74587694 hospital infection control 2008
TRANSCRIPT
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HOSPITAL INFECTION
CONTROL
Cecilia S. Montalban, MD, MScCTM
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INFECTION
the state or condition in which thebody or part of the body is invadedby a pathogenic agent (bacteria,
virus, parasites etc.) which underfavorable conditions multiplies andproduces injurious effects
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NOSOCOMIAL INFECTION
latin word nosocomium meaning hspital
synonymous to hospital-acquired infection
infection acquired 48 hours afteradmission to hospital (not present orincubating at the time of admission)
acquired while in the hospital and
developed after discharge
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Common Sites of
Nosocomial Infections
Urinary tract
Respiratory tract
GastrointestinalBlood stream
Skin, Wound, Burn
Surgical wound infectionOthers
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Factors Promoting
Nosocomial Infection
ageduration of hospitalizationsurgery (type of operation)
immune status: chemotherapy, radiationtherapy, malignancydiagnostic technique/ proceduresenvironment
personnelpatient
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The C ST of
Nosocomial Infection
PERSONNEL
Need for hospitalization
Income loss Pain and suffering
Disfigurement/Disability
Death
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The C ST of
Nosocomial Infection
INSTITUTIONS
Loss of revenue
Extra duty Liability insurance
Malpractice
Reputation
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BSI Pneumonia UTI
Extra daysconfinement
15 11 13
Added cost US$2,619
US$ 2,051 US$ 1,970
EXTRA C STS BY TYPE
OF INFECTION
Rosenthal and Migone. Nosocomial Infections Costs And Extra Days In
Intensive Care Units In Argentina. Prospective Cohort Matched Cases.
IV Infections Control And Hospital Epidemiology
Pan American Congress. 2002, Cancun, Mexico.
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How do infections occur in hospitalsetting ?AGENT
SUSCEPTIBLEHOST
MEANS OFTRANSMISSION
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AGENT
How do infections occur in hospitalsetting ?
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AGENTS
GRAM NEGATIVERODS
GRAM POSITIVECOCCI
OTHERS
Escherichia coli Staphylococcus
aureus
Fungi -
Candida sp.;
Aspergillus sp.
Klebsiella sp. Staphylococcus
epidermidis
Protozoans
Pseudomonas
aeruginosa
Enterococci Mycobacterium
tuberculosis
Acinetobacter sp. Pneumocystis
carinii
Enterobacter sp. Anaerobes
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Sources of Agents of
Nosocomial Infections
EXOGENOUS
Hands
Instruments
Catheters Respiratory
equipments
Transfusions
IV system
Linen
Air
ENDOGENOUS
Oropharynx
Respiratory
Gastrointestinal
Skin
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Factors Promoting EndogenousInfections
Operations
Catheters
Foreign bodies
Chemotherapy
Immunosuppression Pre-existing disease
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AGENT
MEANS OFTRANSMISSION
How do infections occur in hospitalsetting ?
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Means of Transmission ofNosocomial Infections
Contact - direct or indirect
Airborne - measles, varicella, TBDroplet - meningococcemia
Vector - insects or animals
Vehicle - food, water, blood,medication
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MEANS OF TRANSMISSIONOF NOSOCOMIALINFECTIONSCONTACTA. Direct Contact
- occurs when one persontouches another
- direct contact is an ongoing
process in the hospital- best vehicle : Hands
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MEANS OF TRANSMISSIONOF NOSOCOMIALINFECTIONSCONTACTB. Indirect Contact
- occurs when a person touches
an inanimate object
contaminated by an infected
patient
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AGENT
SUSCEPTIBLEHOST
MEANS OFTRANSMISSION
How do infections occur in hospitalsetting ?
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Factors that Increase HostSusceptibility to NosocomialInfections Chronic underlying diseases
Immune deficiency states Malignancies
Therapeutic measures Immunosuppression
Antibiotic therapy
Invasive devices
Surgery Age
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AGENT Means ofTransmission SusceptibleHostBacteria
Virus
Fungi
CONTACT
AIRBORNE
DROPLETVEHICLE
VECTOR
Disease
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BASIC PRINCIPLES ININFECTION CONTROL
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AGENT
Susceptible
HOST
Means of
Transmission
Breaking theChain of Infection
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The hands should be washed afterhandling infectious materials (e.g. bedlinen, dressings, secretion andexcretions).
The skin of the patient should bedisinfected before invasive procedures
Emphasize HANDWASHING for personal
hygiene
Basic Principles in InfectionControl
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Basic Principles in InfectionControlRational Use of Devices- Avoiding or removing factors that
impair host defenses.
