infection control for every one

8/20/2019 Infection Control for Every One

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Hospital Acquired InfectioRole for Everyone

Principles Practice and Prevention

Dr.T.V.Rao MD

Dr.T.V.Rao MD


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The very first

requirement in

a hospital is

that it should do

the sick noharm

Dr.T.V.Rao MD


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Scientific era continues . . . . .

Ignaz Semmelweiss (1818-1865)

• Obstetrician, practised in Vienna

• Studied puerperal (childbed)fever

• Established that high maternalmortality was due to failure ofdoctors to wash hands afterpost-mortems

• educed maternal mortality by

!"# Dr.T.V.Rao MD


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Main Sources of Infecti

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

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

• Environmental contamination

• Airborne transmission

• Hospital staff ho are carriers

• !are common-source outbrea"s


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Hospital Infection

•Hospitalinfection is alsocalledNosoco%ial

infection.•It is t'e sin)lelar)est factort'at adversely

a1ects &ot' t'eDr.T.V.Rao MD' TMC Kollam Kerala


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!r)ani*ation of an infectcontrol pro)ra%%e

•As with all other functions of a health care facthe ultimate res"onsi#ilit for "re$ention an%of infection rests with the health a%ministratohos"ital a%ministrator&hea% of hos"ital shoul%

(

)sta#lish an infeccontrol committee which will in turn a""oint ainfection control team* an%

"ro$i%e a%e+uate resources for e,functionin- of the infection control "ro-ramm


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Infection control co%%itt

•An infection control committee"ro$i%es a forum for multi%isci"linin"ut an% coo"eration! an% informsharin-. This committee shoul% in

wi%e re"resentation from rele$ant%e"artments

e.-. mana-ement! "hsiciaother health care worers! clinical

micro#iolo ! harmac ! sterili/in


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epor n) e a ers2'o%

3•T'e co%%ittee %ust'ave a reportin)relations'ip directlyto eit'erad%inistration or

t'e %edical sta1 topro%ote pro)ra%%evisi&ility ande1ectiveness.


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T'e infection control tea% s'

•A hos"ital0associate% infection"re$ention manual containin-instructions an% "ractices for "aticare is an im"ortant tool. The man

shoul% #e %e$elo"e% an% u"%ate%the infection control team an%re$iewe% an% a""ro$e% # thecommittee. t must #e ma%e rea%

a$aila#le for health care worers!


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-in)s of Infectio

•nce the infectious a-ent enters thhost it #e-ins to "roliferate an% reawith the %efence mechanisms of th#o% "ro%ucin- infection sm"tom

si-ns "ain! swellin-! re%ness! func%isor%ers! rise in tem"erature an% rate an% leucoctosis.

Dr.T.V.Rao MD


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Cannot autoclave patients


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ife is a e,perience start learninT'e TIME I- TI5IN6


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HEATH ARE A--!IATED INFE7N!-!!MIA8

•Infections t'at are aresult of 'ealt' caredelivery( not present atad%ission• E9!6EN!:-

• END!6EN!:-

• IATR!6ENI

Refer to Potter ; Perry Ta&le ? P). @= 7-itesfor auses of HAIBs8


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o%%on Healt'>are AssociInfections

•5rinar Tractnfection

-ur)icalCTrau%atic0ound Infection

•Res"irator Tract

•6loo%stream


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at'eteri*ation

Dr.T.V.Rao MD


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21

eadin) causes of deat


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Major Sites of Nosocomial Infections

•Urinary tract infection

•Bloodstream infection

•Pneumonia (ventilator-associated)

•Surgical site infection


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Sources of SSIs

• Endogenous: patient’s skin or mucosal flora• Increased risk with devitalized tissue, fluid collectionlarger inocula

• Exogenous• Includes OR environment/instruments, ! air, pers

• ematogenous/l"mphatic# seeding of surgical from a distant focus of infection• Ma" occur da"s to weeks following the procedure

• Most infections occur due to organisms implanteduring the procedure


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Wen !ou sa!"ospital ac#uire$ infection

•$nfection which was neither present incubating at the time of admission

• $ncludes infection which only becomeapparent after discharge from hospit

but which was ac%uired duringhospitalisation (cn, &!!')

•lso called nosocomial infection

Dr.T.V.Rao MD


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-ources of Hospital acquired infec

•1.atients own 9Autoinfection ?reatest source o"otential %an-er9

2.)n$ironment 0 )@o-enous1=>9 Air0=>* nstruments01;>93.Another atient&:ta, 0 Crossnfection 3=>9

Dr.T.V.Rao MD

f f ti


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$urke % Infection control&a pro'lem for patient safet" New (ng %ou

of Medicine )*e'ruar" +, -..

+pes of nfections


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AR) 5R ABD: C)AB

:-T NO

The han%s of sta,are the commonest$ehicles # whichmicroor-anisms are

transmitte%#etween "atients.an% washin- isacce"te% as the

sin le most


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0'at is t'e /est -o


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0'at is t'e /est -oto 2as' Hands


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Alco'ol>&ased 'and ru&s are %ore e1ectivea)ainst %ost &acteria and %any viruses t'aeit'er %edicated or non>%edicated soaps


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T'ree evels ofInfection ontrol:aniti/ation F

cleanin- an%scru##in-instruments an%e+ui"ment toremo$econtaminate%materials an%microor-anisms

Disinfection F secon% le$el use% oninstruments an% e+ui"ments that come incontact with intact mucous mem#rane

-terili*ation G co%plete destruction of all%icroor)anis%s>pat'o)enic( &ene"cial( and

'ar%less> surface of instru%ent andequip%ent

Dr.T.V.Rao MD

- iti ti


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0

-aniti*ationMet'ods

ollectin) instru%ents G place icontainer 2it' 2ater and neutradeter)ent until you can )et to t

:se utility )loves al2ays and %

eye protection and protectiveclot'in) if &lood( &ody uids ortissue are present

Dr.T.V.Rao MD


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-tandard Precautio•Apply standard precauti

to all patients re)ardlest'eir dia)nosis( and to a

conta%inated equip%enand %aterials.

•:se $ud)%ent in deter%Dr.T.V.Rao MD


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-cope of Infection ont

• Ai%in) at preventin) spread of infec• :tan%ar% "recautions these measures must #e a""lie% %ue$er "atient care! %urin- e@"osure to an "otentiall infecmaterial or #o%


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Healt'care Associated :rina


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Healt'care>Associated :rinaTract Infection

• :rinary tract infection 7:TIcauses L =JK of 'ospital>acquired infections

•Most infections %ue to urinarcatheters

• 2=> of in"atients are catheteri/e

• ea%s to increase% mor#i%it an%Dr.T.V.Rao MD

N rses s'o ld &e Fa%iliar


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Nurses s'ould &e Fa%iliarINTERVENTI!N-

• I-!ATI!N PREA:TI!N-

•I)RT)RMA BT)RV)BTB• )MBAT) 5BD)RIB? CA5:)

• J)V)R MABA?)M)BT

•)AT T)ACB?•ABT6TC T)RAI

•:IC:CA :5RT

•)AT CAR) R):5RC):

Read Manuals on Isolation


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Read Manuals on IsolationPrecautions

•D and !-HA 6uidelines on

1. Contact

2. Dro"let

3. Air#orne


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0'y Hand 0as'in

Dr.T.V.Rao MD

I%pression of %y Hand -'o2


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I%pression of %y Hand -'o2t'e 6ro2t' of /acteria


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HAND 0A-HIN6• Proper 'and 2as'in) is t'e

sin)le %ost i%portant 2ayto prevent and reduceinfections

• 0as' and rinse 'ands for seconds( usin) a drypaper to2el to turn o1

faucet• Alco'ol &ased 'and2as' is also availa&lein all patient care areas

Dr.T.V.Rao MD


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Hands s'ould &e 2as'

•6efore an% after "atient contac•6efore "uttin- on -lo$es an% atain- them o,

•After touchin- #loo% an% #o%su#stances or contaminate%"atient0care e+ui"ment9! #roesin! or mucous mem#ranes e

Dr.T.V.Rao MD


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HAND 0A-HIN6

Hand 2as'in) is t'e sin)le %ost e1ectiveprecaution for prevention of infectiontrans%ission &et2een patients and sta1.

