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INFECTION CONTROLPRACTICES

1Dr. Priyadarshini PatroMicrobiologistVY Hospital

The nature of infectionMicro-organisms - bacteria, fungi, viruses, protozoa and wormsMost are harmless [non-pathogenic]Pathogenic organisms can cause infectionInfection exists when pathogenic organisms enter the body, reproduce and cause disease

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3Why do we need Infection Control??Hospitals and clinics are complex institutions where patients go to have their health problems diagnosed and treated

But, hospitals, clinics, and medical/surgical interventions introduce risks that may harm a patients health

The risk of infection is always present.

Patient may acquire infection before admission to the hospital = Community acquired infection.Patient may get infected inside the hospital = Nosocomial infection / Hospital acquired infections (HAI).It includes infectionsnot present nor incubating at admission, infections that appear more than 48 hours after admission, those acquired in the hospital but appear after dischargealso occupational infections among staff.

What is Nosocomial InfectionAny infection that is not present or incubating at the time the patient is admitted to the hospital

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Common Health-Care Associated InfectionsUrinary Tract Infection Surgical/Traumatic Wound InfectionRespiratory Tract infectionBloodstream infection

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Additional morbidityProlonged hospitalizationLong-term physical, developmental and neurological sequelaeIncreased cost of hospitalizationDeath

Consequences of Nosocomial Infections

Objectives :To prevent health care workers & the environment from transmission of infections.

To reduce :-Pts morbidity & mortalitylength of hospital stayCost associated with hospital stay

What are Universal Precautions Universal precaution are control guidelines designed to protect workers from exposure to Diseases spread by Blood and other Body fluids.

Why Universal health Precautions

The concept of Universal Health Precautions emphasizes that all our patients should be treated as infectious for blood born infections such as HIV, Hep-B, C, and can infect the caring health care workers. ( CDC )

Human materials/Tissues considered Highly Infectious1 Blood2 Semen3 Vaginal secretions4 C S F5 Synovial fluids6 Amniotic fluid7 All other body fluids

Not Infectious unless contaminated with Blood or Body fluids.Faeces,Nasal secretions,Sputum,Sweat,Tears,Urine / Vomitus,Saliva unless blood stained.

Standard precautionsApplied to all pts. at all times ( regardless of diagnosis & infectious status ).

Aim : To prevent transmission of infections from Pt Health care worker (HCW)HCW Pt.Pt. Pt. (cross transmission )Hospital environment Pt.Hospital waste community

ComponentsHand hygienePersonal protective equipment (PPE).Handling of pt. care equipments & soiled linen.Prevention of needle stick injuries.Environmental cleaning & spills management.Appropriate handling of waste.

Hand transmissionHands are the most common vehicle to transmit health care-associated pathogens

Transmission of health care-associated pathogens from one patient to another via health-care workers hands requires 5 sequential steps .

5 stages of hand transmission

Germs present on patient skin and immediate environment surfacesGerm transfer onto health-care workers handsGerms survive on hands for several minutesSuboptimal or omitted hand cleansing results in hands remaining contaminatedContaminated hands transmit germs via direct contact with patient or patients immediate environmentonetwothreefourfive

protect the patient against harmful germs carried on your hands or present on his/her own skinprotect yourself and the health-care environment from harmful germs

Why should you clean your hands?

Your Unwashed Hand a Great Concern to Your Patient

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Hand hygiene

Hand washingAntiseptic handwashAlcohol-based handrubSurgical hand hygiene/antisepsis

Our Hands are Threat to LIFEJust Washing can Save Many LIVES

There is no Health precaution like Hand washing.

Washing with simple toilet soap - reduces the rate of transmission of common infections including the HIV.

Proper hand washing is the single most important way to prevent and reduce infections.

Hands should be washed:Before and after patient contactBefore putting on gloves and after taking them offAfter touching blood and body substances (or contaminated patient-care equipment), broken skin, or mucous membranes (even if you wear gloves)Between different procedures on the same patient.Before leaving the ward.Before handling food.

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The 5 Moments for Hand Hygiene approach

How to Wash our hands

How to Wash our handsTo effectively reduce the growth of germs on hands, handwashing must last 4060 seconds and should be performed by following all of the illustrated steps.

Hand washing Areas MissedResearch indicates:poor techniques - not all surfaces cleanedfrequency diminishes with workload/distancepoor compliance with guidelines/training

Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger-webs, the palms and the thumbs.

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How to handrub

To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps.This takes only 2030 seconds!

Alcohol-based hand-rub formulationContain 60 to 80% ethanol as isopropanol or n-propanol.Emollients to protect the skin.Available as Liquid solutionsGels Sprays Foams

Choosing hand hygiene techniqueHand washIf there is visible contamination with blood or body fluids.Visible contamination with proteinaceous material.Exposure to spore forming organisms.After using toilet.

Hand rubWhen there is no visible solid contamination on hands.

Longtin Y, Sax H, Allegranzi B, et al.Hand hygiene. N Engl J Med. 2011;364;13: e24.

Advantages of Alcoholic Hand WashRequire less timeCan be strategically placedReadily accessibleMultiple sitesAll patient care areasActs fasterExcellent bactericidal activityLess irritating (??)Sustained improvement

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Adverse effects of hand hygiene

Irritation dermatitis - due to repeated use of hand hygiene. Symptoms include dryness, itching, cracking and bleeding.

Avoid use of hot water when washing hands.

Use gloves only when needed.

Dry hands completely before wearing glovesAllergic dermatitis.

Use skin care products frequently

Longtin Y, Sax H, Allegranzi B, et al.Hand hygiene. N Engl J Med. 2011;364;13: e24.

Time constraint = major obstacle for hand hygiene

Adequate hand washing with water and soap requires 4060 secondsAverage time usually adopted by health-care workers: