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Infection Control Education

Series

A Message for Hospital

OBJECTIVES
1.

Describe the importance of infection control in


hospitals.

2.

List measures for preventing/reducing hospital


infections

3.

List the categories of infection control


precautions that healthcare workers use to
prevent/reduce infections

What is a healthcare-associated infection?


A healthcare associated infection (HAI) is
one which was not present or incubating
when the patient was admitted to the
hospital, but is acquired after admission.

Urinary tract infections are the most common


HAI, followed by surgical wound infections,
lower respiratory tract infections (pneumonia)
and skin infections.

Other infections include gastrointestinal


infections (Clostridium difficile) and
bloodstream infections.

COMMON PROBLEM: -A W.H.O report estimates


that hospital infection affect more than 1.4 million
people worldwide. According to the studies conducted
at different levels in Indian hospitals, the incidents of
post operative infections in various hospitals varies
from 10 % - 25 %

Summary of
Assessment of Injection Practices in India
Over all 63.5% injection are unsafe, 70% Public Sector and
60% in private.
Immunization particularly those given to children below three
year is absolutely essential and all of these must be
administered in a safe manner. These injections assume
additional significance in view of the finding that 74%
injection at immunization clinic were administered in unsafe
manner.
The huge quantum of unsafe injection results that each year
(Rs 189 Crore)* can potentially be associated with major
public health problem
*Approx Amount spend on Health in India
P.A

Healthcare-associated infections are


serious and affect patient and staff safety
Over 98,000 people die each year from
complications of healthcare-associated
infections (HAIs).
HAIs also cause suffering, disability and
increased healthcare costs, which may not be
reimbursed.
Hand hygiene (hand washing or use of an
alcohol hand rub) can prevent nearly half of
preventable infections and helps to protect
staff from infections.
Our goal is to have zero infections!

Risk Factors for HAIs


Invasive devices, such as ventilators, foley
catheters and central lines predispose patients
to infection.
Immune system suppression predisposes
patients to infections with atypical germs (like
fungus) that usually do not make others sick.
Antibiotic use predisposes patients to infections
with antibiotic-resistant germs, fungus, and
gastrointestinal infections.
Numbers of at risk patients are increasing
because of advances in medical therapies,
antibiotic use, and diagnostic techniques.

Organisms that cause HAIs


Any organism which can cause disease is called a
pathogen
Pathogens which cause HAIs include:

Staphylococcus
Pseudomonas, E. coli and other gram negatives
Clostridium difficile
Candida
Some viral agents such as RSV (respiratory syncytial
virus), and influenza
Multidrug resistant organisms (MDROs), such as MRSA,
VRE
Patients, who are colonized (carriers) of MDROs, are a
source for spread within the hospital and are at risk of
developing deadly infections.

Representative
Pathogens

Methicillin-resistant S. aureus (MRSA)


Vancomycin-resistant enterococcus (VRE)
C. difficile
Norovirus
Multiply-drug resistant (MDR) gram negative rods (e.g., B.
cepacia, P. aeruginosa, Acinetobacter)

All of the above organisms can survive on environmental surfaces for


long periods of time and can be transiently carried on hands.

CHAIN OF INFECTION

Infection requires a chain of events


The role of the hospital infection control is to understand
this chain and the most efficient means of interrupting
transmission

How are infections transmitted?

Infections do not occur simply because a pathogen exists in the


environment.
Example: MRSA
The pathogen must have a reservoir in which it grows
and lives (e.g., humans serve as a reservoir as well as the
environment)...
The portal of exit would be contact with the
colonized/infected patient or contaminated environment
The mode of transmission would be direct or indirect
contact, example via hands of healthcare workers
The portal of entry would be via contact with another
patients non intact skin, mucous membranes, contamination
of invasive devices, such as IV lines, etc
- A susceptible host is anyone at risk for colonization or
infection with MRSA, i.e. patients with invasive devices, non
intact skin, acutely ill, etc.

BLOOD BORNE INFECTION


When an injection is given in a medical setting we expect that
the treatment will make us feel better (or at least it will help
more than it harms).But the medical principal First, Do not
harm is violated everyday through unsafe injections. The result
of the infection could be more rashes like skin allergy or it can be
fatal as well. When an unsafe injection causes potentially deadly
infectious with Hepatitis B and C or HIV virus, it could result in
chronic diseases and death in patients.

BLOOD BORNE INFECTION


Infection via needles can be avoided if sterile needles are used. Needles
should also be disposed off properly. Sharp implements that arent
disposed off pose occupational hazard to healthcare workers. Often
nurses or the cleaning crew are unsuspecting victims to needle stick
injuries. Blood transfusions are also very hazardous. There are multiple
opportunities to acquire serious and deadly viral infections including
HIV AIDS and Hepatitis B & C.

Why Education on Infection Control is Needed


We cant be simpler than this. It is education that
makes us more aware and better civilized people. And
if we are well educated about health care facilities then
for sure we may help in building a safer and healthier
place to live in.

Prevention and Control of HAIs


The goal of Infection Control is to reduce
transmission of pathogens from patient to
patient, from staff to patient, and from patient
to staff.
Good infection control practices break the chain
of infection. Examples:
Hand hygiene and changing gloves between patient
contacts prevents transmission.
Removing a foley catheter makes a patient less susceptible
to HAIs by removing an entry point for pathogens.
Vaccinations (e.g., vaccinations for Hepatitis B, influenza,
chickenpox, etc.) reduce the number of susceptible
individuals.

Steps in Infection Control

Hand Hygiene
Clean Designated Area
Gloves / Mask & Shoe Cover
Proper Handling of Sharps
Sharps Box
Single Use Syringes

Devices Available to Curb Infection


Hand Wash

SHARPS BOX

MASK

SINGLE USE SYRINGES

GLOVES & HEAD COVER

SHOE COVER

SHARPS MANAGEMENT

Risk Area Identification


During Operations : By needles, passing
sharps directly in hands.
Sharps left unattended.
Undestroyed Sharps.
Sharps in wrong container.
Unsealed Sharps Container.
Puncture Prone Container.

During Operations : By needles, passing sharps


directly in hands.

Sharps left unattended

Undestroyed Sharps

Sharps in wrong container

Unsealed Sharps Container

Puncture Prone Container

Safe Way of Handling Medical Devices SHARPS

Avoid Needle Stick - Injury

Recapping commonly leads to needle-sticks

If recapping is necessary, use a one-handed technique

BUT AVOID ALL THIS AS WITH HUGE QUANTUM OF


WORK WE TEND TO GET NEEDLE STICK INJURIES,
WICH ARE NOT GIVEN THE DUE IMPORTANCE

Close safety boxes when they are 3/4 full and


lock boxes in a secure area

Needle-sticks can occur if boxes are overfilled

Tips to Manage Sharps


1.) Always wear gloves. One layer of
surgical gloves decreases the volume of
blood injected by needles up to 70 % .
2.) Destroy needles, cut syringes using
needle destroyer.
3.) All sharps to be stored in puncture
resistant container.
4.) Sharps should not be transferred in
hand.
5.) Prohibit recapping.
6.) Vaccination to all health personnel
against HBV / HCV.

THREAT TO RAG PICKERS

Threat to those who repack infected


reuse surgical devices

Picture Perfect: - unhygienic conditions in hospitals, unsafe disposal,


patient getting readmitted for infectious treatment

Aseptic Technique
Practice of ensuring that bacteria are excluded
from open sites during surgery, wound dressing,
blood sampling, and other medical procedures.
Aseptic technique is a first line of defense
against infection.

Use of sterile instruments and supplies and the


application of principles of aseptic while
performing invasive procedures are important
aspects of infection control.

Examples of aseptic technique include:


- Disinfecting IV ports/valves and capping open lines
- Checking the integrity of sterile packages

Standard Precautions
The first tier of the CDC isolation guidelines
is Standard Precautions. Since patient
examination and medical history cannot
reliably identify every patient with blood
borne pathogens and other diseases,
Standard Precautions apply to all patients
and all body substances. The risk of
infection can be minimized if Standard
Precautions are followed for ALL PATIENTS.

Standard Precautions guidelines:

1.

Perform hand hygiene before and after patient


care, regardless of whether gloves are worn.
Perform hand hygiene immediately after the
gloves are removed and between patient
contacts.

2.

Wear gloves when touching blood or any other


body substance, secretion, or excretion except
sweat, or when touching contaminated items.
Put on clean gloves just before touching mucous
membranes or non-intact skin.

3.

Take care to prevent needle sticks and other


injuries when using needles, scalpels, or other
sharp instruments. Also be careful when
handling sharps after procedures and when
cleaning them. Dispose of used needles properly.

4.

Use a mouthpiece, resuscitation bag, or other


ventilation device as an alternative to mouth-tomouth resuscitation. These devices should be
available for use in areas where the need for
mouth-to-mouth resuscitation is predictable.

5.

Wear a gown to protect your skin and to prevent


soiling of your clothing during any patient care
activity that is likely to generate splashes or
sprays of blood or body fluids.

6.

Wear a mask and eye protection or a face shield


to protect the mucous membranes of our eyes,
nose, and mouth during any patient care activity
that is likely to generate splashes or sprays of
blood or body fluids, including respiratory
secretions. You should thoroughly wash your
hands or other skin surfaces immediately after
accidental exposure to blood or body
substances. Wear mask and eye protection when
working closely with a coughing patient.

