PRECAUTIONS IN INFECTION CONTROL Standard precautions Transmission-based precautions Contact precautions Airborne precautions Droplet precautions 1
2/25/2015 WHO HAVE TO PROTECT IN HOSPITALS? Patients Employees Health care students Visitors 2
LEARNING OBJECTIVES Discuss chain of infection and different types of mode of transmission Define isolation precautions and describe different types isolation precautions. Describe standard precautions procedures and conditions under which to use standard precautions Describe contact precautions and conditions under which to use contact precautions. Describe conditions under which to use droplet precautions. Describe conditions under which to use airborne precautions. 3
CHAIN OF INFECTION 4
MODE OF TRANSMISSION A microorganism may be spread by a single or multiple routes. Contact, direct or indirect Droplet Airborne Vector-borne (usually arthropod) and Common environmental sources or vehicles - includes food-borne and waterborne, medications e.g., contaminated IV fluids 5
CONTACT TRANSMISSION Direct-contact Direct body surface-to-body surface contact and Physical transfer of microorganisms between a susceptible host and an infected or colonized person Indirect-contact Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves 6
DROPLET TRANSMISSION Droplet generation coughing, sneezing, talking, procedures such as suctioning and bronchoscopy Droplet transmission Droplet deposited on the host s conjunctivae, nasal mucosa, or mouth. 7
AIRBORNE TRANSMISSION Small-particle residue {5µm or smaller} of evaporated droplets containing microorganisms Suspended in the air for long periods of time Dispersed by air currents Inhaled by a susceptible host within the same room or over a longer distance 8
DEFINITION OF ISOLATION PRECAUTIONS SOURCE: MOSBY'S MEDICAL DICTIONARY, 8TH EDITION. 2009, ELSEVIER. Special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases 9
1996 CDC Guidelines for Isolation Precautions in Hospitals Hospital infection control practices advisory committee (HICPAC) 10
FUNDAMENTALS OF PRECAUTIONS Handwashing and gloving Personal protective equipments: Masks, respiratory protection, eye protection, face shields, gowns and protective apparel Patient-care equipment and articles Linen and laundry Routine and terminal cleaning and disinfection Patient placement Transport of infected patients 11
Isolation Precautions Hand hygiene Patient placement PPE Patient Transport Precautions ROUTIN AND TERMINAL CLEANING AND DISINFECTION Linen & laundry Patient care equipment And articles 12
TYPES OF PRECAUTIONS Standard precautions Transmission-based precautions Contact precautions Airborne precautions Droplet precautions 13
DEFINITION OF STANDARD PRECAUTIONS Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status. Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes. 14
2/25/2015 WHICH SICPS ARE AVAILABLE? 1. Hand Hygiene 2. Personal Protective Equipment 3. Control of the Environment 4. Management of Blood and Body Fluid Spillages 5. Occupational Exposure Management, including Sharps 6. Management of Care Equipment 7. Disposal of Waste 8. Safe Management of Linen 9. Providing Care in the Most Appropriate Place 10. Respiratory Hygiene 15
Standard Precaution - Hand hygiene Handwashing with either plain or antiseptic containing soap and water, and use of alcohol-based Products that do not requre the use of water Perform hand hygiene: Before and after patient contact After removing gloves or any other PPE item After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn 16
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HAND HYGIENE: DEFINITIONS Hand washing The application of non-antimicrobial soap and water to the surface of the hands Antiseptic (Hygienic) hand wash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based hand rub an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed Surgical hand hygiene/antisepsis Hand washing or using an alcohol-based hand rub before operations by surgical personnel
Hygienic hand washing removal of soil and transient. Optimum time 40-60 s.