- Invasive devices should be avoidedor should be removed as soon aspossible
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The environment should beHOSTILE to the multiplication ofpathogens, i.e. clean, dry, exposed
to light and well ventilated. All infectious materials (e.g. linen,
clinical waste, sharps) should be
safely contained, decontaminated ordestroyed.
Basic Principles in InfectionControl
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All instruments and equipment should beclean and dry. Invasive items should besterilized and items in contact with mucousmembranes, body fluids and potentially
infectious materials should be disinfected. Food should be hygienically
prepared, properly cooked and
stored at low temperatures untilused.
Basic Principles in InfectionControl
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Susceptible
HOST
Means of
Transmission
Hand Hygiene
Environmental Care
Waste management
Disinfection and Sterilization
Hand Hygiene
Rational use of Devices
Isolation
Immunization,
Immunotherapy
Prophylaxis
Breaking theChain of Infection
Hand HygieneAseptic Technique
practice
Environmental Care
Disinfection and
Sterilization
AGENT
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The Health Care Worker (HCW) shouldbe aware of how infection istransmitted and the factors involved in
the process The HCW should be able to implement
the MOST effective and applicable
measures to prevent and controlinfection in his place of work
The HCW should have the properattitude of infection control
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Hospita l Infect ion Con trol Comm ittee
Organizational Structure Under the office of the Medical Director
Infection Control Team
Chairperson
Infection Control Physician
Infection Control Nurse
Reps from different clinical departments
Auxiliary members from Employee Health Service,Engineering, Pharmacy, Central Sterilization and
Supply Department and Housekeeping Department
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Hosp i tal Infect ion Contro l Comm ittee
Objective
To facilitate the effective
prevention,detection,and
control
of healthcare associated infection amongpatients, healthcare workers and visitors.
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Infect ion Contro l Comm it tee
Responsibilities:
Formulates, updates, and implements infection
control policies and procedures:- Hand hygiene
- Disinfection & sterilization
- Isolation policy- Antibiotic Use
- Personnel Health
- Dietary
- Linen & Laundry
- Waste Management- Environmental Care
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Infect ion Con tro l Comm ittee
Responsibilities:
Surveillance
- nosocomial infection
- antimicrobial resistance
- proper infection control practice
- personnel health
- outbreaks
- environment
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Infection Control Committee
Training and education of healthcare staff
Conducts orientation of new staff Conducts activities for updates on infection
control for staff regularly
Disseminates necessary information
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Organizational Structure; ICC
Medical Director
ICC----------------------------------
Nursing Service Medical Services Administrative
Membership of the Infection
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Membership of the Infection
Control Committee
Chairperson
Infection control doctor
Infection control nurse
Representative from:
Administration
Clinical departments (medicine, pediatrics, surgery,
obstetrics and gynecology, Infectious Disease Section) Microbiology laboratory
Nursing service
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Membership of the Infection
Control Committee
Representative from:
Pharmacy
Employee Health Service
Central Sterilization and Supply Department
Engineering
Dietary Department
Housekeeping
Linen and laundry
Waste Management
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The Infection Control Team
IC Physician
IC Nurse
Microbiologist
Epidemiologist
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The Infection Control Team
An effective ICT:
Maintains direct access to a representative of the Hospital
Director/Administrator
Responsible to the ICC
Functions on a daily basis
Has access to appropriate facilities to enable it to perform
its duties Have an efficient mechanism of reporting significant
hospital outbreaks
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The Infection Control Team
Responsibilities
Educates, trains, and advises staff on all aspects
of infection control
Conducts surveillance activities:
Nosocomial infections Antibiotic resistance
Infection control practices
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Establishing An
Infection Control Program Identify interested and key hospital
personnel as members of the ICC/ICT
Accomplish a written description of theprogram (Infection Control Plan)
Goals, objectives, structure
Specific surveillance, prevention, control,education, and training activities
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Establishing An
Infection Control Program Formulate written policies and procedures
study existing practices
modify existing policies as needed consider difficulties during implementation
after hospital-wide consultation
Implement changes gradually
Have the cooperation of the staff
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Establishing An
Infection Control Program Formulate written policies and procedures
simple, easy to follow, common sense
consider costs and availability of supplies maintain standard of care
incorporate written policies in the IC manual
Monitor and evaluate periodically
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Establishing An
Infection Control Program Disseminate information
Implement and monitor
Annual evaluation on the IC program Assess the activities
Assess accomplishments
Identify any changes in goals, objectives,structure
Assess the value of the program to the hospital
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INFECTION CONTROL is
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In fect ion Con tro l should be
..... a WAY of L IFE!
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Thank You!