employee induction presentation (hic)

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Hospital infection Control(Induction ppt.) Dr Jayant balani Consultant Microbiologist(MBBS,MD)) Dharamshila hospital &research centre, New Delhi

DefinitionHealth Care-associated Infection (HCAI)Also referred to as nosocomial or hospital infection An infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. This includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among health-care workers of the facility

Sources of infectionSelf( immunity)Staff (contact)Environment (air, water)InstrumentationFoodIatrogenic or ProceduralSurgical site infection

The impact of HCAIHCAI can cause:more serious illnessprolongation of stay in a health-care facilitylong-term disabilityexcess deaths high additional financial burdenhigh personal costs on patients and their families

Importance of hospital associated infectionTerm based payment system for hospitalsQuality indicator: AccreditationHub of M.D.R.O organisims-empiric antibiotic guidelines/Cancer patients

Estimated rates of HCAI worldwideAt any time, hundreds of millions of people worldwide are suffering from infections acquired in health-care facilitiesIn modern health-care facilities in the developed world: 510% of patients acquire one or more infectionsIn developing countries the risk of HCAI is 220 times higher than in developed countries and the proportion of patients affected by HCAI can exceed 25%In intensive care units, HCAI affects about 30% of patients and the attributable mortality may reach 44%

UNIVERSAL PRECAUTIONSUnder Universal precautions , blood and certain bodily fluids of all patients are considered as potentially infectious for HIV, HBV and other bloodborne diseases (12). These precautions include the use of personal protective equipment (PPE), such as gloves, mask, gown and eyewear appropriate for the anticipated risk, and hand hygiene, as well as precautions to avoid needle stick injuries to both patients and health care workers.

STANDARD AND TRANSMISSIONPRECAUTIONSStandard precautions: They are based on the principle that all blood and other bodily fluids, secretions and excretions, excluding perspirations, may contain transmissible infectious agent. These precautions include; hand hygiene; the use of gloves, a gown, a mask, eye protection or a face shield, depending on the anticipated exposure; and safe injection practices. Equipment or items in the patient environment likely to have been contaminated with infectious bodily fluids must be handled appropriately to prevent transmission of infectious. Respiratory hygiene/cough etiquette.Transmission-based precautions should be used suspected to be infected or colonized with infectious agents.

Most frequent sites of infection and their risk factorsLOWER RESPIRATORY TRACT INFECTIONSMechanical ventilationAspirationNasogastric tubeCentral nervous system depressantsAntibiotics and anti-acidsProlonged health-care facilities stayMalnutritionAdvanced ageSurgeryImmunodeficiency13%BLOOD INFECTIONSVascular catheterNeonatal ageCritical care Severe underlying diseaseNeutropeniaImmunodeficiencyNew invasive technologiesLack of training and supervision14%SURGICAL SITE INFECTIONSInadequate antibiotic prophylaxisIncorrect surgical skin preparationInappropriate wound care Surgical intervention durationType of woundPoor surgical asepsisDiabetesNutritional stateImmunodeficiencyLack of training and supervision17%URINARY TRACT INFECTIONSUrinary catheterUrinary invasive proceduresAdvanced ageSevere underlying diseaseUrolitiasisPregnancyDiabetes34%

Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections

LACK OF HAND HYGIENE

Central nervous system depressants

Prevention of HCAI Validated and standardized prevention strategies have been shown to reduce HCAIAt least 50% of HCAI could be prevented Most solutions are simple and not resource-demanding and can be implemented in developed, as well as in transitional and developing countries

SENIC study: Study on the Efficacy of Nosocomial Infection Control>30% of HCAI are preventable With infection control

-31%-35%-35%-27%-32%Without infection control

14%9%19%26%18%LRTISSIUTIBSITotalRelative change in NI in a 5 year period (19701975)

0102030

-40-30-20-10

%Haley RW et al. Am J Epidemiol 1985

Hand transmissionHands are the most common vehicle to transmit health care-associated pathogens Transmission of health care-associated pathogens from one patient to another via health-care workers hands requires 5 sequential steps

5 stages of hand transmission

Germs present on patient skin and immediate environment surfaces

Germ transfer onto health-care workers hands

Germs survive on hands for several minutes

Suboptimal or omitted hand cleansing results in hands remaining contaminated

Contaminated hands transmit germs via direct contact with patient or patients immediate environment

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Why should you clean your hands?Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygieneTherefore hand hygiene concerns you!You must perform hand hygiene to:protect the patient against harmful germs carried on your hands or present on his/her own skinprotect yourself and the health-care environment from harmful germs

The My 5 Moments for Hand Hygiene approach

How to clean your handsHandrubbing with alcohol-based handrub is the preferred routine method of hand hygiene if handsare not visibly soiled Handwashing with soap and water essential when when hands are visibly dirty or visibly soiled (following visible exposure to body fluids)11 If exposure to spore forming organisms e.g. Clostridium difficile is strongly suspected or proven, including during outbreaks clean hands using soap and water

To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps.This takes only 2030 seconds!How to handrub

How to handwashTo effectively reduce the growth of germs on hands, handwashing must last 4060 seconds and should be performed by following all of the illustrated steps.

Hand hygiene and glove useThe use of gloves does not replace the need to clean your hands! You should remove gloves to perform hand hygiene, when an indication occurs while wearing glovesYou should wear gloves only when indicated (see the Pyramid in the Hand Hygiene Why, How and When Brochure and in the Glove Use Information Leaflet) otherwise they become a major risk for germ transmission

BARRIERS TO HAND HYIEGINE

Time constraint = Major factor Adequate handwashing with water and soap requires 4060 seconds

Average time usually adopted by health-care workers: