Seminar on Infetion Control

8/6/2019 Seminar on Infetion Control

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SEMINARON

INFECTION CONTROL

Presenter

Ms.Daisy V.T.

5TH Batch Student

Guided by

Dr. Sreedevi T RAsso. Professor

Govt. College of nursing

Kottayam.


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INTRODUCTION Healthcare-associatedinfections (HAIs)area majorcauseof

morbidityand mortalityaroundthe world.

Accordingto CDC theincreaseininvasive proceduresanda

growingresistancetoantibioticshavefuelledariseintherate

ofHAI by 36% overthe past 20 years.

Overall 1.4 million people worldwidearesufferingfrom

nosocomialinfectionsandin Indiaalone,theinfectionrateisatover25 percent,.reportbythe INICC (the InternationalNosocomial Infection Control Consortium )

Theimportanceofhealthcare-associatedinfections asacause

ofpreventableillnessanddeath- Aseriousglobal public

healthissueandanational priority.


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INFETION CONTROLINFETION CONTROListheresponsibilityofeveryhealthistheresponsibilityofeveryhealth

Care personnelCare personnel


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WHAT IS INFECTION?

The invasion of the body by pathogenic or potentially

pathogenic organisms and their subsequent multiplicationin the body (Medical dictionary)

The lodgement and multiplication of parasite in or on the

tissues of a host.

( Anathanarayanan, 2008)


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Types of infection Primary infection- initialinfection witha parasite

inthehost

Reinfection- issubsequentinfectionsbythesame

parasiteinthehost Secondary infection- anew parasitecausesan

infectioninahost whoseresistancehasbeen

loweredbyanalreadyexistinginfectiousdisease.

Cross infection-anew infectionisestabilshedfromanotherhostorexternalsourceina patientalready

sufferingfrom adisease

Nosocomial infection-crossinfectionoccurringin

hospitals(from Greekword Nosocomion,hospital)


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Hospital acquired infection(HAI) HAI alsocallednosocomialinfectionisdefinedasan

infectionoccurringina patientinahospitalorotherhealth

carefacilityin whom theinfection wasnot presentor

incubatingatthetimeofadmission

Italsoincludesinfectionsacquiredinthehospitalbut

appearingafterdischarge,andoccupationalrelated

infectionsamongstaffofthefacility(WHO 2002)


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Historical Perspective


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Ignaz Semmelweis (1818-1865), the fatherofinfectioncontrol

demonstrated throughexperimentsthathand-washingcould prevent

infections.(Conceptofnosocomialinfection wasborn)

1950s Infection Controlasanorganizedandrecognizeddiscipline was

born.

Post World WarII hospital-basedoutbreaksofinfectioncausedby

Staphylococcus Aureus, mostlyinnewbornnurseries, Outbreaks

demandedanorganizedresponseforinvestigationandcontrol.

HISTORY OF NOSOCOMIAL INFECTION

CONTROL


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Indian context

HAIs hasreceivedtheattentionofthe Govt.ofindiaandthe

Raocommittee,(1968)andthe Sharadkumarcommittee

(1976) weresetup toinvestigatethe problem ofhospital

acquiredinfectionsindepth.

The WorldHealth Organization First GlobalPatient Safety

Challenge, Clean Careis SaferCare, pledgedtotacklethe

problem ofhealthcare-associatedinfection waslaunchedin

2005 . Indiaisthefirstcountryofthe South EastAsian

Regiontoinauguratethe "Clean Careis SaferCare" initiative

andsigna pledgetoaddresshealthcare-associatedinfections.


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MAGNITUDE OF THE PROBLEM

TheProblem 1.7 million HAIs inhospitalsunknownburdeninother

healthcaresettings

99,000 deathsperyear

$28-33 billion inaddedhealthcarecosts

HAI Prevention Implementing what weknow forpreventioncanleadtoup

toa70% ormorereductioninHAIsThe CentersforDisease ControlandPreventionestimates-tenbilliondollarsinadditionalhospitalcostsannuallyasadirectresultofhealthcare-associatedinfections.

