ROLE OF INFECTION CONTROL IN DERMATOLOGY.

Prof Dr AZAM JAH SAMDANI. M.B.B.S, DTM&H , D.D.S, PhD (U.K.) Jinnah Post Graduate Medical Centre. Karachi, Pakistan.

What is an incubation period? The incubation period is the time between being exposed to a disease and when the symptoms start.

The incubation period is the time between being exposed to a disease and when the symptoms start.

What is the contagious period? The contagious period is the amount of time during which a sick person can give the disease to others. For some skin illnesses (such as scabies, chicken pox ), the patient will need to remain in isolation at home or in the hospital until all chance of spread has passed.

The contagious period is the amount of time during which a sick person can give the disease to others.

For some skin illnesses (such as scabies, chicken pox ), the patient will need to remain in isolation at home or in the hospital until all chance of spread has passed.

Scabies. Incubation period: 30 to 45 days. Contagious Period : Onset of rash until one treatment.

Incubation period: 30 to 45 days.

Contagious Period : Onset of rash until one treatment.

Warts. Incubation period: 30 to 180 days. Contagious Period: Staying home is unnecessary because the infection is very mild and/or minimally contagious.

Incubation period: 30 to 180 days.

Contagious Period: Staying home is unnecessary because the infection is very mild and/or minimally contagious.

Impetigo (strep or staph). Incubation period: 2 to 5 days. Contagious Period : Onset of sores until 24 hours on antibiotic.

Incubation period: 2 to 5 days.

Contagious Period : Onset of sores until 24 hours on antibiotic.

Chickenpox. Incubation period: 10 to 21 days. Contagious Period : 5 days before rash until all sores have crusts (5-7 days).

Incubation period: 10 to 21 days.

Contagious Period : 5 days before rash until all sores have crusts (5-7 days).

Measles. Incubation period: 8 to 12 days. Contagious Period: 4 days before until 5 days after rash appears.

Incubation period: 8 to 12 days.

Contagious Period: 4 days before until 5 days after rash appears.

Rubella (German measles). Incubation period: 14 to 21 days. Contagious Period : 7 days before until 5 days after rash appears.

Incubation period: 14 to 21 days.

Contagious Period : 7 days before until 5 days after rash appears.

Rubella (German measles). Incubation period: 14 to 21 days. Contagious Period : 7 days before until 5 days after rash appears.

Incubation period: 14 to 21 days.

Contagious Period : 7 days before until 5 days after rash appears.

Herpes zoster (shingles). Incubation period : 14 to 16 days. Contagious Period : Onset of rash until as for chickenpox) all sores have crusts (7 days) . (Note: No need to isolate if sores can be kept covered).

Incubation period : 14 to 16 days.

Contagious Period : Onset of rash until as for chickenpox) all sores have crusts (7 days) .

(Note: No need to isolate if sores can be kept covered).

There are quite a few dermatological diseases that can be spread and if proper measures are not applied can result in epidemic of these diseases.

There are quite a few dermatological diseases that can be spread and if proper measures are not applied can result in epidemic of these diseases.

Skin diseases with potential for spread. Scabies. Chicken pox. Tinea infections (Scalp and Skin). Pediculosis. Measles. Warts.

Scabies.

Chicken pox.

Tinea infections (Scalp and Skin).

Pediculosis.

Measles.

Warts.

Sexually transmitted Diseases. Aids. Genital herpes. Syphilis Gonorrhea. Lymphgranuloma venerum. Granuloma Inguinale. Hepatitis epidemic.

Aids.

Genital herpes.

Syphilis

Gonorrhea.

Lymphgranuloma venerum.

Granuloma Inguinale.

Hepatitis epidemic.

SKIN INFECTIONS. Primary skin infections. Infections secondary to irritation, allergy or hypersensitivity are common. Skin infections reflecting systemic disorders also occur. By far the most common organism involved is Staphylococcus aureus, followed by Streptococcus pyogenes.

Primary skin infections.

Infections secondary to irritation, allergy or hypersensitivity are common.

Skin infections reflecting systemic disorders also occur.

By far the most common organism involved is Staphylococcus aureus, followed by Streptococcus pyogenes.

