gloves, not gowns.

►► When providing care, change gloves after When providing care, change gloves after contact with any infective material such contact with any infective material such as wound drainage. as wound drainage.

►► Remove the gown and gloves and perform Remove the gown and gloves and perform hand hygiene before leaving the room hand hygiene before leaving the room (take care not to touch any potentially (take care not to touch any potentially infectious items or surfaces on the way infectious items or surfaces on the way out). out).

►► Dedicate the use of nonDedicate the use of non--critical patientcritical patient--care equipment to a single patient. If use care equipment to a single patient. If use of common equipment is unavoidable, of common equipment is unavoidable, adequately clean and disinfect it before adequately clean and disinfect it before use with other patients.use with other patients.

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Isolation Precautions

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Employee Health ProgramEmployee Health Program

WORK RESTRICTION

PRE-EMPLOYMENT SCREENING

IMMUNIZATION

MANGEMENT OFOCCUPATIONALEXPOSURE

TRANING IN EMPLYEE HAELTH & SAFTY ٦٠

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OBJECTIVESOBJECTIVES

►►What the risk of exposure?What the risk of exposure?►►How we can prevent the How we can prevent the

exposure?exposure?►►If the exposure is already If the exposure is already

done, what is the exposure done, what is the exposure management plan? management plan?

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MucousMembrane . Cutaneous

TYPES OF EXPOSURE

Percutaneous Exposure

High Risk Exposure

Moderate Risk Exposure

Low Risk Exposure

Bloodborne Pathogen ExposuresBloodborne Pathogen Exposures

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Exposure Control PLANExposure Control PLANThe single most effective The single most effective measure to control the measure to control the transmission of Bloodborne transmission of Bloodborne Pathogens isPathogens is::

Standard Standard PrecautionsPrecautions

Treat all human blood and other potentially Treat all human blood and other potentially infectious materials like they are infectious infectious materials like they are infectious

for Hepatitis B&C and HIVfor Hepatitis B&C and HIV ٦٤

Safer SharpsSafer Sharps

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SHARP INJURIES PREVENTIONSHARP INJURIES PREVENTION►► Avoid rushing when handling needles and sharps.Avoid rushing when handling needles and sharps.

►► Dispose all needles and other sharps promptly. Place used Dispose all needles and other sharps promptly. Place used disposable items in puncture resistant biohazard containers for disposable items in puncture resistant biohazard containers for disposal.disposal.

DO NOT reDO NOT re--cap needles.cap needles.►► In the event recapping is unavoidable, the oneIn the event recapping is unavoidable, the one--handed scoop handed scoop

technique or a needle recapping device shall be used.technique or a needle recapping device shall be used.

►► Sharps containers shall be labeled as “sharps waste” and Sharps containers shall be labeled as “sharps waste” and biohazardous with international biohazardous symbol.biohazardous with international biohazardous symbol. ٦٦

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►►Sharp containers shall be filled up to Sharp containers shall be filled up to three quarters and taped closed or three quarters and taped closed or tightly lidded.tightly lidded.

►►Sharps containers are placed in yellow Sharps containers are placed in yellow bags by housekeeping personnel for bags by housekeeping personnel for storage and then processing.storage and then processing.

►►Sharps waste is disposed of in sharps Sharps waste is disposed of in sharps containers as close to site of use as containers as close to site of use as possible.possible.

►►InIn--patient rooms shall have wall patient rooms shall have wall mounted mounted ““Sharps ContainerSharps Container”” system, system, which is kept near the patientwhich is kept near the patient’’s bed and s bed and is securely locked. is securely locked.

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To safely recap needles use To safely recap needles use ““the the oneone--handhand”” techniquetechnique

Step Step 11►► Place the cap on a flat surface, then remove Place the cap on a flat surface, then remove

your hand from the cap.your hand from the cap.

Step Step 22►► With one hand, hold the syringe and use the With one hand, hold the syringe and use the

needle to “scoop up” the cap.needle to “scoop up” the cap.

