Infection Control In Hospitals


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Infection Control In Hospitals

  2. 2. Hospital infection control(HIC) Hospital Acquired Infection or Nosocomial Infection is one which manifests itself 72 hours or more after admission to hospital. Aim: To reduce the rate of Hospitals Acquired Infections Objective: To review good practices in infection prevention and control
  3. 3. What is Hospital Acquired infection ? “Hospital-acquired infections”, are infections acquired during hospital care which are not present or incubating at admission. Infections occurring more than 48 hours after admission are usually considered nosocomial.
  4. 4. Contd…  An infection acquired in hospital by a patient who was admitted for a reason other than that infection.  An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility
  5. 5. Frequency of Infection  HAI occur worldwide and affect both developed and resource-poor countries.  Over 1.4 million people worldwide suffer from such infectious  Most frequent of these are infections of surgical wounds, urinary tract infections and lower respiratory tract infections.
  6. 6. Contd…  The WHO study, have also shown that the highest prevalence of HAI occurs in intensive care units and in acute surgical and orthopedic wards.  Infection rates - higher among patients with increased susceptibility because of old age, underlying disease, or chemotherapy.
  7. 7. Impacts of HAI  Add to functional disability  Increases emotional stress of the patient and may, lead to disabling conditions reducing the quality of life.  The economic costs are considerable.  The increased length of stay for infected patients is the greatest contributor to cost .
  8. 8. Contd…  Hospital-acquired infections add to the imbalance between resource allocation for primary and secondary healthcare.  Prolonged stay not only increases direct costs to patients or payers but also indirect costs due to lost work.
  9. 9. Factors influencing the development of HAI  The Microbial Agent Patient’s exposure to a variety of microorganisms during hospitalization increases the risk of HAI  Environmental factors Health care settings are an environment where both infected persons and persons at increased risk of infection congregate.
  10. 10. Contd….  Patient susceptibility Important patient factors influencing acquisition of infection include age, immune status, underlying disease, and diagnostic and therapeutic interventions. Bacterial resistance Many patients receive antimicrobial drugs. Through selection and exchange of genetic resistance elements, antibiotics promote the emergence of multi drug resistant strains of bacteria.
  11. 11. Hospital Acquired infections are widespread  They are important contributors to morbidity and mortality.  They will become even more important as a public health problem with increasing economic and human impact because of: Increasing numbers and crowding of people. More frequent impaired immunity (age, illness, treatments).  New microorganisms.  Increasing bacterial resistance to antibiotics
  12. 12. Prevention of Hospital Acquired infections is the responsibility of all individuals and services providing health care.
  13. 13. Steps to be taken at a National level to control HAI  Set relevant national objectives consistent with other national health care objectives  Develop and continually update guidelines for recommended health care surveillance, prevention, and practice  Develop a national system to monitor selected infections and assess the effectiveness of interventions .
  14. 14. Contd…  Harmonize initial and continuing training programs for health care professionals facilitate access to materials and products essential for hygiene and safety.  Encourage health care establishments to monitor nosocomial infections, with feedback to the professionals concerned
  15. 15. Hospital Programs to prevent HAI The major preventive effort should be focused in hospitals and other health care facilities Risk prevention for patients and staff is a concern of everyone in the facility, and must be supported at the level of senior administration.
  16. 16. Infection Control Committee An Infection Control Committee provides a forum for multidisciplinary input and cooperation, and information sharing. This committee should include wide representation from relevant programmes: e.g. management, physicians, other health care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping, training services.
  17. 17. Tasks of Infection Control Committee  To review and approve a yearly program of activity for surveillance and prevention  To review epidemiological surveillance data and identify areas for intervention  To assess and promote improved practice at all levels of the health facility  To ensure appropriate staff training in infection control and safety.
