by Revelita R.

Linchoco BSN, RN, WCP/ICN

At the end of the lecture, participants will be able to: Understand the importance of infection prevention & control in the healthcare setting Describe the infection process and how to interrupt it Differentiate standard precaution from transmission based precaution Understand Nosocomial Infection Know policy & procedures related to infection control

 Prevents

hospital acquired infections Prevents the increase length of patients hospital stay Decreases morbidity & mortality Decreases hospital cost

Infectious agent

Susceptible host

Reservoir

Chain of Infection
Portal of entry Portal of exit

Mode of transmission

Infectious agent Reverse isolation

Susceptible host

Immunization, hand hygiene, PPE

Reservoir

Chain of Infection
Aseptic technique Portal of entry Portal of exit

Screening Envtl sanitation Disinfection/ster ilization

Standard precaution, Isolation, sterilization, airflow control, proper food handling & waste disposal

Mode of transmission

Control of secretion/excretion Proper waste disposal

Contamination Cleaning Decontamination Disinfection Sterilization Medical asepsis Surgical asepsis Clean technique Aseptic technique Sanitization Antiseptic

Basic requirements for infection prevention & control strategies such as strict hand hygiene, proper use of PPE, handling of contaminated items, waste disposal & cough etiquette Designed for the care & safety of all patients regardless of their diagnosis or presented infection status & for the safety of all personnel & visitors

Indications of Hand Hygiene

Before & after touching the patient Before handling an invasive device for patient care, regardless of whether or not gloves are used After contact with body fluids or excretions, mucus membranes, non-intact skin, or wound dressing If moving from contaminated body sites to another body site during care of the same patient After contact with inanimate surfaces &

After removing sterile/non-sterile gloves Before handling medication or preparing food Before donning & after removing gloves Before eating After using the rest room After sneezing or coughing

Hands of HCW serves as critical reservoirs of infectious agents. Hand hygiene is the single most important strategy to remove these pathogens from their hands & prevent the spread of infection. Methods/Types of Hand Hygiene Hand washing with soap & water (scrub stat 4) (40-60 seconds) Hand antisepsis with the use of alcohol-based hand rub (15-20 seconds) Surgical hand rub in theater (2-6 minutes)

Open top water Wet both hands Apply soap on both hands Vigorous & mechanical friction is applied to all surface of lathered hands using soap & water for at least 15 seconds using a defined technique 5. Dry hands with clean paper towel 6. Close faucet with paper towel
1. 2. 3. 4.

Protective Eye/Face Wear Masks Gowns Gloves

1. At doorway, before leaving patient room or

in anteroom 2. Remove respirator outside room, after door has been closed 3. Perform hand hygiene

Handling of Contaminated Items

LINEN
Should be handled/transported in a manner so as to prevent skin/mucous membrane exposure contamination of clothing/transferring microorganisms to other patients or environment Place linen in an impervious designated bag & close the bag securely Wrap wet linen in another piece of linen to avoid soaking of bag

Staff wear gloves & aprons when handling heavily soiled linen Soiled linen which is capable of leakage is placed in bags with impervious liners Staff should not carry soiled linen or leaving it on the floor instead hamper bag should be taken to the area to collect the soiled linen Staff wash hands following soiled linen handling

Proper Waste Disposal

SHARPS/NEEDLES Dispose immediately after use Do not fixate used sharp items on any environmental surfaces Do not recap/manipulate needles Close sharp containers when full & remove for incineration

Sharps box must be labeled correctly (ward, date & signature) Sharps box must be assembled correctly Sharp boxes must be available in all areas where sharps are generated like in patients room, medication room, crash trolley & medicine trolley

Needle stick or Sharp Injuries carry risk of blood borne infection like AIDS, HBV, HCV & others Wash your hands with soap & water Inform your CN or TL Seek consultation to SH during sat-wed 8AM to 12NN or A&E during non-working hours Serology test must be taken from you & the source You will be given a vaccination depends on the doctors order Complete IR

