Good old flo- it is hard to do a talk on infection control in nursing and not mention flo.
In a WHO sponsored survey study conducted in 55 hospitals of 14 countries representing four WHO regions (South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific) it was found that, on average, 8.7% of hospital patients suffer health care-associated infections. Between 5% and 10% of patients admitted to modern hospitals in the developed world acquire one or more infections. The risk of HAI in developing countries is from 2 to 20 times higher than in developed countries.
WHO  defines a health care-associated infection (also called “nosocomial”) as: An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility.
Students should approach every situation as having the potential to infect a patient or a health-care worker or themselves. Infections are preventable when health-care workers use the right techniques and remain on the look out for unclean and unsafe situations.
Universal precautions: "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. Retrieved from CDC web site http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html
Health care-associated infections Infections are caused by bacteria, fungi or viruses entering the body through one or more of the following routes. • person-person via hands of health-care providers patients and visitors; • personal equipment (e.g. stethoscopes, computers) and clothing; • environmental contamination; • airborne transmission; • carriers on the hospital staff; • rare common-source outbreaks. Epidemiological evidence suggests that multidrug-resistant organisms are carried from person-to-person by health-care professionals. Carriers are individuals who harbor disease organisms in their body without visible symptoms and may pass the infection to another person. It is possible to carry an organism without being aware of it for example, Typhoid Mary a woman who carried the typhoid bacillus and unknowingly started an epidemic in the US in the 1880s . Outbreak is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected in a particular time and place. It may be small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious disease may be sufficient to constitute an outbreak. Outbreaks may also refer to epidemics , which affect a region in a country or a group of countries, or pandemics , which describe global disease outbreaks. Common source outbreak Some diseases arise from a single definable source, such as a common water supply. The basic idea is that common source outbreaks are not propagated from individual-to-individual (e.g., person-to-person). Instead, sick individuals typically are propagation dead ends. Yet the disease continues to be endemic and perhaps epidemic as a consequence of contact with some typically geographically well-defined disease reservoir.
Students should be aware of the significant problem for health-care workers caused by needle stick injuries, which are as prevalent as injuries from falls and handling and exposure to hazardous substances.
HOSPITAL INFECTIONS SKILLS IN PREVENTION
HOSPITAL INFECTIONS SKILLS IN PREVENTION Dr.T.V.Rao MD10/24/12 Dr.T.V.Rao MD@Health care 1
The very first requirement in a hospital is that it should do the sick no harm10/24/12 Dr.T.V.Rao MD@Health care 2
A Tribute to Ignaz Semmelweiss Ignaz Philipp Semmelweis10/24/12 Dr.T.V.Rao MD@Health care 3
New roles in HAI prevention HAI Surveillance nurses – “Hospitals should do the sick no harm” – USA model – Basis of surveillance (Haley et al 1985) Data CollectionApplication to Prevention& Control Analysis Dissemination Interpretation Evaluation Planning Implementation10/24/12 Dr.T.V.Rao MD@Health care 4
1st principle of infection prevention at least 35-50% of all healthcare-associated infections are asociated with only 5 patient care practices:• Use and care of urinary catheters• Use and care of vascular access lines• Therapy and support of pulmonary functions• Surveillance of surgical procedures• Hand hygiene and standard precautions 10/24/12 Dr.T.V.Rao MD@Health care 5
Incidence of Healthcare associated infections– Lack of reliable data affects estimates on the burden- millions worldwide every year– No health-care facility, no country, no health-care system in the world is free of this problem – Developed world: 5–10% patients – Developing countries: risk is at least 2 times higher and can exceed 25% – ICU - 30% patients; attributable mortality as high as 44%10/24/12 Dr.T.V.Rao MD@Health care 6