  18. 18. Contd….  to review risks associated with new technologies, and monitor infectious risks of new devices and products, prior to their approval for use  to review and provide input into investigation of epidemics  to communicate and cooperate with other committees of the hospital with common interests such as Pharmacy and Therapeutics Use Committee, Biosafety or Health and Safety
  19. 19. Role of the physician Physicians have unique responsibilities for the prevention and control of hospital infections:  By providing direct patient care using practices which minimize infection  By following appropriate practice of hygiene (e.g. handwashing, isolation)
  20. 20. Contd…  Supporting the infection control team.  Protecting their own patients from other infected patients and from hospital staff who may be infected  Complying with the practices approved by the Infection Control Committee  Obtaining appropriate microbiological specimens when an infection is present or suspected  Notifying cases of hospital-acquired infection to the team, as well as the admission of infected patients
  21. 21. Role of the hospital pharmacist The hospital pharmacist is responsible for:  Obtaining, storing and distributing pharmaceutical preparations using practices which limit transmission of infectious agents to patients  Dispensing anti-infectious drugs and maintaining relevant records (potency, incompatibility, conditions of storage and deterioration)available  Obtaining and storing vaccines or sera, and making them as appropriate  Maintaining records of antibiotics distributed to the medical departments
  22. 22. Contd….  Providing the Antimicrobial Use Committee and Infection Control Committee with summary reports and trends of antimicrobial use.  providing summary reports of prevalence of resistance monitoring sterilization, disinfection and the environment where necessary  Participation in development of guidelines for antiseptics, disinfectants, and products used for  Washing and disinfecting the hands participation in guideline development for reuse of equipment and patient materials
  23. 23. Contd…  providing summary reports of prevalence of resistance  monitoring sterilization, disinfection and the  environment where necessary  participation in development of guidelines for  antiseptics, disinfectants, and products used for  washing and disinfecting the hands  participation in guideline development for reuse  of equipment and patient materials
  24. 24. Role of the nursing staff Implementation of patient care practices for infection control is the role of the nursing staff. The senior nursing administrator is responsible for:  Participating in the Infection Control Committee  Promoting the development and improvement of nursing techniques, and ongoing review of aseptic nursing policies, with approval by the Infection Control Committee
  25. 25. Factors promoting Infection among hospitalized patients  Decreased immunity among patients  Increasing variety of medical procedures and invasive techniques creating potential routes of infection;
  26. 26. Contd….  Developing training programs for members of the nursing staff.  Supervising the implementation of techniques for the prevention of infections in specialized areas for monitoring of nursing adherence to policies.
  27. 27. Role of the central sterilization service As central sterilization department serves all hospital areas, including the operating suite, an appropriately qualified individual must be responsible for management of the infection control program.  Oversee the use of different methods — physical, chemical, and bacteriological — to monitor the sterilization process  Ensure technical maintenance of the equipment according to national standards and manufacturers’ recommendations
  28. 28. Role of the food service The director of food services must be knowledgeable in food safety, staff training, storage and preparation of foodstuffs, job analysis, and use of equipment. The head of catering services is responsible for:  Defining the criteria for the purchase of foodstuffs, equipment use, and cleaning procedures to maintain a high level of food safety  .
  29. 29. Role of the laundry service The laundry is responsible for:  Selecting fabrics for use in different hospital areas, developing policies for working clothes in each area and group of staff, and maintaining appropriate supplies  Ensuring that liquid soap and paper towel dispensers are replenished regularly  Informing the maintenance service of any building problems requiring repair: cracks, defects in the sanitary or electrical equipment, etc.
  30. 30. Contd….  Distribution of working clothes and, if necessary, managing changing rooms.  Developing policies for the collection and transport of dirty linen.  Defining, where necessary, the method for disinfecting infected linen, either before it is taken to the laundry or in the laundry itself.
  31. 31. Role of the housekeeping service The housekeeping service is responsible for the regular and routine cleaning of all surfaces and maintaining a high level of hygiene in the facility.  Classifying the different hospital areas by varying need for cleaning  Developing policies for appropriate cleaning techniques — procedure, frequency, agents used, etc., for each type of room, from highly contaminated to the most clean, and ensuring that these practices are followed 
  32. 32. Contd…..  Developing policies for collection, transport and disposal of different types of waste (e.g. containers, frequency)  Ensuring that liquid soap and paper towel dispensers are replenished regularly  Informing the maintenance service of any building problems requiring repair.