Hand 2as'in) 2it' plain soap is %ec'anicre%oval of soil and transient &acteria 7for

sec.8Hand antisepsis is re%oval ; destroy of trora usin) anti>%icro&ial soap or alco'ol &'and ru& 7for @J sec.8

Dr.T.V.Rao MD


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Met'ods in Hand 0as'• -ur)ical 'and scru re%oval or destruction of transient

reduction of resident ora usin) anti>%icro&ial soap or a&ased deter)ent 2it' e1ective ru&&in) 7for least ?>< %in

•ur han%s an% n-ers are our #est frien%s #ut coul% #e our enemies if the carr infecti$e or-an% transmit them to our #o%ies an% to those 2

2e care for.•-in+s ; soap %ust &e found in everypatient care roo%. Doctors( nurses %uco%ply to 'and 2as'in) policy.

Dr.T.V.Rao MD

'ildren too are at Ris+ fro


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'ildren too are at Ris+ froHospital Infections.

Dr.T.V.Rao MD

Hand Hy)iene Tec'nique


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Hand Hy)iene Tec'niqueMany 0ays

. Alco'ol 'and ru&

?. Routine 'and 2as' J> seconds


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Dr.T.V.Rao MD

Anti%icro&ialPre>!perative -'o2er

'lor'e,idine6luconate G Pri%aryc'oice

Iodop'ores

He,ac'lorop'ene47

/ i P ti


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/arrier Precautions 1. Gloves:

Disposable gloves must be worn when: a9 Direct contact with 6&6J is e@"ecte%.

#9 )@aminin- a lacerate% or non0intact se.- woun% %ressin

c9 )@amination of oro"harn@! ?T! 5T an% %ental "roce%ures.

Dr.T.V.Rao MD

/ i P ti


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/arrier Precautions %9 Eorin- %irectl with

contaminate% instruments ore+ui"ment.

e9 CE has sin cuts! lesionsan% %ermatitis

Sterile gloves are used forinvasive procedures.

6!VE- M:-T /E of )oodquality( suita&le si*e and%aterial. Never reused.

Dr.T.V.Rao MD

/ i P ti


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/arrier Precautions

•Mas+s ; Protective eye 2ea• M:-T /E :-ED 0HEN# en)a)ed procedures li+ely to )enerate droof /C/F or &one c'ips

• Durin) sur)ical operations to pr2ound fro% sta1 &reat'in)s(

• Mas+s %ust &e of )ood quality(properly ",ed on %out' and nasa

openin)sDr.T.V.Rao MD

/ i P ti


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/arrier Precautions

• 39 ?owns& A"rons

• Are re+uire% when

• :"rain- or s"atterin- of #loo% or #o%


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0'at to do if e,posed to &lo&ody uids

•uncture woun%s shoul% #e washeimme%iatel an% the woun% shoulcause% to #lee%

• f sin contamination shoul% occu

wash the area imme%iatel•:"lashes to the nose or mouth sho#e


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If E,posed

•)e s"lashes re+uire irri-atiowith clean water! saline! or asterile irritant

•Most im"ortantl Com"lete ?6MC )m"loee nci%entRe"ort. Re"ort e@"osure tochar-e nurse an% A-encDr.T.V.Rao MD

-'arp precautions


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-'arp precautions•Needle stic+ and s'arp in$uries carry tris+ of &lood &orn infection e.) AID-(HV(H/V and ot'ers.

•-'arp in$uries %ust &e reported and n

•NEVER T! REAP NEEDE-•Dispose of used needles and s%all s'ai%%ediately in puncture resistant &o,7s'arp &o,es8.

Dr.T.V.Rao MD

Do not Recap Needles


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pA t'reat to IFE

Dr.T.V.Rao MD

Protectin) ourself fro% /lo


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)/orne Pat'o)ens

Dr.T.V.Rao MD' TMC Kollam Kerala

%septic tecni#ue


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%septic tecni#ue

• Sepsis - harmful infection by bacteria

• sepsis - prevention of sepsis• inimise ris* of introducing pathogenmicro-organisms into susceptible sites

• +revent transfer of potential pathogefrom contaminated site to other sitespatients or staff

• ollow local policy of your hospitalDr.T.V.Rao MD


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inen 'andlin) and disposa


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) p

• ed ma*ing and linen changing techni%ues

• loves and apron - handling contaminatedlinen

• ppropriate laundry bags

• void contamination of clean linen

• /a0ards of on-site ward-based laundering

• 1/S E2ecutive guidelines (&!!')

