The document discusses nosocomial (hospital-acquired) infections. It notes that nosocomial infections occur in 5-8% of hospitalized patients, with 1/3 being preventable. They can be transmitted through direct or indirect contact with patients or contaminated surfaces/instruments. Proper infection control practices are important to prevent transmission and protect patients and healthcare workers. These include standard precautions like hand hygiene and use of personal protective equipment, as well as isolation precautions depending on the type of infection.

1. DR LEE OI WAH
PENGARAH HOSPITAL CHANGKAT
MELINTANG

2. Patient may acquire infection before admission to
the hospital = Community acquired infection.
Patient may get infected inside the hospital =
Nosocomial infection.(HAI)
It includes infections
not present nor incubating at admission,
infections that appear more than 48 hours
after admission,
those acquired in the hospital but appear after
discharge
also occupational infections among staff.
Dr.T.V.Rao MD 2

3.  Nosocomial infections occur worldwide.
 The incidence is about 5-8% of
hospitalized patients, 1/3 of which is
preventable.
 The highest frequencies are in East
Mediterranean and South-East Asia.
 A high frequency of N.I. is evidence of
poor quality health service delivered.
Dr.T.V.Rao MD 3

4.  Direct contact with blood or body fluids
 Indirect contact with a contaminated instrument or
surface
 Contact of mucosa of the eyes, nose or mouth with
droplets or spatter
 Inhalation of airborne microorganisms
4

6. Other UTI
27% 23%
Blood
6%
Skin Lower
(May, 2000)
10% Wound respiratory
11% 23%

7. Infection control is a term used that
describes ways we can prevent the
spread of infection.

8. Infections can cause
pain, suffering and often, permanent scarring.
In the worst cases, death can occur.
 Infections cause extra days in the hospital
and lead to higher costs for patients and their
families.

10. INFECTION CONTROL PROGRAM
The important components are :
1) Basic measures i.e. standard and additional precautions
2) Education and training of healthcare workers
3) Protection of healthcare workers e.g. immunization
4) Identification of hazards and minimizing risks
5) Routine practices such as aseptic techniques, handling
and use of blood and blood products, waste
management, use of single use devices
6) Surveillance
7) Incident monitoring
8) Research
Dr.T.V.Rao MD 10

11. There are three principal goals for hospital
infection control and prevention programs:
1. Protect the patients
2. Protect the health care
workers, visitors, and others in the
healthcare environment.
3. Accomplish the previous two goals in a cost
effective and cost efficient
manner, whenever possible.
.
Dr.T.V.Rao MD 11

12. 1. Review and approve surveillance and prevention program
2. Identify areas for intervention
3. To assess and promote improved practice at all levels of
health facility.
4. To ensure appropriate staff training
5. Safety management
6 Development of policies for the prevention and control of
infection
7. To develop its own infection control manual
8. Monitor and evaluate the performance of program
Dr.T.V.Rao MD 12

13. Hospital Program
Infection Conrtol Team Infection control committee Infection control manual
Dr.T.V.Rao MD 13

14.  To review and approve the annual plan for
infection control
 To review and approve the infection control
policies.
 To support the IC team and direct resources to
address problems as identified
 To ensure availability of appropriate supplies
 To review epidemiological surveillance data and
identify area for intervention.
Dr.T.V.Rao MD

15.  To assess and promote improved
practice at all levels of the health care
facility
 To ensure appropriate training in
infection control and safety.
 To review risks associated with new
technology and new devices prior to
their approval for use.
 To review and provide input into an
outbreak investigation
Dr.T.V.Rao MD

16. Aiming at preventing spread of infection:
Standard precautions: these measures
must be applied during every patient care, during
exposure to any potentially infected material or
body fluids as blood and others.
Components:
A. Hand washing.
B. Barrier precautions.
C. Sharp disposal.
D. Handling of contaminated material.
Dr.T.V.Rao MD 16

18. Use of water and antimicrobial soap (germ
killing soap) and washing for at least 15
seconds.
Use of an alcohol based hand rub

19.  Before having direct patient contact
 Before wearing sterile gloves and inserting a central venous
catheter
 Before inserting urinary catheters, peripheral vascular
catheters (IVs), or other invasive devices
 After contact with a patient’s intact skin such as taking a
blood pressure or lifting a patient
 After contact with body fluids, excretions, mucous
membranes, nonintact skin, and wound dressings
 If moving from a contaminated body site to a clean-body site
 After contact with objects in the immediate area of the
patient (such as medical equipment)
 After removing gloves

20.  Model good hand
washing/hand hygiene
practices
 ˙ Encourage others to do
the same
 ˙ Maintain hand hygiene
supplies for your area
 ˙ Maintain soap and
paper products for your
area
Dr.T.V.Rao MD 20

21. Taylor (1978) identified
that 89% of the hand
surface was missed and
that the areas of the
hands most often
missed were the finger-
tips, finger-webs, the
palms and the thumbs.

