Infection Control Education Series

A Message for Hospital

OBJECTIVES

Describe the importance of infection control in hospitals.

List measures for preventing/reducing hospital infections

List the categories of infection control precautions that healthcare workers use to prevent/reduce infections

What is a healthcare-associated infection? A healthcare associated infection (HAI) is one which was not present or incubating when the patient was admitted to the hospital, but is acquired after admission.

Urinary tract infections are the most common HAI, followed by surgical wound infections, lower respiratory tract infections (pneumonia) and skin infections.

Other infections include gastrointestinal infections (Clostridium difficile) and bloodstream infections.

COMMON PROBLEM: -A W.H.O report estimates that hospital infection affect more than 1.4 million people worldwide. According to the studies conducted at different levels in Indian hospitals, the incidents of post operative infections in various hospitals varies from 10 % - 25 %

Over all 63.5% injection are unsafe, 70% Public Sector and 60% in private.Immunization particularly those given to children below three year is absolutely essential and all of these must be administered in a safe manner. These injections assume additional significance in view of the finding that 74% injection at immunization clinic were administered in unsafe manner.The huge quantum of unsafe injection results that each year (Rs 189 Crore)* can potentially be associated with major public health problem

*Approx Amount spend on Health in India P.A

Summary of Assessment of Injection Practices in India

Healthcare-associated infections are serious and affect patient and staff safety

Over 98,000 people die each year from complications of healthcare-associated infections (HAIs).

HAIs also cause suffering, disability and increased healthcare costs, which may not be reimbursed.

Hand hygiene (hand washing or use of an alcohol hand rub) can prevent nearly half of preventable infections and helps to protect staff from infections.

Our goal is to have zero infections!

Risk Factors for HAIsInvasive devices, such as ventilators, foley catheters and central lines predispose patients to infection.

Immune system suppression predisposes patients to infections with atypical germs (like fungus) that usually do not make others sick.

Antibiotic use predisposes patients to infections with antibiotic-resistant germs, fungus, and gastrointestinal infections.

Numbers of at risk patients are increasing because of advances in medical therapies, antibiotic use, and diagnostic techniques.

Organisms that cause HAIsAny organism which can cause disease is called a pathogen

Pathogens which cause HAIs include:Staphylococcus Pseudomonas, E. coli and other gram negatives Clostridium difficile Candida Some viral agents such as RSV (respiratory syncytial virus), and influenzaMultidrug resistant organisms (MDROs), such as MRSA, VREPatients, who are colonized (carriers) of MDROs, are a source for spread within the hospital and are at risk of developing deadly infections.

Representative PathogensMethicillin-resistant S. aureus (MRSA)Vancomycin-resistant enterococcus (VRE)C. difficileNorovirusMultiply-drug resistant (MDR) gram negative rods (e.g., B. cepacia, P. aeruginosa, Acinetobacter)

All of the above organisms can survive on environmental surfaces for long periods of time and can be transiently carried on hands.

CHAIN OF INFECTIONInfection requires a chain of eventsThe role of the hospital infection control is to understand this chain and the most efficient means of interrupting transmission

How are infections transmitted?

Infections do not occur simply because a pathogen exists in the environment. Example: MRSAThe pathogen must have a reservoir in which it grows and lives (e.g., humans serve as a reservoir as well as the environment)...

The portal of exit would be contact with the colonized/infected patient or contaminated environment

The mode of transmission would be direct or indirect contact, example via hands of healthcare workers

The portal of entry would be via contact with another patients non intact skin, mucous membranes, contamination of invasive devices, such as IV lines, etc

- A susceptible host is anyone at risk for colonization or infection with MRSA, i.e. patients with invasive devices, non intact skin, acutely ill, etc.

BLOOD BORNE INFECTION

When an injection is given in a medical setting we expect that the treatment will make us feel better (or at least it will help more than it harms).But the medical principal First, Do not harm is violated everyday through unsafe injections. The result of the infection could be more rashes like skin allergy or it can be fatal as well. When an unsafe injection causes potentially deadly infectious with Hepatitis B and C or HIV virus, it could result in chronic diseases and death in patients.

BLOOD BORNE INFECTION

Infection via needles can be avoided if sterile needles are used. Needles should also be disposed off properly. Sharp implements that arent disposed off pose occupational hazard to healthcare workers. Often nurses or the cleaning crew are unsuspecting victims to needle stick injuries. Blood transfusions are also very hazardous. There are multiple opportunities to acquire serious and deadly viral infections including HIV AIDS and Hepatitis B & C.

