This document discusses infection control in the operating room and burn unit. It outlines the basic principles of operating room environment including design, traffic patterns, and divisions. It emphasizes maintaining cleanliness, proper airflow, and minimizing traffic. Guidelines are provided for staff attire and conduct, handling infectious patients, and environmental cleaning. Definitions of burn wound infections are given and sites of environmental contamination in burn units are identified. Modes of transmission and patient susceptibility factors are discussed.
Planning & day today management of OT services is very complex and needs to be understood by all Hospital administrators for successfully running a hospital.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Environmental cleaning depends on Infection Control risk Assessment as High, Moderate & Low Risk Areas. This document includes Procedures & Practices in Hospital for Environmental Cleaning & Disinfection based on cheapest hospital grade disinfectant i.e Clorox / Household Bleach available for especially third world countries.
An operating theater is a facility within a hospital where surgical operations are carried out in an aseptic environment. Historically, the term "operating theatre" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery.
Laundry services in hospitals –linen handling
During any given hospital stay, patients spend most, if not all, of their time in bed.
•That means they are surrounded all day with hospital linens.
•From their gown to their sheets and blankets patients have more contact with these items than anything else in the hospital.
•Adequatesupplyofcleanlinensufficientforcomfortandsafteyofpatientandpersonalappereance&pleasant,neatlyattiredemployeesattendingpatientsinfreshcrispuniformdomuchsellthehospitaltothepublic
•Thereforeitmakessensetoensurethattheyareproperlycleaned,driedandtransportedtoavoidcrosscontamination
Learn about AORN's recommended practices for surgical attire in the perioperative setting. This presentation is from a webinar on August 8, 2012. Listen to the webinar for free to learn more, and you can also earn 1.0 contact hour: www.aorn.org/PreviouslyRecordedWebinars
by - dr. sheetal kapse, 2nd year p.g. student, dept. of oral & maxillofacial surgery, RCDSR, Bhilai, C.G. please contact for any question...email id - sheetal.kpse@yahoo.com
Planning & day today management of OT services is very complex and needs to be understood by all Hospital administrators for successfully running a hospital.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Environmental cleaning depends on Infection Control risk Assessment as High, Moderate & Low Risk Areas. This document includes Procedures & Practices in Hospital for Environmental Cleaning & Disinfection based on cheapest hospital grade disinfectant i.e Clorox / Household Bleach available for especially third world countries.
An operating theater is a facility within a hospital where surgical operations are carried out in an aseptic environment. Historically, the term "operating theatre" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery.
Laundry services in hospitals –linen handling
During any given hospital stay, patients spend most, if not all, of their time in bed.
•That means they are surrounded all day with hospital linens.
•From their gown to their sheets and blankets patients have more contact with these items than anything else in the hospital.
•Adequatesupplyofcleanlinensufficientforcomfortandsafteyofpatientandpersonalappereance&pleasant,neatlyattiredemployeesattendingpatientsinfreshcrispuniformdomuchsellthehospitaltothepublic
•Thereforeitmakessensetoensurethattheyareproperlycleaned,driedandtransportedtoavoidcrosscontamination
Learn about AORN's recommended practices for surgical attire in the perioperative setting. This presentation is from a webinar on August 8, 2012. Listen to the webinar for free to learn more, and you can also earn 1.0 contact hour: www.aorn.org/PreviouslyRecordedWebinars
by - dr. sheetal kapse, 2nd year p.g. student, dept. of oral & maxillofacial surgery, RCDSR, Bhilai, C.G. please contact for any question...email id - sheetal.kpse@yahoo.com
Discover evidence-based practices to prevent sharps injuries and to reduce blood borne pathogen exposure to perioperative patients and personnel. This presentation is from a recent AORN webinar. Listen to the replay for free at http://bit.ly/1asAKXx. When registering for the replay, you can also earn one contact hour through June 27, 2014.
