Challenges in healthcare and infection control


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Challenges in healthcare and infection control

  2. 2. Challenges <ul><li>Prevention of infection </li></ul><ul><li>Early and accurate diagnosis </li></ul><ul><li>Effective treatment </li></ul><ul><li>Outbreak prevention and management </li></ul>
  3. 3. Greatest challenge in infection control is ……….. <ul><li>Outbreak prevention and management </li></ul><ul><ul><li>Healthcare Associated Infections (HAIs) </li></ul></ul><ul><ul><li>Multidrug Resistant Organisms (MDROs) </li></ul></ul>MRSA E.coli VRE
  4. 4. Our usual response has been……. <ul><li>Surveillance </li></ul><ul><li>Control measures </li></ul><ul><li>BUT problem continues……. </li></ul>
  6. 6. New Challenges (continue) <ul><li>Changing healthcare system </li></ul><ul><li>- Rising healthcare costs </li></ul><ul><li>- Length of stay </li></ul><ul><li>- Moving healthcare from inpatient </li></ul><ul><li>to other settings - outpatient care, </li></ul><ul><li>long term care facilities </li></ul>
  7. 7. We need to be prepared!! HOW?
  8. 8. Hayati S, ID HSB 2010
  9. 9. CDC UNIVERSAL PRECAUTIONS (1987) <ul><li>Recommendations for Prevention of HIV Transmission in Health Care Setting. </li></ul><ul><li>Universal Blood and Body Fluid Precautions. </li></ul><ul><li>Universal Infection Control Precautions. </li></ul><ul><li>The entire focus: protection of HCW from parenteral, mucous membrane and non intact skin exposure to bloodborne pathogens (blood & blood stained body fluids) </li></ul>
  10. 10. BASIC ELEMENTS OF STANDARD PRECAUTION <ul><li>Hand hygiene </li></ul><ul><li>Correct usage of gloves </li></ul><ul><li>Correct usage of PPE ~ goggle/shield </li></ul><ul><li>~ gown/apron </li></ul><ul><li>~ mask </li></ul><ul><li>Cleaning/disinfection/sterilization </li></ul><ul><li>Handling of clinical waste/linen/speciment </li></ul><ul><li>Waste segregation </li></ul><ul><li>Safe handling of sharps </li></ul><ul><li>Handling of spillage </li></ul>
  11. 11. Hayati S, ID HSB 2010
  12. 12. Hayati S, ID HSB 2010
  13. 13. CDC Standard Precautions & Additional precautions (1996) <ul><li>Revised recommendations Focus - Protection of HCWs and to reduce transmission of infectious agents among HCWs (clinical & non-clinical), patients, relatives and environment. New addition : Respiratory hygiene </li></ul><ul><li>Protective environment </li></ul><ul><li>Hand hygiene </li></ul>
  14. 14. Hayati S, ID HSB 2010
  15. 15. Hayati S, ID HSB 2010
  17. 17. RESPIRATORY HYGIENE Cover your mouth and nose with tissue when you cough or sneeze Throw your used tissue into the plastic bag Throw the plastic bag into the clinical waste bin
  18. 18. Hand hygiene with soap and water or alcohol hand rubs Wear the surgical mask to protect other
  19. 19. New category in Expanded Precautions <ul><li>Protective Environment (PE) : </li></ul><ul><li>for allogenic haemopoetic stem cell transplantation (HSCT) patients </li></ul><ul><li>Environmental controls </li></ul><ul><ul><li>HEPA filtration of incoming air </li></ul></ul><ul><ul><li>directed room air flow </li></ul></ul><ul><ul><li>positive room air pressure relative to corridor </li></ul></ul><ul><ul><li>well-sealed rooms (sealed walls, floors, ceilings, windows, electrical outlets) </li></ul></ul><ul><ul><li> 12 ACH (Air Exchanges per Hour) </li></ul></ul><ul><ul><li>no carpets and upholstery, routine cleaning of sprinkler heads </li></ul></ul><ul><ul><li>no dried / fresh flowers and potted plants </li></ul></ul><ul><li>Other measures </li></ul><ul><ul><li>N95 mask for patients upon leaving room </li></ul></ul>NEW
  20. 20. Routes of disease transmission <ul><li>Infected human </li></ul><ul><li>Air Food Direct Indirect Vectors Wounds </li></ul><ul><li>Water contact contact </li></ul><ul><li>Susceptible Human </li></ul><ul><li>Ref: Microbiology, Fundamentals and applications </li></ul>
