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INFECTION AND PREVENTION CONTROL. presentation.pptx
- 1. WHAT IS IPC? WHATIS THE DEFINITION OF INFECTION PREVENTION & CONTROL?
- 2.
- 3. OBJECTIVES ■ KNOW THEHISTORICAL BACKGROUND OF HAND HYGIENE. ■ IDENTIFY KEY DEFINITIONS RELEVANT TO HAND HYGIENE. ■ BE FAMILIAR WITH THE REQUIREMENTS OF A HAND HYGIENE FACILITY. ■ DISTINGUISH DIFFERENT ACCEPTABLE HAND HYGIENE ANTISEPTICS. ■ RECOGNIZE THE 5 MOMENTS OF HAND HYGIENE. ■ DIFFERENTIATE MEDICAL AND SURGICAL HAND HYGIENE. ■ ELABORATE COMMON REASONS OF NON-COMPLIANCE TO HAND HYGIENE. ■ UNDERSTAND THE WHO COMPLIANCE MONITORING TOOL.
- 4. OUTLINE OF TOPICS I.HISTORY OF HAND HYGIENE II. KEY DEFINITIONS AND TECHNIQUES IN HAND HYGIENE III. HAND HYGIENE FACILITY IV. CONTENT (HAND RUB AND SOAP) V. YOUR 5 MOMENTS OF HAND HYGIENE VI. MEDICAL AND SURGICAL HAND HYGIENE VII. COMMON REASONS FOR NON COMPLIANCE TO HAND HYGIENE VIII. STRATEGIES TO IMPROVE HAND HYGIENE COMPLIANCE IX. HAND HYGIENE COMPLIANCE MONITORING (WHO TOOL)
- 5. DOH NATIONAL STANDARDSIN INFECTION CONTROL FOR HEALTHCARE FACILITIES PART 1 – STANDARDS ON MANAGEMENT, STRUCTURE, FUNCTIONS AND RESPONSIBILITIES PART II – STANDARDS ON GUIDELINES, POLICIES AND PROCEDURES PART III – STANDARDS ON MICROBIOLOGY SERVICES PART IV – STANDARDS ON SURVEILLANCE PART V – STANDARDS ON EDUCATION AND TRAINING
- 6. DOH AO NO.2016-0002 NATIONAL POLICY ON INFECTION PREVENTION AND CONTROL IN HEALTHCARE FACILITIES 1. HAND HYGIENE 2. ISOLATION PRECAUTIONS 3. PREVENTION AND CONTROL OF HAIS 4. PREVENTION OF TRANSMISSION OF TB 5. PREVENTION AND CONTROL OF MDROS 6. PREPAREDNESS TO CONTROL EMERGING AND RE-EMERGING ID 7. ENVIRONMENTAL SANITATION 8. REPROCESSING OF REUSABLE MEDICAL DEVICES 9. RECORDING AND REPORTING OF HAIS 10. ANTIMICROBIAL STEWARDSHIP PROGRAM 11. SURVEILLANCE OF MDROS 12. HEALTHCARE PERSONNEL AND SAFETY 13. OUTBREAK MANAGEMENT 14. HEALTHCARE WASTE MANAGEMENT
- 7. DOH NATIONAL STANDARDSIN INFECTION CONTROL FOR HEALTHCARE FACILITIES
- 9. I. HISTORY OFHAND HYGIENE
- 10. HISTORY OF HANDWASHING 18221846 1961 1975 & 1985 1988 & 1995 1995 & 1996 2002 2009 2011 Solutions containing chloride of lime or soda used as disinfectants and antiseptics. Ignaz Philipp Semmelweis insisted that physicians cleanse their hands with chlorine solution between patients. The U.S. Public Health Service recommendations directed personnel to wash their hands with soap and water for 1 to 2 minutes before and after patient contact. Guidelines on hand washing practices in hospitals were published by CDC. The 1995 APIC guidelines included discussion of alcohol-based hand rubs. HICPAC recommended patients with multi-drug resistant pathogens caregivers use either antimicrobial soap or a waterless antiseptic agent to cleanse their hands. Guideline for Hand Hygiene in Health-Care Settings was published. WHO recommended the use of alcohol- based hand rubs as the preferred means for routine hand antisepsis. Various profession groups have undertake studies to identi factors that improv adherence to han hygiene protocol