(AHRQS factsheet 2002)


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HealthyPeople 2020 Phase II

New TopicAreas

AccesstoHealth Services

AdolescentHealth ChildrensHealth

Genomics

GlobalHealth

OlderAdults Healthcare-Associated

Infections

QualityofLife

Social DeterminantsofHealth

Blood Disordersand

Blood Safety

HealthyPlaces Preparedness


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Nosocomialinfectioncontrolinterventions,

althoughnotanexplicittargetofthe United

Nations Millennium Development Goals,

help support Goal 6 (CombatHIV/AIDS,

malariaandotherdiseases)


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AshealthcareAshealthcare

professionals,itisprofessionals,itisimportanttoimportantto

understandtwounderstandtwothingsaboutthingsabout

infectioninfection:


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1.thevarious waysinfectioncan

betransmitted

2.the waystheinfectionchaincanbebroken


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The Chain of InfectionThe Chain of Infection


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1 Causative Agent--any disease-causing

microorganism (pathogen)

Bacteria

Viruses

Fungi

Parasites


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RESEARCH EVIDENCE

.Inadultstudies,E. coli,S. aureus andEnterococcus

faecalis werethethree mostcommon pathogenscausing

HAIsinadult patients.

In pediatric studies,Coagulase negative S. aureus

(20%26%),Pseudomonas aeruginosa (5%20%),S.

aureus (11-15%), Candida species (4%9%)and

viruses, mostlyrotavirusandrespiratorysyncytial virus

(22%23% ) were predominant pathogenscausing

HAIs.


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Characteristics of causative

agents

Infective dose

Pathogenicity

Virulence

Invasiveness

Viability

Antigenic Variation

Host Specificity

Resistance


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22 -- ReservoirReservoir---theorganism in whichthe

infectious microbesgrowsormultipliesHumans: Patients and Healthcare

Workers

Environment- Patient CareEquipment, Environmental Surfaces

and Food

Animals Insects

Rodents

Shell Fish


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3. Portal of Exit

The route by which theinfectious agent

leaves the reservoir

By meansofblood,

excretions,secretions

ordropletsfrom brokenskin( puncture,

cut,surgicalsite,

weeping wound)

Respiratorytract Genitourinarytract

Gastrointestinaltract


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4 Mode of Transmission

The mechanism for

transfer of aninfectious agent from

the reservoir to a

susceptible host.

Contact (Direct and

Indirect)

Airborne

Vector-Borne

Common Vehicle


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DIRECT: immediate

transmission

Actual physical

contact between

source and patient

INDIRECT

CONTA

CT:

Patient to

contaminated indirect

object

Droplets spread


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AIRBORNE Organismscontained withindropletnucleior

dust particles (i.e.dropletnucleioftuberculosis)

Suspendedinairforextended periods, maybespreadthroughventilationsystems


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VECTOR-BORN

Mechanical transfer of microbes on external

appendages (feet of flies)

Harbored by vector, but no biological

interaction between vector and agent (i.e.

(yellow fever virus)


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5. PORTAL OF ENTRY

The route by which aninfectious agent enters

the susceptible host

Respiratory Tract

Genitourinary Tract

Gastrointestinal Tract

Broken skin/Mucous

Membrane

Blood stream


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66 -- TheThe SusceptibleHostSusceptibleHost Theorganism thatacceptsthe pathogen.

Thesupportofpathogenlife & its

reproductiondependonthedegreeofthe

hostsresistance.


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Organisms with strong immuneOrganisms with strong immune

systems are better able to fend offsystems are better able to fend off

pathogens.pathogens.


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Organisms with weakened immuneOrganisms with weakened immune

systems are more vulnerable to thesystems are more vulnerable to the

support & reproduction of pathogens.support & reproduction of pathogens.


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Common HAIs

Nosocomial Pneumonia

Surgical site infections

Catheter associated urinary tractinfections,

Catheter associated blood stream

infections.Other nosocomial infections

Skinandsofttissueinfections:opensores (ulcers,burns

andbedsores)and Gastroenteritis


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functionaldisabilityandemotionalstressof

the patient

Increased morbidityand mortality

longerhospitalstays,

utilize morehealthcareresources

HAIscontributetoincreasedhealthcare

costs,

Impact of nosocomial infections


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Infection control is the discipline concerned

with preventing nosocomial or healthcare-associated infection.

INFECTIONCONTROL-(BREAKING THE

CHAINOF INFECTION)


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INFECTIONCONTROL MEASURES

FORTHE PREVENTION AND CONTROLOF

HEALTHCARE -ASSOCIATED INFECTIONS

(Adapted from CDC/WHO guidelines on INFECTION

CONTROL,2009)


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1.Hand washing

2. Standard Precautions in Hospitals3. Transmission based Precautions in Hospitals

4. Prevention of Ventilator-Associated Pneumonia

5. Prevention ofSurgical Site Infections

6. Prevention ofBloodstream Infections

7. Prevention ofCatheter- AssociatedUrinary Tract

Infections

8. Infection Prevention and Control Programs inHospital Settings.

9. Surveillance and reporting ofHAI


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Mostnosocomialinfectionsarethoughttobe

transmittedbythehandsofhealthcare workers

CDC estimatethatonethirdofallhospital-acquired

infectionsarecausedbyalackofadherenceto

establishedinfectioncontrol practices,suchashand

hygiene.

CDC recommendshandhygiene (i.e.,hand washingwithsoap and wateroruseofa waterless,alcohol-

basedhandrub.asthesingle mosteffective method

ofpreventingthespreadofhealthcare-associated

infections

2. Hand Hygiene


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Research Evidence-

Sustainedhandhygiene promotionin NICU in

Genevaresultedina 60% reductioninbacterimia

among VLBW babies (BorghesiA, 2008)

Larsonandcolleagues (2000)documentedthat

the prevalenceofnosocomialinfectionsdecreasedasHCWs compliance withrecommendedhand

hygiene measuresimproved.


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New CDC/WHO guideline recommendation for

hand hygiene in health care settings

Currentguidelinesrecommendtheuseofalcoholbasedhand

rubformulationsasthenew standardofcare.

Theyarenotasubstituteforhand washingifhandsaresoiled.

Washhand withsoap and waterwheneverthehandare

visiblysoiledorcontaminated withbloodorbodyfluids.

Recommendedbeforeenteringtheunit &beforeany

Procedure Alcoholhand-rubsareappropriateforrapidhand

decontaminationbetween patientcontacts.

(WHO GuidelinesonHandHygieneinHealth Care, 2009)


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HAND WASHING TECHNIQUE Washhandsfor2

complete minutes

beforeenteringtheunit

&beforeany

Procedure

Washhandsforatleast

20 secondsbeforeandaftertouchingeach

patient


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Research EvidenceThe choice of the best method of hand hygiene is still a matter of debate

Larsonetal.foundnostatisticallysignificantdifferencein

mean microbialcountsonnurseshandsaftertraditionalhand

washingoralcohol-baseddisinfection

Ontheotherhand

Girouetal.observedan 83% reductioninbacterial

contaminationofthehandsafteruseofalcoholbased

disinfectantcompared with 58%reductionafterhandwashing

withantisepticsoap


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Sarammaetalevaluatedtheeffectof alcoholbased

handrubbeforeandafterpatientcontacton SSI after

electiveneurosurgical procedures. Resultdidnot

show asignificantreductionin SSI compared with

thecontrolgroup. Studyconcludes withthe

possibilityisthatboththestrategiesareofequalefficacyforpreventionofSSI

(Sarammaetal.alcoholbasedhandrubandsurgicalsite

infection. Neurologyindia.Jan-feb 2011. 59(1).12-17)


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Adherence withhand washing Studiesrepeatedlydocumentedthatthecompliance with

recommendedhand washing practicesisunacceptablylow,

estimatedtobe


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3.Standard precautions

STANDARD

PRECAUTIONS-

Appliedforall patientsat

alltimesregardlessof

theirknownorpresumed

infectiousstatus

hand washing and antisepsis

use of personal protective

equipment

appropriate handling of patient

care equipment and soiled linen

prevention of needle stick/sharpinjuries

environmental cleaning and

spills-management

appropriate hospital waste

management.


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Aseptictechniqueand preventive

practices Refersto practicestoreducetheriskofpost

procedureinfectionsin patients-

measurestodecreasethelikelihoodofmicroorganismsenteringthebodyduring procedures.

Maintainingcleansterilefieldduring procedures

Useofsterileinstrumentsandotheritemsforprocedures

Preparationofthe patientsforclinical procedures

Useofbarriers ( gown masketc.)


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Personal protective equipment UsePPE when

contamination orsplashing with bloodor body fluids isanticipated

Disposable gloves

Plastic aprons

Face masks Safety glasses,

goggles,

Head protection

Foot protection

Fluid repellentgowns (May, 2000)


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Appropriatehandlingofpatientcare

equipment Infectionsfrom used

instrumentsandother

items poseinfection

threatsto patientsand

healthcare workers.

Removalof

microorganism from acontaminatedobjectis

anessential partof

infectioncontrol

Decontamination

Cleaning

Sterilization/ highlevel

disinfection

Storage


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Linen handling and disposal

Gloves and apron - handling contaminatedlinen

Appropriate laundry bags

Avoid contamination of clean linen


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MANAGEMENT OF SHARPS

correct disposal in a puncture resistantcontainer

avoid re-capping the needle

Do not bend, break or cut the needlebefore the disposal.

Avoid mixing sharps with other wastes discard syringes as single unit

avoid over-filling sharps container


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Hospital waste management

Itisanimportant partofinfectioncontrolinhealth

carefacilities.

Itincludessegregation,collection. Transportation

anddisposal. Hospital wasteincludes

75-90%non- hazardous( general) waste- donot

infectthem!!!

10-25% hazardous waste- takecareofthem.

Follow hospitalguidelinesbasedongovt.ofIndia-

Biomedical waste managementguidelines-1998.


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Additional (transmission-based) precautions

aretaken whileensuringstandard precautionsare maintained.

Additional precautionsinclude:

Airborne precautions; Droplet precautions;and

Contact precautions.

4.Additional (transmission-

based) precautions


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Implementstandard precautions.

Place patientinasingleroom withnegativeairflow pressure.

Keep doorsclosed.

Anyone whoenterstheroom must wearaspecial,high

filtration, particulaterespirator(e.g. N 95) mask.

Makethe patientto wearasurgical maskwhilegoingoutof

theroom.

Airborne precautions


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Place patientinasingleroom (orinaroom withanother

patientinfectedbythesame pathogen).

Wearasurgical maskwhen working within 1-2 metersofthe

patient.

Placeasurgical maskonthe patientiftransportisnecessary.

Specialairhandlingandventilationarenotrequiredto

preventdroplettransmissionofinfection.

Droplet precautions


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Place patientinasingleroom (orinaroom withanother

patientinfectedbythesame pathogen).

Wearclean,non-sterilegloves whenenteringtheroom.

Wearaclean,non-sterilegown whenenteringtheroom if

substantialcontact withthe patient,environmentalsurfacesor

itemsinthe patientsroom isanticipated.

Use precautionsto minimizetheriskoftransmissionif

transportofthe patientfrom theroom isrequired.

Contact precautions


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Infectioncontrolrelatedtocommonhospital

acquiredinfections

Nosocomial Pneumonia

Surgical site infections Catheter associated urinary tract

infections,

Catheter associated blood streaminfections


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Ageappropriatecomprehensive mouthcare.

Dailyassessmentforextubationreadiness.

Intubationandreintubationshouldbeavoided

Preventventilatorcircuitcondensation

Keep the patientin semirecumbent position (3045)foradultsand 15-

30 degreeforchildrento preventaspiration,especially whenreceiving

enteralfeeding.

Suctionaboveandbelow thecuffbeforeloweringthe patientsheadless

thanto 30% to prevent microaspiration.

Theendotrachealtubeshouldbeofpropersizeto preventleakageof

bacterial atho ensaroundthecuffintothelowerres irator tract.

Prevention of Ventilator Associated

Pneumonia


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identifyandtreatallinfectionsremotetothesurgicalsitebefore

electiveoperation

Donotremovehairpreoperativelyhairmaybeclippedshortifit

interferesthe procedure. Useanappropriateantisepticagentforskin preparation.

Keep preoperativehospitalstayasshortas possible

Anti microbial prophylaxis

Intra operative Ventilation

Maintain positive-pressureventilationintheoperatingroom.

Maintaina minimum of15 airchanges perhour,ofwhichatleast 3

shouldbefreshair.

Cleaning and disinfection of environmental surfaces

7.Prevention ofSurgical Site Infections


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Airandenvironment

Laminarairflow-designto move particlefreeair( ultralean

air).

Operatingroom equipmentandfurnitureshouldbecleaned

withgermicidalagentattheendofeachsurgical procedure.

Lidwelletal.comparedtheeffectofultracleanairalone,

antimicrobial prophylaxisaloneandcombinationofbothin

prosthesisreplacement. Resultsshownantimirobials more

effectivethanultracleanair. (JHosp Infect, 1988)


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Unexpectedlyinone analysis whichcontrolledformany

patients ORventilation withlaminarairflow showednobenefiton SSI.( Brandt C Ann Surg. 2008Nov, 248(5). 695-700.)

Withoutsurgicalantimicrobial prophylaxis,glove perforation

increasestheriskofSSI (Heidi M etal.Arhivesofsurgery.June 2009,144(6). 553.)

Postoperative Incision Care

Perform handhygienebeforeandafterdressingchanges

andanycontact withthesurgicalsite.

Whenanincisiondressing mustbechanged,usesteriletechnique.

Educatethe patientandfamilyregarding properincision

care,symptomsofSSI,andtheneedtoreportsuch

symptoms.


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Hand hygieneAseptic technique during catheter insertion and care

Catheter insertion

Donotroutinelyusearterialorvenouscutdown procedures

asa methodtoinsertcatheters.Catheter-site dressing regimens

- Useeithersterilegauzeorsterile,transparent,semi

permeabledressingtocoverthecathetersite.

-Gauzedressingsthat preventvisualizationoftheinsertionsiteshouldbechangedroutinelyevery48 hoursoncentral

sitesandimmediatelyiftheintegrityofthedressingis

compromised.

-Replacecatheter-sitedressingifthedressingbecomes

dam loo ened orvi ibl oiled.

8.Prevention ofBloodstream Infections


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Catheter removal

-Promptlyremoveanyintravascularcatheterthatisno

longeressential.

- Donotroutinelyreplacecentralvenousorarterial

catheterssolelyforthe purposesofreducingtheincidenceof

infection.

- Replace peripheralvenouscatheters every 7296 hoursinadultsto prevent phlebitis.

- Leave peripheralvenouscathetersin placeinchildren

until IV therapyiscompleted,unlesscomplications (e.g.,

phlebitisandinfiltration)occur.

AstudyinthejournalInfection Control andHospital Epidemiology shows

thatabout 24% ofpatients withcatheters willdevelop catheterrelated

infections,ofwhich 5.2% willbecomebloodstream infections. Deathhas

beenshowntooccurin420% ofcatheter-relatedinfections.


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Prevention ofCatheter-Associated

Urinary Tract InfectionsBurden ofCAUTIs

Urinarytractinfectionisthe mostcommonhospitalacquired

infection; 80% oftheseinfectionsareattributabletoan

indwellingurethralcatheter.

Risk factors for development ofCAUTI

Thedurationofcatheterization- mostimportantriskfactor

Limitingcatheteruseand, whenacatheterisindicated,

minimizingthedurationthecatheterremainsinsituareprimarystrategiesforCAUTI prevention.

Ensureaseptictechniqueduringcatheterinsertion

Ensurethattrained personnelinserturinarycatheters.


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Reservoir for transmission

Thedrainagebagofthebacteriuric patientisareservoirfor

organismsthat maycontaminatetheenvironmentandbe

transmittedtootherpatients.

Willson M etalidentifiedthefollowing nursing

interventions to reduce the risk of catheter-associated

urinary tract infection:

staffeducation, monitoringofcatheteruseand CAUTI

incidence,insertiontechnique,urethral meatalcare,

securement,useofacloseddrainagesystem,bladder

irrigation,frequencyofcatheterchange,andantisepticsolutionsinthedrainagebag.

J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):137-54.


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Representativesofvariousunits withinthehospital (medical,nursing,

engineering,housekeeping,administrative, pharmacy,sterilizingservice

and microbiologydepartments);

Developmentofpoliciesforthe preventionandcontrolofinfectionandto

overseetheimplementationoftheinfectioncontrol programme

develop itsowninfectioncontrol manual/s;and

monitorandevaluatethe performanceoftheinfectioncontrol programme.

The infection control committee


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Responsiblefortheday-to-dayactivitiesoftheinfectioncontrol

programme.

supportand participateinresearchandassessment programmesat

thenationalandinternationallevels.

carryoutthesurveillance programme;

develop anddisseminateinfectioncontrol policies;

monitorand managecriticalincidents;

coordinateandconducttrainingactivities.

Infection control team


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Hospital-associatedinfectioncontrol

instructionsand practicesforpatientcare.

The manualshouldbedevelopedandupdatedbytheinfectioncontrolteam andreviewed

andapprovedbythecommittee.

Readilyavailableforhealthcare workers,andupdatedinatimelyfashion.

Infection control manual


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SurveillanceandreportingofHAI Surveillanceisthe monitoringofinfectionsin

theunitbyconducting periodicsurveysto

detectandrecord methodicallyallHAIs. Continuoussurveillanceallowstheearly

identificationofoutbreaks.

Agoodsurveillance practiceisanimportantaspectofinfectioncontrol.


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Nursingimplications

Nurses are the key to maintain infection controlmeasures in health care settings


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Roleofthe Infection Control NurseNeedtohave highdegreeofawarenessandknowledge ininfection

control

Researchindicatesa positiverelationshipbetweenknowledgeand

practice. (VijiAetal, 2007)

Collectandcoordinateinformationregardinghospitalinfections

from variousclinicaldepartments

Conductsin-serviceeducation,refreshercoursesandtraining

programmesoninfectioncontrol.

Continuesvigilance,assessmentandsupervisionofclinicalperformanceofvariouslevelsofworkers.

ContinuessurveillanceforHAI.

Conductsawarenessamongthe patientsandvisitorsaboutinfection

control


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CONCLUSION PreventingHealthcare-associated Infections

the Timeis NOW

Problem iscriticalandcostlybut preventable Interventionscanhaveanimmediatenational

impact

Interventionscanbecostsavings Ongoingeffortsareneededtoaddress

changesinhealthcare


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Infectioncontrolisnotjusta matterof

followingstandardsandguidelines. It

involvesimprovingawarenessandchangingattitudesand workpracticesatboththe

institutionalandindividuallevel. Itis

essentialthateveryoneinvolvedinhealthcare

contributetoimprovingthequalityofpatient

care (NHMRC, 1996).


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Thought for infection control It is not important how much you know but it is

most important how much you practice.

Caring attitude should be reflected in your workpractice, which will reflect your infectioncontrol practices.

If you fail to practice infection control,you are failing to care for your patients.


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