2. Nurses playa vital rolein preventing the development and
spread of infections among hospital patients. Some nurses,
calledinfection control nurses, specialize in this, but all nurses
in a hospital share responsibilityfor monitoring patients,
practicing good hygiene and implementing all other methods
designedto keep hospitals sterile and patients safe
3. The very first requirement in a hospital is that it should
do THE SICK NO HARM.
4. INFECTION Definition: Injurious contamination of body or
parts of the body by bacteria, viruses, fungi, protozoa and
rickettsia or by the toxin that they may produce. Infection may be
local or generalized and spread throughout the body. Once the
infectious agent enters the host it begins to proliferate and
reacts with the defense mechanisms of the body producing infection.
Symptoms and Signs: Systemic: headaches, fever, fatigue, vomiting,
diarrhea, increased pulse and respiration. Localized: redness,
swelling, painful, warm to the touch .
5. CHAIN OF INFECTION Model of infectious disease transmission
Six elements must be present for an infection to develop: 1. The
infectious agent . 2. Reservoir host. 3. Portal of exit from the
host 4. Route of transmission. 5. Port of entry. 6. Susceptible
host.
6. CHAIN OF INFECTION Pathogen Susceptible Host Portal Entry
Mode of Transmissi on Reservoir Portal of Exit
7. INFECTION CONTROL Goal of infection control is to prevent
the spread of infectious diseases. Infectious disease is any
disease caused by the growth of pathogens in the body. Pathogens
are disease-causing microorganisms (germs). Infectious diseases can
cause unnecessary pain, suffering and death.
8. BREAKING THE CHAIN OF INFECTION Breaking at least one link
stops the spread of infectious disease 1. The infectious agent :
early recognition of signs of infection. Rapid, accurate
identification of organisms. 2. Reservoir host: Medical asepsis.
Standard precautions. Good employee health. Environmental
sanitation. Disinfectant/sterilization. 3. Portal of exit from the
host: Medical asepsis. Personal protective equipment. Handwashing.
Control of excretions and secretions. Trash and waste disposal.
Standard precautions .
9. BREAKING THE CHAIN OF INFECTION 4. Route of transmission:
Standard precautions. Handwashing. Sterilization. Medical asepsis.
Air flow control. Food handling. Transmission-based precautions.
5.Portal of entry: Wound care. Catheter care. Medical asepsis.
Standard precautions. 6.Susceptible Host: Treating underlying
diseases. Recognizing high-risk patients.
10. Breaking the chain of infection Bacteria ,Virus , Fungi ,
Protozoa Surgery,traum a,immuno- suppressed chronically ill elderly
Mucus membrane Broken skin G.I tract G.U tract Respiratory tract
Contact vehicle Airborne vector borne Human Beings, Animals,
Inanimate objects. Sputum Vomitus , Urine, stool blood
Immunization, nutrition hygiene , adequate rest, regular exercise
Hygiene of hands, sterilization, antibiotics Sterilization, use of
disposable item Hand hygiene , use of mask , gloves , isolation and
barrier techniques Hand hygiene , climate , vector using pesticides
, adequate refrigeration Hand hygiene , proper disposal of waste ,
use of mask and gloves
11. COMMON HEALTH CARE ASSOSIATED(NOSOCOMIAL) Urinary Tract
Infection Respiratory Tract Bloodstream Surgical/Traumatic Wound
Infection
12. 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.
13. THE RISK OF INFECTION IS ALWAYS PRESENT Patient may acquire
infection before admission to the hospital = Community acquired
infection. Patient may get infected inside the hospital =
Nosocomial infection. 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.
14. PATIENT SUSCEPTIBILITY Age: Infancy and old age decreases
resistance to infection. Immune status: Patients with chronic
diseases as malignancy, leukemia, diabetes mellitus, renal failure
or AIDS have increased susceptibility to infection.
Immunosuppressive drugs or irradiation
15. INFECTION PREVENTION at least 35-50% of all
healthcare-associated infections are asociated with only 5 patient
care practices: Use and care of urinary catheters Use and care of
vascular access lines Therapy and support of pulmonary functions
Surveillance of surgical procedures Hand hygiene and standard
precautions
16. ALL NURSING STAFF SHOULD FOLLOW STANDARD PRECAUTION..
Guidelines for preventing exposure to blood, body fluids,
secretions, excretions (except sweat), broken skin, or mucous
membranes Based on the concept that body fluids from ANY patient
can be infectious Should be used on every patient Use necessary PPE
for protection Hand hygiene. Respiratory hygiene/cough etiquette.
