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INFECTION CONTROL
Presenter Ms.Daisy V.T.
5TH Batch Student
Guided by
Dr. Sreedevi T R
Asso. Professor Govt. College of nursing Kottayam.
INTRODUCTION
Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality around the world. According to CDC the increase in invasive procedures and a growing resistance to antibiotics have fuelled a rise in the rate of HAI by 36% over the past 20 years. Overall 1.4 million people worldwide are suffering from nosocomial infections and in India alone, the infection rate is at over 25 per cent,. report by the INICC (the International
Nosocomial Infection Control Consortium )
The importance of healthcare-associated infections as a cause of preventable illness and death- A serious global public health issue and a national priority.
INFETION CONTROL
is the responsibility of every health Care personnel
WHAT IS INFECTION?
The invasion of the body by pathogenic or potentially pathogenic organisms and their subsequent multiplication in the body (Medical dictionary)
The lodgement and multiplication of parasite in or on the tissues of a host. ( Anathanarayanan, 2008)
Types of infection
Primary infection- initial infection with a parasite in the host Reinfection- is subsequent infections by the same parasite in the host Secondary infection- a new parasite causes an infection in a host whose resistance has been lowered by an already existing infectious disease. Cross infection-a new infection is estabilshed from another host or external source in a patient already suffering from a disease Nosocomial infection-cross infection occurring in hospitals(from Greek word Nosocomion, hospital)
Historical Perspective
Indian context HAIs has received the attention of the Govt. of india and the Rao committee,(1968) and the Sharad kumar committee (1976) were set up to investigate the problem of hospital acquired infections in depth. The World Health Organization First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection was launched in 2005 . India is the first country of the South East Asian Region to inaugurate the "Clean Care is Safer Care" initiative and sign a pledge to address health care-associated infections.
1.7 million HAIs in hospitalsunknown burden in other healthcare settings 99,000 deaths per year $28-33 billion in added healthcare costs Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs The Centers for Disease Control and Prevention estimatesten billion dollars in additional hospital costs annually as a direct result of healthcare-associated infections. (AHRQS fact sheet 2002)
HAI Prevention
Quality of Life Social Determinants of Health Blood Disorders and Blood Safety Healthy Places Preparedness
Nosocomial infection control interventions, although not an explicit target of the United Nations Millennium Development Goals, help support Goal 6 (Combat HIV/AIDS, malaria and other diseases)
1.the various ways infection can be transmitted 2. the ways the infection chain can be broken
RESEARCH EVIDENCE .
In adult studies, E. coli, S. aureus and Enterococcus faecalis were the three most common pathogens causing HAIs in adult patients. In pediatric studies, Coagulase negative S. aureus (20%26%), Pseudomonas aeruginosa (5%20%), S. aureus (11-15%), Candida species (4%9%) and viruses, mostly rotavirus and respiratory syncytial virus (22%23% ) were predominant pathogens causing HAIs.
Workers Environment- Patient Care Equipment, Environmental Surfaces and Food Animals Insects Rodents Shell Fish
3. Portal of Exit
The route by which the infectious agent leaves the reservoir
By means of blood, excretions, secretions or droplets from broken skin( puncture, cut, surgical site, weeping wound) Respiratory tract Genitourinary tract Gastrointestinal tract
4 Mode of Transmission
The mechanism for transfer of an infectious agent from the reservoir to a susceptible host.
DIRECT: immediate transmission Actual physical contact between source and patient
AIRBORNE Organisms contained within droplet nuclei or dust particles (i.e. droplet nuclei of tuberculosis) Suspended in air for extended periods, may be spread through ventilation systems
VECTOR-BORN
Mechanical transfer of microbes on external appendages (feet of flies) Harbored by vector, but no biological interaction between vector and agent (yellow fever virus) (i.e.
5. PORTAL OF ENTRY
Respiratory Tract Genitourinary Tract Gastrointestinal Tract Broken skin/Mucous Membrane Blood stream
Organisms with strong immune systems are better able to fend off pathogens.