Location and layout of hospital, need of hospital to community,planning,factors and data required in planning,fundamentals and objectives,principles,different stages,equipment planning,icu design and layout,quality quantity and temperature and noise control in hospital,conclusion
Presentation delivered during a Hospital Efficiency Seminar hosted by Institute for Healthcare Optimization on July 25, 2013. Reviews Mayo Clinic experience and outcomes with using variability theory to re-design the management of the operating rooms at Mayo Clinic Florida.
Ic guidelines for burn unit [compatibility mode]drnahla
Infection Control Guidelines for burn unit
Dr. Nahla Abdel Kader.MD, PhD. Infection Control Consultant, MOH Infection Control Surveyor, CBAHI Infection Control Director,KKH.
Hospital intelligent system engineering: Hospital operating room,ICU, clinical laboratory purification decoration engineering, medical gas engineering design and construction,medical equipment and consumables.
Brief overview of OR guideliens and basic etiquette to be maintained in OR.
For interns, undergraduate and surgical residents. This would help to learn correct protocols and unlearn wrong things. Based on evidence from recent cochrane database studies and WHO guidelines for infection control following elective surgeries.
Introduction to operating room (Part one).pdfTalal Albudayri
Introduction to operating
room techniques
Up on completion of this session , you will be a will :
Define common terminologies
Understand physical organization of operating room
Identify deign of operating room
Distinguish traffic flow and activity patterns
Identify operating suite equipment's.
Identify the relationship between operating team
Identify and prevent hazards in operating room
This Manual of Procedures (MOP) was developed to assist and align the efforts in implementing AMS programs in all (Level I, II, and III) hospitals across the country. It seeks to serve as a guide to individual hospitals in the design and establishment of local AMS programs while providing a framework for national-level action and commitment.
Recommendations within this document are, as far as possible, based on review of published literature on strategies that have shown to be effective. Consultation with key members (Infectious Diseases physicians, clinical pharmacists, and Infection Control nurses) from eight (8) pilot hospitals as well as the National Antibiotic Guidelines Committee (NAGCom), other national Infectious Diseases societies and relevant DOH offices were undertaken to obtain a consensus opinion and ensure that this MOP is practical and feasible.
All attempts to consider the context of local culture and practices have been taken in the creation of this MOP. Nonetheless, we have chosen to only define core aspects of the national AMS program without being overly prescriptive. Hospitals are strongly encouraged to adapt this MOP to their individual setting in order to maximize its effectiveness, including reduce barriers to implementation and encourage shared ownership towards the goal of AMS.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
3. Operating Room
Characteristic features:
• Patients are at risk due to exposed wound
• Natural body defenses are depressed
• Most patients are compromised
• Our goal is to decrease Surgical Site Infection
(SSI)
4. Operating Room
• Room needs to be as
clean as possible
• Houses special
equipments that can
be source of infection
• Set up should take
infection control
principles into account
6. Operating Room Divisions
Design and Traffic Pattern – 3 zone concept
Unrestricted Area which includes the patient reception
area, locker rooms, lounges and offices.
Semi-restricted Areas which include the storage areas
for clean and sterile supplies, work areas for storage
and processing of instruments and corridors to
restricted areas of the suite. Traffic is limited to
authorized personnel and patients. Personnel are
required to wear gown and hair covering.
Restricted Area includes all areas where personnel are
required to wear surgical masks and scrub attire at all
times. It includes operating suites, clean core and scrub
areas.
7. Relative humidity should be approximately
30%-60% in most ORs and in the PACU
Air-change rate in OR of 20 to 25 air
changes per hour (ACH)
Recommended temperatures for ORs are
between 68°F and 73°F (20-23°C) during
surgery , and recommendations for the post-
anesthesia care unit (PACU) are between 70°F
and 75°F (21-24°C)
American Society of Heating, Refrigerating and Air-Conditioning
Engineers, Inc. ASHRAE Journal Ventilation
New Ventilation Guidelines
For Health-Care Facilities
8. The IC Team should be notified
whenever the air delivery system
for the OT has been shut down
for maintenance or malfunction.