  22. 23. Definition of Healthcare Associated Infection Outbreak (Either One ) <ul><li>Two or more associated cases occurs at the same time within same locality/department </li></ul><ul><li>Greater than expected rate of infection compared with the usual background case for the place and time </li></ul><ul><li>In certain newly emerging disease e.g. Legionnaires infection or anthrax, will only require 1 single case. </li></ul>
  23. 24. Why Infection Control? <ul><li>The rise in the rate of HAI over the past 20 years (36%)! </li></ul><ul><li>Various Impacts of HAI </li></ul><ul><li>To minimize risks to patients, staff and visitors from HAI </li></ul><ul><li>To reduce hospital costs of treating HAI and tying up hospital beds. </li></ul><ul><li>SENIC study: </li></ul><ul><li>18% increase in infections – no IC programme </li></ul><ul><li>32% reduction in infections – with IC programme. </li></ul>
  24. 25. Predisposing factors for HAI <ul><li>Extended length of stay esp in intensive care or HDU </li></ul><ul><li>Length of antibiotic treatment </li></ul><ul><li>Prior administration of broad spectrum antibiotic esp. 3rd generation cephalosporins. </li></ul><ul><li>Proximity to another patient with multiple resistant organism (MRO). </li></ul><ul><li>Exposure to healthcare worker for a patient that carried MRO. </li></ul><ul><li>Ventilator-assisted pt. </li></ul>
  25. 26. RISK FACTORS FOR HAI <ul><li>Iatrogenic ~ hands of HCW </li></ul><ul><li>~ invasive procedures eg IV, </li></ul><ul><li>CBD , CVP etc </li></ul><ul><li>Organizational ~ overcrowding </li></ul><ul><li>~ air-conditioning system </li></ul><ul><li>~ physical lay-out & staffing </li></ul><ul><li>pattern </li></ul><ul><li>Patient related ~ chronic illness </li></ul><ul><li>~ immunosuppression </li></ul><ul><li>~ prolong stay in the ward </li></ul>
  26. 27. Common sites associated with etiological agents <ul><li>Urinary tract (UTI) </li></ul><ul><li>Surgical wounds (SSI) </li></ul><ul><li>Respiratory tract </li></ul><ul><li>Skin (especially burns) (MRSA) </li></ul><ul><li>Blood (bacteraemia) </li></ul><ul><li>Gastrointestinal tract </li></ul><ul><li>Central nervous system </li></ul><ul><li>Doctorrao’s ‘e’ learning series </li></ul>
  27. 28. The Principles of Infection Control <ul><li>Hands Hygiene Food Practice </li></ul><ul><li>Clothing Linen </li></ul><ul><li>Environment Equipment </li></ul><ul><li>Disposal </li></ul>IC
  28. 29. Infection control <ul><li>Every health worker plays a vital part in helping to minimise the risk of cross infection </li></ul><ul><li>For example by making certain that hands are properly washed, the clinical environment is as clean as possible, ensuring knowledge and skills are continually updated and by educating patients and visitors. </li></ul>
  29. 30. Infection control <ul><li>1—Achieving optimum hand hygiene. </li></ul><ul><li>2 – Using personal protective equipment. </li></ul><ul><li>3 – Safe handling and disposal of clinical waste and bodily fluids. </li></ul><ul><li>4 – Achieving and maintaining a clean clinical environment. </li></ul><ul><li>5 – Good communication, with other health care workers, patients and visitors </li></ul><ul><li>6 – Training and education. </li></ul>
  30. 31. The chain of infection. Source of infection Method of spreading Person at risk Point of entry Breaking this chain by removing any part of it will control or stop the spread of infection
  31. 32. Contaminated surfaces increase cross-transmission Hayati S, ID HSB 2010
  32. 33. Breaking the chain….. Hayati S, ID HSB 2010
  33. 35. Surveillance and Outbreak investigation ~ An important role of ICN ~ 30-60% of work time ~Purpose of surveillance : 1. To establish the endemic baseline rates of NI. 2. To identify impending outbreak. 3. Convince clinical personnel - For implementation of infection control policies and protocol. 4. For evaluation of infection control measures.
