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HOSPITAL ASSOCIATED Infections overcoming emerging challenge

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HOSPITAL ASSOCIATED Infections overcoming emerging challenge

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HOSPITAL ASSOCIATED Infections overcoming emerging challenge

  1. 1. HOSPITAL ASSOCIATED Infections overcoming emerging challenge Dr.T.V.Rao MD 10-03-2016 Dr.T.V.Rao MD 1
  2. 2. Aim of Infection Prevention • The aim of the Infection Prevention and Control Service is to promote as safe an environment as possible for staff, patients and visitors, in order that the risk of healthcare associated infections are kept to a minimum. 10-03-2016 Dr.T.V.Rao MD 2
  3. 3. What matters Infection to patients and many around • For most patients and their families, the process of healthcare appears to be a simple one. Patients are admitted to the facility and a specific course of treatment and care is carried out by physicians, nurses, and technicians • It is the beginning of many matters and infection is a great preventable factor 10-03-2016 Dr.T.V.Rao MD 3
  4. 4. 10-03-2016 Dr.T.V.Rao MD 4
  5. 5. Never forget the safety of the Patients is interdisciplinary factor • Every healthcare facility uses interdisciplinary task forces such as the Safety Committee and the Infection Control Committee to minimize patient and employee risk. Although its existence may not be widely recognized by patients, the Infection Control Committee plays an integral part in the care of every patient. 10-03-2016 Dr.T.V.Rao MD 5
  6. 6. Objectives of Infection Control Understand basic infection control (IC) concepts Understand the causes of nosocomial infections Understand the components of an infection control program Understand how the Infection Control Committee and DTC can decrease the incidence of nosocomial infections and antimicrobial resistance (AMR)
  7. 7. Introduction—Why Infection Control? • Hospital acquired infections are a common problem—prevalence about 9% • Hospital acquired infections contribute to AMR • Overuse of antimicrobials (development) • Poor infection control practices (spread) • Hospital-acquired infections increase the cost of health care • World Bank studies have shown that two-thirds of developing countries spend more than 50% of their health care budgets on hospitals • Effective IC programs are beneficial • They decrease spread of nosocomial infections, morbidity, mortality, and health care costs 10-03-2016 Dr.T.V.Rao MD 7
  8. 8. Why Is the Infection Control Committee Important? • Everyone knows that infection control is the responsibility of all healthcare workers. Patients and employees are only safe from infectious processes when everyone follows good infection control techniques 10-03-2016 Dr.T.V.Rao MD 8
  9. 9. Why Is the Infection Control Committee Important? • The purpose of the Infection Control Committee is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the facility. Through policies, procedures, and evaluation processes, the committee acts as a central clearing house for all infection control information and channels that information in a manner that will create the safest healthcare environment. 10-03-2016 Dr.T.V.Rao MD 9
  10. 10. Why Is the Infection Control Committee Important? • It also helps to standardize infection control procedures throughout the facility so that the same level of care is provided in all departments. This standardization helps to control and maintain the facility's environment and ensures that patients receive the same level of infection control in all areas. For example, the Infection Control Committee may take steps to ensure that the standard for instruments used in invasive procedures performed outside of the OR is the same as invasive procedures performed . 10-03-2016 Dr.T.V.Rao MD 10
  11. 11. What is Infection Control • Infection Control—The process by which health care facilities develop and implement specific policies and procedures to prevent the spread of infections among health care staff and patients 10-03-2016 Dr.T.V.Rao MD 11
  12. 12. Nosocomial Infection •Nosocomial Infection—An infection contracted by a patient or staff member while in a hospital or health care facility (and not present or incubating on admission)10-03-2016 Dr.T.V.Rao MD 12
  13. 13. Terms we should be Familiar 10-03-2016 Dr.T.V.Rao MD 13
  14. 14. Disinfection • Disinfection—The process of microbial inactivation that eliminates virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., spores) 10-03-2016 Dr.T.V.Rao MD 14