Organisms with weakened immune systems are more vulnerable to the support & reproduction of pathogens.
Common HAIs
Nosocomial Pneumonia Surgical site infections Catheter associated urinary tract infections, Catheter associated blood stream infections.
Other nosocomial infections Skin and soft tissue infections: open sores (ulcers, burns and bedsores) and Gastroenteritis
INFECTION CONTROL-(BREAKING THE CHAIN OF INFECTION) Infection control is the discipline concerned with preventing nosocomial or healthcareassociated infection.
1.Hand washing
2. Standard Precautions in Hospitals 3. Transmission based Precautions in Hospitals 4. Prevention of Ventilator-Associated Pneumonia 5. Prevention of Surgical Site Infections 6. Prevention of Bloodstream Infections 7. Prevention of Catheter- Associated Urinary Tract Infections 8. Infection Prevention and Control Programs in Hospital Settings. 9. Surveillance and reporting of HAI
2. Hand Hygiene
Most nosocomial infections are thought to be transmitted by the hands of health care workers CDC estimate that one third of all hospital-acquired infections are caused by a lack of adherence to established infection control practices, such as hand hygiene. CDC recommends hand hygiene (i.e., hand washing with soap and water or use of a waterless, alcoholbased hand rub. as the single most effective method of preventing the spread of healthcare-associated infections
Research EvidenceSustained hand hygiene promotion in NICU in Geneva resulted in a 60% reduction in bacterimia among VLBW babies (Borghesi A, 2008) Larson and colleagues (2000) documented that the prevalence of nosocomial infections decreased as HCWs compliance with recommended hand hygiene measures improved.
New CDC/WHO guideline recommendation for hand hygiene in health care settings
Current guidelines recommend the use of alcohol based hand rub formulations as the new standard of care. They are not a substitute for hand washing if hands are soiled. Wash hand with soap and water whenever the hand are visibly soiled or contaminated with blood or body fluids. Recommended before entering the unit & before any Procedure Alcohol hand-rubs are appropriate for rapid hand decontamination between patient contacts.
(WHO Guidelines on Hand Hygiene in Health Care, 2009)
Research Evidence
The choice of the best method of hand hygiene is still a matter of debate
Larson et al. found no statistically significant difference in mean microbial counts on nurses hands after traditional hand washing or alcohol-based disinfection On the other hand Girou et al. observed an 83% reduction in bacterial contamination of the hands after use of alcohol based disinfectant compared with 58%reduction after handwashing with antiseptic soap
Saramma et al evaluated the effect of alcohol based hand rub before and after patient contact on SSI after elective neurosurgical procedures. Result did not show a significant reduction in SSI compared with the control group. Study concludes with the possibility is that both the strategies are of equal efficacy for prevention of SSI
(Saramma et al. alcohol based hand rub and surgical site infection. Neurology india.Jan-feb 2011. 59(1).12-17)
3.Standard precautions
STANDARD PRECAUTIONSApplied for all patients at all times regardless of their known or presumed infectious status
appropriate handling of patient care equipment and soiled linen prevention of needle stick/sharp injuries environmental cleaning and spills-management appropriate hospital waste management.
Maintaining clean sterile field during procedures Use of sterile instruments and other items for procedures Preparation of the patients for clinical procedures Use of barriers ( gown mask etc.)
MANAGEMENT OF SHARPS
correct disposal in a puncture resistant container avoid re-capping the needle Do not bend, break or cut the needle before the disposal. Avoid mixing sharps with other wastes discard syringes as single unit avoid over-filling sharps container
Airborne precautions
Implement standard precautions. Place patient in a single room with negative airflow pressure. Keep doors closed. Anyone who enters the room must wear a special, high filtration, particulate respirator (e.g. N 95) mask. Make the patient to wear a surgical mask while going out of the room.
