CARING THE INFECTIOUS PATIENTS

1. CARING THE INFECTIOUS
PATIENTS
DR.T.V.RAO MD
1

3. 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

4. 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.

5. 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

6. 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)

7. 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.

8. 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.

9. 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!

10. 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.

11. What is Infection Control?
Patient to
Worker
Visitor
Patient
Worker to
Worker
Visitor
Patient
Visitor to
Worker
Visitor
Patient

12. 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

13. 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

14. 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)

15. 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.

16. 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

17. 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)

18. 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.

19. Personal protective equipment
 Masks should be worn
if an airborne infection is
suspected or confirmed
 to protect an immune
compromised patient.

20. 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

21. 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

22. Gloves
 Purpose – patient
care, environmental
services, other
 Glove material –
vinyl, latex, nitrile, other
 Sterile or nonsterile
 One or two pair
 Single use or reusable

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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)

32. 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

33. 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

34. 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

35. 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

36. 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.

37. 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.

38. 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

39. Hepatitis B Vaccination a Must for
all Health care Professionals

40. Never forget to Wash your Hands

41. Yet there is no Substitute for HAND
WASHING in Prevention of
Infections

42.  Programme Created and Designed by Dr.T.V.Rao MD
for Medical and Health Care workers in Developing
World
 Email
 doctortvrao@gmail.com