The IC team in conjunction with
facility engineers will assist with
determination of need for any
environmental monitoring needed
once the ventilation system is re-
established. At a minimum
positive pressure, inspection of
filters and air changes per hour
should be verified prior to use of
the affected OT after
interruption. The theatre should
be used only after clearance
from the IC team.
10. A room may be designated for "precaution
cases"(infectious/communicable)” of an infectious patient.
If possible the room at the farthest corner of the area shall
be assigned for the case, OR it will be scheduled last for
the day, provided it is not a stat case.
12. • The inanimate theatre environment should, under normal circumstances, have
a negligible contribution to the incidence of SSI.
• Floors and walls will never be sterile nor is there any point in trying to
achieve that level of cleaning. Floors are rapidly re-contaminated after
cleaning and disinfection and that they should be cleaned at the end of
each session/case. Disinfectant may not be required, except when cleaning
body fluid spillage.
13. Walls and ceilings are rarely
heavily contaminated, cleaning
them once a month is
reasonable.
Correct site decontamination of
blood and other potentially
infectious materials should be in
compliance with the standards.
Brooms of whatever materials
and vacuum cleaners are not to
be used; wet mops shall be
used instead.
16. Environmental Microbiologic sampling
Routine microbiologic sampling of the OT air or surfaces is not recommended
because the results obtained are only valid for the time period and for the
location sampled. Instead, such studies should be limited to recommendations
from the IC-Team, investigations of clusters or outbreaks of infection, or to
validate changes in the ventilation system (e.g. installation of new AHU).
http://www.ems.org.eg/esic_home/data/giued_part2/Operating%20Theatre.pdf
17. Environmental Decontamination
• Aerosolized Hydrogen Peroxide is a new
method of surface area decontamination
that is recommended recently by Infection
Control experts as an adjunct to our usual
manual cleaning. This method eliminates
the deficiencies and inconsistencies
inherent in manual cleaning contributed
by the human factor.
• UV light no-touch environmental
disinfection using ultra violet technology
19. MOBILITY
The number of persons present during an operation must be as small as
possible
Walking in and out during an operation must be kept to a minimum.
People are the most important source of microorganisms in the OR. It is
also certain that the number of microorganisms in the air increases as
the numberof people and movements in OR increase. Walking in and
out disturbs the flow of air, causing unwanted temperature fluctuations.
21. •A distinction must be made between the general clothing in the
OR complex(scrub suits) and the sterile clothing to be worn over it
by the surgical team immediately surrounding the operating table
•No wrist watches, jewellery or piercings may be worn
22. •In the OR complex, operating room clothing is worn. This clothing is not worn outside
the OR.
•In order to maintain the zone system in practice, it is important that everyone complies
with it.
•When someone has to leave the OR complex for a short time, for instance for brief
administrative activities, a white coat or other item of protective clothing be worn over
the scrub suit. This does not apply when examination or treatment of a patient must
take place in the ward.
•Between operations, clothing is changed when it becomes dirty or wet
•Clean operating room clothing must be put on each day
23. Double Gloving
• The transmission of HBV and HCV from surgeon to patient and
vice versa has occurred in the absence of breaks in technique
and with apparently intact gloves (Davis 2001). Even the best
quality, new latex rubber surgical gloves may leak up to 4% of
the time.
• Single gloves had a blood-hand contact rate of 14% while
surgeons wearing double gloves had only a rate of 5% (Tokars
et al 1995; Tokars et al 1992)
24. Guidelines for Double Gloving
• The procedure involves coming in contact with large amounts
of blood or other body fluids (e.g., vaginal deliveries and
cesarean sections).
• Orthopedic procedures in which sharp bone fragments, wire
sutures and other sharps are likely to be encountered.
• Surgical gloves are reused. (The possibility of inapparent holes
or perforations in any type of reprocessed glove is higher than
with new gloves.)
25. Surgical handwash or surgical handrub must be
performed preoperatively by surgical personnel
to eliminate transient and reduce resident hand
flora.
Pre-operative Hand Hygiene
27. Name ___________________________ Sex_______ Form Control #: _____________
Service provider : Consultant/ Surgeon Resident Nurse Intern Surgical Technician
Department : GS Ortho ENT Uro Others, please specify: ____________________
•Purpose
•To decrease the number of resident and transient microorganisms in the skin.