  15. 15. Sterilization • Sterilization—The use of physical or chemical procedures to destroy all microbial life, including large numbers of highly resistant bacterial endospores. Procedures include— • Steam sterilization • Heat sterilization • Chemical sterilization 10-03-2016 Dr.T.V.Rao MD 15
  16. 16. Root Causes of Nosocomial Infections  Lack of training in basic IC  Lack of an IC infrastructure and poor IC practices (procedures)  Inadequate facilities and techniques for hand hygiene  Lack of isolation precautions and procedures 10-03-2016 Dr.T.V.Rao MD 16
  17. 17. Epidemiology of Nosocomial Infections Most common sites for nosocomial infections Surgical incisions Urinary tract (i.e., catheter-related) Lower respiratory tract Bloodstream (i.e., catheter-related)
  18. 18. Epidemiology of Nosocomial Infections Common microorganisms Aerobic gram-positive cocci (Staphylococcus aureas [MRSA], enterococci [vancomycin- resistant]), Aerobic gram-negative bacilli (Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae)
  19. 19. Epidemiology of Nosocomial Infections (3) Nosocomial transmission of community acquired, multidrug-resistant organisms M. tuberculosis Salmonella spp. Shigella spp. V. cholerae
  20. 20. Root Causes of Nosocomial Infections Lack of training in basic IC Lack of an IC infrastructure and poor IC practices (procedures) Inadequate facilities and techniques for hand hygiene Lack of isolation precautions and procedures
  21. 21. Root Causes of Nosocomial Infections (2)  Use of advanced and complex treatments without adequate training and supporting infrastructure, including—  Invasive devices and procedures  Complex surgical procedures  Interventional obstetric practices  Intravenous catheters, fluids, and medications  Urinary catheters  Mechanical ventilators  Inadequate sterilization and disinfection practices and inadequate cleaning of hospital
  22. 22. Root Causes of Nosocomial Infections Use of advanced and complex treatments without adequate training and supporting infrastructure, including—  Invasive devices and procedures  Complex surgical procedures  Interventional obstetric practices  Intravenous catheters, fluids, and medications  Urinary catheters  Mechanical ventilators Inadequate sterilization and disinfection practices and inadequate cleaning of hospital 10-03-2016 Dr.T.V.Rao MD 22
  23. 23. Who Serves on the Infection Control Committee? •The Infection Control Committee is generally comprised of members from a variety of disciplines within the healthcare facility. Representation may include: physicians, nursing staff, infection control practitioners, quality assurance personnel, risk management personnel as well as representatives from microbiology, surgery, central sterilization, environmental services, etc. 10-03-2016 Dr.T.V.Rao MD 23
  24. 24. Infection Control Committee (1) Membership—  Doctors  General physician  Infectious disease specialist  Surgeon  Clinical microbiologist  Infection control nurse  Representatives from other relevant departments  Laboratory  Housekeeping  Pharmacy and central supply  Administration
  25. 25. Infection Control Committee Goal—  To prevent the spread of infections within the health care facility Functions—  Addressing food handling, laundry handling, cleaning procedures, visitation policies, and direct patient care practices  Obtaining and managing critical bacteriological data and information, including surveillance data
  26. 26. Infection Control Committee Functions (cont) Developing and recommending policies and procedures pertaining to infection control Recognizing and investigating outbreaks of infections in the hospital and community
  27. 27. Infection Control Committee •Intervening directly to prevent infections •Educating and training health care workers, patients, and nonmedical caregivers 10-03-2016 Dr.T.V.Rao MD 27
  28. 28. The Purpose of the Team is to find solutions • The goal of this interdisciplinary team is to bring together individuals with expertise in different areas of healthcare. By creating a diverse group, issues can be addressed from several angles, and members can pool their expertise to develop the best solutions possible. 10-03-2016 Dr.T.V.Rao MD 28
  29. 29. What Does the Infection Control Committee Do? •The role of the Infection Control Committee is very multi-faceted. It should be involved in planning, monitoring, evaluating, updating, and educating 10-03-2016 Dr.T.V.Rao MD 29
