infection control measures for nursing care at hospitals

1. Basic infection control
measures for nursing
DR. Soha AL Marsafy
Infection control consultant
1

2. objectives
Goal of IPC
Chain of infection
Colonization versus infection
Environmental contamination
Basic environmental cleaning
 Mode of transmission of infection
Hand hygiene / PPE
Standard precaution
Aseptic technique 2

3. 3

4. Transmission of infection
4

5. 5

6. 6

7. TheChain of Infection
Infectious Agent
Bacteria/Virus
Fungi
Reservoir
People/ Environment
Equipment / Water
Portal of Exit
Excretion/ secretions/ skin
/droplets
Means of
Transmission
Contact/ Inhalation
Airborne
Portal of Entry
M M/ Respiratory / GIT
/Broken Skin
Susceptible Host
Patient /Staff
Visitor
HCW

8. Breaking the
chain of
infection
Infectious Agent
Reservoir
Portal of Exit
Means ofTransmission
Portal of Entry
Susceptible
Host
HCW
Rapid identification,
diagnosis, and treatment
Education
Environmental cleanin
Hand Hygiene
PPE
Hand Hygiene,
Aseptic Technique
Wound/catheter care
Hand Hygiene
Transmission based precautions
Environmental Hygiene
Recognition of high
risk patients
Treatment
Immunizations

9. Colonized or Infected Patient?
People who carry bacteria without evidence of
infection (fever, increased white blood cell count)
are colonized
If an infection develops, it is usually from bacteria
that colonize patients
Bacteria that colonize patients can be transmitted
to environment then from one patient to another
by the hands of HCW
9
~ Bacteria can be transmitted even if the
patient is not infected ~

10. 10
The Iceberg Effect
Infected
Colonized

11. 11

12. Breaking the chain of infection
Equipment cleaning Hand Hygiene Compliance w/ Precautions

13. The EnvironmentAsASource of Nosocomial
Infections
Surfaces
Housekeeping surfaces (bedside tables,
computer keyboards) may lead to the
transmission of potential pathogens if
they are not cleaned between use by
different patients ...
13

14. ‫تتبع‬ ‫اسطح‬
‫االشراف‬
‫الداخلي‬

15. Household cleaning and surface
disinfection: new insights and strategies
M. Exner,V.Vacata, B.Hornei, E. Dietlein,J.Gebel
 Figure 1: Scheme of the mop sweep through four test fields areas. Field
1 is contaminated with 0.05 mL of S. aureus (3 x 107 cfu/mL), areas 2-4
are germ-free surfaces.The arrow shows the cleaning sweep with the
mop.
16

16. 17
The Inanimate Environment Can
Be a Source!!
X represents VRE culture positive sites

17. General Rules
Warm water and detergent removes 80% of
microorganisms.
Minimizes the scattering of dust and dirt.
Cleaning should begin from the least soiled
area to the most soiled area
The use of friction or scrubbing action
18

19. Disinfection solutions
Housekeeping surfaces (chlorine 5%)
20cm of Chlorine +1 L water for regular
disinfection
100cm Chlorine +1 L water for disinfection
of blood and biological fluid
Nursing surfaces :
Chorine
Alcohol
Quaternary ammonium compounds produces
20

20. Hand Hygiene
What should you do
and what do we do?

21. When should I wash my
hands with
Soap andWater?
 Soap and water
 Use when the hands are
visibly soiled.The soap and
water will wash away the
contamination.
 Use when in contact with a
patient who has diarrhoea -
alcohol gel won’t work.
 Use if the gel starts to feel
‘sticky’ on your hands.
 Alcohol gel
 Very quick and effective.
 Use between patients.
 Use when entering or leaving
a ward.
 Use after removing gloves
 Doesn’t work against
Clostridium difficile or any of
the diarrhoea causing viruses.
Use soap and water instead.
When should I wash
my hands with
Alcohol Gel?

22. HandsCanTransmit Bacteria to Patients
23

25. Skin Care
 Provide healthcare workers with hand lotions or
creams
 Get information from manufacturers regarding effects
that hand lotions, creams, or alcohol-based hand rubs
may have on the effectiveness of antimicrobial soaps

26. Fingernails andArtificial Nails
Natural nail tips should be kept to ¼ inch in length
Artificial nails should not be worn with
direct contact with patients

27. PPE

29. how to put on the mask
1
2
4
3

30. Three basic routes of transmission
 Contact
 Direct
 Indirect
 Droplet
 Larger; don’t travel long distances, not infective
over time
 Spatial separation (≥ 3 feet)
 Airborne
 Smaller; infective over time and distance

31. Contact
Precautions
“Contact Precautions are to
prevent transmission of
infectious that spread by:
 direct with the patient
 indirect contact with the
patient
 the patient’s environment

32. ‫؟؟؟ماذا‬
‫ارتدى‬

33. Examples of disease transmit
contact
Infections or colonization with
multidrug-resistant bacteria
such as :
• VRE
• MRSA
• CRE
• MDR Ab
 Diphtheria (cutaneous)
 Herpes simplex virus
 Impetigo
 abscesses, cellulitis,
 Scabies
 Staphylococcal furunculosis
 Zoster
 Viral/hemorrhagic conjunctivitis
 Viral hemorrhagic infections (Ebola)

34. Droplet Precautions
Droplet Precautions are intended to prevent
transmission of pathogens spread through close
respiratory or mucous membrane contact with
respiratory secretions. On a distance less than 3
feet

35. ‫ماذا‬
‫ارتدى؟؟؟؟؟؟‬
‫؟‬

36. Neisseria meningitidis
Haemophilus influenzae
Adenovirus
Influenza
Mumps
Rubella
SARS associated coronavirus

37. Airborne Precautions
“Airborne Precautions prevent transmission of
infectious agents that remain infectious over long
distances when suspended in the air (measles,
chicken pox,TB)”

38. ‫الهواء؟‬ ‫طريق‬ ‫عن‬ ‫كيف‬

39. ‫؟؟؟؟؟‬ ‫ارتدي‬ ‫ماذا‬

40. PPE forAirborne Precautions
Clinical Excellence Commission
41
Note the different mask for droplet and airborne precautions:
remember, how transmission or movement of microorganisms
occurs?
What differences can you spot between the two masks (surgical
and P2/N95 masks)?
P2/N95 masks come in
different shapes and colors.
Local supply and availability
may vary.

41. Mycobacterium tuberculosis
Measles
Spores of Aspergillus
Smallpox
Varicella zoster virus
(chickenpox)
Examples of
disease
transmitted
byAirborne

42. Mode of transmission of COVID

43.  Apply to all patients receiving care in hospitals,
regardless of their diagnosis or presumed
infection status
 Designed to reduce the risk of transmission of
microorganisms from both recognized and
unrecognized sources of infections
 Under standard precautions, blood and body
fluids of all patients are considered potentially
infectious
Standard Precautions

44. 45

45. Instrument reprocessing

46. ‫سبولدينج‬ ‫تصنيف‬
: Spauldingclassification
‫الجلد‬ ‫سطح‬ ‫تالمس‬ ‫ادوات‬
‫الضغط‬ ‫جهاز‬ ‫السليم‬
‫والسماعة‬
)
‫االستخدام‬ ‫احادية‬ ‫ادوات‬
‫الخطورة‬ ‫منخفضة‬ ‫ادوات‬
‫الخطورة‬ ‫متوسطة‬ ‫ادوات‬
‫الخطورة‬ ‫عالية‬ ‫ادوات‬
‫واالغشيه‬ ‫الجلد‬ ‫سطح‬ ‫تخترق‬ ‫ادوات‬
‫مثل‬ ‫المخاطيه‬
(
‫الجراحيه‬ ‫االدوات‬
)
‫المخاطيه‬ ‫االغشيه‬ ‫مع‬ ‫تتعامل‬ ‫ادوات‬
‫السليمه‬ ‫غير‬ ‫االجزاء‬ ‫او‬ ‫السليمه‬
‫مثل‬ ‫بالجلد‬
(
‫او‬ ‫المرنه‬ ‫المناظير‬
‫الحنجرة‬
)
‫مره‬ ‫استخدامها‬ ‫اعادة‬ ‫يجوز‬ ‫ال‬ ‫ادوات‬
‫او‬ ‫تطهيرها‬ ‫اعادة‬ ‫يجوز‬ ‫وال‬ ‫اخرى‬
‫االستخدام‬ ‫بعد‬ ‫تعقيمها‬

47. Safe injection

48. 49

49. 50
Best practice for administering Injection
1. Select safe medicines:
 Proper handling / Check expiry / Label clearly / proper storage
conditions
2. Use of sterile equipment
 Use needle and syringe from sealed package
3. Avoid contamination
 Wash hands/ Prepare on clean surface
4. Reconstitute drugs or vaccines safely
 Use new sterile syringe and needle for each reconstitution
 Use the correct diluents/water for injection
5. Dispose of injection wastes and sharps properly
 Immediate disposal of needle and syringe in puncture- and leak-
proof container
6. Public health education

50. 51
AREASOFASTERILESYRINGEANDNEEDLETHATSHOULDNOTBE
TOUCHED
 Discard any needle that has been touched or
contaminated in a safety box
DO NOT EVER TOUCH

51. 52

52. 53
Do not open glass vials with bare fingers
Use clean pliers, two small hinges, clamps made
from clean bent bottle caps, rigid pieces of plastic
or a carved piece of wood. While rigid materials
protect fingers best, even a piece of gauze is
better than the use of bare hands.