•To keep the population of microorganisms minimal during the surgical procedure by suppression of growth
•To reduce the hazard of microbial contamination of the surgical wound
•Materials
Antiseptic rub, face mask, cap, eye goggles and nail pick
Surgical Scrub Procedure
Activity Done Not Done Remarks
I. Preparation for Surgical Rub Procedure
General Preparation:
•Skin and nails should be kept clean and in good healthy condition.
•Fingernails should not extend beyond fingertips to avoid glove puncture.
•Fingernail polish should not be worn.
•Artificial materials must not cover natural fingernails.
•Remove all jewelry.
II. Preparation Immediately before Surgical Rub
• Inspect the hands for cuts and abrasions.
• Be sure all hair is covered by headgear/bouffant cap.
• Adjust disposable mask snugly and comfortably over nose and mouth.
• Wear eye goggles if needed.
III. Surgical Rub Procedure
1
Wash hands and forearms with antimicrobial soap (such as chlorhexidine or approved alternative soap) and running water
immediately before beginning the surgical hand scrub.
2 Clean the subungual areas of both hands under running water using disposable nail cleaner
3a
Apply 2-3 ml (6 drops) of antiseptic soap from the dispenser to the hands. (or follow manufacturer’s recommendation)
3b
Wash the hands and forearms for 3 – 6 minutes including at least 30 strokes each hand. Pay particular attention to the fingers,
cuticles and interdigital spaces and working the antimicrobial soap to four sides of the forearm. Avoid splashing your surgical attire.
4
Rinse thoroughly hands and forearms under running water, holding hands higher than elbows and away from surgical attire,
allowing water to drip from flexed elbows.
5
Dry hands and arms with sterile linen before donning sterile gloves and gown. (Double glove if with cuts or abrasions.)
6
Repeat the above procedure on the following instances:
Relief during handing-off process between scrub personnel.
To start another OR procedure.
To return to the sterile field when you already scrubbed out.
32. • Visitors to the operating room include visiting doctors from other
wards, parents of young children while thay are brought to the OR,
partners who attend Cesarean, and technicians
• The number of persons present during an operation must be kept to a
minimum. Everyone must be aware of the risks of infections and must
maintain the necessary discipline.
• The number of movements must be kept to a minimum.
• Visitors who are present during the operation must wear the standard
surgical clothing. For a brief visit (less than or equal to 15mins) overalls
with cuffs around the arms and ankles will suffice. In addition,
disposable masks and hair covers are worn.
For longer visits (more than 15mins) visitors must follow the clothes
changing procedure for the staff
34. Patient's Clothing
•The patient wears operating room clothing.
•The patient does not wear shoes.
•In the OR complex, the patient wears surgical
cap.
35. Transport to and across the transfer area
Transport of the patient to operating room can take place in three ways:
1. On the day of the operation, either in the ward or at the boundary of
the operating area, the patient is lifted onto a clean bed with clean
bedding, which is wheeled next to the operating table. After the
operation, this bed is used again to transport the patient to the recovery
room or the nursing ward.
2. The patient is wheeled to the boundary of the operating room area in
his/her own bed. There, the patient is lifted onto an operating surface on
wheels or a mobilift, after which it is wheeled into the operating room.
After the operation the patient is lifted from this system onto a bed with
clean bedding in the recovery room
36. Transport to and across the transfer area
3. If it is not possible to lift the patient onto a clean bed or an
operating surface on wheels outside the operating room(for
example if the patient is in a traction bed), an exception can
be made and the patient can be wheeled to the operating
table on his/her own "dirty" bed from the nursing ward. In
that case, the bed must be made up with clean bedding in the
nursing ward and domestically cleaned insofar as possible.
•The risk of infection is the same in every part of the transfer
area. No link has been demonstrated between one of the
above-mentioned systems of transport and the chance of
infection. The choice between these three methods can be
based on practical and economic considerations.