  33. 33. Role of the infection control team The infection control programme is responsible for  Oversight and coordination of all infection control activities to ensure an effective programme.  Organizing an epidemiological surveillance programme for nosocomial infections  Participating with pharmacy in developing a programme for supervising the use of anti-infective drugs  Ensuring patient care practices are appropriate to the level of patient risk
  34. 34. Contd….  Checking the efficacy of the methods of disinfection and sterilization and the efficacy of systems  Developed to improve hospital cleanliness participating in development and provision of teaching programmes for the medical, nursing, and allied health personnel, as well as all other categories of staff  Providing expert advice, analysis, and leadership assistance for smaller institutions, and undertake
  35. 35. Contd…..  Research in hospital hygiene and infection in outbreak investigation and control  Participating in the development and operation of regional and national infection control initiatives
  36. 36. Universal/Standard Precautions For Infection Control 1. Hand Hygiene 2. Personnel Protective Equipments 3. Safe Handling and Disposal of Sharps 4. Follow needle stick injury protocol 5. Safe Handling and Disposal of Wastes 6. Managing Blood and Body Fluids 7. Disinfection of the Equipments 8. Environmental Disinfection 9. Immunization 10. Isolation
  37. 37. Hand Hygiene Hand wash/ Hand rub is the most effective way to prevent the spread of infections in hospitals. o Before and after each patient contact o Before and after any procedure o Before and after wearing gloves o After contact with body fluids
  38. 38. Why practice Good Hand Hygiene? • To remove visible soiling from hands • To prevent transfer of bacteria from the home to the hospital • To prevent transfer of bacteria from the hospital to the home • To prevent infections that patients acquire in the hospital
  39. 39. Keep nails short, clean and polish free. Avoid wearing wrist watches & jewellery, especially rings with ridges or stones. Any cuts and abrasions should be covered with a waterproof dressing. Do’s & Don'ts
  40. 40. Personal Protective equipment  Gloves  Disposable plastic Apron  Masks.  Eye protection
  41. 41. Safe handling and disposal of sharps The main hazards of a sharps injury are: •Hepatitis B, •Hepatitis C, •HIV. Ensure that: Sharps are not passed from hand to hand. Needles are not broken or bent before use. Sharps are disposed of at the point of use. Sharp containers are not filled more than two third. Staff are aware of inoculation injury policy.
  42. 42. Follow needle stick injury protocol  Irrigate mucous membranes by washing under running water.  Do not suck/ Squeeze the injury site  Wash with soap and water Apply antiseptic lotion to the injury site.  Contact emergency room-medical officer for management  Complete the incident report & inform to ICN
  43. 43. Safe handling and disposal of waste  Segregate the waste at source.  Know the policies and protocols of the state.  Safe disposal.  Safe handling of spillage.
  44. 44. Bio-medical Waste  means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I
  45. 45. Categories of BMW Option Waste category Treatment &Disposal Cat 1 Human Anatomical Waste (human tissues, organs, body parts) incineration@/deep burial* Cat 2 Animal Waste (animals used in research, veterinary hospitals) incineration@/deep burial* Cat 3 Microbiology & Biotechnology Waste local autoclaving/micro- waving/incineration@ Cat 4 Waste sharps disinfection (chemical treat- ment@01/auto claving/micro- waving and mutilation/ shredding" Cat 5 Discarded Medicines and Cytotoxic drugs disposal in secured landfills
  46. 46. Categories of BMW Option Waste category Treatment &Disposal Cat 6 Soiled Waste (Items contaminated with blood, and body fluids ) incineration@ autoclaving/microwaving Cat 7 Solid Waste (disposable items such as tubing's, catheters, iv sets etc). disinfection by chemical treatment@@ autoclaving/ microwaving and mutilation/ shredding## Cat 8 Liquid Waste (lab , washing & disinfecting activities) disinfection by chemical treatment@@ and discharge into drains. Cat 9 Incineration Ash disposal in municipal landfill Cat 10 Chemical Waste (chemicals used in disinfection) chemical treatment@@ and disinfection, discharge into drains for liquids
  47. 47. Bio-Medical Waste Management
  48. 48. Label for Container / Bag Bio Hazard Symbol Cytotoxic Symbol
  49. 49. Managing blood and bodily fluids Spillage is dealt quickly as per the Hospital policy. Handle specimens safely  Collection  Labeling  Transfer
  50. 50. SPILL— TYPES— 4 types 1-Biological Spill 2-Chemical Spill 3-Radiation Spill 4-Mercury Spill
  51. 51. Biological Spill— 2 types A-Small spill/ spotted Spill B-Large Spill
  52. 52. Managt. Of Small Spill— .Wear gloves and eye protection .Contamination should be wiped up with paper towels soaked in freshly prepared Hypochlorite solution(1%) .If broken glasses are present ,1st treat the spillage with Hypochlorite ,then carefully remove the glass piece with disposable forceps to sharp bin & wipe it up .Towel & glasses shld be disposed off in a yellow clinical waste bag for Incineration . Wash hands.
  53. 53. Mangt. Of Large Spill— .Mark that area as Large spill .Wear PPE .Liquid Spill should be Covered up with Hypochlorite solution .Left for 2 min. .use absorbent to absorbe .If glasses are present mangt. same as above .Wipe that with water & detergent .Allow that to dry .Put all the towels ,gloves to yellow bin for incineration
  54. 54. Chemical Spill Mangt.— .Chemical neutralizer . Concentrated acid & alkali are avaible .chemical spill disposed to a suitable container with a tight fitting lid / a suitable sealable plastic Bag. .The Head Of the Dept./ service manager is responsible for ensuring the correct procedure of disposal of chemical waste.
  55. 55. Prevention of Chemical Spillage Pre-planning is essential. Before working with a chemical, the Hospital worker should know how to proceed with spill cleanup and should ensure that there are adequate spill control materials available. Most spills are preventable. The following can be done to prevent or minimize the magnitude of a spill:
  56. 56. •Place chemical containers in a hood or lab bench in a manner that reduces the possibility of accidentally knocking down a container. •Plan your movements. Look where you are reaching to ensure you will not cause a spill. •Transport the chemicals safely. •Place absorbent liners on bench tops or in places where spills can be anticipated. For volumes of liquid larger than what can be absorbed by liners, use trays.
  57. 57. Radiation Spill— .Generate during body organ imaging ,tumor Localization & therapeutic process in radiology dept. .It generate some solid radio active waste i.e vial, Syringe, absorbent paper , protective clothing .store that in a large drum /container .liquid form are generally diluted & dispensed in the sewers .Gaseous form can be diluted through dispersal In the outside atmosphere.
  58. 58. MANAGEMENT OF MERCURY SPILLAGE : In case of thermometer & B.P. Instrument breaking follow the practice as given below. •Wear Nitrile gloves or double gloves before starting the procedure. •Take 10 ml syringe without needle & draw the mercury. •Push the mercury into the water container. •Document in the” MERCURY SPILL”REGISTER. •Inform Sr. Incharge. Medical director & Supervisor. •Inform house keeping to promptly remove the container. •Handover to the Biomedical department. •Label it as a mercury spill kit with date.
  60. 60. Environment Disinfection Achieving and maintaining a clean clinical environment A very important aspect, yet overlooked?? Proper cleaning of the environment Fumigation as required
  61. 61. Immunization & Isolation Immunization  Hepatitis B, Tetanus Toxioid vaccination for all the employees who are coming in direct contact with blood and body fluids Isolation  Isolate patients with communicable diseases
  62. 62. Good communication  Communicate with peers.  Communicate with seniors.  Communicate with doctors.  Communicate with patients and visitors.  Communicate with support staff.
  63. 63. Infection control checklist  Have you washed your hands?  Do you need to use personal protective equipment?  Are you preventing sharp injuries?  Are you disposing off waste safely?  Do you deal promptly with spillages?  Do you thoroughly decontaminate equipment?  Are you maintaining a clean environment?  Do you know what to do in the event of an accident?  And finally, do you know your workplace's procedures?