12 infection control final 08 3

8/13/2019 12 Infection Control Final 08 3

1/38

1

Drug and TherapeuticsCommitteeSession 12.

Infection Control


2/38

Objectives

Understand basic infection control (IC)concepts

Understand the causes of nosocomial

infections Understand the components of an infection

control program

Understand how the Infection Control

Committee and DTC can decrease theincidence of nosocomial infections andantimicrobial resistance (AMR)


3/38

Outline

Key Definitions

Activity 1

Introduction

Epidemiology of Nosocomial Infections

Control and Prevention of Nosocomial Infections

Core Strategies for Reducing the Risk of

Nosocomial Infections Implications for the DTC

Activity 2

Summary


4/38


5/38

Key Definitions (2)

DisinfectionThe process of microbialinactivation that eliminates virtually allrecognized pathogenic microorganisms, but not

necessarily all microbial forms (e.g., spores)

SterilizationThe use of physical or chemicalprocedures to destroy all microbial life,including large numbers of highly resistantbacterial endospores. Procedures include

Steam sterilization

Heat sterilization

Chemical sterilization


6/38

Activity 1

Description of participants infection control and

preventions programs


7/38

IntroductionWhy Infection

Control? (1)

Hospital acquired infections are a common

problemprevalence about 9%

Hospital acquired infections contribute to AMR Overuse of antimicrobials (development)

Poor infection control practices (spread)


8/38

IntroductionWhy Infection Control? (2)

Hospital-acquired infections increase the cost of

health care

World Bank studies have shown that two-thirdsof developing countries spend more than 50%

of their health care budgets on hospitals

Effective IC programs are beneficial

They decrease spread of nosocomial

infections, morbidity, mortality, and health care

costs


9/38

IntroductionDevelopment of AMR

Poor or absent IC practices, especially in intensivecare units, results in cross-transmission ofantibiotic-resistant bacteria.

Resistant bacteria prompts even greater antibioticuse by physicians.

Perception of knowledge by physicians of poorsterilization, disinfection, or patient care practicesprompts increased antibiotic use (e.g., broadspectrum and prolonged surgical prophylaxis in an

effort to prevent infections).


10/38

Epidemiology of Nosocomial

Infections (1)

Most common sites for nosocomial

infections Surgical incisions

Urinary tract (i.e., catheter-related)

Lower respiratory tract

Bloodstream (i.e., catheter-related)


11/38


12/38

Epidemiology of Nosocomial

Infections (3)

Nosocomial transmission of community

acquired, multidrug-resistant organisms

M. tuberculosis

Salmonellaspp.

Shigellaspp.

V. cholerae


13/38

Root Causes of Nosocomial

Infections (1)

Lack of training in basic IC

Lack of an IC infrastructure and poor IC practices

(procedures)

Inadequate facilities and techniques for hand

hygiene

Lack of isolation precautions and procedures


14/38

Root Causes of Nosocomial Infections (2)

Use of advanced and complex treatments without

adequate training and supporting infrastructure,

including

Invasive devices and procedures

Complex surgical procedures

Interventional obstetric practices

Intravenous catheters, fluids, and medications

Urinary catheters

Mechanical ventilators

Inadequate sterilization and disinfection practices

and inadequate cleaning of hospital


15/38

Infection Control Committee (1)

Membership

Doctors

General physician

Infectious disease specialist

Surgeon

Clinical microbiologist

Infection control nurse

Representatives from other relevant departments Laboratory

Housekeeping

Pharmacy and central supply

Administration


16/38


Goal

To prevent the spread of infections within the health

care facility

Functions

Addressing food handling, laundry handling,

cleaning procedures, visitation policies, and directpatient care practices

Obtaining and managing critical bacteriological data

and information, including surveillance data


17/38


Functions (cont)

Developing and recommending policies and

procedures pertaining to infection control Recognizing and investigating outbreaks of

infections in the hospital and community

Intervening directly to prevent infections

Educating and training health care workers,patients, and nonmedical caregivers


18/38

Core Strategies to Reduce Nosocomial

Infections

Hand Hygiene

To ensure appropriate hand washing techniques

Provide sinks, clean water, and soap at convenientlocations

Where sinks, clean water, and hand washing supplies

are unavailable, use alcohol-based products which are

inexpensive, produced locally, convenient, andeffective for hand hygiene.

Monitor compliance

Use gloves when necessary


19/38

-4-3-2-1

0

-5 0 5 10

LogRed

uction

inColony

Counts

Hours

Effect of Antiseptics on Colony Counts

After Hand Scrub

Alcohol

Iodophors

Chlorhexidine

Source: Modified from Larson, E. 1988. Guideline for Use of Topical Antimicrobial Agents.AmericanJournal of Infection Control 16:253.


20/38


21/38

Ensuring a Clean Environment

Establish policies and procedures to prevent food

and water contamination

Establish a regular schedule of hospital cleaning

with appropriate disinfectants in, for example,

wards, operating theaters, and laundry

Dispose of medical waste safely

Needles and syringes should be incinerated

Other infected waste can be incinerated or autoclaved

for landfill disposal

Bag and isolate soiled linen from normal hospital

traffic


22/38

Cleaning, Disinfection, and Sterilization

of Instruments and Supplies Written policies and procedures are needed

All objects to be disinfected or sterilized should first be

thoroughly cleaned

Use stream sterilization whenever possible

Quality control in reprocessing is essential

Monitor and record sterilization parameters (i.e., time, temperature,

pressure)

Biological indicators should be used to ensure sterilization

Chemical indicators are necessary for chemical sterilization

Sterilized items must be stored in enclosed clean areas

Items or devices that are manufactured for single use should

not be reprocessed (e.g., disposable syringes and needles)


23/38

Sterile Invasive Procedures and

Intravenous Medications Intravascular devices

Use only when necessary.