  30. 30. What Does the Infection Control Committee Do? • It sets general infection control policy and provides input into specific infection control issues. Simply stated, its function is to prevent and control nosocomial infections. 10-03-2016 Dr.T.V.Rao MD 30
  31. 31. What Does the Infection Control Committee Do? • . That is accomplished in a variety of ways some of which include: surveillance of nosocomial infections, product evaluation, investigation of infection outbreaks and infection clusters, development of infection control procedures for all departments, staff and patient education, medical waste management, etc 10-03-2016 Dr.T.V.Rao MD 31
  32. 32. How Does the Infection Control Committee Prevent and Control Infection? 10-03-2016 Dr.T.V.Rao MD 32
  33. 33. Planning • Successful prevention and control of infection requires careful planning. The Infection Control Committee is actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, it may provide guidance for the set-up of an endoscopy lab or the implementation of a new procedure 10-03-2016 Dr.T.V.Rao MD 33
  34. 34. Planning •Its role in the planning process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control. 10-03-2016 Dr.T.V.Rao MD 34
  35. 35. Committee Decides on the Chemical and Disinfectants we use in the Hospitals • The committee also may provide input into the selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories. The multidisciplinary composition of the committee makes it an ideal place to examine new product and procedure proposals from several aspects. 10-03-2016 Dr.T.V.Rao MD 35
  36. 36. Monitoring • The Infection Control Committee also monitors infectious processes within the healthcare facility. They track nosocomial infections and incidents that have the potential to cause infections. They review infection control statistics from the facility in an effort to minimize risk, identify problem areas, and implement corrective actions. 10-03-2016 Dr.T.V.Rao MD 36
  37. 37. Monitoring •When infections do occur, the committee undertakes epidemiological investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.10-03-2016 Dr.T.V.Rao MD 37
  38. 38. Evaluating • Along with monitoring specific incidents, the Infection Control Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The committee may also be called upon to evaluate practices and provide input regarding products and protocols. 10-03-2016 Dr.T.V.Rao MD 38
  39. 39. Updating • Perhaps one of the biggest challenges that all Infection Control Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the healthcare facility, new bacterial strains complicate and challenge older infection control practices, and new research often requires re- examination of established procedures 10-03-2016 Dr.T.V.Rao MD 39
  40. 40. Updating • The Infection Control Committee's purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the committee as it works to manage its facility's infection control policy 10-03-2016 Dr.T.V.Rao MD 40
  41. 41. Educating • Finally, as an integral part of its leadership, the committee must take an active role in staff education. That role may be a hands-on approach or it may be an advisory role in partnership with the facility's education department. However it functions, the committee must set direction for staff education and validation of that education. 10-03-2016 Dr.T.V.Rao MD 41
  42. 42. Responsibilities: • 1. Advice staff on all aspects of infection control and maintain a safe environment for patients and staff 2. Provide educational programmes on the prevention of hospital infection for all hospital personnel 3. Provide a basic manual of policies and procedures and ensure that local written guidelines based on these are in existence 10-03-2016 Dr.T.V.Rao MD 42
  43. 43. Responsibilities: • Establish systems of surveillance of hospital infection in order to identify at-risk patients and problem areas that need intervention. Methods for surveillance may include case findings by ward rounds and chart reviews, reviews of laboratory reports, and targeted prevalence of incidence survey 10-03-2016 Dr.T.V.Rao MD 43
  44. 44. Responsibilities: • Advise management of patients requiring special isolation and control measures 6. Investigate and control outbreaks of infection in collaboration with medical and nursing staff . Ensure that an antibiotic policy is in existence 10-03-2016 Dr.T.V.Rao MD 44