Step Step 33►► When the cap covers the needle completely, When the cap covers the needle completely,

use the other hand to secure the cap on the use the other hand to secure the cap on the needle hub. Be careful to handle the cap at needle hub. Be careful to handle the cap at the bottom only (near the hub). the bottom only (near the hub).

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VACCINATIONVACCINATION

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ManagementPLAN

IMMEDIATE CARE OF INJURY

INCIDENTDOCUMENTATION

Risk Risk ReductionReduction

RISK ASSESMENTMANGEMENTOF

EXPOSEDHCWs ٧١

►►The employee concerned should immediately The employee concerned should immediately wash away the contaminating fluid. If blood wash away the contaminating fluid. If blood

or body fluids get in the mouth, spit out or body fluids get in the mouth, spit out and then rinse mouth with water several and then rinse mouth with water several times.times.

►► If there is a puncture wound, wash with soap If there is a puncture wound, wash with soap and water and disinfected by Alcohol or and water and disinfected by Alcohol or Betadine.Betadine.

►► If the eyes are contaminated (may be more If the eyes are contaminated (may be more dangerous than an NSI) rinse well with tap dangerous than an NSI) rinse well with tap water or salinewater or saline..

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►►Should be in detail with Should be in detail with completion of the appropriate form.completion of the appropriate form.

►►Report should include details of the incident Report should include details of the incident ,date & time of incident , people involved ,date & time of incident , people involved ,any witnesses to the incident.,any witnesses to the incident.

►►All occupational exposures must be fully All occupational exposures must be fully documented to meet relevant legal documented to meet relevant legal requirement. requirement.

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InjurySourceExposedHCWs

Percutaneous exposure( High Risk Exposure )

Mucous membrane( Moderate Risk

Exposure )

Cutaneous- exposureto non-intact skin

(Low Risk Exposure)

CHECKHBsAg

Anti-HCVAnti-HIV

CHECK

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►►Source is Source is ––ve for HBV,HCV,HIVve for HBV,HCV,HIV

Anti-HBs Ab titre

< 10 IU /ML> 10 IU /ML

NON IMMUNEIMMUNEPOST-EXPORUE PROPHYLAXIS

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Source is Source is ++veve or likely to be +ve or likely to be +ve forforHBVHBV

Anti-HBs Ab

- Ve+VeNON IMMUNEIMMUNE

POST EXPOSURE PROPHYLAXIS ٧٧

Post Exposure

Prophylaxis

Immunogluline Vaccination Follow up

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Repeat HBs Ag at1 & 6 months

Clinical or serologicalEvidence of acute

hepatitis

No plasma,bl,body tissuedonation.Protect sexual partner.Highest riskpercuteneous exporure,modify WP.

Seek for clinical advise

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Source is +ve orlikely to be +ve for HCV

ConfirmatoryHCV-RNA byreal-time PCR

Screening HCV-IgG

+Ve-Ve -ve+ve-No infection-Early infection-False -ve

-Current infection-past infection-False +ve

Confirms active HCV replication

Does not confirm

absence of HCV

replication

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HCV-RNA by PCR repeatedAfter 2 months

HCV-IgG repeated after 6 to 9 months

Clinical or serologicalevidence of acute

hepatitis

Seek for clinical advise No plasma,bl,body tissue donation

Protect the sexual partner .

Hihgest risk percutaneous exposure,modify WP.

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Source is Source is +ve+ve or likely to be or likely to be +ve+ve for HIVfor HIV

►►Postexporue Prophylactic treatment is Postexporue Prophylactic treatment is indicated.indicated.

►► It must be commenced as soon as possible It must be commenced as soon as possible .preferably within hours rather than days ..preferably within hours rather than days .

►► It should be administrated for It should be administrated for 4 4 weeks.weeks.►► If PEP is offered & taken &the source is If PEP is offered & taken &the source is

later determined to be HIV later determined to be HIV --ve ,PEP should ve ,PEP should be discontinued.be discontinued.

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Repeated HIV screeningat 1 & 3 & 6 months

Until screening forseroconversion

is completed٨٣

PREVENTION IS PREVENTION IS PRIMARY !PRIMARY !

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