  34. 36. 5. Supportive evidence of quality. 6. To defend malpractice. 7. Satisfy regulators (accrediting bodies) 8. Inter hospital comparison. Purpose of surveillance
  35. 37. Establish background rate Verify diagnosis Formulate a case definition Identify cases Outbreak control measures according to known mode of transmission and appropriate source control
  36. 38. Methods of surveillance <ul><li>Passive/active </li></ul><ul><li>Retrospective/prospective </li></ul><ul><li>Observation/Questionnaires </li></ul><ul><li>Reviews </li></ul>
  37. 39. Surveillance Studies <ul><li>Involves data collection </li></ul><ul><li>2 primary methods: </li></ul><ul><ul><li>i) hospital-wide ii) targeted </li></ul></ul><ul><ul><li>“ Focused epidemiological studies” </li></ul></ul><ul><ul><li>MRSA </li></ul></ul><ul><ul><li>Multi-resistant gram negatives ( Klebsiella, Acinetobacter, E. Coli) </li></ul></ul><ul><ul><li>Outbreak investigation </li></ul></ul>
  38. 40. CASE FINDING <ul><li>Active </li></ul><ul><ul><li>Lab report </li></ul></ul><ul><ul><li>Patient chart review </li></ul></ul><ul><ul><li>Regular review with ward staff. </li></ul></ul><ul><ul><li>Nursing kardex /care plan </li></ul></ul><ul><ul><li>Observation chart (temp) </li></ul></ul><ul><ul><li>Survey discharge patients </li></ul></ul><ul><li>Passive </li></ul><ul><ul><li>Report by ward staff </li></ul></ul><ul><ul><li>Discharge record review. </li></ul></ul>
  39. 41. Suspicion of an impending OB <ul><li>Two or more patients are found to have an infection attributed to a same species of organism. </li></ul><ul><li>Multiple infection of a similar nature are reported by ward staff, </li></ul><ul><li>Emergence of organism not previously noted in the specific unit. </li></ul>
  40. 42. ROLE OF ICN IN OUTBREAK <ul><li>Ward visit </li></ul><ul><li>~ Check for any breach in infection control </li></ul><ul><li>procedures. </li></ul><ul><li>~ Any deviation in the ward routine </li></ul><ul><li>environment eg ventilation, new staff, </li></ul><ul><li>influx of trainee </li></ul><ul><li>~ Studying each case /line list sequence of </li></ul><ul><li>event </li></ul><ul><li>~ Sampling when applicable </li></ul>
  41. 43. Collection of Data in Cross Infections <ul><li>Always collect information and document information on </li></ul><ul><li>1 Patient details </li></ul><ul><li>2 Site and extent of infection </li></ul><ul><li>3 Date of admission – operative procedure </li></ul><ul><li>first recognition of infection </li></ul><ul><li>4 Specimen and laboratory isolates and </li></ul><ul><li>typing results </li></ul><ul><li>5 Ward and staff details. </li></ul><ul><li>Doctorrao’s ‘e’ learning series </li></ul>
  42. 44. ROLE OF ICN IN OUTBREAK <ul><li>Liaise with clinical staff </li></ul><ul><li>~ Advise, recommendations, at hoc </li></ul><ul><li>awareness program. </li></ul><ul><li>~ To stop further cross infection. </li></ul><ul><li>~ Discuss the possible control measure to </li></ul><ul><li>be initiated. </li></ul><ul><li>~ Pt progress report. </li></ul>