Use of personal protective equipment (PPE). Prevention of needle
sticks/sharps injuries. Cleaning and disinfection of the
environment and equipment
17. HAND WASHING Hand washing is the single most effective
precaution for prevention of infection transmission between
patients and staff. Hand washing with plain soap is mechanical
removal of soil and transient bacteria (for 10- 15 sec.) Hand
antisepsis is removal & destroy of transient flora using
anti-microbial soap or alcohol based hand rub (for 60 sec.)
18. HAND SHOULD BE WASHED: Before and after patient contact
Before putting on gloves and after taking them off After touching
blood and body substances (or contaminated patient-care equipment),
broken skin, or mucous membranes (even if you wear gloves) Between
different procedures on the same patient
19. Your 5 moments for HAND HYGIENE
20. Methods in Hand Washing Surgical hand scrub: removal or
destruction of transient flora and reduction of resident flora
using anti-microbial soap or alcohol based detergent with effective
rubbing (for least 2-3 min) Our hands and fingers are our best
friends but still could be our enemies if they carry infective
organisms and transmit them to our bodies and to those whom we care
for. Sinks & soap must be found in every patient care room.
Doctors, nurses must comply to hand washing policy.
21. Dr.T.V.Rao MD 21
22. When to Wash our Hands 1. Before & after an aseptic
technique or invasive procedure. 2. Before & after contact with
a patient or caring of a wound or IV line. 3. After contact with
body fluids & excreta removal. 4. After handling of
contaminated equipment or laundry. 5. Before the administration of
medicines 6. After cleaning of spillage. 7. After using the toilet.
8. Before having meals. 9. At the beginning and end of duty. 10.
Gloves cannot substitute hand washing which must be done before
putting on gloves and after their removal.
23. How to Wash our Hands Jewelry must be removed. If unable to
remove rings, wash and dry thoroughly around them. Wet your hands
with running warm water, dispense about 5 ml of liquid soap or
disinfectant into the palm of the hand. Rub hands together
vigorously to lather all surfaces and wrist paying particular
attention to thumbs, finger tips and webs. Rinse hands thoroughly.
Turn off water using elbow-on elbow taps, dry hands thoroughly on a
paper towel OR where elbow taps are not present, first dry hands,
thoroughly, then turns off the taps using fresh paper towel. Hand
cream can be used on personal basis. If a staff member develops a
skin problem, he or she must consult dermatologist.
24. Our Hands are Threat to LIFE Just Washing can Save Many
LIVES
27. TYPES OF PPE USED IN HEALTHCARE : Gloves protect hands
Gowns/aprons protect skin and/or clothing Masks and respirators
protect mouth/nose Respirators /N95 mask protect respiratory tract
from airborne infectious agents Goggles protect eyes Face shields
protect face, mouth, nose, and eyes. Shoe cover
28. Sequence for Donning PPE Gown first Mask or respirator
Goggles or face shield Gloves Dr.T.V.Rao MD 28
29. Key Points About PPE Don before contact with the patient,
generally before entering the room Use carefully dont spread
contamination Remove and discard carefully, either at the doorway
or immediately outside patient room; remove respirator outside room
Immediately perform hand hygiene
30. How to Don a Gown Select appropriate type and size Opening
is in the back Secure at neck and waist If gown is too small, use
two gowns Gown #1 ties in front Gown #2 ties in back PPE Use in
Healthcare Settings
31. How to Don a Mask Place over nose , mouth and chin. Fit
flexible nose piece over nose bridge. Secure on head with ties or
elastic. Adjust fully. PPE Use in Healthcare Settings
32. How to Don Eye and Face Protection Position goggles over
eyes and secure to the head using the ear pieces or headband
Position face shield over face and secure on brow with headband
Adjust to fit comfortably. PPE Use in Healthcare Settings
33. How to Don Gloves Gloves last. Select correct type and size
Insert hands into gloves Extend gloves over isolation gown cuffs.
PPE Use in Healthcare Settings
34. How to Safely Use PPE Keep gloved hands away from face.
Avoid touching or adjusting other PPE. Remove gloves if they become
torn; perform hand hygiene before donning new gloves. Limit
surfaces and items touched.