Factors associated with the spread of skin infections include: Close skin-to-skin contact. Openings in the skin such as cuts or abrasions. Contaminated items and surfaces. Crowded living conditions. Poor hygiene.

Close skin-to-skin contact.

Openings in the skin such as cuts or abrasions.

Contaminated items and surfaces.

Crowded living conditions.

Poor hygiene.

What is Staphylococcus aureus (staph)? Staphylococcus aureus , often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose.

Staphylococcus aureus , often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people.

Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose.

Cont…. Most of these skin infections are minor (such as pimples and boils) and can be treated with local antibiotics. However, bacteria (staph & strep) can cause serious infections (such as cellulitis. erysepilas, surgical wound infections, bloodstream infections).

Most of these skin infections are minor (such as pimples and boils) and can be treated with local antibiotics.

However, bacteria (staph & strep) can cause serious infections (such as cellulitis. erysepilas, surgical wound infections, bloodstream infections).

Cont…. An antibiotic-resistant skin infection known as methicillin-resistant staphylococcus aureus (MRSA) has been reported in clusters since 2000 within the competitive sports population. Wrestling has been a sport that has historically had problems with skin infections.

An antibiotic-resistant skin infection known as methicillin-resistant staphylococcus aureus (MRSA) has been reported in clusters since 2000 within the competitive sports population.

Wrestling has been a sport that has historically had problems with skin infections.

Cont…. MRSA outbreak in a college football team. Community Acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA) in an athletic environment. High school team hit with MRSA.

MRSA outbreak in a college football team.

Community Acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA) in an athletic environment.

High school team hit with MRSA.

Cont…. Soldiers had epidemic of pityriasis versicolor in Vietnam war. Bacterial/fungal infections & scabies are major problem during HAJJ. Today in Afghanistan T.Pedis is the third commonest problem.

Soldiers had epidemic of pityriasis versicolor in Vietnam war.

Bacterial/fungal infections & scabies are major problem during HAJJ.

Today in Afghanistan T.Pedis is the third commonest problem.

Cont…. Tinea capitis, pediculosis capitis today continues to be a major problem in USA schools. In our educational institutions scabies is a major problem. Recently loads of children coming with PV & other fungal infections from swimming pools.

Tinea capitis, pediculosis capitis today continues to be a major problem in USA schools.

In our educational institutions scabies is a major problem.

Recently loads of children coming with PV & other fungal infections from swimming pools.

PREVENTION OF SKIN INFECTIONS.

Our understanding of prevention of infection in patients remains limited. Important questions include: What interventions may prevent endemic infections? What are the most effective means to identify outbreaks? What interventions may minimize the prevalence of antimicrobial-resistant organisms? Programs to optimize antimicrobial use need to be developed.

Our understanding of prevention of infection in patients remains limited. Important questions include:

What interventions may prevent endemic infections?

What are the most effective means to identify outbreaks?

What interventions may minimize the prevalence of antimicrobial-resistant organisms?

Programs to optimize antimicrobial use need to be developed.

INFECTION CONTROL.

INFECTION CONTROL.

Most of the outbreaks reported in the outpatient/hospitals are associated with noncompliance with infection control procedures.

Most of the outbreaks reported in the outpatient/hospitals are associated with noncompliance with infection control procedures.

Infection control practices have long been recognized as an important means of preventing transmission of infectious agents. Infection control should be an integral part of practice in outpatient settings as well as in hospitals. Infection control is important in every patient encounter.

Infection control practices have long been recognized as an important means of preventing transmission of infectious agents.

Infection control should be an integral part of practice in outpatient settings as well as in hospitals.

Infection control is important in every patient encounter.

Definition. It refers to policies and procedures used to minimize the risk of spreading infections, especially: In hospitals. Human or animal health care facilities.

It refers to policies and procedures used to minimize the risk of spreading infections, especially:

In hospitals.

Human or animal health care facilities.

Purpose. The purpose of infection control is to reduce the occurrence or spread of skin infections spread by: Human to human contact. Animal to human contact. Human contact with an infected surface. ( PV from Pools). Airborne transmission through tiny droplets of infectious agents suspended in the air.

The purpose of infection control is to reduce the occurrence or spread of skin infections spread by:

Human to human contact.

