BASIC PRINCIPLES AND IDEAS OF INFECTION CONTROL

Objectives

Present some of the principles of infection control Discuss if you agree with these ideas and principles

Definition

Health care-associated infection (HCAI)

Also

referred to as nosocomial or hospital infection

An

infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. This includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among healthcare workers of the facility

Examples of HAI: a patient develops

a urinary tract infection after having a urinary catheter measles from the patient in the next bed, diarrhea that was not present on admission a surgical site infection after an operation hepatitis C after receiving an injection with a used syringe HIV from receiving a blood transfusion that was not tested

Infection Control: first do no harm

The health care we provide can diagnose diseases, treat patients, relieve suffering and prevent the spread of disease Health care can also kill patients, spread disease, create epidemics and increase suffering. Health care workers can kill more persons in their career than soldiers unless they practice good infection control.

HAI can appear quickly or months later

Diarrhea from norovirus or staph aureus may appear in hours Surgical site infections in patients with implants may not appear for 1 year Patient in the same room as a patient with MRSA may get colonized with the germs but not develop an infection for 18 months Patients exposed to hepatitis may not develop disease for 6 months

We may not be aware of HAI

Physicians and nurses may not be aware of health care infections that develop after the patient goes home.

If a patient develops an infection they may not come back.

First do no harm

Every facility that provides health care must have an infection control program to monitor and prevent infections and injuries to patients that may result from care. Every facility must supervise and monitor the PROCESSES of care to decrease the risk of harm.

Some procedures have more risk of health care associated infections

Risk increases when:

Invasive

procedures that break the skin or enter normally sterile parts of the body With implants and transplants or anything that enters and stays in the body (including catheters, sutures, drains, central lines, Infusions) The longer the invasive procedure If a surgical procedure is in a non-sterile part of the body (respiratory tract, GI or reproductive tract.

HAI come from the patients germs or those transferred to the patient

Present on the patients skin which can not enter the body through an incision or puncture (endogenous) Present on the hands of care givers Present on objects that touch the patient Present on food, water or air Germs may be viruses, bacteria, prions, or other pathogens.

A core principle: Separate clean from dirty

Dirty refers to any devices that has touched a patient or been used Clean refers to new, never used items or items that have be cleaned and sterilized or disinfected

They should NEVER be in the same physical space. They should not cross paths

Health care associated infections (HAI)

Are common:
Can

happen every time a patient is touched In some settings 25% of patients get infections

Can kill patients

Transfusion

reactions, contaminated IV fluids

May not be detected without dedicated surveillance system

The hierarchy of control

The most effective way to reduce harm is to: Eliminate the risk Reduce the risk by engineering controls Administrative controls PPE Training and knowledge

Which option do you think is true?

Most health care infections Most health care infections

Are spread between patients on the hands of caregivers

Are carried between patients by flies and insects

Infection Control Practitioners believe

Most health care infections

Are spread between patients on the hands of caregivers

Which do you think is true?

The best care procedures should be individualized to each patient

The best care is standardized procedures

One should work independently to individualize care and modify procedures as they see fit for each patient. It is best to change how procedures are done to fit each patient.

One should practice standardized procedure and follow approved indications; the more that the care follows evidence based guidelines the better the outcome.

Infection Control Practitioners believe

The best care is standardized procedures

One should practice standardized procedure and follow approved indications; the more that the care follows evidence based guidelines the better the outcome.

Which do you think is true?

A trained health profession

A trained health professional

Is a lifetime student who is never done learning.

Has completed their knowledge and has perfected their knowledge base, and mastered all necessary concepts

Infection Control Practitioners believe

A trained health profession

Is a lifetime student who is never done learning.

Which do you think is true?

Infections and patient injuries are impossible to prevent

Infections and patient injuries are preventable

Infection Control Practitioners believe

Infections and patient injuries are preventable

In my practice

I see health care associated infections

I never see healthcare associated infections

Infection Control Practitioners believe

I see health care associated infections And if I dont seen them, my surveillance system is to blame! All health care systems can be improved

ICP judge the quality of health care by

The disease outcomes including death rate, rate of infection, rates of complications, rate of being readmitted to the hospital. I believe good hospitals monitor the processes of care as well.

