basic princinciples of infection control

7/28/2019 Basic Princinciples of Infection Control

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BASIC PRINCIPLES AND

IDEAS OF INFECTION

CONTROL


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Objectives

Present some of the principles of infection

control

Discuss if you agree with these ideas and

principles


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Examples of HAI: a patient

develops

a urinary tract infection after having a urinarycatheter

measles from the patient in the next bed,

diarrhea that was not present on admission a surgical site infection after an operation

hepatitis C after receiving an injection with aused syringe

HIV from receiving a blood transfusion thatwas not tested


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Infection Control: first do no

harm

The health care we provide can diagnose

diseases, treat patients, relieve suffering and

prevent the spread of disease

Health care can also kill patients, spreaddisease, create epidemics and increase

suffering.

Health care workers can kill more persons intheir career than soldiers unless they practice

good infection control.


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HAI can appear quickly or months

later

Diarrhea from norovirus or staph aureus may

appear in hours

Surgical site infections in patients with

implants may not appear for 1 year

Patient in the same room as a patient with

MRSA may get colonized with the germs but

not develop an infection for 18 months Patients exposed to hepatitis may not develop

disease for 6 months


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We may not be aware of HAI

Physicians and nurses may not be aware of

health care infections that develop after the

patient goes home.

If a patient develops an infection they may not

come back.


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First do no harm

Every facility that provides health care must

have an infection control program to monitor

and prevent infections and injuries to patients

that may result from care.

Every facility must supervise and monitor the

PROCESSES of care to decrease the risk ofharm.


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Some procedures have more risk

of health care associated infections

Risk increases when:

Invasive procedures that break the skin or enter

normally sterile parts of the body

With implants and transplants or anything thatenters and stays in the body (including catheters,

sutures, drains, central lines, Infusions)

The longer the invasive procedure

If a surgical procedure is in a non-sterile part of

the body (respiratory tract, GI or reproductive

tract.


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HAI come from the patients germs

or those transferred to the patient

Present on the patients skin which can not

enter the body through an incision or puncture

(endogenous)

Present on the hands of care givers

Present on objects that touch the patient

Present on food, water or air

Germs may be viruses, bacteria, prions, orother pathogens.


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A core principle:

Separate clean from dirty

Dirty refers to any devices that has touched a

patient or been used

Clean refers to new, never used items or items

that have be cleaned and sterilized or

disinfected

They should NEVER be in the same physical

space. They should not cross paths


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Health care associated infections

(HAI)

Are common:

Can happen every time a patient is touched

In some settings 25% of patients get infections

Can kill patients

Transfusion reactions, contaminated IV fluids

May not be detected without dedicated

surveillance system


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Which option do you think is

true?

Are spread betweenpatients on the

hands of caregivers

Are carried betweenpatients by flies and

insects

Most health care infections Most health care infections


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Infection Control Practitioners

believe

Are spread betweenpatients on the

hands of caregivers

Most health care infections


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Which do you think is true?

One should workindependently toindividualize care andmodify procedures asthey see fit for eachpatient. It is best to

change howprocedures are doneto fit each patient.

One should practice

standardizedprocedure andfollow approvedindications; the

more that the carefollows evidencebased guidelines thebetter the outcome.

The best care proceduresshould be individualized toeach patient

The best care is standardizedprocedures


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believe

One should practice

standardizedprocedure andfollow approvedindications; the

more that the carefollows evidencebased guidelines thebetter the outcome.

The best care is standardizedprocedures


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Is a lifetime student

who is never donelearning.

Has completed their

knowledge and hasperfected their

knowledge base,

and mastered all

necessary concepts

A trained health profession A trained health professional


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believe

Is a lifetime student

who is never donelearning.

A trained health profession


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Infections and

patient injuries are

impossible to

prevent

Infections and


preventable


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believe

Infections and


preventable


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In my practice

I see health care

associated

infections

I never see

healthcare

associated

infections


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believe

I see health care

associated

infections

And if I dont seenthem, my

surveillance system

is to blame!

All health care

systems can be

improved


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ICP judge the quality of health care

by

The disease

outcomes including

death rate, rate of

infection, rates ofcomplications, rate of

being readmitted to

the hospital.

I believe goodhospitals monitor the

processes of care as

well.