- 11. II. KEY DEFINITIONS ANDTECHNIQUES TO HAND HYGIENE
- 12. DEFINITIONS ■ HAND HYGIENE –PERFORMING HANDWASHING, ANTISEPTIC HANDWASH, ALCOHOL- BASED HANDRUB, SURGICAL HAND HYGIENE/ANTISEPSIS. ■ HANDWASHING – WASHING HANDS WITH PLAIN SOAP AND WATER. ■ ANTISEPTIC HANDWASH – WASHING HANDS WITH WATER AND SOAP OR OTHER DETERGENTS CONTAINING AN ANTISEPTIC AGENT. ■ ALCOHOL-BASED HANDRUB – RUBBING HANDS WITH AN ALCOHOL-CONTAINING PREPARATION. ■ SURGICAL HAND HYGIENE/ANTISEPSIS – HANDWASHING OR USING AN ALCOHOL-BASED HANDRUB BEFORE OPERATIONS BY SURGICAL PERSONNEL.
- 13. DEFINITIONS POINT-OF-CARE – REFERS TOTHE PLACE WHERE THREE ELEMENTS OCCUR TOGETHER: THE PATIENT, THE HEALTH-CARE WORKER, AND CARE OR TREATMENT INVOLVING PATIENT CONTACT (WITHIN THE AT THE POINT-OF-CARE Optimal Hand Hygiene Should Be
- 14. MOST FREQUENT SITESOF INFECTION AND THEIR RISK FACTORS LOWER RESPIRATORY TRACT INFECTIONS Mechanical ventilation Aspiration Nasogastric tube Central nervous system depressants Antibiotics and anti-acids Prolonged health-care facilities stay Malnutrition Advanced age Surgery Immunodeficiency 13% BLOOD INFECTIONS Vascular catheter Neonatal age Critical care Severe underlying disease Neutropenia Immunodeficiency New invasive technologies Lack of training and supervision 14% SURGICAL SITE INFECTIONS Inadequate antibiotic prophylaxis Incorrect surgical skin preparation Inappropriate wound care Surgical intervention duration Type of wound Poor surgical asepsis Diabetes Nutritional state Immunodeficiency Lack of training and supervision 17% URINARY TRACT INFECTIONS Urinary catheter Urinary invasive procedures Advanced age Severe underlying disease Urolitiasis Pregnancy Diabetes 34% LACK OF HAND HYGIEN E
- 15. WHAT LIVES ONOUR HANDS? RESIDENT FLORA: ▪ IS OUR “NORMAL SKIN FLORA” ▪ DEEP SEATED ▪ DIFFICULT TO REMOVE ▪ PART OF BODY’S NATURAL DEFENCE MECHANISM ▪ ASSOCIATED WITH INFECTION FOLLOWING SURGERY/INVASIVE PROCEDURES. Transient flora: ▪ Superficial ▪ Transferred with ease to and from hands ▪ Important cause of cross infection ▪ Easily removed with good hand hygiene. ▪ Generally survive on the skin of the hands for less than 25 hours
- 16. 5 STAGES OFHAND TRANSMISSION Germs present on patient skin and immediate environmen t surfaces Germ transfer onto health- care worker’s hands Germs survive on hands for several minutes Suboptimal or omitted hand cleansing results in hands remaining contaminate d Contaminate d hands transmit germs via direct contact with patient or patient’s immediate environment ONE TWO THREE FOUR FIVE
- 17. HAND HYGIENE THE MOSTIMPORTANT WAY TO PREVENT TRANSMISSION OF MICROORGANISMS AND INFECTION
- 18.
