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Sub topics :
Health and Safety Hazards in the Health Care Facilities Definition Source Transmission Precaution in infection control practices Care of health care workers
References
Depkes RI: Pedoman Pengendalian Nosokomial di Rumah Sakit,2001 Bennet,Brachman ed., Hospital Infections,Little Brown,1992 WHO, Practical guidelines for infection control in health care facilities, 2003
Human diseases caused by work associated exposure to microbial agents are called occupational infections Exposure occurs among health care workers in hospitals and laboratories
Occupational infection can occur following contact with infected persons, as in the case of health care workers
Infected with human tissue, secretion or excretion
US : more than 10 % of workers are health care workers Hazards facing health care include :
Biological hazards contact with infectious agent Chemical hazards Physical hazards Safety and ergonomic hazards Violence Psychosocial and organizational factors : stress, shift work
Example
Viral ( hepatitis B, C), HIV, AIDS Bacteria : M. TBC Ethylene oxide, Formaldehyde, Antineoplastic drugs, Waste anesthetic gases Mercury Patient handling, static postures Ionizing radiation, Lasers Violence threat, restructuring, work stress Shift work
Chemical
Physical
Psychosocial
1. Definition Nosocomial
Nosocomial infections : Are infections that develop within a hospital , or Are produced by microorganism acquired during hospitalization
Nosocomial infections : May involve not only patients but also anyone else who has contact with a hospital, including ; - members of staff - volunteers - visitors - workers - salesperson - delivery person
The majority of nosocomial infections become clinically apparent while the patients are still hospitalized; However, the onset of disease can occur after patient has been discharged Hepatitis B is an example of nosocomial disease with a long incubation period; its clinically onset usually occurs long after the patient is discharged from the hospital
1. Preventable infection hand washing can prevent infection gram negative organism from the urinary collection + 30 % 2. Nonpreventable infection is one that will occur despite all possible precaution exp. Infection in an immunosuppresed patient due to his or her own flora
2. Source
Organism that cause nosocomial infections come from Endogenous (Autogenous) Exogenous
1. Endogenous infections Are caused by the patients own flora Organism are brought into the hospital by a patient 2. Exogenous infections Result from transmission of organism from a source other than patient
4 5
Epidemic Outbreak
The agent
Transmission
The host
Agents
The majority of nosocomial infection problems caused by bacteria and viruses
Transmission
Describes the movement of organism from the source to the house
Types of transmission
1. Contact spread disease 1. direct contact 2. indirect contact 2. Common-vehicle spread 3. Air borne spread 4. Vector borne spread
HOST
The third link in the chain of infections
Disease does not always follow the transmission of infection agents to a host
Various agent factors A variety of host factors
NO Entrance 1 Skin
Disease/Agent
Leptospirosis, Staphylococcus, HIV, Hepatitis B, Pseudomonas Aeroginosa Tuberculosis E. Coli, Shigella, Staphylococci Rubella, Toxoplasmosis
2 3 4
Urinary Tract
Infection Control Program : For reducing the risk of health care associated or nosocomial infections Risk prevention program for patients and staff
Standard precautions
Require that health care workers assume that the blood and body substances all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status
Additional precaution Are needed for disease transmitted by air, droplets and contact.
Standard precautions
Treating all patients in the health care facility with the same basic level of standard precautions involves work practices that are essential to provide a high level of protection to patients, health care workers and visitors
Standard precautions
These include the following : 1. Hand washing and antiseptic (hand hygiene) 2. Use of personal protective equipment when handling blood, body substances, excretions and secretions 3. Appropriate handling of patient care equipment and soiled linen 4. Prevention of needle stick/sharp injuries 5. Environmental cleaning and spills management 6. Appropriate handling of waste
Disease which are transmitted by this route airborne TB, measles, chicken pox, pulmonary Precautions plaque
(droplet <5 micron)
contact Infection with multiple antibiotic resistant precautions organism, enteric infections, skin infections
Exp. - Place patient in a single room - Wear protective equipment : mask, gloves, gown
TBC
Is caused by Mycobacterium tuberculosis Is transmitted occupationally by droplet infection, contact with infected material from humans (sputum) or animals Infectious patients disseminate the organism when coughing, sneezing, talking
Use protective clothing and gloves Minimize the contact with patient
Hepatitis A
Is a risk for health care institution for the retarded where personal hygiene is poor Virus is mainly transmitted by the fecal oral route Careful hand washing by health care personnel is the most important measure for preventing
Health care workers are at risk of acquiring HIV via exposure to patients infected blood or body fluid The greatest risk to medical personnel is percutaneous exposure needle stick injury
Prevention
Avoid contact with potentially infected blood, plasma or secretion Hands or skin should be washed immediately and carefully if blood contact occurs Mucous membrane, including the eyes and mouth should be protected Contaminated surfaces should be disinfected with 5 % sodium hypochlorite. Aseptic technique and sterilization Health education concerning transmission of blood borne infections
Sharp injuries Meningococcal meningitis SARS Varicella, Influenza, Pertusiss, Diphteria, Rabies