Concepts of InfectionControlByDr Anjum HashmiMBBS,CCS(USA),MPHInfection Control DirectorMaternity and Children’s HospitalNarjran.
The risk of infection is always present. Patient may acquire infection before admission to the hospital = Community acquired infection. Patient may get infected inside the hospital = Nosocomial infection/Healthcare Associated Infection. 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.
INFECTION• Definition: Injurious contamination of body or parts of the body by bacteria, viruses, fungi, protozoa and rickettsia or by the toxin that they may produce. Infection may be local or generalized and spread throughout the body. Once the infectious agent enters the host it begins to proliferate and reacts with the defense mechanisms of the body producing infection symptoms and signs: pain, swelling, redness, functional disorders, rise in temperature and pulse rate and leucocytosis.
Nosocomial Infection SitesBlood stream infections: most common type of HAIs (30-40% of reported cases), associated with an central line or umbilical catheterVAP and surgical wound infections are the next ( each about 15%).Less frequent include bacteraemia (5%), intravenous site infection, gastrointestinal tract and skin infections.
Microbial Agent1. Commensal bacteria : found as normal flora of healthy humans and prevent pathogenic bacterial colonization e.g. skin, colon, vagina.2. Pathogenic bacteria: have great virulence and causes infection.3. Viruses:4. Parasites:5. Fungi:
Patient SusceptibilityAge: 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
Environmental Factors 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.
Transmission• Where do nosocomial infection come from? Endogenous infection: When normal patient flora change to pathogenic bacteria because of change of normal habitat, damage of skin and inappropriate antibiotic use. About 50% of HAIs Are caused by this way. Exogenous cross-infection: Mainly through hands of healthcare workers, visitors, patients.
Basics of Infection Control Prevention of nosocomial infection is the responsibility of all individuals and services provided by healthcare setting. To practice good asepsis, one should always know: what is dirty, what is clean, what is sterile and keep them separate. Hospital policies & procedures are applied to prevent spread of infection in hospital.
H ospi t a l P r o gr a mI n f e ct i o n C onr t o l Team I n f e ct i o n cont r o l com m i t e e I n f e ct i o n cont r o l m anual
Infection Control Team• The optimal structure varies with hospitals types, needs and resources.• Hospital can appoint public health specialist or epidemiologist or infectious disease specialist, microbiologist to work as infection control director.• Infection control nurse who is interested and has experience in infection control issues.
Infection Control Team cont.Team should have authority to manage an effective control program.Team should directly report to Hospital Director.Infection control team members are responsible for day-to-day functions of IC and prepare yearly work plan.They should be expert and creative in their job.
Infection Control CommitteeIt is a multidisciplinary committee responsible for monitoring IC program policy implementation and recommend corrective actions.It includes representatives from different concerned hospital departments & management. They meet monthly.It establishes standards for patient care, it reviews and assesses IC reports and identifies areas of intervention.
Infection Control ManualEvery Hospital should have a HAIs prevention & control manual having recommended instructions and practices for patient care.IC manual should be developed and updated every two years by the infection control team.It is to be reviewed and accepted by infection control committee.
Pr o gr a m Com ponent sSur v ei l a nce Pr e vent i v e Act i v i t i e s St a f Tr a i n i n g
NOSOCOMIAL INFECTION SURVEILLANCE• HAIs rate in a hospital is an indicator of quality and safety of care.• Surveillance to monitor this rate is essential to identify problems and evaluate control activities• The ultimate aim is the reduction of infection rate and their costs.• The term surveillance implies that observational data are regularly analyzed.
Key points in Surveillance• Active surveillance (Prevalence and incidence studies).• Targeted surveillance (site, unit, priority- oriented).• Appropriately trained investigators.• Standardized methodology.• Risk- adjusted rates for comparisons.
Organization for surveillance D a ta c o lle c tio n a n d a n a ly s i s W a rd a c ti v i t y L a b o ra to ry re p o rts D a ta e l e m e n ts & a n a l y s i sd e v i c e s o r p ro c e d u re s c u l t u re & s e n s i t i v i t y p a ti e n t d a ta & i n fe c ti o n fe v e r & i n f. s i g n s re s i s ta n c e p a tte rn s p o p u l a ti o n & ri s k s a n ti b i o ti c s & c h a rts s e ro l o g i c te s ts c o m p u te ri z a ti o n o f d a ta
Organization for surveillance Feedback & di s sem enat i o npr o m pt , r e le vent t o t a r g et gr o up M eet i n gs & di s scussi o ns Di s sem enat i o n by com m i t e e
Scope of Infection ControlAiming at preventing spread of infection:Standard precautions : these measures must be applied during every patient care, during exposure to any potentially infected material or body fluids as blood and others.Components: A. Hand washing. B. Barrier precautions. C. Sharp disposal. D. Handling of contaminated material.
A. HAND WASHING Hand washing is the single most effective precaution for prevention of infection transmission between patients and staff. Hand washing with plain soap is mechanical removal of soil and transient bacteria (for 40- 60 sec.) Hand antisepsis is removal & destroy of transient flora using anti-microbial soap(for 40- 60 sec.) or alcohol based hand rub (for 15-20 sec.)
Surgical hand scrub:removal / destruction of transient flora andreduction of resident flora using anti-microbial soapwith effective rubbing (for least 3-5 min)Our hands and fingers are our best friends butstill could be our enemies if they carry infectiveorganisms and transmit them to our bodies and tothose whom we care for.Sinks & soap must be found in every patient careroom. Doctors, nurses must comply to handwashing policy.
When to Wash our Hands1. Before & after an aseptic technique or invasive procedure.2. Before & after contact with a patient.3. After contact with blood and body fluids.4. After touching patient surroundings
When to Wash our Hands cont.5. Before the administration of medicines6. After cleaning of spillage.7. After using the toilet.8. Before meals.9. At the beginning and end of duty. Gloves is not substitute hand washing, it must be done before putting on gloves and after their removal.
How to Wash our HandsJewelry must be removed. If unable to removerings, wash and dry thoroughly around them.Wet your hands with running warm water,dispense about 5 ml of liquid soap or 2ml ofEz-clean into the palm of the hand.Rub hands together vigorously to all surfacesand wrist paying particular attention to thumbs,finger tips and webs.
B. Barrier Precautions1. Gloves:Disposable gloves must be worn when:a) Direct contact with B/BF is expected.b) Examining a lacerated or non-intact skin e.g. wound dressing.c) Examination of oropharynx, GIT, UIT and dental procedures.
Gloves: cont.d) Working directly with contaminated instruments or equipment.e) HCW has skin cuts, lesions and dermatitis.Sterile gloves are used for invasiveprocedures.GLOVES MUST BE of good quality,suitable size and material. Never reused.
2) Masks & Protective eye wear:• MUST BE USED WHEN engaged in procedures likely to generate droplets of blood/body fluid or bone chips.• During surgical operations to protect wound from staff breathings, …• Masks must be of good quality, properly fixed on mouth and nasal openings.
3) Gowns / Aprons:Are required when:• Spraying or splashing of blood or body fluids is anticipated e.g. surgical procedures.• Gowns must not permit blood or body fluids to pass through.• Sterile linen gown or disposable ones are used for sterile procedures.
C. Sharp precautions Needle stick and sharp injuries carry the risk of blood born infection e.g. AIDS, HCV,HBV and others. Sharp injuries must be reported and notified. NEVER RECAP NEEDLES Dispose of used needles and small sharps immediately in puncture resistant boxes (sharp container ). Sharp Containers: must be easily accessible and at eye level, must not be overfilled, labeled or color coded. Needle incinerators can be another safe way of disposal. Reusable sharps must be handled with care avoiding direct handling during processing.
D. Handling of Contaminated Material1. Cleaning of B/BF spills: a- wear gloves. b- wipe-up the spill with paper or towel. c- apply disinfectant.2. Cleaning & decontamination of equipment: protective barriers must be worn.3. Handling & processing lab specimens: must be in strong plastic bags with biohazard label
4. Handling and processing linen: Soiled linen must be handled with barrier precautions, sent to laundry in coded bags.5. Handling and processing infectious waste:a. must be placed in color coded, leakage proof bags, collected with barrier precautionsb. contaminated waste incinerated or better autoclaved prior to disposal in a landfill.
Environmental control:1. Facility plans which must met criteria of infection control and also traffic flow, patient equipment positioning and installation.2. Cleaning of hospital environment and disinfection according to policies.3. Proper air ventilation.4. Water pipes examination, check its quality.5. Proper waste collection and disposal.
Environmental control: cont6. Cleaning and disinfection of equipment.7. Proper linen collection, cleaning, distribution.8. Food : ensure quality and safety.9. Sterilization: Central sterilization department serving all hospital departments compiling with infection control precautions.
.Patient Protection :* Corrective measures before major procedure, vaccination, proper use of antibiotics.* Isolation precautions.* Limiting endogenous risk
Staff Health Promotion And Education:1. HCW are at risk of acquiring infection, they can also transmit infection to patients and other employee.2. Employee health history must be reviewed, immunizations recommendations to be considered.3. Release from work if sick, occupation injury must be notified.4. Continuous education to improve practice, better performance of new techniques.
PROPER SHARP DISPOSAL• Avoid rushing when handling needles and sharps.• Dispose all needles and other sharps promptly. Place used disposable items in puncture resistant biohazard containers for disposal.
• DO NOT re-cap needles.• In the event recapping is unavoidable, the one-handed scoop technique or a needle recapping device shall be used.
• Sharps containers shall be labeled as “sharps waste” and biohazardous with international biohazardous symbol.
• Sharp containers shall be filled up to three quarters and taped closed or tightly lidded.• Sharps containers are placed in yellow bags by housekeeping personnel for storage and then processing.
• Sharps waste is disposed of in sharps containers as close to site of use as possible.• In ICU should have wall mounted “Sharps Container” system, which is kept near the patient’s bed and is securely locked.