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PSEUDOMONAS

Normally lives in soil and in water


storage tank. but, once he gets into the hospital,
is notoriously difficult to remove

ESCHERICHIA COLI
generally lives a blameless life in the gut
but assumes a life of crime once he is
allowed to roam in the hospital

KLEBSIELLA.
Lesser known resident of the intestine,
fond of hitchhiking on the hands of doctors
and nurses. Known to take over entire wards.

The

Hospital Gang

STREPTOCOCCUS
Still a common cause of throat infection
but also involved in more serious
offenses against the rest of the person

PROTEUS
A motile young bacterium, anxious to swim
into the wrong places. Generally follows up
the dirty work of other bacteria

STAPHYLOCOCCUS AUREUS
Alias Goldie the Grape, found
in the nose and on the hands of
hospital staff but survives
for days in dusty places

Susceptible
Host
Pathogen

Place of
Entry

Reservoir

Chain
of
Infection
Method of
Transmission

Place of
Exit

Susceptible
Host
Pathogen

Place of
Entry

Breaking
the
Chain
of
Infection

Reservoir

Place of
Exit

Method of Transmission

Routes of Transmission in Healthcare Settings

Droplet
Contact
Airborne

Droplet Transmisson
droplets generated from the
source person primarily during
coughing, sneezing & talking
droplets propelled a short distance
through the air & deposited on
the hosts eyes, nasal mucosa, or
mouth
droplets do not remain suspended in
the air

Direct - contact Transmission


direct body surface-to-body
surface contact & physical
transfer of microorganisms
between a susceptible host &
an infected or colonized person

can also occur between 2 patients

Indirect-contact Transmission
contact of a susceptible host
with a contaminated intermediate
object, usually inanimate

contaminated instruments,
needles, or dressings, or
contaminated hands and gloves

Airborne Transmission
dissemination of airborne droplet
nuclei (5 um or less)
suspended in the air for long
periods of time
dispersed widely by air currents
special air handling and ventilation
required to prevent transmission

Routes of Transmission
Droplet
Diphtheria (pharyngeal)
Mycoplasma pneumonia
Pertussis
Pneumonic plague
Influenza
Adenvirus
Mumps
Rubella
Parvovirus B19
Invasive N. meningitidis
disease (pneumonia,
meningitis, sepsis)
Invasive H. influenzae
type b disease (sepsis,
meningitis, pneumonia)

Contact
Enteric infections
( C. difficile,
Shigella, hepatitis A)
RSV, parainfluenza or
enteroviral infections
Diphtheria ( skin )
Impetigo
Pediculosis
Scabies
Staph. furunculosis
Herpes simplex virus
Herpes zoster
(disseminated or in
immunocompromised)
Viral hemoorharrhagic
(Ebola, Lassa, Marburg)

Airborne
TB
Measles
Varicella

Basic Principles of Infection Control


Separate the infection

source from the rest


of the hospital

Cut off any route of


transmission

Standard Precautions

Previously called Universal Precautions

Assumes blood and body fluid of ANY


patient could be infectious

Recommends PPE and other infection


control practices to prevent
transmission in any healthcare setting

Decisions about PPE use determined by


type of clinical interaction with patient

Standard Precautions

Designed to reduce the risk of transmission of


microorganisms from both recognized & unrecognized
sources of infection in hospitals

Apply to :
blood
all body fluids, secretions, & excretions except sweat,
regardless of whether or not they contain visible
blood
non-intact skin
mucous membranes

Transmission-based Precautions

Droplet Precautions

Contact Precautions

Airborne Precautions

Droplet Precautions
Patient placement :

- single room
- cohorting ( keep at least 1 meter
between patients beds)

Use surgical or procedure mask.


Patient transport :

- limit patient movement


- use of surgical mask by patient

Contact Precautions
Use gloves & gown for all contact with the
patient or the patients environment.

Use either disposable equipment or dedicate


equipment to specific patients.

HCWs should refrain from touching their eyes,


nose, or mouth with potentially contaminated
gloved or ungloved hands.

Avoid contaminating environmental surfaces


that are not directly related to patient care
( e.g. door handles, light switches ).

Airborne Precautions

Airborne Infection (AI)


Isolation Room

Cough Etiquette

HCWs to use N95 Mask

Patient to wear surgical mask


during transport to other hospital
areas.