  43. 45. ROLE OF ICN IN OUTBREAK <ul><li>Inform the administrator </li></ul><ul><li>~ Report incidence of OB to the </li></ul><ul><li>management for decisions </li></ul><ul><li>~ Closing of ward. </li></ul><ul><li>~ Alternative ward to cohort the infected </li></ul><ul><li>patients </li></ul>
  44. 46. ROLE OF STAFFS IN INFECTION CONTROL <ul><li>Staff education </li></ul><ul><li>~ Familiarization with hospital infection control </li></ul><ul><li>policies and procedures </li></ul><ul><li>~ On-going education, campaigns and specialized </li></ul><ul><li>education to increase awareness of illnesses, </li></ul><ul><li>infection risks and preventive measures </li></ul><ul><li>~ Staff education is of UTMOST importance in </li></ul><ul><li>infection control </li></ul>
  45. 47. Containment of Infection <ul><li>Good patient care practices </li></ul><ul><ul><li>HANDWASHING </li></ul></ul><ul><ul><li>Care of hospital equipment </li></ul></ul><ul><ul><li>Infection control policies </li></ul></ul><ul><ul><li>Prophylaxis of health care workers </li></ul></ul>
  46. 48. Efficacy of Infection control <ul><li>The Following measures will certainly control the infections </li></ul><ul><li>1 Sterilization </li></ul><ul><li>2 Hand washing </li></ul><ul><li>3 Closed drainage systems for urinary </li></ul><ul><li>catheters. </li></ul><ul><li>4 Intravenous catheter care </li></ul><ul><li>5 Peri operative antibiotic prophylaxis for </li></ul><ul><li>contaminated wounds, and care of equipment </li></ul><ul><li>used in respiratory therapy. </li></ul>
  47. 49. EMPLOYEE HEALTH PROGRAM <ul><li>Objectives: </li></ul><ul><ul><li>To improve the safety of the hospital environment </li></ul></ul><ul><ul><li>To maintain the well-being of healthcare workers </li></ul></ul><ul><ul><li>To contain or reduce costs resulting from absenteeism </li></ul></ul>
  48. 50. <ul><li>Immunization Program </li></ul><ul><ul><li>Ensuring that staff are immuned to vaccine preventable diseases </li></ul></ul><ul><ul><li>Immunization of new and currently employed staff </li></ul></ul><ul><ul><li>Continual review of immunization status </li></ul></ul>
  49. 51. <ul><li>Sharp injuries and Post-exposure Management </li></ul><ul><ul><li>Prompt diagnosis and management is important </li></ul></ul><ul><ul><li>A hospital policy on reporting and management should be made known to all staff </li></ul></ul><ul><ul><li>Record keeping </li></ul></ul>
  50. 52. KEY ELEMENT FOR THE SUCCESS OF INFECTION CONTROL PROGRAM <ul><li>Learn the expertise and skills required for the practice of infection control in hospitals </li></ul><ul><li>Collect data on hospitals-acquired infections in the country </li></ul><ul><li>Press the health authorities to provide resources and deploy full-time ICNs </li></ul><ul><li>Initiate training for IC personnel </li></ul><ul><li>Initiate IC programmes at the local hospital level </li></ul><ul><li>Provide vehicles for collaboration and continuing education. </li></ul>
  51. 53. “Above all, a hospital must do the patient no harm” (Florence Nightingale)
  52. 54. Hayati S, ID HSB 2010
  53. 55. The End. Thank you!! <ul><li>There are 3 types of people in the world </li></ul><ul><li>Those who MAKE things happen </li></ul><ul><li>Those who LET t hings happen </li></ul><ul><li>Those who WONDERED what happened! </li></ul>