35. PPE FOR STANDARD PRECAUTIONS Based on Risk Assessment IF
direct contact with blood & body fluids, secretions,
excretions, mucous membranes, non-intact skin Gloves Gown Mask IF
there is the risk of spills onto the body and/or face Gloves Gown
Face protection (mask plus eye protection goggle or visor; face
shield) Booties
36. BARRIER PRECAUTIONS Gloves: Disposable gloves must be worn
when: a) Direct contact with B/BF is expected. b) Examining a
lacerated or non-intact skin.e.g wound dressing. c) Examination of
oropharynx, GIT, UIT and dental procedures. ) Working directly with
contaminated instruments or equipment. e) HCW has skin cuts,
lesions and dermatitis Sterile gloves are used for invasive
procedures. GLOVES MUST BE of good quality, suitable size and
material. Never reused.
37. BARRIER PRECAUTIONS Gowns/ Aprons: Are required when:
Spraying or spattering of blood or body fluids is anticipated e.g
surgical procedures. Gowns must not permit blood or body fluids to
pass through. Sterile linen or disposable ones are used for sterile
procedures.
38. BARRIER PRECAUTIONS Masks & Protective eye wear: MUST
BE USED WHEN: engaged in procedures likely to generate droplets of
B/BF or bone chips During surgical operations to protect wound from
staff breathings, Masks must be of good quality, properly fixed on
mouth and nasal openings.
39. What to do if exposed to blood / body fluids Puncture
wounds should be washed immediately and the wound should be caused
to bleed If skin contamination occurs, wash the area immediately
Splashes to the nose or mouth should be flushed with water Eye
splashes require irrigation with clean water, saline, or a sterile
irritant
40. Handling of Contaminated Material 1. Cleaning of B/BF
spills: a- wear gloves. b- wipe-up the spill with paper or towel.
c- apply disinfectant. 2. Cleaning & decontamination of
equipment: protective barriers must be worn. 3. Handling &
processing lab specimens: must be in strong plastic bags with
biohazard label 4. Handling and processing linen: Soiled linen must
be handled with barrier precautions, sent to laundry in coded bags.
5. Handling and processing infectious waste: a. must be placed in
color coded, leakage proof bags, collected with barrier precautions
b. contaminated waste incinerated or better autoclaved prior to
disposal in a landfill.
41. SHARP PRECAUTION Needle stick and sharp injuries carry the
risk of blood born infection e.g AIDS, HCV,HBV and others. Sharp
injuries must be reported and notified NEVER TO RECAP NEEDLES
Dispose of used needles and small sharps immediately in puncture
resistant boxes (sharp boxes). Sharp boxes: must be easily
accessible, must not be overfilled, labeled or color coded. Needle
incinerators can be another safe way of disposal. Reusable sharps
must be handled with care avoiding direct handling during
processing. Do not Recap Needles A threat to LIFE
42. DOUBLE BAGGING TECHNIQUES Used when disposing of medical
waste from clients with infections (ex HIV). Health care worker A,
wearing proper PPE, takes the contaminated bag from the area. A
slips it into another bag held by co-worker B. B does not touch the
contaminated bag. A does not touch the clean bag. The bags are
labeled according to the facility policy with hazardous waste or
linen markers to alert to the need for special handling.
43. CLEANING , DISINFECTION AND STERILIZATION CLEANING
:cleaning is the removal of all soil from objects and surfaces.
Generally involves use of water and mechanical action with
detergents or enzymatic products. Proper cleansing ,disinfection
and sterilization of contaminated objects significantly reduce and
oten eliminate micro-organisms.
44. DISINFECTANT Chemical disinfectants can be harmful to the
skin. When using chemical disinfectants follow manufacturers
directions for dilution and for antidoting any exposure 10%
household bleach in water meets OSHA requirements, kills HBV, HIV
and TB Soaking for 20-30 minutes in 70% isopropyl alcohol acts as a
disinfectant: used for some instruments, glass thermometers.
Boiling instruments in water , rarely used today.
45. STERILIZATION Chemical agents and physical methods used to
destroy or inhibit growth of pathogens Bacteriostatic inhibits
growth Bactericidal/germicidal kills microorganisms Antiseptics
bacteriostatic chemical agents, mild enough to use on skin: 70%
isopropyl alcohol Disinfectants destroy most bacteria and viruses.
Used for instruments that do not penetrate the skin and for
cleaning the environment floors, bathrooms, equipment
Agents/methods that totally destroy all microorganisms including
viruses and spores Include chemical agents, gas, radiation, dry or
moist heat under pressure Most common method used is the autoclave,
which sterilizes by steam created by a pressurized heating system
Small units used in a medical office; large units used in
hospitals
46. Factors influencing the Effecacy of the disinfecting and
sterilising methods. Concentration of solution and duration of
contact. Type and number of pathogen. Surface areas to treat.