- 19. HANDWASHING STATIONS COMMONREQUIREMENTS ■ DEEP BASINS TO PREVENT SPLASHING – SHALL NOT BE LESS THAN 144 SQ. IN – MINIMUM 9-IN WIDTH OR LENGTH. ■ THE DISCHARGE POINT OF THE FAUCET SHALL BE AT LEAST 10 INCHES ABOVE THE BOTTOM OF THE BASIN. ■ SINK-TO-PATIENT BED RATIO SHOULD BE OF 1:10. ■ BASINS OR COUNTERTOPS SHALL BE MADE OF PORCELAIN, STAINLESS STEEL, OR SOLID SURFACE MATERIALS.
- 20. HANDWASHING STATIONS COMMONREQUIREMENTS ■ DEEP BASINS TO PREVENT SPLASHING – SHALL NOT BE LESS THAN 144 SQ. IN – MINIMUM 9-IN WIDTH OR LENGTH. ■ THE DISCHARGE POINT OF THE FAUCET SHALL BE AT LEAST 10 INCHES ABOVE THE BOTTOM OF THE BASIN. ■ SINK-TO-PATIENT BED RATIO SHOULD BE OF 1:10. ■ BASINS OR COUNTERTOPS SHALL BE MADE OF PORCELAIN, STAINLESS STEEL, OR SOLID SURFACE MATERIALS.
- 21. OTHER THINGS NEEDEDFOR HAND HYGIENE Running Clean Water Soap Paper Towel / Jet Air Dryer Trash Bin Posters
- 22. ALCOHOL-BASED HAND RUB(AHBR) STORAGE: ■ THE WHO–RECOMMENDED FORMULATION HANDRUB SHOULD NOT BE PRODUCED IN QUANTITIES EXCEEDING 50 L. LOCATION OF DISPENSERS: ■ HANDRUB DISPENSERS SHOULD NOT BE PLACED ABOVE OR CLOSE TO POTENTIAL SOURCES OF IGNITION. ■ HANDRUB DISPENSERS SHOULD NOT BE SITED IN ANY CORRIDOR THAT FORMS PART OF A MEANS OF ESCAPE (I.E. OUTSIDE THE WARD). IF DISPENSERS ARE PLACED IN A CIRCULATION AREA WITHIN A WARD (E.G. OUTSIDE BEDDED AREAS) IT IS RECOMMENDED THAT THEY ARE AT LEAST 1.2 METRES APART, THE CIRCULATION AREA IS AT LEAST 2 METRES WIDE AND THE MAXIMUM CONTAINER SIZE IS 1 LITRE.
- 23. IV. CONTENT (HAND RUBAND HAND SOAP)
- 24. ALCOHOL-BASED HAND RUB(AHBR) ALCOHOL SOLUTIONS CONTAINING 60 –80% ALCOHOL ARE MOST EFFECTIVE, WITH HIGHER CONCENTRATIONS BEING LESS POTENT. FRAGRANCE PRODUCTS WITH STRONG FRAGRANCE MAY LEAD TO DISCOMFORT AND RESPIRATORY SYMPTOMS. CONSISTENCY / TEXTURE HANDRUBS ARE AVAILABLE AS GELS, SOLUTIONS, OR FOAMS: ■ GELS–MAY PRODUCE A FEELING OF HUMECTANT “BUILD-UP”, OR THE HANDS MAY FEEL SLIPPERY OR OILY WITH REPEATED USE. ■ SOLUTIONS–CONSISTENCY SIMILAR TO WATER. OFTEN DRY MORE QUICKLY ■ FOAMS–LESS FREQUENTLY USED AND MORE EXPENSIVE, MAY
- 25. ANTIMICROBIAL ACTIVITY ANDSUMMARY OF PROPERTIES OF ANTISEPTICS USED IN HAND HYGIENE GOOD = +++ MODERATE = ++ POOR = + VARIABLE = ± NONE = – HR: HANDRUBBING; HW: HANDWASHING *ACTIVITY VARIES WITH CONCENTRATION. A BACTERIOSTATIC. B IN CONCENTRATIONS USED IN ANTISEPTICS, IODOPHORS ARE NOT SPORICIDAL. C BACTERIOSTATIC, FUNGISTATIC, MICROBICIDAL AT HIGH CONCENTRATIONS. D MOSTLY BACTERIOSTATIC. E ACTIVITY AGAINST CANDIDA SPP., BUT LITTLE ACTIVITY AGAINST FILEMENTOUS FUNGI.