•The bed a patient was lying in his/her ward may only be
wheeled to the operating table in exceptional cases.
39. Pre-Operative Showers
• 4% Chlorhexidine
solution used,
preferred night before
and morning of
surgery
• Cochrane review,
showed no clear
evidence or advantage
• Pre-operative shower
reduces SSIs
40. Re-use of Single use Items
• Big issue
• Little available evidence of harm from reuse, FDA
says oversight is warranted
• Problems involved- thousands of equipment and
supplies, re-processing differs, need for authority,
issue of efficacy
41. • Single-use equipment
Reuse of disposable/ single-use equipment
is not recommended. Chemical disinfection
and sterilization processes may damage or
weaken the integrity of single-use items
and make them unsafe for use.
43. INFECTION CONTROL IN THE
BURN UNIT
Ma. Laarni D. Canceran, R.N.
Department Manager, St. Luke’s Medical Center- Global City
44. Burn Wound Patient
• Among patients at highest risk for hospital-
acquired infections
• Have lost a portion of their integument that
would ordinarily be a strong barrier to
invasion of microorganisms
• Necrotic tissue in the burn eschar– combined
with the presence of serum CHON, provides
a rich culture for MOs
45.
46. Infections
• Most common cause of death in burn patients
• Most common site of infection are the burn wound
and lungs
• May also initiate a septic response accompanied
by multi-organ failure
47. Types of Burns
• Majority of Burns– caused by thermal injury
• Adults– flame burns
• Children– scalding and flames
• Others– chemical, electrical, fire cracker injuries
48.
49.
50.
51. Epidemiology of Burn Wounds
The development of infection depends on the
presence of three conditions:
• Source of organisms-
• A. Burn wound of patient
• B. Environment
• C. Endogenous flora
• Mode of transmission
• Susceptibility of the patient.
52. Sites of Environmental Contamination in
Burn Care Facilities
Site Microorganism
Hydrotherapy equipment P. Aeruginosa, E. Cloacae
Sink faucets P. Aeruginosa
Faucet handles P. Aeruginosa
Bars of soap P. Aeruginosa
Towel racks P. Aeruginosa
Sink basins P. Aeruginosa
Transportation equipment P. Aeruginosa
Water supply P. Aeruginosa
Sink drains P. Aeruginosa
53. Sites of Environmental Contamination in
Burn Care Facilities
Site Microorganism
Nebulizer/humidifier water P. Aeruginosa
Counter surface P. Aeruginosa
Bed Rails P. Aeruginosa
Air Providencia stuartii
Chair (hydrotherapy area) E. cloacae
Filling hose E. cloacae
Matresses Acinetobacter calcoaceticus
P. Aeruginosa
54. Mode of Transmission
• Contact-- either via the hands of the
personnel caring for the patient or from
contact with inappropriately decontaminated
equipment.
• Droplet spread.
• Airborne spread.
In general, the larger the burn injury, the greater the
volume of organisms that will be dispersed into the
environment from the patient.
55. Patient Susceptibility
What Lowers Physical Defenses:
• Invasive devices, such as endotracheal tubes,
• Intravascular catheters and urinary catheters,
Bypass the body’s normal defense mechanisms..
56. Mode of TransmissionRisk Factors
• Duration of hospitalization
• Burn wound size
• Transfusions
• Resistance of microorganisms to topical
antibiotic agents
• Resistance of microorganism to systemically
administered antimicrobial agents
57. Characteristics of Burn Wound Infection
• Focal gangrene that spreads throughout the
wound
• Conversion of a partial-thickness wound to a
full-thickness wound
• Hemorrhagic discoloration of sub-eschar tissue
• Focal, multi-focal or generalized dark brown,
black or violaceous discoloration
• Changes in the unburned skin at the wound
margins char. by edema and violaceous
discoloration
60. Definitions for Burn Wound Infections
Burn infections must meet the following criteria:
Criterion 1: Patient has a change in burn wound
appearance or character, such as dark brown,
black or violaceous discoloration of the eschar,
or edema at wound margin
And Histologic examination of burn biopsy
shows invasion of organisms into adjacent
viable tissue
61. Definitions for Burn Wound Infections
Burn infections must meet the following criteria:
Criterion 2: Patient has a change in burn wound
appearance or character, such as dark brown,
black or violaceous discoloration of the eschar,
or edema at wound margin
And At least one of the following:
a. Organisms cultured from blood in the absence of other
identifiable infection
b. Isolation of herpes simplex virus in biopsies
62. Definitions for Burn Wound Infections
Burn infections must meet the following criteria:
Criterion 3: Patient w/ a burn has at least two of
the following signs or symptoms with no other
recognized cause: fever (>38˚C) or hypothermia
(<36 ˚C), hypotension, oliguria (<2oml/hr),
hyperglycemia at previously tolerated level of
dietary carbohydrate, or mental confusion
And at least one of the following:
a. Histo exam of burn biopsy shows invasion of organisms
into adjacent viable tissues
b. Organisms cultured from blood
c. Isolation of herpes simplex virus in biopsies
63. REMINDERS:
• Purulence alone at the burn wound site is
not adequate for the diagnosis of burn
infection; such purulence may reflect
incomplete wound care.
• Fever alone in a burn patient is not adequate
for the diagnosis of a burn infection
because fever may be the result of tissue
trauma or the patient may have an
infection at another site.
64. Prevention and Control
There is evidence that improvements in the
prevention and control of infections in burn
patients has led to improvements in patient
survival
65. BURN WOUND INFECTION CONTROL
MEASURES
Goals:
• Control the transfer of endogenous organisms to
the burn sites
• Prevent the transfer of exogenous organisms from
other persons to patients
66. GENERAL MEASURES
Ward setting
• Burn cases should be accommodated in Burns Unit
• Burns Unit must be physically separated from other areas
• Single rooms should be provided for isolation
Ventilation
• Filtered air at positive pressure into individual rooms,
extracted in the corridor outside each room
• Air from ventilated rooms should be extracted to the
exterior
• No direct airflow between Burns Unit and other areas
67.
68.
69. GENERAL MEASURES
Environmental hygiene
• Daily mopping of furniture, bedside lamps, door
handles or knobs
• No sharing of wash bowls, or furniture (e.g., beds
and chairs)
• Restrict stuffed toys and items which cannot be
effectively decontaminated
• Minimize linen agitation
70. GENERAL MEASURES
Visitors and Traffic Control
• Orient all visitors to burn unit infection control
practices ( i.e. Hand washing, gowning and
isolation precautions)
• Limit amount of visitors present at any one time
• Screen visitors for infection and restrict if present
• Monitor visitors for compliance with infection
control practices
71. GENERAL MEASURES
Hand Washing
• Hand washing should be done before and after
each patient contact with antiseptic .Hand washing
sinks should be conveniently accessed
• Antiseptic hand rub is an alternative for hands
without visible dirt
72. Prevention and Control
Use of Barrier Techniques
- Used to prevent contact transmission of
microorganisms from patient to patient via
contaminated hands and clothing of HCW who provide
direct care
• Use of gloves and gown made of impermeable
material
• Washing of hands before donning of gloves and after
removal of gloves– need not be sterile for routine non-
invasive patient care
• If sink is not directly accessible, alcohol should always
be at bedside (this is a necessity)
73. On Gowns and Aprons...
• Protective gown or apron is worn to prevent soiling
and in-apparent contamination of personal
uniform
• Should be replaced in-between patients
74. On gloving...
• Gloves should be worn when contact with
blood, body fluids, secretions and excretions
• Gloves(sterile) should be worn for burn
wound dressing
• Gloves should be changed when
contaminated with secretions or excretions
from one site prior to contact with another site,
even if care of the patient is not completed
• Hand washing after removing gloves
75. Prevention and Control
Prevention of Cross-Contamination From Inanimate
Surfaces and Food
• Each patient should be assigned his or her own
stethoscope, blood pressure cuff, box of clean
disposable gloves and container(s) of topical
antimicrobial agent
• Items of equipment that must be shared between
patients should be thoroughly cleaned and disinfected
between patients
• Covers on mattresses should be inspected between
patients and mattresses with damaged covers should
not be used
76.