The happiness of the patient The fame of the provider The wealth of the physician The reputation of the hospital

ICP judge the quality of health care by

The disease outcomes including death rate, rate of infection, rates of complications, rate of being readmitted to the hospital. Good hospitals monitor the processes of care because reducing the variation in processes controls much of the variation in outcome.

Surgeries and procedures are

UNNECESSARY

NECESSARY

Often unnecessary and expose patient to disease, injuries and unnecessary costs

Always beneficial because other wise the physician or nurse wouldnt do them There is an important placebo effect that can always help the patient feel better with the act of IV and other health care procedures.

Surgeries and procedures are

UNNECESSARY

Often unnecessary and expose patient to disease, injuries and unnecessary costs

ANTIBIOTICS ARE
OFTEN UNNECESSARY

The overuse of antibiotics is a global problem that creates multiple drug resistant infections. Drug resistance is dangerous to the patient and to the community

SOMETIMES GIVEN UNNECESARILY BUT THIS IS JUST A PROBLEM OF UNTRAINED PROESSIONALS

Trained professionals only give antibiotics according to evidence based guidelines. If the patient didnt need them the provider wouldnt give them.

ANTIBIOTICS ARE
OFTEN UNNECESSARY

The overuse of antibiotics is a global problem that creates multiple drug resistant infections. Drug resistance is dangerous to the patient and to the community

Alcohol hand rub

Is always less effective than hand washing with soap and water

Is very effective at preventing health care associated infections

Alcohol hand rub

Is very effective at preventing health care associated infections

Procedures that worked in the past

Should always be continued May not work well in the future

They have been proven by decades of experience and tradition and are the best way

The ways of the past medical leaders will remain effective

New infections, new devices, changing patient issues, and new procedures mean that what was safe in the community may not be safe. Change is necessary

Procedures that worked in the past

May not work well in the future

New infections, new devices, changing patient issues, and new procedures mean that what was safe in the past may not be safe now. Change is necessary

Steps in the process of care

Need to be monitored and supervised regardless of who does them For example hand hygiene should be monitored

Need to be monitored only for non-professional staff

Individual professionals can be trusted to do the right thing.

Steps in the process of care

Need to be monitored and supervised regardless of who does them For example hand hygiene should be monitored

Wet and dry

Wet surfaces have greater risk

Wet means freshly cleaned

Nothing should ever be stored wet in disinfectants. Wet hands are dangerous even after being washed because they can pick up more germs All disinfectants can be contaminated by germs

Store thermometers and frequently used equipment in disinfectants to protect patients No germs can grow in disinfectants Hands that are wet after hand washing do not need to be dried

Wet and dry

Wet surfaces have greater risk

Nothing should ever be stored wet in disinfectants. Wet hands are dangerous even after being washed because they can pick up more germs All disinfectants can be contaminated by germs

When IVs, urinary catheters and other devices are inserted properly

They can be left in safely for the maximum recommended time

They should be removed as soon as possible.

When IVs, urinary catheters and other devices are inserted properly

They should be removed as soon as possible.

When problems occur, it is better to

Encourage staff to report problems, discuss them openly with all staff involved, and monitor if things get better or worse after trying the suggestions.

Not discuss problems openly, as they are usually due to personal errors and it is best to work with the individual to get them to change their behavior.

Infection Control Practitioners believe that when problems occur, it is better to

Encourage staff to report problems, discuss them openly with all staff involved, and monitor if things get better or worse after trying the suggestions.

Cleaning

Is less important if a device is sterilized, as germs and dirt on the item will be killed during sterilization

Is the step that removes the most germs from patient care items. If a device is not cleaned, it can not be sterilized.

Cleaning

Is the step that removes the most germs from patient care items. If a device is not cleaned, it can not be sterilized.

Problems of the quality of care are usually due to

The few individuals who are lazy, irresponsible and careless

Systems of care that have weakness due to facilities, equipment, task design, communication, supplies, and training.

Problems of the quality of care are usually due to

Systems of care that have weakness due to facilities, equipment, task design, communication, supplies, and training.

Summary

IC Programs are necessary to prevent harm from health care that is common and severe Process monitoring is essential, standardized care is desirable. Monitoring of outcomes is desirable but resource intensive. Separation of clean and dirty is key Working in infection control involves frank discussion of issues, openness to change as new problems and new information are learned.