INFECTION CONTROL

SHEHZAD HUSSAIN04-03-2015

Introduction to Patient Safety:

• This unit of patient safety will focus on Infection Control

Global Infection Problems

According to WHO (2005),• On average, 8.7% of hospital patients

suffer health care-associated infections (HAI).

• In developed countries: 5-10% • In developing countries: – Risk of HAI: 2-20 times higher– HAI may affect more than 25% of patients

• At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

Health Care-Associated Infections (HAI)

According to WHO:• HAI is also called “nosocomial”.• HAI is defined as: – an infection acquired in hospital by a

patient who was admitted for a reason other than that infection.

– an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.

Preventing infections

Requires health care providers who have: – Knowledge of common infections and

their vectors– An attitude of cooperation and

commitment – Skills necessary to provide safe care

Required Knowledge

• Knowledge of the extent of the problem;

• Knowledge of the main causes, modes of transmission, and types of infections.

Required Skills

• Apply universal precautions*• Use personal protection methods• Know what to do if exposed• Encourage others to use universal

precautions• Report breaks in technique that

increase patient risks• Observe patients for signs and

symptoms of infection

Initiation:• Purpose:• To ensure that all health care workers (HCWs) involved in patient management or

working in a clinical environment are• aware of the use of standard precautions and to prevent transmission of

microorganism/infection in hospital.• 2. Applicable to: All health care staff• 3. Standard Precautions consist of: Hand hygiene Appropriate use of personal protective equipment (PPE). Respiratory hygiene/cough etiquette Decontamination Handling of linen Safe disposal of sharps and waste

One more important thing!

Protect YourselfProtect Yourself Be sure you have been immunized

against Hepatitis B since it is very easy to transmit!

Main Sources of Infection

• Person to person via hands of health-care providers, patients, and visitors

• Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.)

• Environmental contamination• Airborne transmission• Hospital staff who are carriers • Rare common-source outbreaks

Main Routes for infections

• Urinary tract infections (UTI)– Catheter-associated UTIs are the most

frequent, accounting for about 35% of all HAI.

• Surgical infections: about 20% of all HAI• Bloodstream infections associated with the

use of an intravascular device: about 15% of all HAI

• Pneumonia associated with ventilators: about15% of HAI

Four Ways to Prevent HAI

1. Maintain cleanliness of the hospital.2. Personal attention to hand washing

before and after every contact with a patient or object.

3. Use personal protective equipment whenever indicated.

4. Use and dispose of sharps safely.

Your 5 moments for HAND HYGIENE

How to Clean Hands

• Remove all wrist and hand jewelry.• Cover cuts and abrasions with

waterproof dressings.• Keep fingernails short, clean, and

free from nail polish.

Five moments for hand hygiene

• Before patient contact• Before an aseptic task• After body fluid exposure even if

wearing gloves!• After patient contact• After contact with patient

surroundings

Effective Hand washing Technique

• Steps in hand washing: • Remove jewelry (rings, bracelets) and watches before washing hands• Ensure that the nails are clipped short (do not wear artificial nails)• Ensure that sleeves are up to the elbow before planning for hand washing• Wet hands and wrists, keeping hands and wrists lower than the elbows• Apply soap (plain or antimicrobial) and lather thoroughly.• Use firm circular motions to wash the hands and arms up to the wrists,

covering• all areas including palms, back of the hands, fingers, between fingers and

lateral• side of fifth finger, and wrists. Rub for minimum of 10-15 seconds.• Repeat the process if the hands are very soiled.• wash hands with soap and water before using hand rubs/ gel/alcohol

swabs.

• Clean under the fingernails.• Rinse hands thoroughly, keeping the hands lower than the forearms.• Dry the hands thoroughly with disposable paper towel.• Discard the towel in a dustbin without touching the bin lids.• Use a fresh paper towel or your elbow/foot to turn off the faucet, to

prevent• recontamination of hands.• Steps using antiseptics, hand rubs, gels or alcohol swabs for hand

antisepsis:• Apply the product to the palm of one hand.• Rub hands together, covering all surfaces of hands and fingers, until

hands are dry. Do not rinse.

