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Infection prevention & control general orientation [compatibility mode]


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Infection prevention & control general orientation
Dr. Nahla Abdel Kader, MD, PhD.
Infection Control Consultant, MOH
Infection Control CBAHI Surveyor
Infection Prevention Control Director

Published in: Health & Medicine, Business
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Infection prevention & control general orientation [compatibility mode]

  2. 2. Infection Control Overview • Infection control (IC) is a quality standard that is essential for the well being and safety of patients, staff and visitors. • It affects most departments of the hospital and involves issues of quality, risk management, clinical governance and health and safety. • It is a discipline that applies epidemiologic and scientific principles and statistical analysis to the prevention or reduction in rates of Healthcare Acquired Infections (HAIs). ٢
  3. 3. Hospital Acquired Infections or Healthcare Associated Infections ( HAIs ) An infection meeting the following criteria: a) Not present or incubating on admission. admission. b) An infection incubating at the time of admission that is related to previous hospitalization at the same facility or identified in an admission following performance of a procedure during a previous admission. ٣
  4. 4. HEALTHCARE ASSOCIATED INFECTIONS Remember ►Infection in a hospitalized patient ►Not present or incubating on admission ►Hospital acquired infection ٤
  5. 5. Why now the urgent need for Infection Control Program ► HAIs are becoming more prevalent, especially with the advent of more invasive procedures & increase in use of immunosuppresive therapy. ► HAIs are preventable( can kill ) ► HAIs are associated with prolonged morbidity. ► HAIs are associated with increased length of stay & increased cost of care. ٥
  6. 6. TYPES OF HAIs Devices Associated Infections  Catheter Associated Urinary tract infections (CAUTI)  Central Line Associated Blood Stream Infections (CLABSI)  Ventilator Associated Pneumonia (VAP) Procedure Associated Infections  Surgical Site infections (SSI) ٦
  7. 7. Main Types of Infections 17% 44% 18% 10% 11% UTI SSI BSI Pneumo Others ٧
  8. 8. Source Healthcare Associated Infections Patient’s Own Flora HAIs Medical Equipment Staff Member ٨
  9. 9. KKH INFECTION CONTROL PROGRAM KKH Infection Control Program is a coordinated program designed by the hospital to reduce the risk of healthcarehealthcare-associated infections in patients, visitors, and workers. It describes the structure, authority and functions of it. ٩
  10. 10. The GOAL The goal of Infection Control Program is to provide a safe healthy environment through identification and reduction the risks of acquiring and transmission of HAIs among patients, medical staff, administration staff, volunteers, students and visitors. ١٠
  11. 11. Importance of Infection Control Program 1. We have an obligation to reduce the morbidity and mortality of our patients. 2. Accreditation requirements demand a strong infection control program. 3. The infection control efforts are part of the '' risk management'' efforts of any hospital. 4. Hospital outbreaks now occur frequently in the average community hospital. 5. Financial deficit control has become a crucial issue for many hospital. ١١
  12. 12.  Prevention of healthcare acquired infections is the responsibility of all individuals and services providing healthcare.  Everyone must work cooperatively to reduce the risk of infection for patients ,staff and visitors.  Infection control programs are effective, provided they are comprehensive and including surveillance and prevention activities, as well as staff training.  There must also be effective support at the national and regional levels. ١٢
  13. 13. Infection Control is Everyone’ Everyone’s Responsibility! ١٣
  15. 15. How are infections transmitted? ١٥
  16. 16. How to Break the Chain of Infection???? ١٦
  17. 17. Standard Precautions Expanded Precaution Staff Protection Primary strategy for preventing transmission Transmission Based of microorganisms to Precautions for patient patients, They are with suspected or applied to all patients confirmed Hand hygiene & communicable Appropriate use of disease PPE Employee Health Program ١٧
  18. 18. Practical Issues and Considerations for Standard Precautions ► Hand Hygiene. ► Personnel Protective Equipment (PPE). ► Safe Use of Sharps. ► Monitoring Staff Health. ► Cleaning and Disinfecting Patient Care Equipment. ► Disposing of Waste Safely. ► Cleaning the Environment. ► Removing Spills of Blood and Body Fluids ١٨
  19. 19. ١٩
  20. 20. So Why All the Fuss About Hand Hygiene? Most common mode of transmission of pathogens is via hands!  Infections acquired in healthcare  Spread of antimicrobial resistance ٢٠
