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Transcript of 7.Hospital Infection,OTdiscipline c
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Hospital infection and
OT discipline
Professor Panna Lal Saha
Professor of Surgery & HeadDepartment of Surgery
BGC Trust Medical College
Chittagong
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Definition
Nosocomial infections are
infections which are a result of
treatment in a hospital or a
healthcare service unit, but
secondary to the patient's
original condition.
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Definition
Infections are considered
nosocomial if they first appear
48 hours or more after hospital
admission or within 30 days
after discharge.
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Definition
Nosocomial comes from the
Greek word nosokomeion
() meaning hospital
(nosos = disease, komeo = to
take care of). This type of
infection is also known as ahospital-acquired infection (or
more generically healthcare-
associated infections).
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Introduction
Nosocomial infections are even more
alarming in the 21st century as
antibiotic resistance spreads.Reasons why nosocomial infections
are so common include:
Hospitals house large numbers of
people who are sick and whoseimmune systems are often in a
weakened state;
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Introduction
Increased use of outpatient
treatment means that people who
are in the hospital are sicker onaverage;
Medical staff move from patient to
patient, providing a way for
pathogens to spread;
Many medical procedures bypass the
body's natural protective barriers;
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Introduction
Sanitation protocol regardinguniforms, equipment sterilization,washing, and other preventative
measures may be either unheeded byhospital staff or too lax to sufficientlyisolate patients from infectiousagents.
Patients are often prescribedantibiotics and other anti-microbialdrugs to help treat illness; this mayincrease the selection pressure for
the emergence of resistant strains.
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Introduction
Thorough hand washing
and/or use of alcohol rubsby all medical personnel
before each patient
contact is one of the mosteffective ways to combat
nosocomial infections.
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Introduction
More careful use of
anti-microbial agents,such as antibiotics, is
also considered vital.
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Epidemiology
As many as 92 percent of deaths
from hospital infections could be
prevented. The most commonnosocomial infections are :
Urinary tract infection: 40%;
infection of the skin and mucous
membrane: 10.8%; infections of surgery site: 10.3%;
Pneumopathy : 10%.
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Transmission
Microorganisms are transmitted inhospitals by several routes, and the
same microorganism may betransmitted by more than one route.There are five main routes oftransmission
Contact
Droplet
Airborne
Common vehicle
Vector borne
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Transmission
Contact transmission, themost important and frequent
mode of transmission ofnosocomial infections, isdivided into two subgroups:
direct-contact transmissionand indirect-contacttransmission.
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Transmission
Direct-contact transmission involves adirect body surface-to-body surfacecontact and physical transfer of
microorganisms between a susceptiblehost and an infected or colonized person,such as occurs when
A person turns a patient,
Gives a patient a bath, or
Performs other patient-care activities thatrequire direct personal contact.
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Transmission
Indirect-contact transmission
involves contact of a susceptible
host with a contaminated
intermediate object, usually
inanimate, such as contaminated
instruments, needles, or dressings,
or contaminated gloves that are not
changed between patients.
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Transmission
Droplet transmission occurs whendroplets are generated from the
source person mainly during coughing,sneezing, and talking, and during theperformance of certain proceduressuch as bronchoscopy. Transmissionoccurs when droplets containinggerms from the infected person arepropelled a short distance through theair and deposited on the host's body.
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Transmission
Airborne transmission occurs bydissemination of either airbornedroplet nuclei of evaporated dropletscontaining microorganisms thatremain suspended in the air for longperiods of time or dust particlescontaining the infectious agent.Microorganisms transmitted byairborne transmission includeMycobacterium tuberculosis and therubeola and varicella viruses
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Predisposition to
infection Factors predisposing a patient to
infection can broadly be divided
into four areas:
People in hospitals are usually
already in a poor state of health,
impairing their defense againstbacteria
Advanced age or premature
birth
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Predisposition to
infectionAlong with immunodeficiency
(due to drugs, illness, or IR
radiation) present a general risk,
While other diseases can present
specific risks - for instance
chronic obstructive pulmonarydisease can increase chances of
respiratory tract infection.
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Predisposition to
infection Invasive devices, for instance
intubation tubes, catheters, surgical
drains and tracheostomy tubes allbypass the bodys natural lines of
defence against pathogens and
provide an easy route for infection.
Patients already colonised onadmission are instantly put at
greater risk when they undergo an
invasive procedure.
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Predisposition to
infection A patients treatment itself can leave
them vulnerable to infection
immunosuppression and antacidtreatment undermine the bodys
defenses, while antimicrobial therapy
(removing competitive flora and only
leaving resistant organisms) andrecurrent blood transfusions have also
been identified as risk factors.
