THEIN SHWE, MPH, MS, MBBS HEALTHCARE ASSOCIATED INFECTION COORDINATOR DIVISION OF INFECTIOUS DISEASE...
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Transcript of THEIN SHWE, MPH, MS, MBBS HEALTHCARE ASSOCIATED INFECTION COORDINATOR DIVISION OF INFECTIOUS DISEASE...
THEIN SHWE, MPH, MS, MBBSHEALTHCARE ASSOCIATED INFECTION COORDINATOR
DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYOFFICE OF EPIDEMIOLOGY & PREVENTION SERVICES
BUREAU FOR PUBLIC HEALTHWEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN
RESOURCES
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Discuss chain of infection and different types of mode of transmission
Define isolation precautions and describe different types isolation precautions.
Describe standard precautions procedures and conditions under which to use standard precautions
Describe contact precautions and conditions under which to use contact precautions.
Describe conditions under which to use droplet precautions.
Describe conditions under which to use airborne precautions.
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A microorganism may be spread by a single or multiple routes. Contact, direct or indirect Droplet Airborne Vector-borne (usually arthropod) and Common environmental sources or vehicles -
includes food-borne and waterborne, medications e.g., contaminated IV fluids
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Direct-contact Direct body surface-to-body surface contact and Physical transfer of microorganisms between a
susceptible host and an infected or colonized person
Indirect-contact Contact of a susceptible host with a contaminated
intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves
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Droplet generation coughing, sneezing, talking, procedures such as suctioning and
bronchoscopy Droplet transmission Droplet deposited on the host’s
conjunctivae, nasal mucosa, or mouth.
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Small-particle residue {5µm or smaller} of evaporated droplets containing microorganisms
Suspended in the air for long periods of time
Dispersed by air currents Inhaled by a susceptible host within the
same room or over a longer distance
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Special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases
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1996 CDC Guidelines for Isolation Precautions in HospitalsHospital infection control practices advisory committee (HICPAC)
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Handwashing and gloving Personal protective equipments:
Masks, respiratory protection, eye protection, face shields, gowns and protective apparel
Patient-care equipment and articles Linen and laundry Routine and terminal cleaning Patient placement Transport of infected patients
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Unit 6 - Infection Control Measures
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Isolation Precautions
Patient Transport
Linen & laundry
Patient care equipmentAnd articles
Routine and Terminal Cleaning
PPE
Hand hygiene
Patient placement
Isolation Precautions
Standard precautions
Transmission-based precautions Contact precautions Airborne precautions Droplet precautions
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Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status.
Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes.
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Handwashing with either plain or antiseptic containing soap and water, and use of
alcohol-based products (gels, rinses, foams) that do not
requre the use of water
Perform hand hygiene: Before and after patient contact After removing gloves or any other PPE
item After touching blood, body fluids,
secretions, excretions, and contaminated items, whether or not gloves are worn
Standard Precaution - Hand hygiene
The selection of PPE based on The nature of patient interaction and/or The likely mode(s) of transmission
Designated containers for used disposable or reusable PPE should be placed in a convenient to the site of removal
Hand hygiene is always the final step after removing and disposing of PPE
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1. Exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items
3. Perform hand hygiene immediately after glove removal
2. Change gloves when heavily contaminated
4. Disposable glove should not be reused
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1. When splashes or sprays of blood and body fluids, secretions and excretions to skin and working clothes are likely
2. When working clothes has substantial contact with patient, environmental surfaces or patient items
3. Select an appropriate gown for the procedure
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Surgical masks and eye protection: When splashes or sprays of blood and body fluid, secretions and excretions are likely Sterile technique Respiratory etiquette
Change PPE promptly if heavily contaminated during the procedure
Prevent needles and other sharps instrument injuries
Prevent mucous membrane exposures Safe work practices and PPE to protect
mucous membranes and non-intact skin
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Clean and disinfect non-critical surfaces in
patient-care areas are part of SP.