  21. 21. All health care’s works care’ involve the hands ٢١
  22. 22. Hands are contaminated Hands spread germs ٢٢
  23. 23. The health care environment is contaminated ٢٣
  24. 24. Colonized or Infected: What is the Difference? ► 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 from one patient to another by the hands of healthcare workers ~ Bacteria can be transmitted even if the patient is not infected ~ ٢٤
  25. 25. The Iceberg Effect Infected Colonized ٢٥
  26. 26. The inanimate environment is a reservoir of pathogens X represents a positive Enterococcus culture The pathogens are ubiquitous ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL. ٢٦
  27. 27. The inanimate environment is a reservoir of pathogens Recovery of MRSA , VRE & ACINITOBACTER. Devine et al. Journal of Hospital Infection. 2007;43;72-75 Lemmen et al Journal of Hospital Infection. 2004; 56:191-197 Trick et al. Arch Phy Med Rehabil Vol 83, July 2006 Walther et al. Biol Review, 2007:849-869 ٢٧
  28. 28. Patients are vulnerable to infection ٢٨
  29. 29. Hand Hygiene is the simplest, most effective measure for preventing HospitalHospital-Acquired Infections. ٢٩
  30. 30. 30% 40% 30%-40% of all HAIs are Attributed to Cross Transmission: Importance of Hand Hygiene? ٣٠
  31. 31. Types of Hand Hygiene ►Normal hand washing ►Antiseptic hand washing ►Alcohol-based hand rub AlcoholCan be used instead of hand washing , if hands are not visibly soiled with blood or any other patient body fluids ►Surgical hand wash ٣١
  32. 32. Routine Hand Washing ٣٢
  33. 33. Antiseptic Hand Washing ٣٣
  34. 34. Samples taken before and after antiseptic handwashing ٣٤
  35. 35. Waterless Hand Rub “alcohol“alcohol-based hand rub ٣٥
  36. 36. Efficacy of Hand Hygiene Preparations in Killing Bacteria Good Plain soap Better Antimicrobial soap Best Alcohol-based hand rub Guideline for Hand Hygiene in Health-Care Settings MMWR,2009. vol. 51, no. RR-16. ٣٦
  37. 37. Hand Hygiene Options Wet hands, apply soap and rub for >10 seconds. Rinse, dry & turn off faucet with paper towel. Apply to palm; rub hands until dry ~ Use soap and water for visibly soiled hands ~ ٣٧ ~ Do not wash off alcohol handrub ~
  38. 38. Surgical Hand Wash ٣٨
  39. 39. ٣٩
  40. 40. ٤٠
  41. 41. Areas Most Frequently Missed HAHS © 1999 ٤١
  42. 42. ٤٢
  43. 43. Types of PPE used in Healthcare Gloves Masks Head Covers Shoes Covers Gowns Face shields Eye protection ٤٣
  44. 44. Personal Protective Equipment (PPE) ٤٤
  45. 45. ٤٥
  46. 46. Procedures ►Putting on Gowns, Gloves, and Mask Gown: Put on gown so that its edges overlap in back to cover clothing. Fasten closures. Gloves: If worn with gown, pull up over cuffs of gown to protect the wrists. Mask: Apply mask over mouth and nose by securing mask with ties so that it fits tightly over the face. ٤٦
  47. 47. ►Removing Gloves, Gowns, and Mask Gloves: Remove gloves before exiting the patient room by pulling them inside-out, so that the insidecontaminated side is not exposed. Discard in trash receptacle lined with red bag. Gown: Unfasten closures, pull off sleeves and turn gown to the inside so that the contaminated side is not exposed. Place in red bag prior to washing hands and exiting the room . Mask: Remove mask and place in trash receptacle lined with a red bag. ٤٧
  48. 48. ٤٨
  49. 49. ISOLATION PRECAUTIONS Types of Isolation Precautions 1- Standard Precautions Standard precaution (SP) is the primary strategy for preventing transmission of microorganisms to patients, They are applied to all patients . ٤٩
  50. 50. Practical Issues and Considerations ► Hand Hygiene. ► Personnel Protective Equipment (PPE). ► Safe Use of Sharps. ► Monitoring Staff Health. ► Cleaning and Disinfecting Patient Care Equipment. ► Disposing of Waste Safely. ► Cleaning the Environment. ► Removing Spills of Blood Fluids and Body ٥٠
  51. 51. Expanded Precautions Expanded precautions are designed for patients with documented or suspected infection with communicable or epidemiologically important pathogens for which additional precautions beyond SP are needed to interrupt transmission. The aim of isolating a patient is to prevent the spread of communicable ٥١
  52. 52. Types of Expanded Precautions Airborne Precautions Pulmonary TB Meseals Chickenpox Droplet Precautions Meningitis Influenza A H1N1 Mumps Contact Precautions MDR ٥٢
  53. 53. ٥٣
  54. 54. ٥٤
  55. 55. ٥٥
  56. 56. ٥٦
  57. 57. ٥٧
  58. 58. CONTACT PRECAUTIONS ► ► The patient is placed into a private room whenever possible. Cohorting patients with the same organism may be done if needed. A GOWN AND GLOVES MUST BE WORN BY ALL ENTERING THE ROOM! THIS INCLUDES VISITORS. Dietary staff that are delivering trays are required to wear gloves, not gowns. ► When providing care, change gloves after contact with any infective material such as wound drainage. ► Remove the gown and gloves and perform hand hygiene before leaving the room (take care not to touch any potentially infectious items or surfaces on the way out). ► Dedicate the use of non-critical patientnonpatientcare equipment to a single patient. If use of common equipment is unavoidable, adequately clean and disinfect it before use with other patients. ٥٨
