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  2. 2. Florence Nightingale, Notes on Hospitals, 1863 It may seem a strange principle to enunciate as the very first requirement of a hospital that it do the sick no harm
  3. 3. Learning Objectives 1. Recognize patient safety as an important nursing responsibility in global health care systems. 2. Apply required knowledge in preventing and/or minimizing infection. 3. Perform appropriate behaviors required to prevent health care associated infections. 4. Demonstrate required competence to provide patients with safe care.
  4. 4. Main types of infections  Urinary track infections usually associated with catheters  Surgical infections  Blood stream infections associated with the use of an intravascular device  Pneumonia associated with ventilators  other sites
  5. 5. Health workers to be alert Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhoea, rash, re spiratory symptoms, draining wounds or skin lesions)
  6. 6. Global Infection Problems According to WHO (2005),  On average, 8.7% of hospital patients suffer health care-associated infections (HAI).  In developed countries: 5-10%  In developing countries:  Risk of HAI: 2-20 times higher  HAI may affect more than 25% of patients  At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.
  7. 7. Infection control in the Hospitals  Infection control and prevention uses a risk management approach to minimise or prevent the transmission of infection. Standard and additional precautions principles and practice are based on the mode of transmission of an infectious agent.
  8. 8. Chain of Infection Pathogen Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host Why Isolation?.. because transmission is easier to control than the source / host!
  9. 9. Practice basic Protocols with Universal Precautions  Standard precautions are work practices required for the basic level of infection control. They include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, gowns, plastic aprons, masks, eye shields or goggles, appropriate handling and disposal of sharps and other contaminated or clinical (infectious) waste, and use of aseptic techniques.
  10. 10. What is Infection Control? Patient to Worker Visitor Patient Worker to Worker Visitor Patient Visitor to Worker Visitor Patient
  11. 11. Infectiousness Patients should be considered infectious if they • Are coughing • Are undergoing cough-inducing or aerosol-generating procedures, or • Have sputum smears positive for acid-fast bacilli and they • Are not receiving therapy • Have just started therapy, or • Have poor clinical response to therapy
  12. 12. Infectiousness in Tuberculosis patients Patients no longer infectious if they meet all of these criteria: •Have completed at least two weeks of directly-observed ATT; and Have had a significant clinical response to therapy and •Have had 3 consecutive negative sputum-smear results; Retreatment /MDR cases may take longer to convert The only objective criteria is negative bacteriology
  13. 13. Airborne Precautions  Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:  Tuberculosis  Measles  Chickenpox (until lesions are crusted over)  Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
  14. 14. Fate of Droplets Organisms Liberated Talking 0-200 Coughing 0-3500 Sneezing 4500-1,000,000 Droplets can remain suspended in the air for hours.
  15. 15. Droplet Precautions  Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:  Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)  Bordetella pertusis  For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
  16. 16. Standard precautions apply to all patients regardless of their diagnosis blood all other body fluids, secretions and excretions (except sweat), regardless of whether they contain visible blood non-intact skin mucous membranes (mouth and eyes)
  17. 17. Personal Protective Equipment  Gloves, aprons, gowns, eye protection, and face masks  Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.
  18. 18. Personal protective equipment  Masks should be worn if an airborne infection is suspected or confirmed  to protect an immune compromised patient.
  19. 19. Gloves Gloves must be worn for:  all invasive procedures  contact with sterile sites  contact with non-intact skin or mucous membranes  all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. Hands should be washed before and after gloving
  20. 20. Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or nonsterile • One or two pair • Single use or reusablePPE Use in Healthcare Settings
  21. 21. Gloves  Purpose – patient care, environmental services, other  Glove material – vinyl, latex, nitrile, other  Sterile or nonsterile  One or two pair  Single use or reusable
  22. 22. Do’s and Don’ts of Glove Use • Work from “clean to dirty” • Limit opportunities for “touch contamination” - protect yourself, others, and the environment – Don’t touch your face or adjust PPE with contaminated gloves – Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings
  23. 23. Safe Use and Disposal of Sharps  Keep handling to a minimum  Do not recap needles; bend or break after use  Discard each needle into a sharps container at the point of use  Do not overload a bin if it is full  Do not leave a sharp bin in the reach of children
  24. 24. Do’s and Don’ts of Glove Use (cont’d)  Change gloves  During use if torn and when heavily soiled (even during use on the same patient)  After use on each patient  Discard in appropriate receptacle  Never wash or reuse disposable glovesPPE Use in Healthcare Settings
  25. 25. Required Performance Nursing students need to:  aapply universal precautions  be immunized against Hepatitis B  use personal protection methods  know what to do if exposed  eencourage others to use universal precautions
  26. 26. Prevention through hand washing  how to clean hands  rationale for choice of clean hand practice  technique for hand hygiene  protecting hands from decontaminates  promoting adherence to hand hygiene guidelines
  27. 27. Face Protection • Masks – protect nose and mouth – Should fully cover nose and mouth and prevent fluid penetration • Goggles – protect eyes – Should fit snuggly over and around eyes – Personal glasses not a substitute for goggles – Antifog feature improves clarity PPE Use in Healthcare Settings
  28. 28. Face Protection Face shields – protect face, nose, mouth, a nd eyes Should cover forehead, extend below chin and wrap around side of face PPE Use in Healthcare Settings
  29. 29. Respiratory Protection • Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) • PPE types for respiratory protection – Particulate respirators – Half- or full-face elastomeric respirators – Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings
  30. 30. Respiratory Protection  infectious aerosols (e.g., Mycobacterium tuberculosis)  PPE types for respiratory protection  Particulate respirators  Half- or full-face elastomeric respirators  Powered air purifying respirators (PAPR)
  31. 31. Sequence* for Donning PPE • Gown first • Mask or respirator • Goggles or face shield • Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings
  32. 32. How to Don a Gown • Select appropriate type and size • Opening is in the back • Secure at neck and waist • If gown is too small, use two gowns – Gown #1 ties in front – Gown #2 ties in back PPE Use in Healthcare Settings
  33. 33. How to Don a Mask • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with ties or elastic • Adjust to fit PPE Use in Healthcare Settings
  34. 34. Safe Injection Practices  Outbreaks of hepatitis B and hepatitis C infections in US ambulatory care facilities have prompted the need to re-emphasize safe injection practices. All health care personnel who give injections should strictly adhere to the CDC recommendations - Safe Injection Practices which include:  Use of a new needle and syringe every time a medication vial or IV bag is accessed  Use of a new needle and syringe with each injection of a client  Using medication vials for one client only, whenever possible
  35. 35. Contact precautions may be needed for germs that are spread by touching.  Everyone who enters the room who may touch the patient or objects in the room should wear a gown and gloves.  These precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched.  Some of the germs that contact precautions protect us from are C.difficileand norovirus, and respiratory syncytial virus (RSV). These germs can cause serious infection in the intestines.
  36. 36. Summary Know the main guidelines in each of the clinical environments you are assigned. Accept responsibility for minimizing opportunities for infection transmission. Let staff know if supplies are inadequate or depleted.
  37. 37. Summary Educate patients and families/visitors about clean hands and infection transmission. Ensure patients on precautions have same standard of care as others: frequency of entering the room monitoring vital signs
  38. 38. Hepatitis B Vaccination a Must for all Health care Professionals
  39. 39. Never forget to Wash your Hands
  40. 40. Yet there is no Substitute for HAND WASHING in Prevention of Infections
  41. 41.  Programme Created and Designed by Dr.T.V.Rao MD for Medical and Health Care workers in Developing World  Email 