V Missed-areas-of-hands
Hygienic hand rub (without water), 3-5 cc solution, 20 s rubbing. N- propanol>isopropanol> ethanol Reduces bacterial count on hands More effective for standard hand wash Reduces adverse outcomes and cost associated with HAI s Requires less time Less irritating Can be readily accessible/
HYGIENIC HAND RUB 1 2 3 4 5 6 7
Good Better Best Plain Soap Antimicrobial soap Alcohol-based handrub Time After Disinfection % log 99.9 3.0 0 60 180 minutes Bacterial Reduction 99.0 90.0 2.0 1.0 Alcohol-based handrub (70% Isopropanol) Antimicrobial soap (4% Chlorhexidine) 0.0 0.0 Baseline Plain soap
TIME CONSUMING One nurse per 8 hour shift Hand washing with soap and water: 56 minutes Based on seven (60 second) hand washing episodes per hr Alcohol-based hand rub: 18 minutes Based on seven (20 second) hand rub episodes per hr Alcohol-based hand rubs reduce time needed for hand hygiene
Accessibility
- Alcohols are flammable and should be stored away from high temperatures or flames and electrical outlets. - Provide HCP with hand lotions or creams to help ease the dryness from frequent handwashing and to prevent dermatitis from glove use.(only USE MTF-approved and supplied lotions). - Fingernails & Artificial Nails: Keep fingernails short. (<1/4 inch) use of artificial fingernails is usually not recommended.
STANDARD PRECAUTIONS PERSONAL PROTECTIVE EQUIPMENT (PPE) The selection of PPE based on The nature of patient interaction and/or The likely mode(s) of transmission Designated containers for used disposable or reusable PPE should be placed in a convenient to the site of removal Hand hygiene is always the final step after removing and disposing of PPE 29
STANDARD PRECAUTIONS GLOVES (PPE) 1. Exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items 2. Change gloves when heavily contaminated 3. Perform hand hygiene immediately after glove removal 4. Disposable glove should not be reused 30
STANDARD PRECAUTIONS GOWN (PPE) 1. When splashes or sprays of blood and body fluids, secretions and excretions to skin and working clothes are likely 2. When working clothes has substantial contact with patient, environmental surfaces or patient items 3. Select an appropriate gown for the procedure 31
STANDARD PRECAUTIONS MASK AND EYE PROTECTION (PPE) Surgical masks and eye protection: When splashes or sprays of blood and body fluid, secretions and excretions are likely Sterile technique Respiratory etiquette Change PPE promptly if heavily contaminated during the procedure 32
GLOVES ARE NOT A SUBSTITUTE FOR HANDWASHING!
STANDARD PRECAUTIONS - PREVENT HCWS EXPOSURE TO BLOODBORNE PATHOGENS Prevent needles and other sharps instrument injuries Prevent mucous membrane exposures Safe work practices and PPE to protect mucous membranes and non-intact skin 34
Scoop method
STANDARD PRECAUTIONS: ENVIRONMENTAL MEASURES Clean and disinfect non-critical surfaces in patient-care areas are part of SP. Clean and disinfect all frequently touched surfaces in patient-care areas FDO-registered disinfectants or detergents 36
STANDARD PRECAUTIONS: PATIENT CARE EQUIPMENT AND INSTRUMENTS/DEVICES Clean and maintain medical equipment and instruments/devices according to the manufacturers instructions 37
STANDARD PRECAUTIONS: TEXTILE AND LAUNDRY Key principles for handling of soiled laundry: Don t shaking items or handle them in any way that may aerosolize infectious agents Avoid contact with one s body and personal clothing Contain soiled items in a laundry bag or designated bin 38
PLACE OF CARE (PATIENT PLACEMENT) 2/25/2015 39
TRANSMISSION-BASED PRECAUTIONS 40
TRANSMISSION-BASED PRECAUTIONS - PATIENT PLACEMENT Single patient rooms - always indicated for patients placed on airborne precautions and preferable for those who require contact of droplet precautions Cohort patients with same organism 41
TRANSMISSION-BASED PRECAUTIONS - MANAGEMENT OF VISITORS Visitors as sources of healthcare associated infections e.g., pertussis, influenza, tuberculosis Cough etiquette Use of barrier precautions by visitors Educate patients and family members Follow signs for isolation precautions 42