  59. 59. Isolation Precautions ٥٩
  61. 61. ٦١
  62. 62. OBJECTIVES ►What the risk of exposure? ►How we can prevent the exposure? ►If the exposure is already done, what is the exposure management plan? ٦٢
  63. 63. Bloodborne Pathogen Exposures TYPES OF EXPOSURE Percutaneous Exposure Mucous Membrane High Risk Exposure Moderate Risk Exposure . Cutaneous Low Risk Exposure ٦٣
  64. 64. Exposure Control PLAN The single most effective measure to control the transmission of Bloodborne Pathogens is: Standard Precautions Treat all human blood and other potentially infectious materials like they are infectious for Hepatitis B&C and HIV ٦٤
  65. 65. Safer Sharps ٦٥
  66. 66. SHARP INJURIES PREVENTION ► Avoid rushing when handling needles and sharps. ► Dispose all needles and other sharps promptly. Place used disposable items in puncture resistant biohazard containers for disposal. DO NOT re-cap needles. re► In the event recapping is unavoidable, the one-handed scoop onetechnique or a needle recapping device shall be used. ► Sharps containers shall be labeled as “sharps waste” and biohazardous with international biohazardous symbol. ٦٦
  67. 67. ٦٧
  68. 68. ► Sharp containers shall be filled up to three quarters and taped closed or tightly lidded. ► Sharps containers are placed in yellow bags by housekeeping personnel for storage and then processing. ► Sharps waste is disposed of in sharps containers as close to site of use as possible. ► In-patient rooms shall have wall Inmounted “Sharps Container” system, Container” which is kept near the patient’s bed and patient’ is securely locked. ٦٨
  69. 69. To safely recap needles use “the one-hand” one-hand” technique Step 1 ► Place the cap on a flat surface, then remove your hand from the cap. Step 2 ► With one hand, hold the syringe and use the needle to “scoop up” the cap. Step 3 ► When the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub). ٦٩
  70. 70. VACCINATION ٧٠
  72. 72. ► The employee concerned should immediately wash away the contaminating fluid. If blood or body fluids get in the mouth, spit out and then rinse mouth with water several times. ► If there is a puncture wound, wash with soap and water and disinfected by Alcohol or Betadine. ► If the eyes are contaminated (may be more dangerous than an NSI) rinse well with tap water or saline. ٧٢
  73. 73. ► Should be in detail with completion of the appropriate form. ► Report should include details of the incident ,date & time of incident , people involved ,any witnesses to the incident. ► All occupational exposures must be fully documented to meet relevant legal requirement. ٧٣
  74. 74. Exposed HCWs CHECK Source CHECK HBsAg Anti-HCV Anti-HIV Injury Percutaneous exposure ( High Risk Exposure ) Mucous membrane ( Moderate Risk Exposure ) Cutaneous- exposure to non-intact skin ٧٤ (Low Risk Exposure)
  75. 75. ٧٥
  76. 76. ►Source is –ve for HBV,HCV,HIV Anti-HBs Ab titre > 10 IU /ML IMMUNE < 10 IU /ML NON IMMUNE ٧٦ POST-EXPORUE PROPHYLAXIS
  77. 77. Source is +ve or likely to be +ve forHBV forHBV Anti-HBs Ab +Ve IMMUNE - Ve NON IMMUNE POST EXPOSURE PROPHYLAXIS ٧٧
  78. 78. Post Exposure Prophylaxis Immunogluline Vaccination Follow up ٧٨
  79. 79. Clinical or serological Evidence of acute hepatitis Seek for clinical advise Repeat HBs Ag at 1 & 6 months No plasma,bl,body tissue donation. Protect sexual partner. Highest risk ٧٩ percuteneous exporure,modify WP.
  80. 80. Source is +ve or likely to be +ve for HCV Screening HCV-IgG -Ve -No infection -Early infection -False -ve +Ve -Current infection -past infection -False +ve Confirmatory HCV-RNA by real-time PCR +ve Confirms active HCV replication -ve Does not confirm absence of ٨٠ HCV replication
  81. 81. Clinical or serological evidence of acute hepatitis Seek for clinical advise HCV-RNA by PCR repeated After 2 months HCV-IgG repeated after 6 to 9 months No plasma,bl,body tissue donation Protect the sexual partner . Hihgest risk percutaneous exposure,modify WP. ٨١
  82. 82. Source is +ve or likely to be +ve for HIV ► Postexporue Prophylactic treatment is indicated. ► It must be commenced as soon as possible .preferably within hours rather than days . ► It should be administrated for 4 weeks. ► If PEP is offered & taken &the source is later determined to be HIV -ve ,PEP should be discontinued. ٨٢
  83. 83. Repeated HIV screening at 1 & 3 & 6 months Until screening for seroconversion is completed ٨٣
  85. 85. ٨٥
  86. 86. ٨٦
  87. 87. ٨٧