53. 54
54
Open containers
should not be used
to collect sharps
Put the sharps box
at the work site
where injections are given

54. 55
New needle each time even for same pateint

55. 56
18/04/1444 56
Bad practice

56. 57
Bad practice

57. Taking blood sample

58. Hand disinfection then put on clean gloves
59

59. 60

60. 61

61. 62

62. Taking blood
sample

63. 64

64. 65

65. 66

66. 67

67. 68

68. 69

69. 70

70. 71

71. Respiratory hygeine

72. Respiratory hygiene/cough etiquette:
Respiratory hygiene and cough etiquette
include covering the mouth and nose during
coughing and sneezing with a tissue
offering a surgical mask to the coughing
patient, discarding the mask
performing hand hygiene
educating healthcare staff, patients, and
visitors

74. ‫عادية‬
‫خطرة‬
‫االمان‬ ‫صندوق‬
‫اسود‬ ‫او‬ ‫ابيض‬ ‫كيس‬
‫العاديه‬ ‫مخلفات‬
‫احمر‬ ‫كيس‬
‫خطره‬ ‫طبيه‬ ‫مخلفات‬
‫امان‬ ‫صندوق‬
‫حاد‬ ‫ماهو‬ ‫كل‬

75. ‫السوداء‬ ‫األكياس‬
(
‫خطرة‬ ‫غير‬ ‫مخلفات‬
)
(
‫الدم‬ ‫أو‬ ‫الجسم‬ ‫بسوائل‬ ‫تلوثها‬ ‫عدم‬ ‫يشرط‬
)
‫الحمراء‬ ‫األكياس‬
(
‫خطرة‬ ‫مخلفات‬
)
‫األمان‬ ‫صندوق‬
(
‫خطرة‬ ‫مخلفات‬
)
(
‫الكسر‬ ‫وسهل‬ ‫حاد‬ ‫هو‬ ‫ما‬ ‫كل‬
)

‫األوراق‬

‫الفارغ‬ ‫التغليف‬ ‫صناديق‬
‫ة‬

‫البالستيكية‬ ‫األغلفة‬

‫األطعمة‬ ‫مخلفات‬

‫الجروح‬ ‫على‬ ‫الغيار‬ ‫نواتج‬
(
‫الشاش‬
–
‫القطن‬
-
‫البالستر‬
-
‫استرى‬
‫باد‬
-
‫الجبس‬
-
‫الدرنقة‬
–
‫االنبوبة‬
‫الصدريه‬
-
‫الويرات‬
-
‫الغرز‬
)....

‫األسطح‬ ‫وتطهير‬ ‫تنظيف‬ ‫نواتج‬
(
‫القفازات‬ ‫و‬ ‫القطن‬
)

‫المعقمة‬ ‫و‬ ‫التكس‬ ‫القفازات‬
-
‫غطاء‬
‫الرأس‬
-
‫الماسك‬
-
‫البالستيك‬ ‫االبرون‬
‫المستخدم‬ ‫العمليات‬ ‫فرش‬
(
‫احاد‬ ‫النوع‬
‫ى‬
‫االستخدام‬
)
‫القساطر‬ ‫أنواع‬ ‫جميع‬
(
‫وريدية‬ ‫قسطرة‬
–
‫بوليه‬ ‫قسطرة‬
–
‫رايل‬ ‫قسطرة‬
-
..........
).

‫الوريد‬ ‫أجهزة‬
-
‫الدم‬ ‫لنقل‬ ‫وريد‬ ‫جهاز‬
–
‫المحاليل‬ ‫زجاجات‬
-
‫بى‬ ‫تى‬ ‫ال‬ ‫أكياس‬
‫ان‬
-
‫السكر‬ ‫تحليل‬ ‫شرائط‬

‫العزل‬ ‫غرف‬ ‫مخلفات‬

‫بدو‬ ‫المستعملة‬ ‫السرنجات‬
‫ن‬
‫غطاء‬

‫السنون‬

‫الشكاكات‬

‫المشارط‬

‫الكانيوالت‬

‫الكسر‬ ‫سهلة‬ ‫االمبوالت‬
76

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18/04/1444 77
Do not recap needles
 Rationale:
In many settings, recapping is the most common action that leads to
needle sticks
One handed scooping technique

77. Needle stick injury
78
78

78. Percutaneous injuries & needle stick injuries risk
for transmission of :
HIV 0.3%
HCV 3%
HBV 30%
Needle stick injuries In the United States have
decreased to 384,325 per year in 2000, from an
estimated 800,000 to 1 million exposures per
year in 1996
Blood Borne Pathogens

79. 80