Animal to human contact.

Human contact with an infected surface. ( PV from Pools).

Airborne transmission through tiny droplets of infectious agents suspended in the air.

Clean your hands. You, your family, and others in close contact should wash their hands frequently with : Soap and warm water. Use an alcohol-based hand sanitizer especially after changing the bandage or touching the infected wound. Avoid contact with other people’s wounds or bandages.

You, your family, and others in close contact should wash their hands frequently with :

Soap and warm water. Use an alcohol-based hand sanitizer especially after changing the bandage or touching the infected wound.

Avoid contact with other people’s wounds or bandages.

Cover your wound. Keep wounds (infected eczemas & cellulitis) that are draining or have pus covered with clean, dry bandages. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others.

Keep wounds (infected eczemas & cellulitis) that are draining or have pus covered with clean, dry bandages.

Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others.

Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying also helps kill bacteria.

Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage.

Wash sheets, towels, and clothes that become soiled with water and laundry detergent.

Drying clothes in a hot dryer, rather than air-drying also helps kill bacteria.

Talk to your doctor.

Talk to your doctor.

SPECIFIC PROTECTIVE MEASURES (GLOVES). Medical gloves should be worn when touching blood and body fluids, mucous membranes and non-intact skin of all patients. Gloves should also be worn when handling items or surfaces soiled with blood and body fluids. Gloves should be changed after contact with each patient. Sterile gloves should be used for surgical procedures.

Medical gloves should be worn when touching blood and body fluids, mucous membranes and non-intact skin of all patients.

Gloves should also be worn when handling items or surfaces soiled with blood and body fluids.

Gloves should be changed after contact with each patient.

Sterile gloves should be used for surgical procedures.

SPECIFIC PROTECTIVE MEASURES (GLOVES). Non-sterile gloves may be used for examinations and other non-surgical procedures. Do not use any chemical such as petroleum-based hand lotion that may affect the integrity of the gloves. Medical, sterile, and non-sterile gloves may not be washed or disinfected for reuse.

Non-sterile gloves may be used for examinations and other non-surgical procedures.

Do not use any chemical such as petroleum-based hand lotion that may affect the integrity of the gloves.

Medical, sterile, and non-sterile gloves may not be washed or disinfected for reuse.

Protective Gowns/Uniforms of Patients. Protective gowns or aprons made of materials that provide an effective barrier should be worn during invasive procedures that are likely to result in the splashing of blood or other body fluids (wart removal, mollascum contagiosum). Protective clothing of patients in wards should be changed daily or when visibly soiled.

Protective gowns or aprons made of materials that provide an effective barrier should be worn during invasive procedures that are likely to result in the splashing of blood or other body fluids (wart removal, mollascum contagiosum).

Protective clothing of patients in wards should be changed daily or when visibly soiled.

Hand Care. Hands should be washed: Before and after treating each patient Health- care workers who have exudative lesions or weeping dermatitis, fungal (Nails), herpes infection should refrain from all direct patient care and from handling patient-care equipment until condition resolves.

Hands should be washed:

Before and after treating each patient

Health- care workers who have exudative lesions or weeping dermatitis, fungal (Nails), herpes infection should refrain from all direct patient care and from handling patient-care equipment until condition resolves.

Sterilization/Disinfection. Before sterilization or high-level disinfection, instruments should be cleaned thoroughly by scrubbing with: Soap & water or Detergent solution. With a mechanical devise ultrasonic cleaner.

Before sterilization or high-level disinfection, instruments should be cleaned thoroughly by scrubbing with:

Soap & water

or

Detergent solution.

With a mechanical devise ultrasonic cleaner.

Disposable instruments. Single disposable instruments are neither designed nor intended to be cleaned, disinfected or sterilized for reuse. Single-use disposable instruments must be used for only one patient and discarded appropriately.

Single disposable instruments are neither designed nor intended to be cleaned, disinfected or sterilized for reuse.

Single-use disposable instruments must be used for only one patient and discarded appropriately.

Housekeeping and Laundry. Environmental surfaces that have become contaminated with patient material shall be cleaned and disinfected after treatment Counter-tops and other surfaces should be cleaned with disposable toweling/cleaning agent. After cleaning, surfaces should be disinfected with a suitable chemical germicide.

Environmental surfaces that have become contaminated with patient material shall be cleaned and disinfected after treatment

Counter-tops and other surfaces should be cleaned with disposable toweling/cleaning agent.

After cleaning, surfaces should be disinfected with a suitable chemical germicide.

Immunization/Infection Control. Mandatory immunizations should be made available to all health-care personnel. Guidelines for post-exposure evaluation (scabies, chicken pox, herpes) should be followed. Prophylaxis and follow-up after exposure.

Mandatory immunizations should be made available to all health-care personnel.

Guidelines for post-exposure evaluation (scabies, chicken pox, herpes) should be followed.

Prophylaxis and follow-up after exposure.

Recommending policies. Written skin infection prevention/control policies and procedures must be established. Then implemented, maintained, and updated periodically. The policies and procedures should be scientifically valid.

Written skin infection prevention/control policies and procedures must be established.

Then implemented, maintained, and updated periodically.

The policies and procedures should be scientifically valid.

Compliance with regulations and accreditation requirements. Infection control personnel should have appropriate access to medical or other relevant records and to staff members who can provide information.

Infection control personnel should have appropriate access to medical or other relevant records and to staff members who can provide information.

Surveillance. The surveillance process should: Define the population at risk. Surveillance data must be analyzed appropriately and used: To monitor. To improve skin infections in future.

The surveillance process should:

Define the population at risk.

Surveillance data must be analyzed appropriately and used:

To monitor.

To improve skin infections in future.

Employee Health. At the time of employment, all facility personnel should be evaluated for conditions relating to communicable skin diseases (Leprosy,Scabies). The evaluation should include: Medical history. Immunization status.

At the time of employment, all facility personnel should be evaluated for conditions relating to communicable skin diseases (Leprosy,Scabies).

The evaluation should include:

Medical history.

Immunization status.

Education & training of healthcare workers. Educational programs should meet the needs of dermatology. Resources should be provided for continuing professional education.

Educational programs should meet the needs of dermatology.

Resources should be provided for continuing professional education.

RESOURCES: (Nonpersonnel). Healthcare facilities should provide or make available: Sufficient office space/equipment. Statistical/computer support.

Healthcare facilities should provide or make available:

Sufficient office space/equipment.

Statistical/computer support.

RESOURCES: (Personnel). All hospitals should have the services of a trained hospital Epidemiologist(s).

All hospitals should have the services of a trained hospital

Epidemiologist(s).

Threat of emerging infectious diseases. Many new contagious diseases have been identified, such as AIDS, Ebola, and hantavirus. Increased travel between continents makes the worldwide spread of disease a bigger concern than before. Additionally, many common skin/infectious diseases have become resistant to treatments.

Many new contagious diseases have been identified, such as AIDS, Ebola, and hantavirus.

Increased travel between continents makes the worldwide spread of disease a bigger concern than before.

Additionally, many common skin/infectious diseases have become resistant to treatments.

PRECAUTIONARY MEASURES. Avoid areas with a lot of insects, (leishmania, pruritis, urticaria). Be cautious around with: Wild or unfamiliar animals. Animals that are unusually aggressive. Do not purchase exotic animals as pets.

Avoid areas with a lot of insects, (leishmania, pruritis, urticaria).

Be cautious around with:

Wild or unfamiliar animals.

Animals that are unusually aggressive.

Do not purchase exotic animals as pets.

PRECAUTIONARY MEASURES. Find out about infectious diseases when you make travel plans. Advisory on Schistosomasis for Egypt. Leishmaniasis/leprosy India,Pakistan. Fungal diseases in sub tropical regions. Cutaneous larva migrans in south America and sub tropical zones.

Find out about infectious diseases when you make travel plans.

Advisory on

Schistosomasis for Egypt.

Leishmaniasis/leprosy India,Pakistan.

Fungal diseases in sub tropical regions.

Cutaneous larva migrans in south America and sub tropical zones.

PRECAUTIONARY MEASURES. Do not engage in unprotected sex. Avoid intravenous drug use. To protect from Syphilis, Gonorrhea, Genital herpes and Aids for Far East & India specially. Travelers' advisories and vaccination recommendations are available on the WHO web site.