Clean and disinfect all frequently touched surfaces in patient-care areas
EPA-registered disinfectants or detergents
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Clean and maintain medical equipment and instruments/devices according to the manufacturers’ instructions
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Key principles for handling of soiled laundry:
Don’t shaking items or handle them in any way that may aerosolize infectious agents
Avoid contact with one’s body and personal clothing
Contain soiled items in a laundry bag or designated bin
Three new elements added to standard precautions:
Respiratory hygiene/cough etiquette
Safe injection practices
Use of masks for insertion of catheters or injection into spinal or epidural areas
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Three elements include: Educate healthcare workers, patients, and visitors Post signs in appropriate language(s) Source control measures:
Cover the nose/mouth when coughing or sneezing
Use tissue paper respiratory secretions and dispose in the waste receptacle
Perform hand hygiene after contact with respiratory secretions and contaminated objects
Place a surgical mask on the coughing person when tolerated and appropriate
Spatial separation, ideally >3 feet24
Large outbreaks of HBV and HCV among patients in the United States
The primary breaches Reinsertion of used needles into a multiple-
dose vial or solution container (e.g., saline bag)
Use of a single needle/syringe to administer intravenous medication to multiple patients.
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Face masks limit dispersal of oro-pharyngeal droplets during: central venous catheters placement Placement of catheter or injection to
epidural space HICPAC recommends the use of a face
mask when placing a catheter or injection to epidural space.
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TRANSMISSION-BASED PRECAUTIONS
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Single patient rooms - always indicated for patients placed on airborne precautions and preferable for those who require contact of droplet precautions
Cohort patients with same organism
Visitors as sources of healthcare associated infections – e.g., pertussis, influenza, tuberculosis Cough etiquette
Use of barrier precautions by visitors Educate patients and family members Follow signs for isolation precautions
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Infections spread by direct or indirect contact with patients or patient-care environment – shigellosis, C. difficle, MRSA
Limit patient movement Private/SINGLE room or cohort with patients with
same infection Wear disposable gown and gloves when entering
the patient room Remove and discard used disposable gown and
gloves inside the patient room Wash hands immediately after leaving the patient
room Clean patient room daily using a hospital
disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces)
Use dedicated equipment if possible (e.g., stethoscope) 32
GLOVES Use gloves when entering the room. Change gloves after contact with infective material. Remove gloves before leaving the room. Wash hands or use appropriate gel after glove removal. Do not touch infective material or surfaces with hands. Clean, non-sterile gloves are usually adequate.
GOWN Use protective gown when entering the room if
direct contact with patient or potentially contaminated surfaces or equipment near patient is anticipated or if the patient has diarrhea or colostomy or wound drainage that is not covered by a dressing.
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Reduce the risk of transmission by large particle droplets (larger than 5 in size).
Requires close contact between the source person and the recipient
Droplets usually travel 3 feet or less
E.g., influenza, rubella, parvovirus B19, mumps, H. influenzae, and N. meningitidis
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A private/single room or
Cohort with patient with active infection with same microorganism
Use a mask when entering the room and definitely if within 3 feet of patient
Limit movement and transport of the patient. Use a mask on the patient if they need to be moved and follow respiratory hygiene/cough etiquette
Keep at least 3 feet between infected patient and visitors
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Tuberculosis, measles, varicella
Place the patient in an airborne infection isolation room (AIIR)
Pressure should be monitored with visible indicator
Use of respiratory protection (e.g., fit tested N95 respirator) or powered air-purifying respirator (PAPR) when entering the room
Limit movement and transport of the patient. Use a mask on the patient if they need to be moved
Keep patient room door closed.
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Isolation precautions is important in all healthcare settings to prevention transmission of infections
2 types of isolation precautions Usage of each type of precautions
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ISOLATION PRECAUTIONS
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Contact Precautions
Standard
Precautions
Airborne
Precautions
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In contact precaution, if a privateroom is not available, do this forpatient with someone with same infection.
Contact Precautions for $100?
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Contact Precautions
Standard
Precautions
Airborne
Precautions
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You should wear this when touch-ing blood and other body fluids and contaminated instruments.
Standard Precautions for $300?
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Contact Precautions
Standard
Precautions
Airborne
Precautions
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These infections require airborne precautions in aHealthcare facility.
Airborne Precautions for $200?
TO BE CONTINUED!
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2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
CDC guidelines for isolation precautions in hospitals 1996, Hospital Infection Control Practices Advisory Committee (HICPAC): http://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp
Principles of Epidemiology in public health practice, 3rd edition
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