The happiness of the

patient

The fame of the

provider The wealth of the

physician

The reputation of the

hospital


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ICP judge the quality of health care

by

The diseaseoutcomes includingdeath rate, rate ofinfection, rates of

complications, rate ofbeing readmitted tothe hospital.

Good hospitalsmonitor the processes

of care becausereducing the variationin processes controlsmuch of the variationin outcome.


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Surgeries and procedures are

Often unnecessary

and expose patientto disease, injuries

and unnecessary

costs

Always beneficialbecause other wise the

physician or nursewouldnt do them

There is an importantplacebo effect that can

always help the patientfeel better with the actof IV and other healthcare procedures.

UNNECESSARY NECESSARY


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Surgeries and procedures are

Often unnecessary

and expose patientto disease, injuries

and unnecessary

costs

UNNECESSARY


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ANTIBIOTICS ARE

The overuse ofantibiotics is a global

problem that createsmultiple drug resistantinfections.

Drug resistance isdangerous to thepatient and to thecommunity

OFTEN UNNECESSARY


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Alcohol hand rub

Is always less

effective than hand

washing with soap

and water

Is very effective at

preventing health

care associated

infections


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Alcohol hand rub

Is very effective at

preventing health

care associated

infections

P d th t k d i th


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Procedures that worked in the

past

They have been

proven by decades ofexperience and

tradition and are the

best way

The ways of the past

medical leaders will

remain effective

New infections, new

devices, changingpatient issues, andnew procedures

mean that what wassafe in the

community may notbe safe.

Change is

necessary

Should always be continuedMay not work well in the

future


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Steps in the process of care

Need to be

monitored and

supervised

regardless of whodoes them

For example handhygiene should be

monitored

Need to be

monitored only for

non-professional

staff

Individualprofessionals can be

trusted to do the

right thing.


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Steps in the process of care

Need to be

monitored and

supervised

regardless of whodoes them

For example handhygiene should be

monitored


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Wet and dry

Nothing should everbe stored wet in

disinfectants. Wet hands are

dangerous even afterbeing washedbecause they canpick up more germs

All disinfectants canbe contaminated bygerms

Store thermometersand frequently used

equipment indisinfectants toprotect patients

No germs can grow indisinfectants

Hands that are wetafter hand washing donot need to be dried

Wet surfaces have greater risk Wet means freshly cleaned


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Wet and dry

Nothing should everbe stored wet in

disinfectants. Wet hands are

dangerous even afterbeing washedbecause they canpick up more germs

All disinfectants canbe contaminated bygerms

Wet surfaces have greater risk

Wh IV i th t d


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When IVs, urinary catheters and

other devices are inserted properly

They can be left in

safely for the

maximum

recommended time

They should be

removed as soon as

possible.

Wh IV i th t d


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When IVs, urinary catheters and

other devices are inserted properly

They should be

removed as soon as

possible.

Wh bl it i b tt


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When problems occur, it is better

to

Encourage staff to

report problems,

discuss them openly

with all staffinvolved, and

monitor if things get

better or worse after

trying thesuggestions.

Not discuss

problems openly, as

they are usually due

to personal errorsand it is best to work

with the individual to

get them to change

their behavior.

Infection Control Practitioners believe


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Infection Control Practitioners believethat when problems occur, it is better

to

Encourage staff to

report problems,

discuss them openly

with all staffinvolved, and

monitor if things get

better or worse after

trying thesuggestions.


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Cleaning

Is less important if a

device is sterilized,

as germs and dirt on

the item will be killedduring sterilization

Is the step that

removes the most

germs from patient

care items. If adevice is not

cleaned, it can not

be sterilized.


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Cleaning

Is the step that

removes the most

germs from patient

care items. If adevice is not

cleaned, it can not

be sterilized.

Problems of the quality of care are


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usually due to

The few individuals

who are lazy,

irresponsible and

careless

Systems of care that

have weakness due

to facilities,

equipment, taskdesign,

communication,

supplies, and

training.



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usually due to

Systems of care that

have weakness due

to facilities,

equipment, taskdesign,

communication,

supplies, and

training.


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Summary

IC Programs are necessary to prevent harm

from health care that is common and severe

Process monitoring is essential, standardized

care is desirable. Monitoring of outcomes isdesirable but resource intensive.

Separation of clean and dirty is key

Working in infection control involves frankdiscussion of issues, openness to change as

new problems and new information are

learned.

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