Leading causes of death 53.9 million from all causes, worldwide10/24/12 Dr.T.V.Rao MD@Health care 7
Global Infection ProblemsAccording 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.10/24/12 Dr.T.V.Rao MD@Health care 8
Health Care-Associated Infections (HAI) According to WHO:• HAI is also called “nosocomial”.• HAI is defined as: – an infection acquired in hospital by a patient who was admitted for a reason other than that infection. – an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.10/24/12 Dr.T.V.Rao MD@Health care 9
Infection Control in developing countries None/inadequate Infection Control infrastructure Lack of strategic direction at national/local level Lack of resources/financial governance Well-organized, effective infection control programmes are confinedto academic institutions, well-funded government and private hospitals Smaller hospitals in urban areas and hospitals in rural centres haveless resources None or inadequate infection control programme Lack of Microbiology Laboratory supports Availability of antimicrobial agents, hand hygiene products and hand washing facilities, Personal Protective Equipment and sterile goods 10/24/12 Dr.T.V.Rao MD@Health care 10
Even though infection rates can be drastically reduced in most hospitals in developing countries, the rates cannot be reduced below 5% unless excessive costs are incurred ‘irreducible minimum’. Ayliffe GAJ: Infection Control 1986;7:92-9510/24/12 Dr.T.V.Rao MD@Health care 11
Four Ways to Prevent HAI1. Maintain cleanliness of the hospital.2. Personal attention to handwashing before and after every contact with a patient or object.3. Use personal protective equipment whenever indicated.4. Use and dispose of sharps safely.10/24/12 Dr.T.V.Rao MD@Health care 12
Required Skills• Apply universal precautions*• Use personal protection methods• Know what to do if exposed• Encourage others to use universal precautions• Report breaks in technique that increase patient risks• Observe patients for signs and symptoms of infection10/24/12 Dr.T.V.Rao MD@Health care 13
Main Sources of Infection• Person to person via hands of health-care providers, patients, and visitors• Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.)• Environmental contamination• Airborne transmission• Hospital staff who are carriers• Rare common-source outbreaks10/24/12 Dr.T.V.Rao MD@Health care 14
• Staff nurses play an important role in risk reduction by 1.paying careful attention to hand hygiene, 2.by ensuring careful administration of prescribed antibiotics, 3.and by following procedures to reduce the risks associated with patient care devices.10/24/12 Dr.T.V.Rao MD@Health care 15
COST SAVING MEASURES Unnecessary and wasteful practices• Routine – Microbiological Swabbing of environment – Disinfectants for environmental cleaning e.g. floors & walls – Fumigation of isolation room with formaldehyde• Unnecessary – Use of overshoes and dust attracting matt – Personal Protective Equipment in the Intensive Care, & Neonatal Unit• Excessive/unnecessary use of – IM/IV injections – Insertion of indwelling devices e.g. IV lines, urinary catheters, nasogastric tube – Antibiotics both for prophylaxis and treatment Damani NN. Journal of Hospital infection 2007; 65(S1): 151-154. 10/24/12 Dr.T.V.Rao MD@Health care 16
NO COST MEASURES Good infection control practices• Aseptic technique for all sterile procedures• Remove indwelling devices when no longer needed• Isolation of patient with communicable diseases/multi- resistant organism• Avoid unnecessary Per Vaginal (PV) examination in women in labour• Placing mechanically ventilated patients in a semi- recumbent position• Minimize number of people in operating theatre Damani NN. Journal of Hospital infection 2007; 65(S1): 151-154. 10/24/12 Dr.T.V.Rao MD@Health care 17
LOW COST MEASURES Cost effective practices • Education and practical training in – Hand hygiene – Aseptic technique – Appropriate use of PPE – Sharp use and disposal in robust containers • Provision of alcoholic hand rub and hand washing facilities for hand hygiene • Use of adequately sterile items for invasive procedures • Use of single-use disposable sterile needles and syringes • Adequate decontamination of items/equipment between patients • Provision of Hep B vaccination for healthcare workers • Post exposure management of healthcare workers Damani N.N .Journal of Hospital infection 2007; 65(S1): 151-154.10/24/12 Dr.T.V.Rao MD@Health care 18
HAND HYGIENE - NO ARTIFICIAL NAILS - CLEANSING HANDS - THE MOST IMPORTANT MEANS OF PREVENTING THE SPREAD OF INFECTION Germs don’t have a chance with the proper use of these weapons. Soap / Water Alcohol-based hand10/24/12 Dr.T.V.Rao MD@Health care hygiene products 19
Our 5 moments for HAND HYGIENE10/24/12 Dr.T.V.Rao MD@Health care 20
Hand keep your hands germ free Two different ways to Hygiene Speed ot ing n wash allowed and water for 15 seconds. (Make Soap bubbles while applying friction). Alcohol hand rub if no visible soiling present on hands. Hand Hygiene is JCAHO’s # 7 Patient Safety Goal Speak-up Campaign for PatientsEncouraging patients to ask the Healthcare Worker (HCW) about handwashing! 10/24/12 Dr.T.V.Rao MD@Health care 21
STANDARD PRECAUTIONS Healthcare workers must treat all blood & body fluids as infectious.10/24/12 Dr.T.V.Rao MD@Health care 22
Transmission-based PRECAUTIONSAlways Communicate to others when patients are in isolation For any room entry don appropriate PPEClean ANY shared equipment between Patients Although Isolation Signs May Appear Different, ALL Will Have: - a STOP Sign - List of Room Entry PPE10/24/12 Dr.T.V.Rao MD@Health care 23
Lets now put the “Spotlight” on Misuse of Antituberculous Regimens MDR - Tuberculosis 10/24/12 Dr.T.V.Rao MD@Health care 24
Implementation• Holding seminar on antibiotic use• Case studies on antibiotic use in departmental meeting• Distribution & Reinforcement of the use of antibiotic guidelines10/24/12 Dr.T.V.Rao MD@Health care 26
Standard Precautions also include: • Hand Hygiene • Personal Protective Equipment ES (PPE) gloves,gowns,masks,face-shields,goggles EY UR YO ER MB • Anticipate Your Exposure EREM • Use Sharp-Safety Devices • Clean Surfaces Regularly • Appropriate Waste Disposal (Red bags, regulated medical waste) 10/24/12 Dr.T.V.Rao MD@Health care 27
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 children10/24/12 Dr.T.V.Rao MD@Health care 28
CDC RECOMMENDATION1. Intensified environmental cleaning using 1:10 bleach : water solution2. Equipment cleaned whenever visibly soiled3. Items close to the patient should be cleaned daily4. IV poles should be cleaned when the patient is discharged.10/24/12 Dr.T.V.Rao MD@Health care 29
BLOODBORNE PATHOGENS “The Big 3” HIV, HEPATITIS B AND HEPATITS CSPREAD THROUGH CONTACT WITH BLOOD & BODY FLUIDS HIGH RISK BEHAVIORS: Sharing Needles or other sharp objects Unprotected Sexual Contact Unclean Tattoo Parlors Accidental puncture from contaminated needles and other sharps can result in transmission of Bloodborne pathogens. Safety Needles, Devices and PPEs = Protection.10/24/12 Dr.T.V.Rao MD@Health care 30
Hepatitis B Vaccinated: If you have received the vaccine (all 3 shots) and have developed immunity, virtually no risk for infection. Unvaccinated: Risk from single needlestick or cut 6-30% Depends on the Hepatitis (antigen of sources blood). Hepatitis C Limited studies available but risk seems to be about 1.8%. HIV Average risk for HIV infection to develop after needlestick or cut exposure to HIV blood is 0.3% Risk after exposure to HIV blood through splashes to eyes, mouth or nose is 0.1%10/24/12 Dr.T.V.Rao MD@Health care 31
IMMUNIZATIONS, INJURIES & Employee Health -HEPATITIS B VACCINE -ANNUAL TB RISK ASSESSMENT -Other vaccinations - REPORT ALL INJURIES10/24/12 Dr.T.V.Rao MD@Health care 32
One more important thing! Protect YourselfBe sure you have been immunized against Hepatitis B since it is very easy to transmit!10/24/12 Dr.T.V.Rao MD@Health care 33
Patient family education is Important• 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 –10/24/12 monitoring vital signs Dr.T.V.Rao MD@Health care 34
Discussion• Two-thirds of the problem may be improved by reinforcement on the use of antibiotic guidelines. – IMPACT guidelines/ Sanford guide/ Therapeutic guidelines – antibiotics/ Production of local guidelines etc.• The remaining one-third may be improved by continuous medical education, training on making a correct diagnosis and fine tuning of the clinical skills. – No shortcut.10/24/12 Dr.T.V.Rao MD@Health care 35
In Conclusions• Identify unsafe, unnecessary and ineffective infection control practices• Divert resources to apply basic evidence based practice in Infection control• Implement simple & effective solutions according to local need and resources which are achievable and affordable Simple measures do save lives !10/24/12 Dr.T.V.Rao MD@Health care 36
Please Visit me for More Articles of Interest on Infections at ….10/24/12 Dr.T.V.Rao MD@Health care 37
• Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World • Email • firstname.lastname@example.org/24/12 Dr.T.V.Rao MD@Health care 38