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
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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$aila#le for health care worers!
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-in)s of Infectio
•nce the infectious a-ent enters thhost it #e-ins to "roliferate an% reawith the %efence mechanisms of th#o% "ro%ucin- infection sm"tom
si-ns "ain! swellin-! re%ness! func%isor%ers! rise in tem"erature an% rate an% leucoctosis.
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Cannot autoclave patients
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ife is a e,perience start learninT'e TIME I- TI5IN6
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HEATH ARE A--!IATED INFE7N!-!!MIA8
•Infections t'at are aresult of 'ealt' caredelivery( not present atad%ission• E9!6EN!:-
• END!6EN!:-
• IATR!6ENI
Refer to Potter ; Perry Ta&le ? P). @= 7-itesfor auses of HAIBs8
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o%%on Healt'>are AssociInfections
•5rinar Tractnfection
-ur)icalCTrau%atic0ound Infection
•Res"irator Tract
•6loo%stream
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at'eteri*ation
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21
eadin) causes of deat
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Major Sites of Nosocomial Infections
•Urinary tract infection
•Bloodstream infection
•Pneumonia (ventilator-associated)
•Surgical site infection
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Sources of SSIs
• Endogenous: patient’s skin or mucosal flora• Increased risk with devitalized tissue, fluid collectionlarger inocula
• Exogenous• Includes OR environment/instruments, ! air, pers
• ematogenous/l"mphatic# seeding of surgical from a distant focus of infection• Ma" occur da"s to weeks following the procedure
• Most infections occur due to organisms implanteduring the procedure
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Wen !ou sa!"ospital ac#uire$ infection
•$nfection which was neither present incubating at the time of admission
• $ncludes infection which only becomeapparent after discharge from hospit
but which was ac%uired duringhospitalisation (cn, &!!')
•lso called nosocomial infection
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-ources of Hospital acquired infec
•1.atients own 9Autoinfection ?reatest source o"otential %an-er9
2.)n$ironment 0 )@o-enous1=>9 Air0=>* nstruments01;>93.Another atient&:ta, 0 Crossnfection 3=>9
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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
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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
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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
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Hands s'ould &e 2as'
•6efore an% after "atient contac•6efore "uttin- on -lo$es an% atain- them o,
•After touchin- #loo% an% #o%su#stances or contaminate%"atient0care e+ui"ment9! #roesin! or mucous mem#ranes e
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HAND 0A-HIN6
Hand 2as'in) is t'e sin)le %ost e1ectiveprecaution for prevention of infectiontrans%ission &et2een patients and sta1.
Hand 2as'in) 2it' plain soap is %ec'anicre%oval of soil and transient &acteria 7for
sec.8Hand antisepsis is re%oval ; destroy of trora usin) anti>%icro&ial soap or alco'ol &'and ru& 7for @J sec.8
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Met'ods in Hand 0as'• -ur)ical 'and scru re%oval or destruction of transient
reduction of resident ora usin) anti>%icro&ial soap or a&ased deter)ent 2it' e1ective ru&&in) 7for least ?>< %in
•ur han%s an% n-ers are our #est frien%s #ut coul% #e our enemies if the carr infecti$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
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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.
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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.
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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
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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""")
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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
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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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