Droplet precautions
Implement standard precautions. Place patient in a single room (or in a room with another patient infected by the same pathogen). Wear a surgical mask when working within 1-2 meters of the patient. Place a surgical mask on the patient if transport is necessary. Special air handling and ventilation are not required to prevent droplet transmission of infection.
Contact precautions
Implement standard precautions. Place patient in a single room (or in a room with another patient infected by the same pathogen). Wear clean, non-sterile gloves when entering the room. Wear a clean, non-sterile gown when entering the room if substantial contact with the patient, environmental surfaces or items in the patients room is anticipated. Use precautions to minimize the risk of transmission if transport of the patient from the room is required.
Nosocomial Pneumonia Surgical site infections Catheter associated urinary tract infections, Catheter associated blood stream infections
Intubation and reintubation should be avoided Prevent ventilator circuit condensation Keep the patient in semi recumbent position (3045) for adults and 1530 degree for children to prevent aspiration, especially when receiving enteral feeding. Suction above and below the cuff before lowering the patients head less than to 30% to prevent micro aspiration. The endotracheal tube should be of proper size to prevent leakage of bacterial pathogens around the cuff into the lower respiratory tract.
Air and environment Laminar airflow-design to move particle free air( ultra lean air).
Operating room equipment and furniture should be cleaned with germicidal agent at the end of each surgical procedure.
Lidwell et al. compared the effect of ultraclean air alone, antimicrobial prophylaxis alone and combination of both in prosthesis replacement. Results shown antimirobials more effective than ultra clean air. (J Hosp Infect, 1988)
Unexpectedly in one analysis which controlled for many patients OR ventilation with laminar airflow showed no benefit on SSI. ( Brandt C Ann Surg. 2008Nov, 248(5). 695-700.) Without surgical antimicrobial prophylaxis, glove perforation increases the risk of SSI (Heidi M et al. Arhives of surgery. June 2009,
144(6). 553.)
Postoperative Incision Care Perform hand hygiene before and after dressing changes and any contact with the surgical site. When an incision dressing must be changed, use sterile technique. Educate the patient and family regarding proper incision care, symptoms of SSI, and the need to report such symptoms.
Catheter removal -Promptly remove any intravascular catheter that is no longer essential. - Do not routinely replace central venous or arterial catheters solely for the purposes of reducing the incidence of infection. - Replace peripheral venous catheters every 7296 hours in adults to prevent phlebitis. - Leave peripheral venous catheters in place in children until IV therapy is completed, unless complications (e.g., phlebitis and infiltration) occur.
A study in the journal Infection Control and Hospital Epidemiology shows that about 24% of patients with catheters will develop catheter related infections, of which 5.2% will become bloodstream infections. Death has been shown to occur in 420% of catheter-related infections.
Reservoir for transmission The drainage bag of the bacteriuric patient is a reservoir for organisms that may contaminate the environment and be transmitted to other patients. Willson M et al identified the following nursing interventions to reduce the risk of catheter-associated urinary tract infection: staff education, monitoring of catheter use and CAUTI incidence, insertion technique, urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change, and antiseptic solutions in the drainage bag.
J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):137-54.
basic measures for infection control. education and training of health care workers; protection of health care workers, e.g. immunization; Surveillance for infections in patients and personnel incident monitoring; outbreak investigation; infection control in specific situations research.
Nursing implications
Nurses are the key to maintain infection control measures in health care settings
CONCLUSION
Preventing Healthcare-associated Infections the Time is NOW Problem is critical and costly but preventable Interventions can have an immediate national impact Interventions can be cost savings Ongoing efforts are needed to address changes in healthcare
Infection control is not just a matter of following standards and guidelines. It involves improving awareness and changing attitudes and work practices at both the institutional and individual level. It is essential that everyone involved in health care contribute to improving the quality of patient care (NHMRC, 1996).
It is not important how much you know but it is most important how much you practice. Caring attitude should be reflected in your work practice, which will reflect your infection control practices.
If you fail to practice infection control, you are failing to care for your patients.
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