Infection prevention & control

Transcription

1 Infection control in Australian medical practice: Current practice and future developments John Ferguson Infectious Diseases & Microbiology Director, Infection Prevention & Control, Hunter New England Health Service, Newcastle, NSW July 2012, ASID Zoonosis Conference MMWR July 30, 1999 Infection prevention & control MMWR July 30, Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system.. addresses factors related to the spread of infections within healthcare settings (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff), including: prevention (via hand, hygiene/ cleaning/ disinfection/ sterilization/ vaccination/ surveillance), monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation), and management (interruption of outbreaks) Intervention Students and doctors required to clean their hands with a chlorinated lime solution when entering the labour room in particular when moving from the autopsy to the labour room 1

2 Medical Infection Prevention and Control: practice essentials Generic measures Standard precautions Asepsis Immunisation Sterilisation and disinfection Antimicrobial stewardship Surveillance and audit Risk identification and management Healthcare facility design Targeted measures STANDARD PRECAUTIONS The assumption is made that all human blood or other body fluids are potentially infectious. The aim of these practices is to protect patients, visitors and health care workers from exposure to infection via the contact route by using STANDARD practices for ALL parts of the healthcare system and ALL contacts between staff and patients. Standard Precautions: what is included? Hand hygiene before and after patient care Use of personal protective equipment as required to prevent blood or body substance exposure (gloves, mask, eye protection, gowns) Cleaning and disinfection of patient care environments Safe handling of sharps (contaminated needles/ instruments) Safe handling and disposal of contaminated waste Safe handling of spills and environmental contamination Safe handling and transport of laboratory specimens and contaminated reused equipment Safe transport, cleaning and storage of laundry 2

3 Australia: national hand hygiene program Adoption of the WHO 5 Moments for Hand Hygiene standard Point of care access to alcohol-based hand rubs Uniform approach to hand hygiene training and audit Audits three times per year across most public and private facilities Publically reported audit data Outcome indicator - Healthcare-associated Staphylococcus aureus bloodstream infections Point-of-care availability. Reports and planned evaluation Hunter New England, NSW data: 3

4 Medical Infection Prevention and Control: practice essentials Generic measures Targeted measures Screening of at-risk patient groups for colonisation/infection with key pathogens Additional (transmission-based) precautions: airborne, droplet, contact Outbreak management National initiatives HC facility design: critical issues facilities for the isolation of infectious patients; air handling and ventilation; linen handling; separation of clean and dirty work flows; storage; waste management surface finishes. Surveillance National IPC Guidelines (with NHMRC) Hand hygiene- national HH program IC practitioner capacity building Antimicrobial stewardship Estimated 200,000 healthcare-associated infections per annum in Australia Recommended priorities for national surveillance in Australia 4

5 Public reporting of hospital performance Healthcare-associated Staphylococcus aureus bloodstream infection by AIHW Peer Group (2010_11 data) Peer group A1 and A2 hospitals (83 facilities, 1,616 events, mean = 1.36/10,000) per 10,000 bed-days SAB / 10,000 bed-days Peer group A1, A2 Hospitals Total bed-days Endorsed - 17 Oct 1999 ELEMENTS: 1. Workplace based infection control plan 2. Standard Infection Control Procedures 3. High Risk Procedures and need for additional precautions 4. Demonstrated commitment to infection control practices 5. Monitoring of infection control programs 5

6 Future developments Standard 3 appropriate antimicrobial use Experience in Perth: effect of reducing 3 rd generation cephalosporin use on C. difficile incidence Ṙeference: : Dr Claudia Thomas, PhD thesis 2003 Wide unexplained variation in tertiary hospital cephalosporin use (NAUSP 2009_10) Standard 3 asepsis requirement Undergraduate and postgraduate training Procedure definition wide current variation in the way in which common invasive procedures are performed Audits of compliance how, what procedures, how often? 6

7 Sources of intravascular catheter infection Haematogenous from distant sites Infusate from contamination during preparation of additives Intraluminal from tubes and hubs Environmental hygiene: need for a higher standard Environmental reservoir is implicated in transmission of many nosocomial pathogens Patients expect not to be contaminated either by staff or an unclean healthcare environment Environmental hygiene standard: cleaning AND disinfection of patient care environments environmental audits that go beyond a visibly clean standard Skin Vein Extraluminal from skin Risk identification & management Hospital epidemiology still a fledgling discipline in Australia Challenge to better identify at-risk patients and outbreaks in real-time Implement targeted, cost-effective interventions using public health principles Need for sophisticated software that assists analysis of microbiological and patient demographic and administrative data Emerging infectious disease threats to healthcare settings Foreign acquired multi/pan drug resistant bacteria including tuberculosis Zoonotic pathogens eg. SARS coronovirus Novel pathogens Infection prevention and control in the pacific/ SE Asia region Thank you! High incidence of healthcare infection High burden of (drug-resistant) tuberculosis in many locations with nosocomial spread Most countries with under-developed or absent infection control effort Virtually no antimicrobial stewardship work Increases risk to Australian patients 7