Silicon elastomer or polyurethane catheters have lower infection riskthan polyvinyl catheters

Procure IV solutions and IV devices from quality suppliers when

assured GMP.

Prepare and administer IV medicines and fluids in a sterile manner,

in a designated uncontaminated area, using specially trained staff.

Urinary catheters

Avoid in-dwelling urinary catheters whenever possible.

Use closed drainage systems.


24/38

Respiratory Therapy

Mechanical ventilation and respiratory

equipment

Use only when absolutely necessary.

Use suction catheters only once (or reprocess them

appropriately).

Ensure that all equipment has ethylene oxide sterilization

or high-level disinfection before use.

Wean patient early from ventilators.

Ensure proper handling of inhalation medications and

supplies.


25/38

Surgery and Surgical Site Care Implement comprehensive policies and procedures.

Minimize preoperative stays in the hospital.

If necessary to shave the planned operative site, useclippers (not razors) and shave immediately before the

procedure.

Use antibiotic prophylaxis only when indicated andaccording to established protocols.

Provide sterile instruments in individually wrapped sterile

packages.

Use an effective antiseptic, such as iodine, to prepare theincision site.

Include perioperative scrub with antiseptic scrub for hand

and forearm antisepsis for surgical teams.


26/38

Employee Health and Training

Program Treat work-related illnesses

Provide vaccinations to decrease infections

Routine vaccinations (e.g., diphtheria, tetanus, polio,measles, mumps, rubella, varicella, hepatitis A and B, BCG)

Vaccinations during epidemics (e.g., meningitis, typhoid,

influenza)

Train health workers in Appropriate sterile techniques

Infection control procedures

Use of barrier precautions (e.g., gloves) for certain

procedures


27/38

Food and Water Precautions

Contamination of food and water supplyfrequently occurs in hospitals.

Inadequate cooking may lead to overgrowth ofpathogenic bacteria.

Food handlers may contract an infectiousdisease.

Policies and procedures to prevent food andwater contamination are necessary.


28/38

Antimicrobial Use and Monitoring(DTC and Infection Control Committee Collaboration)

Establish protocols recommending use of the most

cost-effective agents when treatment is indicated

Therapeutic guidelines Prophylactic guidelines

Guidelines for surgical prophylaxis

Measure antimicrobial use to identify misuse

Aggregate methods Indicator studies in primary health care

Drug use evaluations (DUEs) in hospitals

Implement interventions to improve antimicrobials use


29/38

Case StudyCesarean Section

The risk of endometritis after cesarean section

exceeds 30%.

Antibiotic prophylaxis reduces the incidence

by two-thirds.


30/38

Inappropriate Timing of Antibiotic

Prophylaxis for Cesarean Section

Patients

Receiving

Prophylaxis

Patients Receiving

Prophylaxis 1

Hour after Delivery

Hospital A 70% 31%

Hospital B 32% 70%


31/38

Effect of Appropriate Perioperative

Antibiotic Prophylaxis on Surgical SiteInfections after Cesarean Section

(Source:Goldman, 2001, unpublished)

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Month

%

0

2

4

6

8

10

12

14

16

18

20

#

sur

gicalsite

infections

per10

0

cesareans

ection

s

Period I Period II Period III


32/38

Infection Control Priority Matrix

Factor Importance

Within the Capacity

of Hospital Personnel

to Improve

Time Frame

for

Improvement

Antibiotic prophylaxis 4 4 Short

Skin preparation 3 4 Short

Surgical technique 4 4 Medium

Prenatal factors 3 1 Long

Peripartum events 4 2 Medium


33/38


34/38

Infection Control Resources

Infection control manuals, protocols, and

training programs (See Participants Guide, annex 1)

CDC websiteprotocols

EngenderHealth training programweb-based training

for basic infection programs

ICATtool that can be used in low-resource countriesto improve infection control practices (can be obtained

from RPM Plus/MSH)


35/38

Infection Control Assessment Tool

The ICAT and quality improvement programprovide a standardized approach.

Combining an infection control self-assessmenttool (ICAT) and rapid cycle quality improvement(RCQI) (or rapid team problem solving) methodsimproves hospital infection control practices.

RCQI is a quality improvement approach in whicha multidisciplinary team collaborates on improvingan identified problem or situation.


36/38

Activity 2

Review the current session and make

recommendations for your hospital or primary care

clinic for starting an Infection Control Committee,improving the current committee, or making an

Infection Control Subcommittee of the DTC.


37/38

Summary (1)

IC procedures are vital to preventing nosocomial infections andfor controlling hospital costs.

Simple, inexpensive strategies can prevent many infections.

DTC can support many IC activities. Hand washing and use of appropriate antiseptics and

disinfectants

Monitoring IV and injection preparation and administration

DTC should actively promote better use of antimicrobials. Guidelines for treatment and surgical prophylaxis

Selection of appropriate antimicrobials for the formulary

Antimicrobial use reviews


38/38

Summary (2)

Infection Control Committees or programs, whenfunctioning effectively, will

Reduce the spread of infectious diseases Decrease morbidity and mortality due to

nosocomial infections

Maintain employee health and morale

Decrease the incidence of AMR

Decrease health care costs

12 infection control final 08 3

Documents