INFECTION CONTROL FOR HCW

DR LEE OI WAHPENGARAH HOSPITAL CHANGKAT

MELINTANG

Dr.T.V.Rao MD 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.

THE RISK OF INFECTION IS ALWAYS PRESENT IN EVERY HOSPITAL

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FREQUENCY OF NOSOCOMIAL INFECTION

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

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

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MODES OF TRANSMISSION

CRITERIA OF NOSOCOMIAL INFECTIONS

Common types of HAI

Other

27%

UTI

23%

Lower

respiratory

23%

Wound

11%

Skin

10%

Blood

6%

(May, 2000)

WHAT IS INFECTION CONTROL?

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

Infections can causepain, 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.

Why is infection controlimportant in health care?

Dr.T.V.Rao MD 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

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GOALS FOR INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY

There are three principal goals for hospital infection control and prevention programs:

1. Protect the patients2. 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.

.

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INFECTION CONTROL COMMITTEE

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

In fec tio n C on r to l T e am In fec tion co n tro l co m m ittee In fec tio n co n tro l m a nu a l

H osp ita l P ro gram

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Dr.T.V.Rao MD 14

THE ICC HAS THE FOLLOWING TASKS:

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

THE ICC HAS THE FOLLOWING TASKS (CONT):

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

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SCOPE OF INFECTION CONTROL

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.

HAND HYGIENE

Use of water and antimicrobial soap (germ killing soap) and washing for at least 15 seconds.

Use of an alcohol based hand rub

When should you perform hand hygiene? 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

Dr.T.V.Rao MD 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

MAKE OUR HOSPITAL A MODEL FOR HAND WASHING

Hand washing – areas missed

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.

Personal protective equipment

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)

Sharps injuries Prevention

correct disposal in appropriate container

avoid re-sheathing needleavoid removing needlediscard syringes as single unitavoid over-filling sharps container

Management follow local policy for sharps injury

Aseptic technique

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

ISOLATION

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.

What are Contact Precautions?

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.

What are Droplet Precautions?

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.

What are Airborne Precautions?

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.

What are Protective Precautions?

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.

Let’s look at some other importantinfection control practices.

Storage of Patient Supplies

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.

Proper Refrigeration

Monitor and maintain temperature between 2 and 8 degrees C Keep food/nourishments in a separate

refrigerator from medications/IV fluidsNEVER place lab specimens in a medication or

nourishment refrigerator

Regular HospitalWaste

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

Regulated Medical Waste 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 containersII. >20ml blood or blood products that cannot be easily

emptied (e.g., pleurevacs, blood administration tubing, evacuated containers)

III. Microbiology and Pathology specimensIV. Items used in the preparation and administration of

hazardous drugs

Single-Use versus ReusablePatient Items

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.

Cleaning and Disinfection

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.

Renovation and Construction

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.

Linen handling and disposal 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

Spillage of body fluids 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

Dr.T.V.Rao MD 40

INFECTION CONTROL IS RESPONSIBILITY OF ???

Dr.T.V.Rao MD 41

DO NOT FORGET IT IS EVERYONE'S RESPONSIBILITY

THANK YOU