PATIENT SAFETY & INFECTION CONTROL IN HEALTH CARE FACILITIES

• Melad Kamran• Mel Martins• Ammar Saeed

Infection Control Squad:

SEMINAR OUTLINE

1) Infection Control: A Brief Introduction

2) Why Infection Control?

3) Disease Transmission and the Chain of Infection

4) Protection and Preventative Measures

5) Infection Control: Ethics and the Law

6) Economics of Infection Control

7) Conclusion ... Things to Ponder

INFECTION CONTROL: A BRIEF INTRODUCTIONDefinition

• DEFINITION

“Infection control refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and health care facilities.”

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory : Ignaz Semmelweis

• Obstetrician in the mid 1800’s• Hand washing ↓ “Childbed fever”(infection) 30 % to 1%! • Great discovery but his colleagues weren’t impressed. • Semmelweis was censored by the establishment and stripped of his privileges. • He even reported his findings to the Medical Society of Vienna, and they weren’t interested• Committed to a mental asylum and died of in infection similar of those he was trying to prevent

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory : Florence Nightengale

• Passionate sanitarian • Different view on “nursing” • Sanitary reform : emphasis on cleanliness,

hygiene, clean air, and water• Re-design hospital architecture • Hygienic practices = “Laws of Life”

• “If I were not afraid of being misunderstood I would say that the less knowledge of medicine that the hospital matron has the better, because it does not improve her sanitary practice;”

• Crimian war (1854): “There were no vessels for water or utensils of any kind; no soap, towels, or clothes, no hospital clothes; the men lying in their uniforms, stiff with gore and covered with filth to a degree and of a kind no one could write about; their persons covered with vermin . ..”

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory : Louis Pasteur

• “Germ theory of disease”• Proved with experiments• Now there was some support that ‘germs ‘ were the cause of contagious disease

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory : Joseph Lister

• Pioneer of antiseptic surgery (1827-1912)

•Lister used Pateur’s idea about chemicals as antimicrobials and applied it to surgery• Used cotton wool and bandages treated with phenol (antiseptic) to dress surgical wounds

• Post surgery mortality rate ↓ 50 to 15%• In these days the bloodier/dirtier a surgeons coat, the more experienced he was!

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory : Joseph Lister

• Lister tested the results of spraying instruments, the surgical incisions, and dressings with a solution of it. Lister found that if phenol solution swabbed on wounds remarkably reduced the incidence of gangrene

• Story: Eleven year old Glasgow boy with compound fracture

INFECTION CONTROL: A BRIEF INTRODUCTIONHistory: AIDS

• Introduced to the American public in the 80’s• Infection control becomes an issue: No vaccine, no cure!

•Strict protocols in healthcare field: Needles/sharps, instruments disinfection, PPE of healthcare works, biohazard clean up procedures.

• In 1999, 5% of US AIDS population had been employed in a health care field. The vas majority were infected with HIV through cuts and needle sticks.

(Kennamer, 2002)

INFECTION CONTROL: A BRIEF INTRODUCTIONThe Purpose of Infection Control

• PURPOSE OF INFECTION CONTROLTo reduce the occurrence of infectious diseases, usually by breaking the chain of infection.

• HOW? (1) Immunize against preventable diseases(2) define precautions that can prevent exposure to infectious agents (3) restrict the exposure of health care workers and patients to infection.

• CAN BE DONE VIA... - Prevention- Monitoring/investigating outbreaks - Management.

Why Infection Control

• Even with the development of standards, infections still a prevalent problem

• At any given time 1.4 million individuals suffering from Hospital based infection

• Since the development of standards, most infections are now present within individuals

WHY INFECTION CONTROL?

THE CHAIN OF INFECTION(Does NOT refer to the bling that epidemiologists wear)

Infection? WHAT!?YEAAAHHHHHH

THE CHAIN OF INFECTIONThe “links”

(1) Infectious agent - Virus, bacteria, fungi, parasites,, etc

(2) Reservoir- Place that the MO lives, grows and reproduces (can be more than one)

(3) Portal of exit- Path by which the MO leaves the reservoir, can be single or multiple)

(4) Mode of Transmission- How the infectious agent gets travels from the reservoir to the susceptible host- Contact: Direct or Indirect. - Common vehicle (non-living) :food, water, bodily fluids- Airborne- Vectors (living): external and internal

(5) Portal of entry- How the IA enters the susceptible host

(6) Susceptible host- Person/animal who is not protected (no IC) , susceptible or lacks resistance (CSA, 1994)

THE CHAIN OF INFECTIONThe “links” – A detailed example

THE CHAIN OF INFECTIONBreaking the chain

(CSA, 1994)

• To improve quality of care at the facility and safety of staff, patients and visitors

• Implementation of guidelines set in place to prevent the spread of infection

• Joint responsibility of healthcare professional and patients

PREVENTATIVE MEASURES Purpose

• Includes gloves, masks/respirators, gowns and other protective equipment mandated according to the setting

• Important to don the PPE appropriate to condition

• In Hong Kong, 241 non-infected and 13 infected staff exposed to patients with SARS were surveyed about use of mask, gowns, gloves, and handwashing. All infected omitted atleast one.

• Common misconception: the use of gloves eliminates the need to wash hands

Image from safetyworld.com

PREVENTATIVE MEASURES Personal Protection Equipment (PPE)

• Accurate identification of infection or pathogen

• Training and raising of awareness potential pathogens in the environment of the healthcare facility

• Proper handling of specimen in the lab

• Frequent monitoring of sterilization devices and protocolsImage from

http://www.contractlaboratory.com/labclass/microbiology.cfm

PREVENTATIVE MEASURES Role of the Laboratory

• Over 800,000 needlestick incidents occur in US hospitals each year—most AFTER needle was used, 1/3 during disposal

• National Institute for Occupational Safety and Health (NIOSH): blood-drawing injuries reduced by 82% through the use of needle shields

Image from kidshealth.org

PREVENTATIVE MEASURES Medical Devices and Sharps

• Proper storage, usage and disposal

• 1877 – Healthcare providers started practicing isolation

• Newer hospitals are built with more single-patient rooms and separate entrances

Image from Bennett and Brachman’s Hospital Infections

PREVENTATIVE MEASURES Isolation

2004 – Northern Europe and West Australia isolated patients infected with MRSA

• Growing concern in healthcare facilities, especially LTCFs

• Some common ARPs include MRSA, VRE, gram-negative uropathogens

• Before the use of penicillin in the mid-1940s, S. aureus resistance was rare. Within 3 years, half of the known isolates became resistant

Preventative measures:

Isolation Rapid discharge Handwashing and antimicrobial

agents Appropriate PPE

Image from foodylife.com

PREVENTATIVE MEASURES Antimicrobial-Resistant Pathogens

Image from http://jagrnako1031.wordpress.com/2010/09/30/handwashing-the-best-preventive-measure/

Image from http://instanthandsanitizers.blogspot.com/2011/01/purell-hand-sanitizer-and-purell.html

• Mid-1800s evidence of correlation between hand hygiene and prevention of nosocomial infections

• 57% reduction in hospital-acquired infections (HAIs) of methicillin-resistant staphylococcus aureus (MRSA) and 41% in vancomycin-resistant enterococcus (VRE)

PREVENTATIVE MEASURES Hand Hygiene

• Either by handwashing or handrubbing

• Most important method for infection control

Table from Bennett and Brachman’s Hospital Infections

Still, In 2008, CDC reported nurses washed hands 40% of the times they should have

PREVENTATIVE MEASURES Antimicrobial Agents

Image from http://dnr.wi.gov/org/caer/ce/greenschools/gsPoster/classroom.htm

• Handwashing by nurses in ICU went up to 94% from 81% the week after watching training videos; back to 81% by third week

Why the lack of adherence?

Insufficient time Skin irritation Lack to access to handwash

stations Ignorance

PREVENTATIVE MEASURES Edumacation?

• 1958: outbreaks of S. aureus in hospitals prompted prompted AHA suggested initiating IC programs

• To prevent HAIs in staff, patients and visitors and to do so in a cost-effective manner

• Conduct on-going, systematic collection, analysis and interpretation of data pertaining to infection transmission

• Monitor and keep record of compliance rates; frequently receive feedback from healthcare workers of progress

• Make short-term and long-term goals evident to staff and public to increase sense of responsibility on individual basis

Image from openlibrary.org

PREVENTATIVE MEASURES Infection Surveillance and Control Program

• A combination need to be practiced to control transmission of infection

Hurdle Concept

• Residents & staff cohorted, gloves & gowns worn, staff education, isolation

PREVENTATIVE MEASURES The Big Picture

Long-term care facility (LTCF) in St. Louis – MRSA cases dropped from 16 to 5 in six months

LTCF in Los Angeles – 28% reduction in resident and 32% reduction in staff colonization rates of MRSA within 3 months

INFECTION CONTROL & THE LAW Ethics

Is it our ethical responsibility to control infection? To make others aware that we have an infection?

To demand to know if people we contact are infectious?

Should their be consequences for people who knowingly spread infection?

RIGHT

WRONG?

“Maximize good outcome, and reduce harm.”

• Lab Labels Do you label that the sample is infected? Is that a breach of privacy? What about the protection of the lab tech?

INFECTION CONTROL & THE LAW Some Examples of Ethical Scenario’s

• Isolation of patientsRestrict the rights and movements of one patient to protect other patients. What if that person is dying? What if their family wants to see them?

• Infected Health Care Workers Does the patient have the right to refuse care from that health care worker? Does the health care worker have to disclose their infectious status?

INFECTION CONTROL & THE LAW Legal Aspects

• Administrative law: Employees must have training on IC issues• Employee who fails national standards may be subjected to civil action• Employees SHOULD want to get IC education because it will protect the individual, as well as the community

Ryan White Care Act Gives employees the right to learn if they were exposed to infection while caring for a patient

Civil LiabilityDamages occur as a result of not meeting national standards (negligence)

Criminal Transmission of Disease

Mohammed Dica;Stephen Kelly;Giovanni Mola

Economics of Infection control

• Funding and resources limited

• Different accounting and economic cost of controlling infections

• Infection control affects all members of society.

THE ECONOMICS OF INFECTION CONTROL

(Graves, 2004)

THE ECONOMICS OF INFECTION CONTROL CDC - Financial VS Opportunity Costs

CONCLUSION Some Food For Though

• Even with the development and progression of preventive measures, infection control is still is a still a prevalent problem ...