77. Prevention and Control
Prevention of Cross-Contamination From
Inanimate Surfaces and Food
• Raw vegetables have been shown to be a
source of P. Aeruginosa microorganisms that
cause burn wound infections. Patients, as
much as possible should not be fed raw fruits
and vegetables
78. Prevention and Control
Prevention of Cross-Contamination From
Convalescent Patients
• Convalescent burn patients may be a reservoir of
microorganisms for cross-contamination and
infection of burn patients in the acute phase of care
• They are least likely to become infected but may be
ignored as reservoir for patients in intensive care
• Ideally, there should be a separate area for
convalescent patients and nursing staff should
handle patients without crossover between these
two patient care areas
79. Prevention and Control
Hydrotherapy
• Also considers the use of barrier techniques but is a
separate entity in the prevention and control of
infection because of its emphasis on cross-
contamination
• Hydrotherapy is provided in a common area using
common equipment and involves exposure to water
• Effective decontamination of complex equipment
between patients in a limited period may be a major
challenge to burn care personnel
• Always remember that water contacts the entire burn
wounds surface
81. Prevention and Control
Topical Antimicrobial Agents
Daily Wound Care
• Aseptic technique for wound manipulation and
dressing
• All dressing should preferably be done on bedside
• Expose, clean and re-wrap less infected areas first
82. Prevention and Control
Topical Antimicrobial Agents
• Applied to the burn wound surface to diminish
colonization and multiplication of
microorganisms on the surface of the wound
• Most commonly used agents:
1. Silver sulfadiazine
2. Cerium-nitrate-silver-sulfadiazine
• Microbial resistance has been reported
• Administer topical antimicrobial agents
aseptically
83.
84. Prevention and Control
Systemic Antimicrobial Agents
• Extensive use frequently leads to selection of
resistant microorganisms
• Continued use of the same antibiotics provides a
selective advantage for these microorganisms and
are able to proliferate and displace susceptible
microorganisms in and on burn wounds
• Continued colonization may lead to an outbreak
• Appropriate use of antibiotics– use in clearly
indicated situations with appropriate basis
85. ANTIMICROBIALS AND BURNS
• The burn wound will always be colonized with
organisms until wound closure is achieved and
administration of systemic antimicrobials will
not eliminate this colonization but rather
promote emergence of resistant organisms.
• If antimicrobial therapy is indicated to treat a
specific infection, it should be tailored to the
specific susceptibility patterns of the organisms,
86. ANTIMICROBIALS AND BURNS
• Empiric antimicrobial therapy to treat fever
should be strongly discouraged because burn
patients often have fever secondary to the
systemic inflammatory response to burn injury.
• Prophylactic antimicrobial therapy is
recommended only for coverage of the
immediate peri-operative period surrounding
excision or grafting of the burn wound. This
should be discontinued within 24 hours.
87. CULTURING
Why?
• To provide early identification of organisms colonizing the
wound
• To monitor the effectiveness of current wound treatment
• To guide peri-operative or empiric antibiotic therapy
• To detect any cross-colonizations which occur quickly so that
further transmission can be prevented.
When?
• when the patient is admitted and at least weekly until the
wound is closed.
88. Burn Wound Infection Prevention and Control
Summary of Approaches:
• Use of barrier techniques
• Prevention of cross-contamination from inanimate
surfaces and food
• Prevention of cross-contamination from convalescent
patients
• Hydrotherapy
• Application of topical anti-microbial agents
• Appropriate use of systemically administered
antimicrobial agents
90. St. Luke's Medical Center's legacy of excellence surpasses all expectations. For
over a century, St. Luke's superior brand of healthcare service has made it truly
world class.
With astounding success anchored on five pillars of expertise-expert doctors,
state-of-the-art technology, guaranteed patient safety, excellent success rate
and passionate customer service, St Luke's Medical Center is the first hospital in
the country to be accredited by the Joint Commission International(JCI).