Do not engage in unprotected sex.

Avoid intravenous drug use.

To protect from Syphilis, Gonorrhea, Genital herpes and Aids for Far East & India specially.

Travelers' advisories and vaccination recommendations are available on the WHO web site.

Conclusion. Personnel health & safety measures should be adopted. Clinicians should have the know how regarding various skin diseases: Thus enabling them to diagnose/ manage and prevent the spread of such infections.

Personnel health & safety measures should be adopted.

Clinicians should have the know how regarding various skin diseases:

Thus enabling them to diagnose/ manage and prevent the spread of such infections.

CONCLUSION. HEALTH EDUCATION FOR ALL.

HEALTH EDUCATION FOR ALL.

Health education. In Schools/Madrassahs. In higher education institutions. Information in print media. Through electronic media Radio/T.V. By organizing Seminars/Symposiums. National and international conferences in the country.

In Schools/Madrassahs.

In higher education institutions.

Information in print media.

Through electronic media Radio/T.V.

By organizing Seminars/Symposiums.

National and international conferences in the country.

Conclusion. Infection control courses to be imparted: As curriculum in medical education. General practitioners. Doctors, nursing staff & paramedics working in hospitals & primary health care centers.

Infection control courses to be imparted:

As curriculum in medical education.

General practitioners.

Doctors, nursing staff & paramedics working in hospitals & primary health care centers.

Conclusion. Special monitoring for: Fungal/ bacterial/ viral infections, scabies& venereal diseases. In religious festivals. Cultural festivals. Institutions with large boarding facilities. Army barracks, police quarters. prisons.

Special monitoring for:

Fungal/ bacterial/ viral infections, scabies&

venereal diseases.

In religious festivals.

Cultural festivals.

Institutions with large boarding facilities.

Army barracks, police quarters. prisons.

COST EFFECTIVENESS. In our OPD 30-40% cases are of scabies. Studies have shown that proper skin care management can reduce the cost of institutions by at least 20%. This would mean a big cut for health system. The money can be utilized on other aspects of health care.

In our OPD 30-40% cases are of scabies.

Studies have shown that proper skin care management can reduce the cost of institutions by at least 20%.

This would mean a big cut for health system.

The money can be utilized on other aspects of health care.

Conclusion. Modern and well equipped clinical microbiology and pathology laboratory services to support the infection control surveillance system.

Modern and well equipped clinical microbiology and pathology laboratory services to support the infection control surveillance system.

CONCLUSION. Periodic, skin examination for various dermatological problems: Scabies, warts, tinea infections is important : In hospitals. Schools/ collages. Nursing homes. Child care centers. Orphanages.

Periodic, skin examination for various dermatological problems:

Scabies, warts, tinea infections is important :

In hospitals.

Schools/ collages.

Nursing homes.

Child care centers.

Orphanages.

NEED FOR: NATIONAL INFECTION CONTROL CENTRE. Monitoring. Management.

NEED FOR:

NATIONAL INFECTION CONTROL

CENTRE.

Monitoring.

Management.

Conclusion. There would be no epidemic pockets as seen today for Leishmaniasis. There will decrease in Scabies which is a menace in our society today. No spikes of chicken pox infections. Children in schools would be wart, mollascum free. No large groups of children with tinea & pediculosis as seen in institutions these days.

There would be no epidemic pockets as seen today for Leishmaniasis.

There will decrease in Scabies which is a menace in our society today.

No spikes of chicken pox infections.

Children in schools would be wart, mollascum free.

No large groups of children with tinea & pediculosis as seen in institutions these days.

Conclusion. Number of infants with Impetigo. Candidiasis. Nappy rash (Dermititis). Scabies can be reduced significantly.

Number of infants with

Impetigo.

Candidiasis.

Nappy rash (Dermititis).

Scabies can be reduced significantly.

Conclusion. There would be no life long suffering with conditions such as: Syphilis & genital herpes. NO FATAL END TO MANY INDIVIUALS FROM AIDS.

There would be no life long suffering with conditions such as:

Syphilis & genital herpes.

NO FATAL END TO MANY INDIVIUALS FROM AIDS.