Environmental Infection Control

remove & dilute the air by


maximizing natural ventilation
through open windows

use of mechanical ventilation


(window fans, exhaust systems)

air filtration & ultraviolet


germicidal irradiation

Natural Ventilation

Open
windows

Open
windows

bed

bed

bed

door
Direction of air
flow under the
door

Recommended Ventilation in
Prevention of Airborne
Infections

Negative-pressure ventilation in rooms :

air flow into room from adjacent areas,


exhaust air to the outside
6 or more air changes per hour (ACH)
desirable
6 ACH 99% reduction of
concentration of infectious particles

Negative Pressure Ventilation


air conditioner

Airflow
exhaust

bed

bed

bed

Airflow
intake

door
Direction of air
flow under the
door ; negative
pressure with
respect to corridor

LCP Airborne Infection Isolation Units

W
E
N

RESPIRATO
RY
HYGIENE /
COUGH
ETIQUETTE

Respiratory Hygiene / Cough Etiquette


Cover the nose / mouth
when coughing or
sneezing.

Use tissues to contain respiratory secretions


and dispose of them in the nearest waste
receptacle after use.

Perform hand hygiene after having contact


with respiratory secretions and contaminated
objects / materials.
CDC 2003

Standard Precautions
Hand Hygiene
Hand washing
Alcohol-based hand rubs

Personal Protective Equipment (PPE)


Gloves
Facial protection : mask
face shield
goggles
Gown
Foot protection
Proper handling of needles & sharp devices.

HEALTH CARE
WORKERS HANDS

Probably the MOST common


means by which spread of
infection by direct contact can
occur

The
TheHand
HandTakes
TakesGerms
Germsfrom
from: :
- -the
theskin,
skin,dirty
dirtywounds,
wounds,pus
pus
excretions
excretionsofofthe
thesick
sick
- -the
thebody,
body,the
thehands,
hands,the
the
clothes
clothesofofthe
thephysicians
physicians
and
andhospital
hospitalpersonnel
personnel

The
TheHand
HandTakes
TakesGerms
Germsfrom
from: :
- -the
theskin,
skin,dirty
dirtywounds,
wounds,pus
pus
excretions
excretionsofofthe
thesick
sick
- -the
thebody,
body,the
thehands,
hands,the
the
clothes
clothesofofthe
thephysicians
physicians
and
andhospital
hospitalpersonnel
personnel

The Hand Infects


- newly operated
- the child, the chronically ill
- the old patient
- ALL sick people
- ALL hospital personnel

The
TheHand
HandTakes
TakesGerms
Germsfrom
from: :
- -the
theskin,
skin,dirty
dirtywounds,
wounds,pus
pus
excretions
excretionsofofthe
thesick
sick
- -the
thebody,
body,the
thehands,
hands,the
the
clothes
clothesofofthe
thephysicians
physicians
and
andhospital
hospitalpersonnel
personnel

The Hand Infects


- newly operated
- the child, the chronically ill
- the old patient
- ALL sick people
- ALL hospital personnel

The
TheHand
Handcontaminates
contaminates
- -the
physicians
the physiciansinstruments
instruments
- -clean
laundry
clean laundry
- -toiletries
toiletries
- -sanitary
sanitaryequipments
equipments
- -dishes
and
dishes andsilver
silveretc.
etc.

The
TheHand
HandTakes
TakesGerms
Germsfrom
from: :
- -the
theskin,
skin,dirty
dirtywounds,
wounds,pus
pus
excretions
excretionsofofthe
thesick
sick
- -the
thebody,
body,the
thehands,
hands,the
the
clothes
clothesofofthe
thephysicians
physicians
and
andhospital
hospitalpersonnel
personnel

The
TheHand
Handtransfer
transferGerms
Germs
from:
from:
bed
sheets,
dirty
bed sheets, dirtyunderwear,
underwear,
moist
towels,
sinks
moist towels, sinksand
and
bathtubs,
toiletries
bathtubs, toiletries

The Hand Infects


- newly operated
- the child, the chronically ill
- the old patient
- ALL sick people
- ALL hospital personnel

The
TheHand
Handcontaminates
contaminates
- -the
physicians
the physiciansinstruments
instruments
- -clean
laundry
clean laundry
- -toiletries
toiletries
- -sanitary
sanitaryequipments
equipments
- -dishes
and
dishes andsilver
silveretc.
etc.

Hand Hygiene

Required for Standard and Expanded


Precautions

Perform

Immediately after removing PPE

Between patient contacts

Wash hands thoroughly with soap and


water or use alcohol-based hand rub

Types of Hand Hygiene


Level 1 : Handwashing plain soap +

Level 2 : Hand Antisepsis - antimicro


or alcohol-based products
Level 3 : Surgical Hand Scrub

HANDWASHING
Considered to be one of the MOST
important procedures in the prevention
of hospital-acquired infection

defined as vigorous, brief rubbing


together of all surfaces of lathered
hands, followed by rinsing under stream
of water for at least 10 seconds

Handwashing
When?