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Prevention
Isolation: Isolation precautions are designed
to prevent transmission of microorganisms by common routesin hospitals. Because agent and hostfactors are more difficult to control,
interruption of transfer of microorganisms is directed primarilyat transmission.
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Hand washing and
gloving
Hand washing frequently is called the single
most important measure to reduce the risks of
transmitting microorganisms from one person to
another or from one site to another on the same
patient. Washing hands as promptly and
thoroughly as possible between patient contacts
and after contact with blood, body fluids,secretions, excretions, and equipment or articles
contaminated by them is an important
component of infection control and isolation
precautions.
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Hand washing and
gloving Although handwashing may seem like a
simple process, it is often performed
incorrectly. Healthcare settings mustcontinually remind practitioners andvisitors on the proper procedure inwashing their hands to comply withresponsible handwashing. Simple
programs such as Henry the Hand, andthe use of handwashing signals canassist healthcare facilities in theprevention of nosocomial infections.
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Hand washing and
gloving All visitors must follow the same
procedures as hospital staff toadequately controlled the spread of
infections. Visitors and healthcare personnel
are equally to blame in transmittinginfections.
Moreover, multi-drug resistantinfections can leave the hospital andbecome part of the community floraif we don't take steps to stop thistransmission.
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Hand washing and gloving
In addition to handwashing, gloves playan important role in reducing the risks oftransmission of microorganisms. Glovesare worn for three important reasons inhospitals.
First, gloves are worn to provide aprotective barrier and to prevent grosscontamination of the hands whentouching blood, body fluids, secretions,
excretions, mucous membranes, andnonintact skin; the wearing of gloves inspecified circumstances to reduce therisk of exposures to bloodbornepathogens is mandated by the OSHA
Bloodborne Pathogens final rule .
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Hand washing and
gloving Second, gloves are worn to reduce the
likelihood that microorganisms present onthe hands of personnel will be transmitted to
patients during invasive or other patient-careprocedures that involve touching a patient'smucous membranes and non intact skin.
Third, gloves are worn to reduce thelikelihood that hands of personnelcontaminated with microorganisms from a
patient or a fomite can transmit thesemicroorganisms to another patient. In thissituation, gloves must be changed betweenpatient contacts and hands should bewashed after gloves are removed.
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Hand washing and
gloving Wearing gloves does not replace the
need for handwashing, because
gloves may have small, non-apparentdefects or may be torn during use,
and hands can become
contaminated during removal of
gloves. Failure to change glovesbetween patient contacts is an
infection control hazard.
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Aprons
Wearing an apron during patient
care reduces the risk of
infection. The apron shouldeither be disposable or be used
only when caring for a specific
patient.
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Mitigation
The most effective of controllingnosocomial infection is to strategicallyimplementing QA / QC measures to the
health care sectors and evidence-basedmanagement can be a feasibleapproach. For those VAP/HAP (ventilatorassociated pneumonia/health careassociate pneumonia) diseases,
controlling and monitoring hospitalindoor air quality needs to be on agendain management whereas for nosocomialrotavirus infection, a hand hygieneprotocol has to be enforced.
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OT DISCIPLINE
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OT DISCIPLINE
In operation theatre properdress of patient, paramedics
and all doctors to wellmaintained
Dress includes pant, shirt footwear etc.
Area limitation should be wellmaintained
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OT DISCIPLINE
OT to be designed such a way
that thorough fare must be
blocked
Limitation of movement by
everyone to be monitored
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OT DISCIPLINE
Good hygienic practice in hospitals
and other medical institutions ismandatory to avoid or to minimise
nosocomial infections
Official recommendations for
hospital hygiene and infection
control is necessary
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OT DISCIPLINE
Automatic door closers isessential for operation theatre.
Operation theatre areas musthave correct hand washingsystem in appropriately designedareas.
Recommendations regardingsurgical drapes and gowns shouldbe correctly maintained.
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OT DISCIPLINE
No toilet facilities should be
maintained with in the actual OT
complex. Harmony to be maintained in
hygienic procedures between
nursing service and physicians.
Laminar air flow air conditioningsystems should be maintained in
whole ot complex area.
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OT DISCIPLINE
Cleaning and disinfection after
single operations and at the end
of the operating day to be carriedout correctly .
Manual preparation and
disinfection / sterilization ofsurgical instruments to be
avoided.
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OT DISCIPLINE
All the instruments and other
materials used in operationpurpose to be sterilized
For this protocol to be
maintained
Dress to be prepared such a way
that personal identity can be
easily evident.
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