TRANSMISSION-BASED PRECAUTIONS - CONTACT PRECAUTIONS Infections spread by direct or indirect contact with patients or patient-care environment shigellosis, C. difficle, MRSA Limit patient movement Private/SINGLE room or cohort with patients with same infection Wear disposable gown and gloves when entering the patient room Remove and discard used disposable gown and gloves inside the patient room Wash hands immediately after leaving the patient room Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces) Use dedicated equipment if possible (e.g., stethoscope) 43
CONTACT PRECAUTIONS CONT. GLOVES Use gloves when entering the room. Change gloves after contact with infective material. Remove gloves before leaving the room. Wash hands or use appropriate hand rubs after glove removal. Do not touch infective material or surfaces with hands. Clean, non-sterile gloves are usually adequate. GOWN Use protective gown when entering the room if direct contact with patient or potentially contaminated surfaces or equipment near patient is anticipated or if the patient has diarrhea or colostomy or wound drainage that is not covered by a dressing. 44
CONTACT PRECAUTIONS SIGNS 45
DROPLET PRECAUTIONS Reduce the risk of transmission by large particle droplets (larger than 5 µ in size). Requires close contact between the source person and the recipient Droplets usually travel 3 feet or less E.g., influenza, rubella, parvovirus B19, mumps, H. influenzae, and N. meningitidis 46
DROPLET PRECAUTIONS CONT. A private/single room or Cohort with patient with active infection with same microorganism Use a mask when entering the room and definitely if within 3 feet of patient Limit movement and transport of the patient. Use a mask on the patient if they need to be moved and follow respiratory hygiene/cough etiquette Keep at least 3 feet between infected patient and visitors 48
DROPLET PRECAUTIONS SIGNS 49
AIRBORNE PRECAUTIONS Tuberculosis, measles, varicella Place the patient in an airborne infection isolation room (AIIR) Pressure should be monitored with visible indicator Use of respiratory protection (e.g., fit tested N95 respirator) or powered air-purifying respirator (PAPR) when entering the room Limit movement and transport of the patient. Use a mask on the patient if they need to be moved Keep patient room door closed. 50
NEGATIVE PRESSURE VENTILATION
AIRBORNE PRECAUTIONS SIGNS 52
ISOLATION ROOMS Isolation room At least 4 single rooms for each 24-bedded ward Should preferably have an ante-room Isolation of patients with suspected or confirmed infection Source isolation room 1 respiratory isolation room per 100 beds Negative pressure ventilation only for conditions transmitted via airborne route 6-12 exchanges of air per hour Regulation of temperature and humidity Protective Isolation room To prevent patients (e.g., from Aspergillosis) High efficiency particulate air (HEPA) filter
OPERATING THEATRES Mechanical ventilation is recommended The air should be at positive pressure The ventilation must be maintained by an appropriate engineer Coarse and fine air filters must be replaced regularly A minimum of 20 air changes/hour of filtered air should be delivered Temperature and humidity should be maintained at 18 25 C and 40-60% respectively
SUMMARY Isolation precautions is important in all healthcare settings to prevention transmission of infections 2 types of isolation precautions Usage of each type of precautions 56
ISOLATION PRECAUTIONS 57
Contact Precautions 100 200 Standard Precautions 100 200 Airborne Precautions 100 200 300 300 300 400 400 400 500 500 500 58
Contact Precautions for $100? In contact precaution, if a private room is not available, do this for patient with someone with same infection. Row 1, Col 159
Contact Precautions 100 200 Standard Precautions 100 200 Airborne Precautions 100 200 300 300 300 400 400 400 500 500 500 60
Standard Precautions for $300? You should wear this when touch- ing blood and other body fluids and contaminated instruments. 1,3 61
Contact Precautions 100 200 Standard Precautions 100 200 Airborne Precautions 100 200 300 300 300 400 400 400 500 500 500 62
Airborne Precautions for $200? These infections require airborne precautions in a Healthcare facility. 1,4 63
TO BE CONTINUED! 64
REFERENCES 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings: http://www.cdc.gov/hicpac/2007ip/2007isolationprecautions. html CDC guidelines for isolation precautions in hospitals 1996, Hospital Infection Control Practices Advisory Committee (HICPAC): http://wonder.cdc.gov/wonder/prevguid/p0000419/p000041 9.asp Principles of Epidemiology in public health practice, 3 rd edition 65