- 26. V. YOUR 5MOMENTS OF HAND HYGIENE
- 27. YOUR 5 MOMENTSOF HAND HYGIENE Clean your hands before touching a patient when approaching him/her! To protect the patient against harmful germs carried on your hands!
- 28. YOUR 5 MOMENTSOF HAND HYGIENE Clean your hands immediately before accessing a critical site with infectious risk for the patient! To protect the patient against harmful germs, including the patient’s own, entering his/her body!
- 29. YOUR 5 MOMENTSOF HAND HYGIENE Clean your hands as soon as a task involving exposure risk to body fluids has ended (and after glove removal)! To protect yourself and the health-care environment from harmful germs!
- 30. YOUR 5 MOMENTSOF HAND HYGIENE Clean your hands when leaving the patient’s side, after touching a patient and his/her immediate surroundings, To protect yourself and the health-care environment from harmful germs!
- 31. YOUR 5 MOMENTSOF HAND HYGIENE Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving without having touched the patient! To protect yourself and the health-care environment against germ spread!
- 32. THE 5 MOMENTSAPPLY TO ANY SETTING WHERE HEALTH CARE INVOLVING DIRECT CONTACT WITH PATIENTS TAKES PLACE
- 33. VI. MEDICAL AND SURGICALHAND HYGIENE
- 34. PREPARATIONS FOR HANDHYGIENE WRISTWATCHES, BRACELETS (EXCEPT KARA) & ALL RINGS (EXCEPT FOR A PLAIN WEDDING BAND) MUST BE REMOVED. Remove jackets/ cardigans/ jumpers/ coats & hang them up in a designated secure area. Long sleeves must be rolled up to above the elbow. If applicable, try to adopt a “Nothing Below the Elbows” policy. • Fingernails should be: • Short (1/4 inch in length) • Clean • Free from nail varnish • Free from nail art • Free from nail extensions • Free from artificial fingernails
- 35. HOW TO HANDWASH WET-LATHER-SCRUB-RINSE-DRY Toeffectively reduce the growth of germs on hands, handwashing must last 40–60 secs and should be performed by following all of the illustrated steps
- 36. To effectively reducethe growth of germs on hands, handrubbing must be performed by following all of the illustrated steps. This takes only 20–30 seconds! HOW TO HANDRUB
- 37.
- 38.
- 39. PUT EMPHASIZE ONTHESE AREAS… 1. Webs of fingers, 2. Thumbs, 3. Palms, 4. Nails, 5. Backs of fingers & hands, 6. Wrists
- 40. VII. COMMON REASONS FORNON- COMPLIANCE TO HAND HYGIENE
- 41. BARRIERS TO HANDHYGIENE ■ INACCESSIBLE HAND HYGIENE SUPPLIES ■ SKIN IRRITATION CAUSED BY HAND HYGIENE AGENTS ■ HAND WASHING AND HYGIENE PRODUCTS THOUGHT TO BE HARMFUL TO THE SKIN ■ PRIORITY OF CARE (THE PATIENT’S NEED TAKES PRIORITY OVER HAND HYGIENE) ■ LACK OF KNOWLEDGE OF THE GUIDELINES ■ LACK OF FEEDBACK TO ENCOURAGE COMPLIANCE ■ INSUFFICIENT TIME FOR HAND HYGIENE ■ FORGETFULNESS ■ HIGH WORKLOAD AND UNDERSTAFFING ■ LACK OF SCIENTIFIC INFORMATION ABOUT HEALTHCARE- RELATED INFECTION RATES
- 42. VIII. STRATEGIES TO IMPROVEHAND HYGIENE COMPLIANCE
- 43. ■ MORE CONVENIENTSINK LOCATIONS ■ PERFORMANCE FEEDBACK, POLICY REVIEWS, MEMO ■ POSTERS, FILMS, BROCHURES, STICKERS ■ LECTURES AND DEMONSTRATIONS ■ ALCOHOL-BASED HAND RUB MADE AVAILABLE ■ ANNOUNCEMENT OF OBSERVATIONS (COMPARED TO COVERT OBSERVATION AT BASELINE) ■ FOCUS GROUP DISCUSSION (FGD) ■ VOICE PROMPTS IF FAILURE TO HANDRUB ■ INTRODUCTION OF WEARABLE PERSONAL HANDRUB DISPENSERS ■ EDUCATION ■ ADMINISTRATIVE SUPPORT
- 44. Based on the evidenceand recommendations from the WHO Guidelines on Hand Hygiene in Health Care (2009), made up of 5 core components, to improve hand hygiene in health- care settings ONE System change Alcohol-based handrubs at point of care and access to safe continuous water supply, soap and towels TWO Training and education Providing regular training to all health-care workers THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions, & knowledge, while providing results feedback to health-care workers FOUR Reminders in the workplace Prompting and reminding health-care workers FIVE Institutional safety climate Individual active participation, institutional support, patient participation What is the WHO Multimodal Hand Hygiene Improvement Strategy? Utilize WHO Hand Hygiene Self-Assessment Framework 2010
- 45. IX. HAND HYGIENE COMPLIANCE MONITORING(WHO TOOL)
- 46. MOST COMMON MODEOF TRANSMISSION OF PATHOGENS IS VIA HANDS! • Infections acquired in healthcare. • Spread of antimicrobial resistance (MDROs). TARGET HAND HYGIENE COMPLIANCE RATE: >80%
- 47. HOW TO MEASUREHAND HYGIENE COMPLIANCE? ■ DIRECT OBSERVATION OF PRACTICE ■ ALCOHOL HAND RUB UTILIZATION ■ TECHNOLOGY MONITORING ■ HEALTHCARE- ASSOCIATED INFECTION (HAI) RATES
- 48. HOW TO OBSERVEHAND HYGIENE? – DIRECT OBSERVATION IS THE MOST ACCURATE METHODOLOGY. – COMPLIANCE SHOULD BE DETECTED ACCORDING TO THE "MY 5 MOMENTS FOR HAND HYGIENE" APPROACH RECOMMENDED BY WHO.
- 49. THE OBSERVER POINTOF VIEW COMPLIANCE WITH HAND HYGIENE (1) performed hand hygiene actions (x 100) -------------------------------------------- required hand hygiene actions (opportunities) COMPLIANCE
- 50. SUMMARY ■ HAND HYGIENEWAS SIGNIFICANTLY INTRODUCED BY SEMMELWEIS. ■ TRANSMISSION OF HEALTH CARE-ASSOCIATED PATHOGENS FROM ONE PATIENT TO ANOTHER VIA HEALTH-CARE WORKERS’ HANDS REQUIRES 5 SEQUENTIAL STEPS. ■ HAND HYGIENE IS THE SINGLE MOST EFFECTIVE PRECAUTION FOR PREVENTION OF INFECTION TRANSMISSION BETWEEN PATIENTS AND STAFF. ■ HAND HYGIENE MAY BE PERFORMANCE OF HANDWASHING, ANTISEPTIC HANDWASH, ALCOHOL-BASED HANDRUB, AND SURGICAL HAND HYGIENE/ANTISEPSIS. ■ HAND HYGIENE FACILITY SHOULD FOLLOW SPECIFIC STANDARDS. ■ HAND HYGIENE FORMULATION FOR HAND ANTISEPSIS SHOULD BE TESTED FOR ITS ANTIMICROBIAL EFFICACY. ■ TO FURTHER FACILITATE EASE OF RECALL AND EXPAND THE ERGONOMIC DIMENSION, THE FIVE MOMENTS FOR HAND HYGIENE ARE NUMBERED ACCORDING TO THE HABITUAL CARE WORKFLOW. ■ HAND HYGIENE COMPLIANCE MONITORING HELPS IDENTIFY THE MOST APPROPRIATE INTERVENTIONS FOR HAND HYGIENE PROMOTION, EDUCATION AND TRAINING.