  45. 45. Isolation and Standard Precautions Whenever possible, avoid crowding wards. Implement specific policies and procedures for patients with communicable diseases: Private rooms and wards for patients with specific diseases Visitation policies Hand washing and use of gloves Gowns, when appropriate Masks, eye protection, gowns Precautions with sharp instruments and needles
  46. 46. Ensuring a Clean Environment Establish policies and procedures to prevent food and water contamination Establish a regular schedule of hospital cleaning with appropriate disinfectants in, for example, wards, operating theaters, and laundry Dispose of medical waste safely  Needles and syringes should be incinerated  Other infected waste can be incinerated or autoclaved for landfill disposal Bag and isolate soiled linen from normal hospital traffic
  47. 47. Universal Precautions •Precautions that protect the patient/client, co- workers, and community from infection •Universal Precautions
  48. 48. Universal Precautions •Universal Precautions Techniques • Wear gloves when • touching blood • touching mucous membranes • performing venipuncture • touching body fluids of any kind
  49. 49. Practice Universal Precautions with Body fluids • Body Fluids • vaginal fluids or semen • cerebrospinal fluid • pleural fluid (fluid around lung) • pericardial fluid (fluid around heart) • synovial fluid (fluid in the joints) • amniotic fluid (fluid around the fetus) • placenta tissue • saliva with blood in it
  50. 50. Isolation Precautions • Isolation • condition of having limited contact with others • Protective Isolation • guarding workers and visitors from danger • Reverse Isolation • guarding the patient from danger
  51. 51. Types of Isolation •Respiratory Isolation •protection from airborne droplets •Skin and wound Isolation •protection from open wounds, skin drainage
  52. 52. Types of Isolation •Enteric Isolation •solid body wastes •Strict Isolation •complete protection •Blood and body fluids
  53. 53. Responsibilities: • Coordinate with the hospital doctors and administration (managerial and nursing), community health doctors and nurses and infection control staff in adjacent hospitals 10-03-2016 Dr.T.V.Rao MD 53
  54. 54. Hand Washing – a Great Idea to control and prevent Infections • Hand Hygiene is of paramount important to the Trust and we have trained designated Hand Hygiene Champions in every clinical area who promote the World Health Organisation’s (WHO) 5- Moments of Hand Hygiene standards 10-03-2016 Dr.T.V.Rao MD 54
  55. 55. Hand Hygiene • Handwashing is one of the most effective measures of reducing infection and all staff and visitors are asked to wash their hands or use the alcohol hand foam l before and after seeing relatives or patients. These facilities are available throughout our hospitals. 10-03-2016 Dr.T.V.Rao MD 55
  56. 56. If you have washed your hands you have contributed your best in reduction of Nosocomial Infections 10-03-2016 Dr.T.V.Rao MD 56
  57. 57. 10-03-2016 Dr.T.V.Rao MD 57
  58. 58. Infection Control Resources Infection control manuals, protocols, and training programs (See Participants’ Guide, annex 1) CDC website—protocols Engender Health training program—web-based training for basic infection programs ICAT—tool that can be used in low-resource countries to improve infection control practices (can be obtained from RPM Plus/MSH)
  59. 59. References • The Infection Control Committee Farrah Lee, BSN, and Natalie Lind, ACE Infection control today • CDC guidelines 10-03-2016 Dr.T.V.Rao MD 59
  60. 60. Attention of Viewers • I am thankful to many in the world who made me to achieve my desired goals faster than I thought, having > 3-5 million health professionals share and utilize my knowledge for the benefit of mankind, Today I wish to be freelancer to the world to create interest in Medical, Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases and Hospital associated Infection wish to be your partner in educating many millions who know well the importance of Infectious diseases • You can visit many web sites of mine • www.medmicrobes.com • www.slidehsare.com • www.authourstream.com • www,scribd.com • Be a friend on Facebook with tummalapalli venkateswararao access • Rao’s Microbiology • Rao’s Infection care • Microbiology connected Travancore Medical College • For any assistance on INFECTION REALTED ISSUES CONTACT ME AT doctortvrao@gmail.com •Mob +91 720411315410-03-2016 Dr.T.V.Rao MD 60
  61. 61. •Program Created by Dr.T.V.Rao MD for Benefit of Medical and Paramedical Professionals in the Developing World Created from World Wide Resources •Email •doctortvrao@gmail.com 10-03-2016 Dr.T.V.Rao MD 61

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