Transmission-Based Precautions
The second tier of the CDC guidelines is
transmission-based precautions. There are three
simple sets of precautions based on likely routes
of transmission.
The precautions are designed to prevent airborne,
droplet, and contact transmission of pathogens.

These precautions are to be followed when a


patient is suspected or known to have infection
or colonization by epidemiologically important
pathogens (MRSA, VRE, TB, Influenza, etc).

Airborne Precautions

Airborne precautions are designed


to protect against the transmission
of airborne droplet nuclei for
illnesses such as measles,
chickenpox, and tuberculosis.
Airborne droplet nuclei are smaller
than 5 microns in diameter and can
remain suspended in the air and
dispersed widely by air currents.

Airborne precautions include:


Isolation of the patient in a private room with monitored negative air pressure.
The door to the room must remain closed and the patient must remain in the room.
Always wear appropriate respiratory protection when you enter the room. For
tuberculosis, you should wear a respirator mask fit tested to your face size.
Contact Infection Control if you are not sure what type of protection to wear.
Limit the movement and transport of the patient from the room for essential
purposes only. If at all possible, have the patient wear a surgical or procedure mask
during transport.

Droplet Precautions

Droplet precautions are designed to


protect against the transmission of
infectious droplets larger than 5
microns (such as mycoplasma
pneumonia, pertussis, mumps, and
influenza). Patients with these
illnesses tend to generate
infectious droplets while sneezing,
coughing, or talking.

Droplet precautions include:


Keeping the patient in a private room. The door may remain open.
You should wear a mask when you enter the room.
You should also wear a mask when examining or transporting a patient
who is suspected to have an illness requiring droplet precautions.
Limit the movement and transport of the patient from the room for
essential purposes only. If at all possible, have the patient wear a surgical
or procedure mask during transport.

CONTACT PRECAUTIONS
Contact Precautions are
designed to halt the
transmission of pathogens
which may be spread by
direct contact with the
patient, contaminated
equipment, or the
patients environment.
Contact Precautions are
designed for different
types of infections which
may survive for extended
periods in the
environment (e.g., C diff,
MRSA, VRE,).

CONTACT PRECAUTIONS

The patient is placed into a private room whenever possible.

A GOWN AND GLOVES MUST BE WORN BY ALL ENTERING THE


ROOM! THIS INCLUDES VISITORS. Dietary staff that are delivering
trays are required to wear gloves.

When providing care, change gloves after contact with any


infective material such as wound drainage.

Remove the gown and gloves and perform hand hygiene before
leaving the room (take care not to touch any potentially infectious
items or surfaces on the way out).

Dedicate the use of non-critical patient-care equipment to a single


patient. If use of common equipment is unavoidable, adequately
clean and disinfect it before use with other patients.

Surgical Site Infection (SSI)


Prevention

2 to 5% of surgical patients will develop SSI

SSI increases length of stay by7.5 days on average and


adds costs of $2600 to $27,000 per case
Measures to Reduce SSI Include:
- Preoperative antiseptic bathing. This is hospital policy,
C-139.
- Identifying and treating infections prior to surgery,
such as UTI.
- Appropriate antibiotic selection and administration.
Antibiotics should be given within an hour of incision.
Discontinue antibiotics after surgery within 24 hours of
surgery.

UTI Prevention
Most healthcare acquired UTIs are related to
foley catheters-avoid catheter placement if at
all possible-remove catheters as soon as
possible
Use strict aseptic technique for foley insertionsterile field, prep with pick ups, dont
contaminate catheter
Bag below level of patient.
Proper technique for specimen collection
Foley Care twice a day and with continous care

ADDITIONAL CONCERNS

Keep clean separate from dirty

Follow appropriate cleaning and disinfecting procedures


Stethoscopes (no fabric covers)
Multi-use patient equipment
Multi-use diagnostic equipment
Toys and other distraction devices

Conclusion
Infection Control is crucial for patient safety.
Infection control in the hospital is the responsibility of
every person working in healthcare. Consistent and
conscientious practice of infection control principles
can prevent unnecessary suffering.
Effective communication about the presence of
infectious diseases and following hospital policies are
essential to the hospital's effort to protect patients,
staff, and others in the acute-care environment.
All employees are urged to report poor practices
which might harm patients or staff. Report to
manager or to Infection Control Dept.
The safety of our patients and staff depends on all of
us.

THANK YOU!
For any further information
Hindustan Syringes & Medical
Devices Ltd
Kindly Contact
GL -3 Ashoka Estate
24.Bharakhamba Road.C.P
New Delhi -110001
or call +91 -11 -23314785 /
23316528