Dr. Ebtisam Al- Moayad

Infection control in special areas

Sources of infections in hospital

Infection control in Endoscopy

Infection control in ICU

Infection control in Neonatal ICU

Infection control in Dialysis

Contents of workshop

Decreased immunity.

The increasing variety of medical procedures and invasive techniques.

The emerging of antibiotics resistant bacteria.

Factors promote infection among hospitalized patients

Nosocomial infections/ hospital acquired infections are a major source of morbidity and mortality in hospital.

In the United States, CDC estimated that 1.7 million hospital acquired infections contribute to 99,000 deaths each year.

Nosocomial infections

from patient to patient

from patients

to

staff

from staff to patients

among staff

Nosocomial infections

1- Endogenous:

Patients own microbial flora

Sources of infections in hospital

2- Exogenous:

Contaminated environment.

Instruments.

Another patients.

Staff.

Visitors.

Sources of infections in hospital

How Do Infections Happen?

Contact

Droplet

Airborne

SOURCE HOST

The chain of infection

Types of nosocomial infections

Endoscopy

Every patient must be considered a potential source of infection.

All endoscopes and accessory devices must be decontaminated with the same degree following every endoscopic procedure.

All staff in the endoscopy unite should be trained in standard infection control procedures.

Infection in Endoscopy

Risk factors in Endoscopy

1. The infecting agents present on the endoscope.

2. The particular type of endoscopic procedure.

3. Patient factors.

Pathogens in endoscopy Bacteria Salmonella Mycobacteria Helicobacter pylori Clostridium difficile Pseudomonas Staphylococcus Shigella Enterobacter E.coli Klebsiella Viruses Human Immunodeficiency Virus (HIV) Hepatitis B Hepatitis C

Endoscope reprocessing

To reduce nosocomial transmission of microorganisms by endoscopy a standard reprocessing procedure must be systematically followed:

1 •Cleaning

2 •Rinsing

3 •Disinfection

4 •Rinsing

5 •Drying

6

•Storage

Endoscope reprocessing sequence

1. Cleaning: Mechanically clean internal and

external surfaces, including brushing internal channels and flushing each internal channel with water and a detergent or enzymatic cleaners (leak testing is recommended for endoscopes before immersion).

2. Rinsing

3.Disinfection:

• Immerse endoscope in high-level disinfectant (or chemical sterilant) and perfuse (eliminates air pockets.

• Ensures contact of the germicide with the internal channels).

• Disinfectant into all accessible channels, such as the suction/biopsy channel and air/water channel.

4.Rinsing: rinse the endoscope and all channels with sterile water, filtered water or tap water.

5.Drying: rinse the insertion tube and inner channels with alcohol, and dry with forced air after disinfection and before storage. Drying is important to the prevention of disease transmission.

6. Storage

• Endoscopes should be stored hanging vertically in well-ventilated areas in a way that prevents recontamination or damage.

Intensive care unit (ICU)

Risk factors of ICU-acquired infections

• Healthcare worker hands.

• Patient close together or sharing rooms.

• Understaffing.

• Lack of isolation.

• No separation of clean and dirty AREAS.

• Excessive antibiotic use and antibiotic. resistant bacteria (MRSA).

• Inadequate decontamination of items & equipments.

Risk factors of ICU-acquired infections

• Inadequate cleaning of environment.

• More invasive procedures.

• Longer length of stay.

• More tube feeding and more ventilation.

ICU-acquired infections

Catheter-related bloodstream infections.

Ventilator-associated pneumonia.

Catheter-associated urinary tract infections.

Surgical-site infection.

ICU

Neonatal intensive-care unit (NICU)

Neonates are at high risk of acquiring health care-associated infections because of :

Immature immune systems.

Limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth.

Reduced barrier function of their skin.

Use of invasive procedures and devices.

Frequent exposure to broad spectrum antibiotic.

Risk factors in NICU

Bloodstream infection is one of the most serious complications in the NICU.

NICU infections

Pathogens in NICU

Staphylococcus epidermidis

Staphylococcus aureus

Enterococci

P. aeruginosa

Klebsiella

Candida

Rotavirus

Central lines can be life-saving, but also come with risks, including infection. NICU team must put measures to prevent such infections. These include:

Inserting central lines only when they are clearly needed.

Training staff who insert central lines to use careful sterile technique.

Following a checklist to be sure all infection prevention steps are taken.

Wearing a cap, mask, sterile gown and gloves to keep the area clean.

Carefully cleaning the skin where the line will be inserted.

Having all staff clean their hands before handling the line.

Disinfecting the line before injecting medications.

Using a closed medication system to protect the inside of the line.

Removing lines as soon as they are no longer needed.

NICU acquired infections result in:

• Increased morbidity and mortality.

• Prolonged lengths of stay.

• Increased medical costs.

Dialysis

Why are Dialysis Patients at Risk for Infection?

• Patients who undergo dialysis have a higher risk of infection, due to the following factors:

Frequent use of catheters or insertion of needles to access the bloodstream

Weakened immune systems

Frequent hospital stays and surgery

• Dialysis patients are at risk of getting hepatitis B and C infections, HIV infection and bloodstream infections.

• Bloodstream infections are a dangerous complication of dialysis.

• 1 in 4 patients who get a bloodstream infection caused by S. aureus bacteria can face complications (Endocarditis).

• Bloodstream infections can cause sepsis (a potentially deadly condition).

Infections in Dialysis Patients

• All equipment and surfaces are considered to be contaminated after a dialysis session and therefore must be cleaned and disinfected.

• Disinfect the dialysis station after each patient treatment.

Disinfecting the Dialysis Station

Infection Control

Infection Control

1. Standard precautions.

2. Infection control policies.

3. Infection control committee.

4. Vaccination.

1. Hand hygiene.

2. Use of personal protective equipment (PPE) when handling blood, body fluid, excretions and secretions.

3. Prevention of needle stick/sharp injuries.

4. Reprocessing of medical devices.

5. Environmental cleaning and spills-management.

6. Appropriate handling of waste.

Standard precautions

Hand hygiene is one of the most

important ways for you to prevent the spread of infections

Hands Need to be Cleaned When:

Visibly dirty

After touching contaminated objects.

Before and after patient treatment.

Before gloves placement and after gloves removal.

After removing PPE and when leaving the hospital.

There are three common techniques for hand hygiene:

1. Hand wash with soap and water.

2. Alcohol hand rub.

3. Surgical hand scrub.

Surgical hand scrub

2- Use of personal protective

equipment (PPE)

Sequence for Donning PPE

1. Gown

2. Mask

3. Goggles or face shield

4. Gloves

How to Remove Gloves?

3- Prevention of needle stick/sharps

injuries Take extra care when using sharp

instruments or equipment.

Never recap needles.

All needles and sharps should be disposed of in puncture resistant containers at their point of use.

1. Needles and syringes are single use devices. They should not be used for more than one patient or reused to draw up additional medication.

2. Do not administer medications from a single-dose vial or IV bag to multiple patients.

3. Limit the use of multi-dose vials and dedicate them to a single patient whenever possible.

Follow Safe Injection Practices

Safe Use of Medication Vials

• Prepare all individual patient doses in a clean area away from patients stations.

• Prepare doses as close as possible to the time of use.

• Do not carry medications from station to station.

• Use single-dose vials whenever possible and dispose of them immediately after use

4- Reprocessing of medical devices

Cleaning Disinfection Sterilization

5- Environmental cleaning

Environmental cleaning

Separate clean areas from contaminated areas

Clean areas should be used for the preparation, handling and storage.

Contaminated areas are where used supplies and equipment are handled.

Do not store medications in the same area that used for blood samples.

Dedicate Supplies to a Single Patient

• Any item taken to a patient’s

station could become contaminated.

• Unused medications or supplies taken to the patient’s station should not be returned to a common clean area (e.g., medication vials, syringes, alcohol swabs).

6- Safe management for medical waste

Segregation

Additional precautions

Infection Control

1. Standard precautions.

2. Infection control policies.

3. Infection control committee.

4. Vaccination.