22.  PPE when contamination or splashing with
blood or body fluids is anticipated
 Disposable gloves
 Plastic aprons
 Face masks
 Safety glasses, goggles, visors
 Head protection
 Foot protection
 Fluid repellent gowns (May, 2000)

23.  Prevention
 correct disposal in appropriate container
 avoid re-sheathing needle
 avoid removing needle
 discard syringes as single unit
 avoid over-filling sharps container
 Management
 follow local policy for sharps injury

24.  Sepsis - harmful infection by bacteria
 Asepsis - prevention of sepsis
 Minimise risk of introducing pathogenic
micro-organisms into susceptible sites
 Prevent transfer of potential pathogens
from contaminated site to other
sites, patients or staff
 Follow local policy

25. Another way to prevent the spread of
infectious disease is to place the infectious
patient on special precautions or “isolation”.
The type of precautions depends upon how
the infection is spread.

26.  Contact Precautions are used to prevent
infections spread by touching an infected or
contaminated body site (direct contact) or by
handling objects in the environment that are
contaminated (indirect contact).
 Gastrointestinal (GI) infections such as rotavirus
and antibiotic resistant germs such as Oxacillin
Resistant Staphylococcus aureus (ORSA)can be
spread this way.
 Gowns and gloves will be needed if providing
direct care.

27.  Droplet Precautions are used when a patient has a
disease spread by respiratory droplets.
 The infectious droplets are released when the patient
sneezes or coughs. Since droplets are heavy, they fall
rapidly usually within 3 feet of the patient.
 Whooping cough and meningococcal meningitis are
examples of diseases spread this way.
 A private room is used and all persons entering must
wear a surgical mask.

28.  Airborne Precautions are used to prevent
infections
spread through the air.
 Unlike droplets, the germs involved with airborne
diseases are so small that they can remain in the
air for long periods of time and float on air
currents.
 Tuberculosis, varicella (chickenpox) and measles
are airborne diseases.

29.  Protective Precautions are used for patients who
are at high risk for acquiring infection.
 A private room is used with special ventilation
that prevents air from flowing from the hallway
into the room (positive pressure room).
 Staff and visitors must perform hand hygiene
before entering the room and persons should not
enter the room if they are Sick
 Read the posted sign because at times special
garments or gloves are required before entry.

30. Let’s look at some other important
infection control practices.

31.  Patient care items must be stored in a clean
location at least 8 inches above the floor
 Patient care items must not be stored in
under-sink cabinets.
 Since some items have expiration dates, it is
important to establish a routine for checking
dates.

32. Monitor and maintain temperature between 2
and 8 degrees C
 Keep food/nourishments in a separate
refrigerator from medications/IV fluids
NEVER place lab specimens in a medication or
nourishment refrigerator

33. Regular hospital waste is placed in black trash
bags.
Remember, before discarding items in the
regular trash:
I. Empty fluid-filled containers such as IV bags
and tube feedings
II. Remove any labels which have the patient’s
name and/or medical record number

34.  Malaysian law requires that certain medical waste be
incinerated.
 Regulated medical waste must be placed in yellow trash
bags.
 Examples of regulated medical waste include:
I. Full sharps containers
II. >20ml blood or blood products that cannot be easily
emptied (e.g., pleurevacs, blood administration
tubing, evacuated containers)
III. Microbiology and Pathology specimens
IV. Items used in the preparation and administration of
hazardous drugs

35. Many patient care devices and items are
designed to be used with one patient and
often only one time. These items are
considered disposable and must not be
resterilized or reused.
Read the manufacturer’s directions to be sure
how a device is intended to be used.

36. Reusable patient care devices/items must be
properly cleaned and disinfected following
STRICT guidelines.
 Unless an item has been thoroughly
cleaned, disinfection cannot occur.
 Health care workers responsible for cleaning
and disinfecting reusable patient items must
be trained in these procedures.

37.  Hospital construction generates dust and debris.
 Construction dust, including dust released from the
removal of ceiling tiles, may contain molds that can
cause serious infections in high risk patients.
 Plastic and solid wall barriers are designed to prevent
movement of dust outside the construction site.
 Contact your supervisor or an Infection Control
Professional to report barriers that appear damaged.
 Remember, only authorized personnel should enter a
construction site.

38.  Bedmaking and linen changing techniques
 Gloves and apron - handling contaminated
linen
 Appropriate laundry bags
 Avoid contamination of clean linen
 Hazards of on-site ward-based laundering

39.  PPE - disposable gloves, apron
 Soak up with paper towels, kitchen roll
 Cover area with hypochlorite solution
e.g., Milton, for several minutes
 Clean area with warm water and
detergent, then dry
 Treat waste as clinical waste - yellow
plastic sack

40. Dr.T.V.Rao MD 40

41. Dr.T.V.Rao MD 41