After removing gloves


Before and after
patient contact
After contact with
blood or body fluids
from any patient
After taking blood
pressure or vital signs
from any patient

Handwashing
When?

After using
bathroom
After blowing or
wiping nose
Before preparing
food
Before eating

Handwashing How?
Handwashing
procedure
Running water
Soap
Friction
Alcohol-based
hand rub

Defined Technique for Hand Washing


The Hands are moistened and 33-5 ml formulation is applied to cupped hands. The
hands are then rubbed together 5 times as follows :

1. PALM to PALM

4. Back of fingerrs
to opposing palms,
fingers interlocked

2. Right Palm over


dorsum and vice versa

5. Rotational rubbing of
right thumb clasped in
left palm and vice versa

3. PALM to
to PALM
fingers interlaced

6. Rotational rubbing,
backwards and forwards
with clasped fingers of
right hand
hand in left
palm and
and vice versa

Handwashing Steps
Step 1
Wet hands and
wrists.
Apply soap or
alcohol-based
hand rub.

Handwashing Steps
Step 2
Right palm over
left ,
left over right.

Handwashing Steps
Step 3
Palm to
palm , fingers
interlaced.

Handwashing Steps
Step 4
Back fingers
to opposing
fingers
interlocked.

Handwashing Steps
Step 5
Rotational
rubbing of right
thumb clasped
in left palm and
vice versa.

Handwashing Steps
Step 6
Rotational
rubbing
backwards and
forwards with
tops of fingers
and
thumb of right
hand in left and

Handwashing Steps
Step 7
Rinse hands well
under running
water.

HYGIENIC HAND RUB

An alternative method
of hand disinfection if
hands are not
visibly
soiled.

A rapid and effective


alternative to hand
washing (e.g. ward
rounds with no water
and no wash basin)

HYGIENIC HAND RUB


Alcohol-based products are

more effective for standard


handwashing or hand sepsis by
HCWs than soap or
antimicrobial soaps.

Alcohol solutions containing


60% - 95% are most effective.
Higher concentrations are less
potent.
(HICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force)

HYGIENIC HAND RUB


ALCHOLIC HAND
RUBS DO NOT
CLEANSE,
therefore hands
should be cleaned
with soap and water
in the presence
of visible
contamination

HYGIENIC HAND RUB


PROCEDURE:
Apply 3-5 ml of fast acting antiseptic (e.g.
alcohol hand
rub containing glycerol as an emollient to
prevent excessive drying of hands).

Rub hands together after application of


alcohol-based products until all the alcohol
has evaporated.

What infections can be caused by


needlestick injuries?
Pathogens that pose the most serious health
risks :
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)
Human immunodeficiency virus (HIV)
causes AIDS

Preventing needlestick injuries is the


best way to protect yourself from
these blood-borne infections.

Who is at risk of needlestick injury ?


Any worker who may come in contact with
needles is at risk :
doctors
nursing staff

laboratory workers
housekeepers

What kinds of needles usually cause


needlestick injuries?
Hypodermic needles
Blood collection needles
Suture needles
Needles used in IV delivery
systems

What work practices increase the risk of


needlestick injuries?
Recapping used needles.
Transferring a body fluid between
containers.
Failing to dispose of used needles
properly in puncture-resistant
sharps containers.

How can you protect yourself from


needlestick injuries? (1)

Avoid the use of needles where safe and


effective alternatives are available.

Use devices with safety features.

Avoid recapping needles.

Plan for safe handling and disposal of needles


before using them.

Promptly dispose of used needles in appropriate


sharps disposal containers.

Syringes with Safety Features

Handling Needles & Other Sharps


Handle

all needles & sharp


instruments with care.

Use devices with safety


features.

Never recap used needles


with hands.

Recap

needles using the


scooping method.

Proper Sharps Disposal


Plan safe handling and

disposal before beginning


any procedure using
needles.

Dispose of used needle


device promptly in
appropriate sharps
disposal containers.

Puncture resistant Container

How can you protect yourself from


needlestick injuries? (2)

Report all needlestick and sharps-related injuries


promptly to the employees physician to ensure
that you receive appropriate medical care.

Tell your supervisor about any needlestick


hazards you observe.

Get a hepatitis B vaccination.

Participate in training related to infection


prevention.

PREVENTIO
N IS
PRIMARY!

Protect patientsprotect healthcare personnel


promote quality healthcare!