Temperature of the environment. Presence of organic material.
47. PREVENTION: Medical Asepsis Medical asepsis (clean
technique): procedures to decrease the number and spread of
pathogens Hand washing, good personal hygiene, cleaning rooms
between patient use, proper disposal of gloves after contact with
body fluids or contaminated objects
48. PREVENTION: Surgical Asepsis Surgical asepsis (sterile
technique): procedures that completely eliminate the presence of
pathogens from objects and areas Sterile caps, gowns, masks, and
gloves Sterilizing instruments Maintaining sterile fields Changing
dressing Disposing of contaminated materials In Surgical hand
asepsis , hands should be above elbows while prescrubing and
rinsing.
49. Surgical Asepsis Sterile Technique Aseptic: free from
pathogenic microorganisms Sterile Technique: refers to a group pf
principles and procedures designed to eliminate pathogens Sterile
field: an area designated as free from microorganisms Example: a
sterile towel placed on a clean, dry surface the towel becomes the
sterile field Consider the field as a 3-dimensional area
50. Maintaining a Sterile Field Field should be above the waist
height Do not bring contaminants into the field Actions that
contaminate the field: touching it, allowing it to become wet,
reaching across it, talking or coughing directly over the surface
Work to the side of the field Sterile gloves come in sealed
packages that must be opened at the edge of the sterile field and
placed onto the field
51. TRANSMISSION BASED PRECAUTIONS.
52. CONTACT PRECAUTIONS Use for protection against infections
which spread by contact In addition to Standard Precautions: Use
non-sterile, clean, disposable gloves, gown, apron (only if gown is
not impermeable) Use disposable or dedicated reusable equipment
(which must be cleaned and disinfected before use on other
patients) Limit patient contact with non-infected persons Place
patient in a single room or cohort with similar patients
53. DROPLET PRECAUTIONS Use for protection against respiratory
pathogens transmitted by large droplets In addition to Standard
Precautions: Use a surgical/medical mask Maintain a distance 1
meter between infectious patient and others. Place patient in a
single room or cohort with similar patients. Limit patient
movement.
54. AIRBORNE PRECAUTIONS Use for protection against inhalation
of tiny infectious droplet nuclei In addition to Standard
Precautions: Use particulate respirator /N 95 mask Place the
patient in adequately ventilated room ( 12 air changes per hour)
Limit patient movement Use airborne precautions during performing
of any aerosol-generating procedures associated with risk pathogen
transmission like bone cutting, dental procedures
55. SURVEILLANCE
56. NOSOCOMIAL INFECTION SURVEILLANCE The term surveillance
implies to regular analysis of observational data aiming at the
reduction of HAIs rate and their costs. HAIs rate of a hospital is
an indicator for quality of service & safety of patient care.
Surveillance is done to monitor HAIs rate, which is essential to
identify problems and to evaluate infection control
activities.
57. Nurses should be familiar with Surveillance Activities
Operative Procedures Critical Care Units (MICU, SICU, NICU)
Targeted Surveillance Outbreak Investigation
58. Surveillance Data Improves the Patient Safety. USES Improve
patient outcomes by modifying patient care practices reducing
length of stay Identify education needs Evaluate new products
Identify new opportunities for improvement.
59. Benchmarking Hospital Acquired Infections CDCs Hospital
Infections Program Submit monthly data on ICU infections
Benchmarking with similar hospitals Networking opportunities Annual
reports Start having a Infection Audit
60. Reporting Accidental Exposure Report any injury or accident
involving exposure to blood or body fluids immediately to your
clinical preceptor/supervisor. Complete a written incident or
injury report. Reporting facilitates evaluation, appropriate
treatment and follow-up. Failure to report can result in negative
health consequences and is in violation of OSHA requirements
61. 97 total slides 61 Regulatory Agencies Center for Disease
Control and Prevention (CDC) - Responsible for developing safe
guidelines to help prevent and control the spread of infectious
diseases Occupational Safety and Health Administration (OSHA) -
Responsible for maintaining minimum health and safety standards for
employees
62. SUMMARY ROLE OF NURSES AS INFECTION CONTROL PROFESSIONAL:
Provide staff and client education on infection prevention and
control. Develop and review infection prevention and control
policies and procedures. Recomment appropriate isolation
procedures. Screen client records for infection that are
reportable. Consult with all hospital departments to investigate
unusual events or clusters of infection. Monitor antibiotic
resistant organisms in the hospitals.
63. Never Forget Everyone is a Active Member in the Infection
Control