Other Medical Waste

Place biomedical waste in identifiable

bags/appropriate containers Securely tie/close bags/containers & remove as a single unit for appropriate disposal Orange/Yellow Bag: IV bags & tubing, foley catheter & bag without urine, gauze/dressing, syringes, disposable suction, used gloves/gown/apron/mask. Blue/Black Bag: non-infected waste

Cleaning of body fluid spillage

Wear gloves Wipe-up the spill with paper towel Apply disinfectant of presept solution 7tabs (2.5g/tab) into 1L of water Leave it for 5-10 minutes Clean it with a towel & discard all items to orange bag Do hand hygiene

Cover nose & mouth with a tissue when coughing or sneezing Dispose of the used tissue in the nearest waste receptacle Clean hands with soap & water, an alcohol based-hand rub, or antiseptic hand wash after touching respiratory secretions/handling contaminated objects

Is one that develops & manifest during or after admission to the hospital, which was neither present nor incubating at the time of admission & the diagnosis is confirmed by clinical or laboratory evidence

Both infections with endogenous (contaminant) organisms carried by the patient & (exogeneous) organisms originating in the animate or inanimate environment of the hospital are designated hospital infections

Epidemiologically Important Organism

MRSA VRE

MDR Gram Negative Bacteria like MDR

acinetobacter spp, MDR pseudomonas aerigenosa) Extended Spectrum Beta Lactimace (ESBL) producing organism like ESBL E. coli, ESBL klebsiella spp. Clostridium deficile

Health Care Associated Infections (HAI):

Blood Stream Infections Urinary Tract Infections

Hospital acquired pneumonias including

ventilator associated pneumonia Surgical site infections

PURPOSE To protect employees, visitors & nonisolated patients from transmission of agents believed or known to be infectious.
To prepare supplies required for isolation precautions and to implement medical & nursing procedures to prevent the spread of infection

Policy Statement: 1. All patients with specified or suspected contagious conditions should be placed under proper isolation precaution as early as possible 2. All patients identified & treated for MRSA shall be placed in isolation on readmission 3. The attending physician will have the responsibility of making an appropriate written order to place on isolation precaution 4. The admitting physician & HN shall see to it that the patient was place on proper isolation precaution

Designed for patient with documented or suspected to be infectious. These are used in ADDITION to Standard Precaution
Three types:
Contact precaution Droplet precaution Airborne precaution

Are use for patients known to be infected with a microbes that is easily transmitted between the health care worker & patient, & between patient to patient through direct or indirect contact. Example: all MDRO cases, draining abscess or bedsore, C. defficile infection, Hepatitis A with diarrhea, Impetigo, etc

Are designed to prevent the transmission of certain diseases which are transmitted through air
Droplet nuclei (particle size 5 microns or smaller) which carry the infectious organism may be released into the air and be carried via air currents

Can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning; can remain in the air for up to several hours and be spread widely within a room or over longer distance.
Examples: Tuberculosis, Measles, Varicella

Are designed to reduce the risk of droplet transmission of infectious agents from patients known or suspected to be infected with microbes (droplets) transmitted through talking, sneezing, coughing, spitting and undergoes any certain procedures e.g. oral, tracheal/bronchial suctioning. Transmission occurs when droplet containing micro organisms generated from an infected person are propelled a short distance about 3 feet and may come in contact with another persons conjunctiva or mucous membranes like eyes, nose and mouth

Droplet do not remain suspended in the air and are not transmitted by the airborne route as the size of droplet are >5 micro meter Example: Rubella (german measles) , Epiglottitis due to Heamophilus Influenzae, Meningococcal meningitis or Neisseria, Bordetella Pertussis, Group A Streptococcus, Diphtheria, Pertussis, Seasonal influenza

Contact Precaution
1. Patient placement 2. Gloving 3. Handwashing 4. Gowns & protective apparel 5. Patient transport 6. Patient care equipment 7. Visitors

Airborne Precaution
1. Patient placement 2. Respiratory protection 3. Patient transport 4. Visitors

Droplet Precaution
1. Patient placement 2. Respiratory protection 3. Visitors

Thank You & Good Day