How to use waterless handrub• Apply a palmful of product in cupped hand• Rub hands palm to palm • Right palm over left hand with interlaced fingers• Palm to palm with fingers interlaced• Backs of fingers to opposing palms with fingers

intelocked• Rub between thumb and forefinger• Rotational rubbing, backwards and forwards with

clasped fingers of right hand in left palm and vice versa

• Once dry your hands are safe.

Personal Protective Equipment

Personal Protective Equipment (PPE):PPEs are clothing, items used to prevent cross

transmission from patients to staff or fromstaff to patients. It includes gloves,

gown/apron, masks, eye shield/goggles etc.NOTE: Remove and discard PPE before

leaving the patient’s room or cubicle

Gloves

Wear gloves when contact with blood or body fluids (BBF), mucous membranes, non-intact skin, or

potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) is anticipated.

Wear disposable medical examination gloves for providing direct patient care.

Do not wear the same pair of gloves for the care of more than one patient.

Perform hand hygiene before and immediately after removing gloves.

Polythene gloves are not suitable for use when dealing with blood and/or blood and body fluids, i.e. in a clinical setting.

Cont…

Remove gloves after contact with a patient and/or the surrounding environment (including medical

equipment) using proper technique to prevent hand contamination.

Do not wear the same pair of gloves for another patient.

Never leave the patient care area without removing gloves and don’t move around with gloved hands.

Gowns/Apron:

Wear a gown, to protect skin and clothes to prevent contamination during patient-care activities when

contact with BBF, secretions/excretions is anticipated.

Remove gown and perform hand hygiene before leaving the patient’s environment.

Gowns may be reused by the same HCW for the same patient.

If the gown is visibly soiled then it should be replaced.

Masks/Eye Shield/Goggles:

Use masks and/or eye shield to protect the mucous membranes of the eyes, nose and mouth during

procedures that are likely to generate aerosols. During aerosol-generating procedures e.g.

bronchoscopy, suctioning, intubation; HCWs should wear

Mask & Eye Shield. For suspected or proven cases of open TB, H1N1,

VHF wear N95 mask with other PPE.

Caps and boots/shoe covers:

Along with above mentioned PPE, wear cap and shoe cover where there is likelihood of major spillage of

BBF. Do not reuse disposable caps/shoe covers. Clean and disinfect reusable boots.

• Respiratory Hygiene/Cough Etiquette: Cover the nose/mouth with inside of elbow when coughing or sneezing. Use tissues to contain respiratory secretions and dispose of them in the

nearest waste receptacle after use. Perform hand hygiene after having contact with respiratory secretions and

contaminated objects/materials.

Handling of linen:

• Used linen should be handled and disposed of appropriately as per institutional policy

• All soiled linen should be placed in water soluble and then in red bag (double bagged) immediately by the end user.

Handling of sharps• Discard sharp in designated puncture-resistant containers. All

needle stick injuries/exposure to BBF• should be reported immediately to infection control through

IRF link. http://portal.aku.edu/irf/• Never recap or bend needles.• Replace the sharps disposal container when two-third (2/3)

filled.• Cutting of needle is prohibited.• All BBF spillages should be dealt immediately.• All BBF should be considered potentially infectious.

Environmental cleaning

• Use adequate procedures for the routine cleaning and disinfection of environmental and other frequently

• touched surfaces.• Proper environmental interventions required

such as daily cleaning and disinfection of, doctors & staff

• changing areas, toilets, doctor’s room and lounges.

Encourage Others to Participate in Infection

ControlStudents may routinely observe staff

who: – apply inadequate technique in

handwashing – fail to wash hands– routinely violate correct infection control

procedures