Post on 18-Dec-2015
Global Health Prep Course 2008
W. Charles Huskins, MD, MSc
Mayo Clinic, Rochester, MN
November 8, 2008
Infection Prevention in Settings with Limited Resources
Disclosures: None
Healthcare-associated infections in settings with limited resources are…
A. B. C. D.
21%
10%
67%
2%
A. Caused by agents typically associated with infections in tropical settings
B. Infrequent because most care is not associated significant risk
C. Similar to those in settings with adequate resources
D. Unfortunate but mostly unavoidable
Protect Your Patients and Yourself From “community infections” spread in healthcare settings
Respiratory & GI infections
Infection
Person-to-person, via direct, indirect or droplet spread
Contaminated infant formula, enteral feedings
Improperly prepared/stored foodContaminated waterContaminated surfaces
RSV, influenza, etcRotavirus, etcGiardia, Cryptosporidium
SalmonellaShigellaVibrio cholera
Source/causeOrganisms
Airborne spread from infected persons
Measles, varicella, rubella, mumps
Systemic viral infections
Airborne spread from unidentified and/or inadequately treated persons
M. tuberculosisTB
Protect Your Patients and Yourself From “community infections” spread in healthcare settings
• Hand hygiene– Use an alcohol-based hand rub in most situations– Wash hands with soap & water if visible contamination
• Barrier precautions– Wear gloves for contact with blood, body fluids, secretions,
excretions, mucous membranes, & non-intact skinIf limited in supply, use new gloves for contacts with blood &
body fluids and reused gloves for other types of contactsIf limited in supply, dip gloved hands in diluted household bleach
(0.05% chlorine concentration) for 1 minute between contacts; remove soiling by washing with soap and water first.
– Wear goggles & mask if splashing/aerosolization possible– Wear gowns if soiling of clothing is possible
Simple Solutions to Improve Hand Hygiene
Alcohol-based hand rub &container with clean gloves on cart
Cistern with clean water, soap & clean, single use cloth towels on cart
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm
Infection Control for Viral Hemorrhagic Fevers in the African Healthcare Setting
• Detailed descriptions of IC procedures for VHF
• Practical descriptions of general IC procedures– Standard Precautions– Isolation Precautions– Disinfection of reusable
supplies & equipment– Disinfection water for
drinking, cooking & cleaning– Disposal of waste– Safe burial practices
Protect Your Patients and Yourself From “community infections” spread in healthcare settings
• Additional measures for infections spread by airborne or droplet contact– Cohort patients with same disease– Avoid cough-inducing procedures– Ensure adequate ventilation– Close doors and use out-facing window or wall fan to
direct air out of building– Ultraviolet germicidal irradiation may be appropriate in
some situations
http://www.who.int/tb/publications/who_tb_99_269/en/index.html
WHO Guidelines for Preventing Spread of TB in Healthcare Settings
Initial Management of a Patient with Suspected TB
• Provide face mask or tissues
• Instruct in cough hygiene – cover nose and mouth when coughing or sneezing
• Dispose of tissues, cloths or masks in no-touch waste receptacles after use
• Direct to a separate waiting area
• Deliver services quickly (ahead of the queue)
• Refer to a TB diagnostic & treatment facility
Protect Your Patients and YourselfFrom bloodborne infections
Blood productsUnsafe injection practicesContaminated fluids/meds & sharps
Hepatitis B & C viruses
HIV
Hepatitis, AIDS
Source/causeOrganismsInfection
Blood productsUnsafe injection practicesContaminated fluids/meds
Plasmodium sp.Trypanosoma cruzi
MalariaChagas Disease
Direct contact with blood, body fluids, or mucous membranes
Unsafe injection practicesContaminated sharps
Ebola, Lassa Fever, Marburg, etc
Hemorrhagic fever
Protect Your Patients and YourselfFrom bloodborne infections
• Blood products– Eliminate unnecessary transfusions– Screen products appropriately– Administer products appropriately
• Injections– Use sterile needles & syringes– Prevent contamination of injection equipment and
fluids or medications
• Sharps injuries– Avoid handling sharps– Dispose sharps properly
Syringes for Injection Safety Reuse Prevention Feature Reuse & Needlestick
Prevention Features
Internal mechanism blocks plunger once it is fully pressed.
Internal mechanism cracks plunger completely once it is fully pressed
Additional shield to cover needle creating a protective cap
Needle is pulled back inside the syringebarrel upon retraction of the plunger
Protect Your Patients From infections associated with invasive
devices and procedures
IV cathetersContaminated fluids and medications
Gram negative rodsStaph. aureusCandida
Bloodstreaminfections
Source/causeOrganismsInfection
Urinary catheters & open collection systems
Gram negative rodsCandida
Urinary tractinfection
Poor techniqueContaminated instrumentsNo/late/inadequate prophylaxis
Staph. aureus Gram negative rods
Surgical site infection
Intrapartum examsContaminated instrumentsNo/late/inadequate prophylaxis
Gram negative rodsAnaerobes
Postpartum endometritis
Etiology of Invasive Bacterial Infections in Newborns 0-3 day in Hospitals, 1990-2004
E. coli GBS S. aureus OthersKlebsiella, Pseudomonas, Acinetobacter & other gram negative rods
0
10
20
30
40
50
60
70
Africa (n=110) Middle East (n=27) South Asia (n=239) South East Asia (n=91) LatinAmerica/ Caribbean
(n=41)
All developing regions(n=508)
%
Zaidi AKM, Huskins WC, Thaver D, et al. Lancet 2005; 365:1175-88
Protect Your Patients From infections associated with invasive
devices and procedures
• Invasive devices– Eliminate unnecessary use– Remove as soon as possible– Use sterile devices and supplies– Use aseptic technique during insertion and care– Maintain closed systems
• Invasive procedures– Eliminate unnecessary use– Use sterile instruments and supplies– Use aseptic/sterile technique– Use peri-procedure antimicrobial prophylaxis as indicated
(clean-contaminated, contaminated, dirty procedures)
Infection Control Assessment ToolA Standardized Approach for Improving
Hospital Infection Control Practices
• Modules for assessment and problem-solving regarding– Infection control programs
– Practices: hand hygiene, isolation & standard precautions, injections, IV catheters, fluids & meds, urinary catheters, sterilization/disinfection
– Areas: general wards, labor & delivery, surgery, ICUs
– Ancillary services: microbiology, pharmacy, employee health, waste management
• Developed and supported by – Rational Pharmaceutical Management Plus Infection Control
Project team
– USAID Rational Pharmaceutical Management Plus Project, Management Sciences for Health, Washington DC