Why Education on Infection Control is Needed

We cant be simpler than this. It is education that makes us more aware and better civilized people. And if we are well educated about health care facilities then for sure we may help in building a safer and healthier place to live in.

Prevention and Control of HAIsThe goal of Infection Control is to reduce transmission of pathogens from patient to patient, from staff to patient, and from patient to staff.

Good infection control practices break the chain of infection. Examples:Hand hygiene and changing gloves between patient contacts prevents transmission.

Removing a foley catheter makes a patient less susceptible to HAIs by removing an entry point for pathogens.

Vaccinations (e.g., vaccinations for Hepatitis B, influenza, chickenpox, etc.) reduce the number of susceptible individuals.

Steps in Infection Control

Hand HygieneClean Designated AreaGloves / Mask & Shoe CoverProper Handling of SharpsSharps BoxSingle Use Syringes

Hand WashDevices Available to Curb InfectionMASK GLOVES & HEAD COVER SHOE COVER SINGLE USE SYRINGES SHARPS BOX

SHARPS MANAGEMENT

Risk Area Identification

During Operations : By needles, passing sharps directly in hands. Sharps left unattended.

Undestroyed Sharps.

Sharps in wrong container.

Unsealed Sharps Container.

Puncture Prone Container.

During Operations : By needles, passing sharps directly in hands.

Sharps left unattended

Undestroyed Sharps

Sharps in wrong container

Unsealed Sharps Container

Puncture Prone Container

Avoid Needle Stick - InjuryRecapping commonly leads to needle-sticks If recapping is necessary, use a one-handed techniqueBUT AVOID ALL THIS AS WITH HUGE QUANTUM OF WORK WE TEND TO GET NEEDLE STICK INJURIES, WICH ARE NOT GIVEN THE DUE IMPORTANCESafe Way of Handling Medical Devices SHARPS

Close safety boxes when they are 3/4 full and lock boxes in a secure area

Needle-sticks can occur if boxes are overfilled

Tips to Manage Sharps

1.) Always wear gloves. One layer of surgical gloves decreases the volume of blood injected by needles up to 70 % .2.) Destroy needles, cut syringes using needle destroyer.3.) All sharps to be stored in puncture resistant container.4.) Sharps should not be transferred in hand.5.) Prohibit recapping.6.) Vaccination to all health personnel against HBV / HCV.

THREAT TO RAG PICKERS

Threat to those who repack infected reuse surgical devices

Picture Perfect: - unhygienic conditions in hospitals, unsafe disposal, patient getting readmitted for infectious treatment

Aseptic Technique Practice of ensuring that bacteria are excluded from open sites during surgery, wound dressing, blood sampling, and other medical procedures. Aseptic technique is a first line of defense against infection.

Use of sterile instruments and supplies and the application of principles of aseptic while performing invasive procedures are important aspects of infection control.

Examples of aseptic technique include: - Disinfecting IV ports/valves and capping open lines

- Checking the integrity of sterile packages

Standard PrecautionsThe first tier of the CDC isolation guidelines is Standard Precautions. Since patient examination and medical history cannot reliably identify every patient with blood borne pathogens and other diseases, Standard Precautions apply to all patients and all body substances. The risk of infection can be minimized if Standard Precautions are followed for ALL PATIENTS.

Standard Precautions guidelines: Perform hand hygiene before and after patient care, regardless of whether gloves are worn. Perform hand hygiene immediately after the gloves are removed and between patient contacts.

Wear gloves when touching blood or any other body substance, secretion, or excretion except sweat, or when touching contaminated items. Put on clean gloves just before touching mucous membranes or non-intact skin.

Take care to prevent needle sticks and other injuries when using needles, scalpels, or other sharp instruments. Also be careful when handling sharps after procedures and when cleaning them. Dispose of used needles properly.

Use a mouthpiece, resuscitation bag, or other ventilation device as an alternative to mouth-to-mouth resuscitation. These devices should be available for use in areas where the need for mouth-to-mouth resuscitation is predictable.

Wear a gown to protect your skin and to prevent soiling of your clothing during any patient care activity that is likely to generate splashes or sprays of blood or body fluids.

Wear a mask and eye protection or a face shield to protect the mucous membranes of our eyes, nose, and mouth during any patient care activity that is likely to generate splashes or sprays of blood or body fluids, including respiratory secretions. You should thoroughly wash your hands or other skin surfaces immediately after accidental exposure to blood or body substances. Wear mask and eye protection when working closely with a coughing patient.

Transmission-Based Precautions The second tier of the CDC guidelines is transmission-based precautions. There are three simple sets of precautions based on likely routes of transmission. The precautions are designed to prevent airborne, droplet, and contact transmission of pathogens.

These precautions are to be followed when a patient is suspected or known to have infection or colonization by epidemiologically important pathogens (MRSA, VRE, TB, Influenza, etc).

Airborne PrecautionsAirborne precautions are designed to protect against the transmission of airborne droplet nuclei for illnesses such as measles, chickenpox, and tuberculosis. Airborne droplet nuclei are smaller than 5 microns in diameter and can remain suspended in the air and dispersed widely by air currents.

Airborne precautions include:

Isolation of the patient in a private room with monitored negative air pressure. The door to the room must remain closed and the patient must remain in the room.

Always wear appropriate respiratory protection when you enter the room. For tuberculosis, you should wear a respirator mask fit tested to your face size. Contact Infection Control if you are not sure what type of protection to wear.

Limit the movement and transport of the patient from the room for essential purposes only. If at all possible, have the patient wear a surgical or procedure mask during transport.

Droplet PrecautionsDroplet precautions are designed to protect against the transmission of infectious droplets larger than 5 microns (such as mycoplasma pneumonia, pertussis, mumps, and influenza). Patients with these illnesses tend to generate infectious droplets while sneezing, coughing, or talking.

Droplet precautions include:

Keeping the patient in a private room. The door may remain open.

You should wear a mask when you enter the room.

You should also wear a mask when examining or transporting a patient who is suspected to have an illness requiring droplet precautions.

Limit the movement and transport of the patient from the room for essential purposes only. If at all possible, have the patient wear a surgical or procedure mask during transport.

CONTACT PRECAUTIONSContact Precautions are designed to halt the transmission of pathogens which may be spread by direct contact with the patient, contaminated equipment, or the patients environment. Contact Precautions are designed for different types of infections which may survive for extended periods in the environment (e.g., C diff, MRSA, VRE,).

CONTACT PRECAUTIONSThe patient is placed into a private room whenever possible.

A GOWN AND GLOVES MUST BE WORN BY ALL ENTERING THE ROOM! THIS INCLUDES VISITORS. Dietary staff that are delivering trays are required to wear gloves.

When providing care, change gloves after contact with any infective material such as wound drainage.

Remove the gown and gloves and perform hand hygiene before leaving the room (take care not to touch any potentially infectious items or surfaces on the way out).

Dedicate the use of non-critical patient-care equipment to a single patient. If use of common equipment is unavoidable, adequately clean and disinfect it before use with other patients.

Surgical Site Infection (SSI) Prevention2 to 5% of surgical patients will develop SSI

SSI increases length of stay by7.5 days on average and adds costs of $2600 to $27,000 per case

Measures to Reduce SSI Include: - Preoperative antiseptic bathing. This is hospital policy, C-139.

- Identifying and treating infections prior to surgery, such as UTI.

- Appropriate antibiotic selection and administration. Antibiotics should be given within an hour of incision. Discontinue antibiotics after surgery within 24 hours of surgery.

UTI PreventionMost healthcare acquired UTIs are related to foley catheters-avoid catheter placement if at all possible-remove catheters as soon as possibleUse strict aseptic technique for foley insertion-sterile field, prep with pick ups, dont contaminate catheterBag below level of patient.Proper technique for specimen collectionFoley Care twice a day and with continous care

ADDITIONAL CONCERNSKeep clean separate from dirty

Follow appropriate cleaning and disinfecting proceduresStethoscopes (no fabric covers) Multi-use patient equipmentMulti-use diagnostic equipment Toys and other distraction devices

Infection Control is crucial for patient safety.

Infection control in the hospital is the responsibility of every person working in healthcare. Consistent and conscientious practice of infection control principles can prevent unnecessary suffering. Effective communication about the presence of infectious diseases and following hospital policies are essential to the hospital's effort to protect patients, staff, and others in the acute-care environment.

All employees are urged to report poor practices which might harm patients or staff. Report to manager or to Infection Control Dept.

The safety of our patients and staff depends on all of us.Conclusion

THANK YOU!For any further information

Hindustan Syringes & Medical Devices Ltd

Kindly Contact

GL -3 Ashoka Estate24.Bharakhamba Road.C.PNew Delhi -110001or call +91 -11 -23314785 / 23316528

www.hmdhealthcare.com

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