health care associated infection mitesh

INFECTION CONTROL PROGRAMME

Mitesh LoharInfection control nurse

WHAT IS INFECTION?

• INFECTION MEANS DEPOSITION OF MICROORGANISMS IN TISSUES AND THEIR GROWTH WITH ASSOCIATED TISSUE REACTIONS

Healthcare associated infection

• Infections that are not present, nor under incubation at the time of hospital admission, and that they appear after 48-72 hrs after hospitalization.

• In case of any MIS up to 30 days post discharge and in case of implant surgeries, up to 1 year of surgery can be included as HAIs.

• Infections acquired from patient’s, HCWs, visitors and environments of the healthcare set-up.

WHERE DO H.A.I. COME FROM?

Colonization

Food & water

Hands: HCW, visitors

Hospital equipments and air.

Risk factors

• Long hospital stay• Use of indwelling catheters• Failure of health care workers to wash

hands• Overuse of antibiotics• Mechanical ventilation• Intravenous catheters• Underlying disease

Impact of HAI on customer

• Increase the LOS.

• Increase the cost .

• Increase mortality and morbidity.

• Decrease the customer satisfaction.

• Decrease the employee satisfaction as a care giver.

• Decreasing the hospital income.

Who are at risk?

• Patients• Healthcare Workers (Staff)• Visitors• Community• Environment

RESERVOIRS

PORTALS

OF

EXIT

SUSCEPTIBLE HOST

PORTALS

OF

ENTRY

INFECTIOUS AGENTS

MODES OF

TRANSMISSION

HOW TO BREAK THE CHAIN OF INFECTION?

Standard Precautions

and/or

Universal Precautions

•Standard precautions are the precautions to be used/practiced By ALL healthcare workers in ALL situations involving the careof patients, or contact with the environment.

Universal precautions are a set of precautions designed to prevent transmission of HBV, HCV, HIV and other blood-borne pathogens while providing healthcare to all patients regardless of their diagnosis or presumed infective status.

Definition

Remember…/Please note…

Standard Precautions Standard Precautions have replaced

Universal Precautions.

The additional precautions go beyond standard precautions and are based on the basis of the mode of transmission of microorganisms or

infectious agents leading to infection.

Airborne precautions

Droplet precautions

Contact precautions

Remember…/Please note…

So before we go on to describe

Standard Precautions

let us be clear…

Remember…/Please note…

Remember…/Please note…

Standard precautions are the precautions to be used/practiced

by

ALL healthcare workers in

ALL situations involving the care of patients, or

contact with the environment.

ELEMENTS of

STANDARD PRECAUTIONS

Elements of Standard Precautions

• Hand Hygiene• Use of Personal Protective Equipments (PPEs)• Preventing Occupational Exposure• Accommodation: Patient Placement – ISOLATION• Patient-Care Equipment• Environment• LAUNDRY (Linen)• Biomedical Waste Management• Blood and Body Fluid Spillages

HAND HYGIENE

SAVE LIVESClean Your Hands

Hand washing Washing hands with plain or antiseptic soap and

water, Social Procedural or Antiseptic Surgical hand wash/scrub

Hand rub Rubbing hands with alcohol (without water)

Plain alcohol Procedural - alcohol with antiseptic agent Surgical hand rub/scrub

Hand Hygiene Techniques

The “My 5 Moments for Hand Hygiene” approach

When should you wash your hands with soap and water?

(INDICATIONS)Wash your hands with plain soap and water, or with antimicrobial soap and water if:

• your hands are visibly soiled (dirty) • hands are visibly contaminated with blood or body fluids • On entering workplace• After leaving workplace• Before and after drinking, eating and food contact • after using the restroom or toilet

When should you use an alcohol-based hand rub?

If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub for routinely cleaning your hands:

before having direct contact with patientsBefore entering into and leaving isolation roomBefore taking care of susceptible patientBefore performing any invasive procedureBefore moving from a contaminated site to clean body

site

Personal Protective Equipment

Definition

“Specialized clothing or equipment worn by an employee for protection against infectious

materials”

• Gloves – protect hands

• Gowns/aprons – protect skin and/or clothing

• Masks & respirators – protect mouth/nose

• Respirators – protect respiratory tract from airborne infectious agents

• Goggles – protect eyes

• Face shields – protect face, mouth, nose & eyes

Types of PPE Used in Healthcare Settings

Steps for wearing PPE

Steps for Removing PPE

Preventing OccupationalExposure

• Cover all cuts and abrasions with waterproof dressings• Take care to prevent sharps injuries.

– Use gloves when handling sharps.– Do not resheath or recap needles.– Never manipulate any sharp that involves directing the point of a

needle toward any part of the body.– Dispose of sharps immediately into an approved container.– Take a sharps container to the point of use.– Refer to needle stick injury guideline.– HCWs with skin conditions must seek the advice of an

Occupational Health Nurse.– Use devices such as Pocket Mask as an alternative to mouth-to

-mouth resuscitation.

ISOLATION

Accommodation: Patient Placement -

ISOLATION• Place a patient who could contaminate the environment,

with blood, body fluid or faeces in a single room. • If a single room is not available, consult with the ICN.• If the patient is clinically unsuitable to be placed in a

single room a risk assessment must be undertaken by the clinical team in conjunction with a member of the ICT.

• Babies and children will be isolated if they have symptoms suggestive of an infectious disease which can spread person to person. The ICT will advise.

Patient-Care Equipment

• Patient-care equipment should be decontaminated as per the Decontamination Policy. Wear protective clothing when handling contaminated equipment.

• Patient-related equipment, e.g. pumps, drip stands, etc, must be kept clean.

• Do not reuse single-use equipment.• Do not reuse single-patient equipment on more

than one patient.

Environment

• Ensure that the clinical areas are clean. • Particular attention must be paid to cleaning of

horizontal surfaces, floors, beds, bed-side equipment and other frequently touched surfaces.

• If areas are not clean the domestic supervisor must be informed.

LAUNDRY (Linen)

• Always wear a plastic apron (and gloves where linen is soiled) when handling used linen.

• Discard linen soiled with blood / body fluids, or from patients in isolation, directly into a yellow bag and then a secondary bag (clear plastic or laundry bag) to prevent further contamination.

• Never place linen (soiled/used or clean) on the floor.

• Do not expose clean linen to potential contamination by storing inappropriately before it is used.

Bio-Medical Waste

"Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological, and including categories mentioned in Schedule I/GPCB.

NON-HAZARDOUS

(80%)

HAZARDOUS

(20%)

Infectious (15%)

• Non-sharp

• Sharp

• Disposable plastic

• Liquid

CLASSIFICATION OF BIO-MEDICAL WASTE

TYPES OF BIOMEDICAL WASTE

GENERAL (NON – INFECTIOUS) WASTE

BIO MEDICAL PLASTIC WASTEBIO MEDICAL PLASTIC WASTE

BIO MEDICAL INFECTED WASTEBIO MEDICAL INFECTED WASTE

SHARP WASTESHARP WASTE

GENERAL WASTEGENERAL WASTE

- PAPERS & WRAPPERS- PAPERS & WRAPPERS- CARTONS & CARDBOARD- CARTONS & CARDBOARD- KITCHEN WASTE- KITCHEN WASTE- PLASTIC BAGS- PLASTIC BAGS

COLLECTION :COLLECTION : BLACK BAGBLACK BAG(CONSIDER FOR RECYCLING)(CONSIDER FOR RECYCLING)

DISPOSAL : DISPOSAL : - FERTILISER- FERTILISER - RAGPICKERS- RAGPICKERS

BIO MEDICAL PLASTIC WASTEBIO MEDICAL PLASTIC WASTE

EMPTY BLOOD BAG GLOVES, URO BAGS IV SETS, CATHETERS, FEEDING TUBES DRAINS, ICDS, SYRINGES

COLLECTION: RED BAGRED BAG(MUTILATION BEFORE DISPOSAL)(MUTILATION BEFORE DISPOSAL)DISPOSAL : LANDFILL

Bio Medical Infectious WasteBio Medical Infectious Waste AMPUTED HUMAN ORGANSAMPUTED HUMAN ORGANS PLACENTAPLACENTA DRESSING COTTON, BANDAGES, PADSDRESSING COTTON, BANDAGES, PADS ALL DRESSING MATERIALSALL DRESSING MATERIALS BLOOD STAINED CLOTHES, BEDSHEETSBLOOD STAINED CLOTHES, BEDSHEETS BIOPSY SAMPLESBIOPSY SAMPLES MICROBIOLOGY CULTURE & SPECIMENSMICROBIOLOGY CULTURE & SPECIMENS

COLLECTION :COLLECTION : YELLOW BAGYELLOW BAG(NO DISINFECTION BEFORE DISPOSAL) DISPOSAL : (NO DISINFECTION BEFORE DISPOSAL) DISPOSAL :

INCINERATION AND DEEP BURIALINCINERATION AND DEEP BURIAL

INFECTIOUS SHARP WASTEINFECTIOUS SHARP WASTE NEEDLES BROKEN GLASS SLIDES & COVER GLASS AMPOULES SCALPEL KNIFE

COLLECTION : BLUE BAGBLUE BAG(MUTILATION BEFORE DISPOSAL & IN PUNCTURE (MUTILATION BEFORE DISPOSAL & IN PUNCTURE

PROOF CONTAINER)PROOF CONTAINER)

DISPOSAL METHOD : LANDFILL / DEEP BURIAL

Blood and Body Fluid Spillages

• Disinfect all blood and body fluid spillages immediately wearing protective clothing (gloves, apron and if risk of splash, goggles).

• Chlorine releasing agents will inactivate the blood borne viruses.

• NB: Chlorine releasing granules must not be used on URINE spillages.

• Decontaminate spillages as per the Spillages Management section of the Decontamination Policy.

Who is responsible for implementing Standard

Precautions?

ANY QUESTIONS?