Promotion of Infection Control in RCHEs

Transcription

1 Promotion of Infection Control in RCHEs

2 Infection Prevention and Control is Everyone s Business Family/Visitors CNA/PCA/CMA

3 Safety Measures Standard Precautions

4 Infection Control n Safety Hospital Long Term Care Facility Our collective concern.

5 Definitions/Terms used

6 Microbes Microbes are everywhere. They populate the air, the water, the soil, and have even evolved intimate relationships with plants and animals. Microbes that colonize the human body during birth or shortly thereafter, remaining throughout life, are referred to as normal flora.

7 Normal Flora (Commensal) Normal flora can be found in many sites of the human body including the skin (especially the moist areas, such as the groin and between the toes), respiratory tract (particularly the nose), urinary tract, and the digestive tract (primarily the mouth and the colon). However, areas of the body such as the brain, the circulatory system and the lungs are intended to remain sterile (microbe free).

8 Deposition & multiplication of microorganisms No host response No harm Colonization Pathogens may inhabit without causing adverse effects

9 Infection Deposition & multiplication of microorganisms Cause adverse effects

10 Healthcare-associated (or nosocomial ) infection Infections acquired while the person is in the healthcare institution / LTCF May manifest - in hospital / LTCF - after returning home

11 Sources of Infection Endogenous (autogenous) - own bacterial flora Exogenous - from a source other than the patient/own

12 Self-infection or endogenous Infection Infection caused by microbes which the patient carries - normal flora - septic areas e.g. GNB of the intestine are a common cause of wound infection following abdominal surgery

13 Exogenous or Cross-infection Infection acquired from residents staff other persons

14 More frequent types of Infections in LTCF Urinary tract Wounds Decubitus ulcers Respiratory tract Gastroenteritis

15 Factors involved in Institutionassociated Infection

16 Major elements leading to institutionally associated infections are: 1. Infectious agents 2. Susceptible hosts 3. Mode of transmission

17 Chain of Infection The chain begins with the existence of a specific pathogenic microorganism. Infectious agent Susceptible Host Reservoir HAI: How is it transmitted? Portal of Entry Portal of Exit Mode of Transmission

18 Routes of Infection

19 Infection Control n Safety Points of entry -: -Look at the ways in which diseases can be spread: air/ droplet food touch water vector Microorganisms are transmitted by several routes, and the same microorganism may be transmitted by more than one route. There are 5 main routes of transmission: - contact, droplet, airborne, common vehicle and vector-borne. Precautions (isolation) are designed to prevent transmission of microorganisms by these routes. The aim of isolation precautions is to decrease the risk of transmission of microorganisms from infected or colonized patients to other patients, healthcare workers and visitors in institutions.

20 HAI: How is it transmitted? SOURCES Self UTI, oral cavity PRINCIPAL ROUTES Direct extension Cross-infection other people wounds, catheters Hands/ airborne Environment equipment food, drugs water, air, etc. Contact (etc) Control: remove sources, block the routes, protect patients

21 How do we interrupt the chain of infection? Precautions are designed to break the transmission of microorganisms by the various routes. Its aim is to decrease the risk of transmission of microorganisms from one to another.

22 hospitals for the sick existed as early as 500 BC particularly in Asia, Egypt, Palestine & Greece separate rooms, good ventilation, cleaning and hot ovens to sterilize instruments (Selwyn 1991) The concept of Universal precautions was developed in the mid 1980 s as a result of the human immunodeficiency virus (HIV) epidemic. The Center for Disease Control and Prevention (CDC) recognized that there was an urgent need to create strategies

23 Infection Control n Safety In 1996, the definition and recommendations for Universal Precautions was revised and given the new name of Standard Precautions. TRANSMISSION-BASED PRECAUTIONS At the same time, a new isolation guidelines issued by CDC involve a two-level approach: Standard Precautions, which apply to all clients and patients attending healthcare facilities, and Transmission-Based Precautions, which apply only to hospitalized patients (Garner and HICPAC 1996).

24 STANDARD / TRANSMISSION BASED PRECAUTIONS The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) revised the "CDC Guideline for Isolation Precautions in Hospitals with the following objectives: -to be epidemiologically sound -to recognize the importance of all body fluids, secretions, and excretions in the transmission of nosocomial pathogens -to contain adequate precautions for infections transmitted by these routes of transmission -to be as simple and user friendly as possible and -to avoid confusion with existing infection control and isolation systems. CDC, 2004 HEALTHCARE INFECTION CONTROL PRACTICES ADVISORY COMMITTEE

25 STANDARD / TRANSMISSION BASED PRECAUTIONS Airborne Droplet Common vehicle Vector-borne Contact

26 TRANSMISSION BASED PRECAUTIONS Airborne and Droplet Infections Airborne PTB; unknown viruses Airborne transmission occurs by dissemination of either airborne droplet nuclei (small particle residue which are 5 micrometers or smaller in diameter) of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time.

27 TRANSMISSION BASED PRECAUTIONS Airborne and Droplet Infections Droplet borne Meningococcal, mumps, rubella Droplets are generated from the source person primarily during coughing, sneezing, and talking and during the performance of certain procedures such as suctioning and bronchoscopy. Transmission occurs when droplets containing microorganisms generated from infected persons are propelled a short distance (within a 3 feet range) through the air and deposited on the host s conjunctivae (membrane lining the eyelids and covering the eyeball), nasal mucosa, or mouth.

28 TRANSMISSION BASED PRECAUTIONS Contact precautions Contact precautions are used when an infectious agent--virus or bacterium--can be spread either by directly touching infected body fluid or an infected site, or by touching equipment contaminated by the infection. Eg Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug resistant organisms- MRSA /VRE

29 Standard Precautions Standard Precautions combine the major features of Universal Precautions and Body Substance Isolation and apply them to all patients receiving care, regardless of their diagnosis or presumed infection status.

30 Standard Precautions Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognised and unrecognised sources of infection in the health care setting.

31 Standard Precautions & Rationale for Transmission-based Precautions Components of Standard Precautions: Handwashing Barrier Precaution Sharps Environmental / Patient Care Equipment Patient placement

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33 Hand Hygiene The purpose of handhygiene is to prevent transmission of infectious agents from: Patient to Patient Patient to Health Care worker Health Care Worker to Patient

34 Hand Hygiene Reinforced since 1840s Most effective measure to reduce nosocomial transmission After removal of gloves If contaminated with blood and body fluids

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38 ANTISEPTIC HANDWASH at least 1 minute for an effective hand wash use an antiseptic cleanser prior to an invasive procedure (eg urinary catheterisation, placement of intravascular catheters

39 SURGICAL HANDWASH at least 3 minutes for an effective hand wash use an antiseptic cleanser prior to a surgical procedure

40 Hand Hygiene Technique

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42 Effective Hand washing

43 Barrier Precaution Protective barriers reduce the risk of exposure of the health care workers skin or mucous membrane to potentially infective materials.

44 Barrier Precaution Examples: Gloves Plastic aprons Masks Goggles Face shield Should be appropriately applied to perform the intended task

45 All health care workers should take precautions to prevent sharp injuries caused by: needles scalpels and other used sharp instruments or objects

46 Use appropriate strength instrument to remove needles, blade and all sharps Handling of Sharps Plan safe handling and disposal before beginning any procedure using needles Avoid recapping needles. Do not bend or manipulate needles Dispose of used needle devices promptly in appropriate sharps disposal containers

47 Sharps When you sustain a sharp injury:

48 1. Immediate Action

49 2. Subsequent Action At the clinic

50 BLOOD SPILLS

51 STANDARD PRECAUTIONS & RATIONALE FOR TRANSMISSION- BASED PRECAUTIONS

52 RATIONALE FOR ISOLATION PRECAUTIONS Patient placement

53 Infections n Precautions Recognition of the epidemiology of diseases and its mode of transmission is pivotal for a variety of reasons. Step-down facility The primary reason - naturally is to prevent the transmission of organisms Safety

54 A risk assessment helps determine what measures should be used and when to use them

55 Infection Prevention And Control

56 Safe

57 Thank You