Basic principles of infection control. Rule of infection control committee. Health care related issues, finance

1. Dr. Mohammed Hajhamad. MB.BCH,
MS.
Surgeon and Endoscopist
basic principles and practice

2. ‫المستشفيات‬ ‫مشكلة‬ ‫شو‬
What this lecture about ??
17-Mar-20
2

3. This is how hospital looks like.
17-Mar-20
3

4. This is the reality !!!
17-Mar-20
4

5. Video
17-Mar-20
5

6.  1.7 million case in 2002
 33,269 high risk newborns
 19,059 healthy newborns
 417,946 in ICUs
 1,266,851 outside ICUs
Kleevens et al. 2007. Public Health Reports,122, 160-617-Mar-20
6

7. Developing countries
 The highest frequencies are
in East Mediterranean and
South-East Asia.
 Rates usually higher than
15%. (WHO 2013)
 In these countries, over
4000 children die of HAI
every day.
 Approximately 50% of all
patients admitted to
neonatal intensive care
units acquire an infection,
and over 50% of them die.
At least 1/3 is preventable.
17-Mar-20
7

8. Nosocomial Infections
Sites
 Urinary tract infection: most common, 30-40%.
 Lower respiratory 15%
 Surgical wound infections 15%.
 Bacteremia, intravenous site infection,
gastrointestinal tract and skin infections 5%.
17-Mar-20
8

9. Nosocomial Infections
Consequences
 1 to 4 extra days for a urinary tract infection
 7 – 8 days for a surgical site infection
 7 – 21 days for a blood stream infection
 7 – 30 days for pneumonia.
17-Mar-20
9

10. 35.7$-45$ billion/year (2007)
5.7$-6.8$ billion/year (2007)
17-Mar-20
10

11. The beginning
 Ignaz Semmelweiss (1818-1865)
 Obstetrician, in Vienna
 Established that high maternal
mortality was due to failure of
doctors to wash hands after
post-mortems.
 Reduced maternal mortality by
90%.
 Ignored and ridiculed by
colleagues.
17-Mar-20
11

12. History of infection control and
in the USA
 1800: Early efforts at wound prophylaxis
 1800-1940: Nightingale, Semmelweis, Lister,
Pasteur
 1940-1960: Antibiotic era begins
 1960-1970’s: Documenting need for infection
control programs.
 1980’s: focus on patient care practices, intensive
care units, resistant organisms, HIV
 1990’s: Hospital Epidemiology = Infection control,
quality improvement and economics.
 2000’s: Healthcare system epidemiology
17-Mar-20
12

13. Objectives
 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
can decrease the incidence of nosocomial
infections and antimicrobial resistance.
17-Mar-20
13

14. Key Definitions
 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.
 Nosocomial Infection (Health-Care-
Associated-Infections): An infection contracted
by a patient or staff member while in a hospital or
health care facility (and not present or incubating
on admission)
17-Mar-20
14

15. Key Definitions
 Disinfection: (‫التطهير‬) The process of microbial
inactivation that eliminates virtually all recognized
pathogenic microorganisms, but not necessarily
all microbial forms (e.g., spores)
 Sterilization (‫التعقيم‬) The use of physical or
chemical procedures to destroy all microbial life,
including large numbers of highly resistant
bacterial endospores.
 Steam sterilization
 Heat sterilization
 Chemical sterilization (Cidex®)
17-Mar-20
15

16. Infection Control Committee
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
17-Mar-20
16

17. Basics of infection control
 Prevention of HAIs is the responsibility of all
individuals and services providers of the
healthcare setting.
 To practice good asepsis, one should know:
what is dirty, what is clean, what is sterile
and how to keep them separate.
 Hospital Infection Control policies &
procedures are applied to prevent spread of
infection in hospital.
17-Mar-20
17

18. Rule of Infection Control Committee
 Achieving optimum hand hygiene.
 Using personal protective equipment.
 Safe handling and disposal of clinical waste
and bodily fluids.
 Achieving and maintaining a clean clinical
environment.
 Good communication, with other health care
workers, patients and visitors
 Training and education.
17-Mar-20
18

19. Infection control precautions
1. Standard Precautions
Should be applied for ALL patients
2. Transmission-based Precautions
– Contact
– Droplet
– Airborne
3. Transmission-based precautions
17-Mar-20
19

20. Standard precautions
 Hand hygiene.
 Respiratory hygiene/cough etiquette.
 Use of personal protective equipment(PPE).
 Prevention of needle sticks/sharps injuries.
 Cleaning and disinfection of the environment
and equipment.
17-Mar-20
20

21. Hands hygiene
TYPES
 Routine Hand wash with plain soap & water is the
mechanical removal of soil and transient bacteria (for
40-60 sec).
 Aseptic hand wash is removal & destruction of
transient flora using anti-microbial soap & water (for 40-
60 sec).
When hands are visibly soiled do wash hands with soap
and water.
 Alcohol hand rub 2cc gel is use (for 15-20 sec).
Use alcohol-based hand rub when hands are not visibly
soiled.
 Surgical hand scrub: removal / destruction of
17-Mar-20
21

22. Advantages of alcoholic hand wash
 Require less time
 Can be strategically placed
 Readily accessible
 Multiple sites
 All patient care areas
 Acts faster
 Excellent bactericidal
activity
 Less irritating
17-Mar-20
22

23. When to Wash our Hands
1. Before & after an
aseptic technique or
invasive procedure.
2. Before & after
contact with a patient
or caring of a wound
or IV line.
3. After contact with
body fluids & excreta
removal.
4. After handling of
contaminated
equipment or laundry.
17-Mar-20
23

24. Hand washing is a Priority
5. Before the administration of medicines
6. After cleaning of spillage.
7. After using the toilet.
8. Before having meals.
9. At the beginning and end of duty.
10. Gloves cannot substitute hand washing
which must be done before putting on
gloves and after their removal.
17-Mar-20
24

25. When to wash your hands
17-Mar-20
25

26. How to Wash our Hands
 Jewelry must be removed. If unable to remove
rings, wash and dry thoroughly around them.
 Wet your hands with running warm water,
dispense about 5 ml of liquid soap of
disinfectant into the palm of the hand.
 Rub hands together vigorously to lather all
surfaces and wrist paying particular attention
to thumbs, finger tips and webs.
17-Mar-20
26

27. 17-Mar-20
27

28. Missed areas
17-Mar-20
28

29. UV light training
17-Mar-20
29

30. Washing hands … save lives
17-Mar-20
30

31. Droplet precautions
In addition to Standard Precautions:
 Use a surgical/medical mask
 Maintain a distance ≥ 1 meter between
infectious patient and others.
 Place patient in a single room or with similar
patients.
 Limit patient movement.
17-Mar-20
31

32. Contact precautions
In addition to Standard Precautions:
 Use non-sterile, clean, disposable gloves,
gown, apron.
 Use disposable or dedicated reusable
equipment (which must be cleaned and
disinfected before use on other patients).
 Limit patient contact with non-infected persons
 Place patient in a single room or with similar
patients.
17-Mar-20
32

33. Airborne precautions
Use for protection against inhalation of tiny
infectious droplet nuclei:
 In addition to Standard Precautions:
–Use particulate respirator /N 95 mask
– Place the patient in adequately ventilated room
(≥ 12 air changes per hour)
– Limit patient movement
 Use airborne precautions during performing
of any aerosol-generating procedures associated
with risk pathogen transmission like bone cutting,
dental procedures.
17-Mar-20
33

34. Respiratory hygiene and cough etiquette
 Part of standard precautions.
 Education of health care workers, patients and
visitors.
 Source control measures ( cover mouth to
prevent dissemination of infectious droplets)
 Perform Hand hygiene
 Spatial separation (> 1 meter) of persons with
acute febrile respiratory symptoms.
17-Mar-20
34

35. Sharp precautions
 Needle stick and sharp injuries carry the risk of blood
born infections e.g. AIDS, HCV,HBV and others.
 Sharp injuries must be reported and notified so that
treatment & post exposure prophylaxis can possible.
 Reusable sharps must be handled with care to avoid
injury during procedure.
 Never recap needles, if necessary use one hand
scoop method.
 Dispose used needles and other sharps immediately
in puncture resistant boxes (sharp container ).
 Sharp Containers: must be easily accessible and at
eye level, must not be overfilled, labeled or color
coded.
17-Mar-20
35

36. 17-Mar-20
36

37. Sharp injury
If a needle pricks you or blood and/or body
fluids enter your eye(s) or mouth:
1. Wash wounds with soap and water
2. Flush eyes and mouth with water
3. Check the patient record to see if the patient
is HIV+, HIV- , or untested
4. Check patient record for Hepatitis B or C
infection
5. Call the medical duty immediately.
17-Mar-20
37

38. Medical wastes disposal
 Waste must be placed
in color coded,
leakage proof bags,
collected with barrier
precautions like
gloves. (Yellow and
Blue)
 Contaminated waste
incinerated or better
autoclaved prior to
disposal in a landfill
according to local
regulations.
17-Mar-20
38

39. Handling of contaminated material
 Cleaning of Blood/Body Fluid spills:
a- wear gloves gown mask.
b- wipe-up the spill with paper towel.
c- apply disinfectant Clorox for 2 to 10 minutes.
 Cleaning & decontamination of equipment:
Protective barriers must be worn, like gloves.
 Handling & processing lab specimens:
Must be placed in strong plastic bags with biohazard
label.
 Handling and processing linen:
Soiled linen must be handled with barrier precautions
like gloves & mask and sent to laundry in coded bags
in designated trolleys.
17-Mar-20
39

40. Environmental decontamination
 Cleaning MUST precede decontamination
 Disinfectant ineffective if any organic matter is
present.
 Use mechanical force
- Scrubbing
- Brushing
- Flush with water
 Wipe nonporous surfaces with sponge or wet
cloth allow to dry.
 Use fresh diluted Clorox/bleach daily!
- 100 ml Clorox into 900ml water
17-Mar-20
40

41. Environmental decontamination
17-Mar-20
41

42. Immunization Program
 Ensuring that staff are immuned to vaccine
preventable diseases
 Immunization of new and currently employed
staff
 Continual review of immunization status
17-Mar-20
42

43. “Above all, a hospital must do the patient no
harm”
(Florence Nightingale 1820–1910)
17-Mar-20
43

44. 17-Mar-20
44

45. Time to wake up ….
17-Mar-20
45