• ollow local policy of your hospitalDr.T.V.Rao MD

Waste $isposal


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Waste $isposal• 3linical waste - /$/ ris*

•potentially4actually contaminated waste inclubody fluids and human tissue

• yellow plastic sac*, tied prior to incineration

• /ousehold waste - 5O6 ris*• paper towels, pac*aging, dead flowers, other

waste which is not dangerously contaminated• blac* plastic sac*, tied prior to incineration

• ollow local policy of your /ospitals

Dr.T.V.Rao MD

-pilla)e of &ody uid


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p ) y• ++E - disposable gloves, apron

• Soa* up with paper towels, *itchen roll

• 3over area with hypochlorite solution e.g., iltofor several minutes

• 3lean area with warm water and detergent, thendry

• 7reat waste as clinical waste - yellow plastic sac• ollow local policy (ay, 8""")

Dr.T.V.Rao MD


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is* assessment


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• 1o ris* of contact4splashing with blood4bodyfluids - ++E not re%uired

• 5ow or moderate ris* of contact4splashing - weagloves and plastic apron

• /igh ris* of contact4splashing - wear gloves,plastic apron, gown, eye4face protection (cn,

&!!')• 3erebrospinal fluid, peritoneal fluid, pleural flui

synovial fluid, amniotic fluid, semen, vaginalsecretions, and

• ny other fluid containing visible blood e.g., urinDr.T.V.Rao MD

In spite %any develop%ents in %edicine


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asepsis 'and 2as'in) still t'e &est solut

Hand 'y)iene is t'si%plest( %ost

e1ective %easure fpreventin) 'ospitaacquired infection

Dr.T.V.Rao MD


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Dr.T.V.Rao MD

0ays to overco%e t'e


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nosoco%ial infections

•6esi%es! hos"itals nee% to ha$einfection control committees tocon%uct outcome an% "rocesssur$eillance for nosocomial infect

This committee shoul% meet re-uan% "u#lish the results of theirsur$eillance. At the same time!healthcare institutions shoul% a%o

% # tt t h l li lDr.T.V.Rao MD


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Nurses s'ould &e fa%iliar 2- ill A ti iti


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-urveillance Activities

• "erati$e roce%ures

• Critical Care 5nitsMC5! :C5! BC59

• Tar-ete% :ur$eillance

• ut#rea n$esti-ation

/enc'%ar+in) HospitalA i d I f ti


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Acquired Infections

•DBs Hospital Infections Pro)

•:u#mit monthl %ata on C5 infec

•6enchmarin- with similar hos"ita

•Betworin- o""ortunities•Annual re"orts

•:tart ha$in- a nfection Au%it

-urveillance DataI t' P ti t - f t


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I%proves t'e Patient -afety

• :-E-

• m"ro$e "atientoutcomes #

• mo%ifin- "atient care"ractices

• re%ucin- len-th of sta

• %entif e%ucationnee%s

• )$aluate new "ro%ucts

• %entif new

t iti f

Nurses s'ould Evaluate t'eir! t


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!utco%e

• M)A:5R) :5CC):: J

BJ)CTB CBTR T)CB5):

• CMAR) AT)BTL:R):B:) T ACT5A5TCM)

• EAT E I5 D J?A&5TCM): BTAC)V)D

!ur Hands are T'reat to IFEust 0as'in) can -ave Many


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ust 0as'in) can -ave Many

Dr.T.V.Rao MD

et us support our 'ospitals 2clean 'ands


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clean 'ands

Dr.T.V.Rao MD

:oa" Eater an% Common sense are Antise"tics Eilliam sler


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Antise"tics0 Eilliam sler

Dr.T.V.Rao MD' TMC Kollam Kerala

0E ARE A RE-P!N-I/EINFETI!N !NTR!


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INFETI!N !NTR!

I a% t'an+ful to every on5inder Hospital 'ert'a


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pAlappu*'a 5erala


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infection control for every one

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