CARING THE INFECTIOUS PATIENTS

Dr.T.V

.Rao M

D

1

CARING THE INFECTIOUS

PATIENTS DR.T.V.RAO MD

Florence Nightingale, Notes on Hospitals, 1863

It may seem a strange principle

to enunciate as the very first requirement

of a hospital that it do the sick no harm

Learning Objectives

1. Recognize patient safety as an important nursing responsibility in global health care systems.

2. Apply required knowledge in preventing and/or minimizing infection.

3. Perform appropriate behaviors required to prevent health care associated infections.

4. Demonstrate required competence to provide patients with safe care.

Main types of infections

Urinary track infections usually associated with catheters

Surgical infections Blood stream

infections associated with the use of an intravascular device

Pneumonia associated with ventilators

other sites

Health workers to be alert

Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhoea, rash, respiratory symptoms, draining wounds or skin lesions)

Global Infection Problems

According to WHO (2005), On average, 8.7% of hospital patients suffer

health care-associated infections (HAI). In developed countries: 5-10% In developing countries:

Risk of HAI: 2-20 times higher HAI may affect more than 25% of patients

At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

Infection control in the Hospitals

Infection control and prevention uses a risk management approach to minimise or prevent the transmission of infection. Standard and additional precautions principles and practice are based on the mode of transmission of an infectious agent.

Chain of Infection

Pathogen

Reservoir

Portal of Exit

Mode

of

Transmission

Portal of Entry

Susceptible Host

Why Isolation?.. because transmission is easier to control than the source / host!

Practice basic Protocols with Universal

PrecautionsStandard precautions are work practices

required for the basic level of infection control. They include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, gowns, plastic aprons, masks, eye shields or goggles, appropriate handling and disposal of sharps and other contaminated or clinical (infectious) waste, and use of aseptic techniques.

What is Infection Control?

Patient to

Worker

Visitor

Patient

Worker toWorker

Visitor

Patient

Visitor toWorker

Visitor

Patient

Infectiousness Patients should be considered infectious if they

• Are coughing

• Are undergoing cough-inducing or aerosol-generating procedures, or

• Have sputum smears positive for acid-fast bacilli and they

• Are not receiving therapy

• Have just started therapy, or

• Have poor clinical response to therapy

Infectiousness in Tuberculosis patients

Patients no longer infectious if they meet all of these criteria:

•Have completed at least two weeks of directly-observed ATT; and Have had a significant clinical response to therapy and

•Have had 3 consecutive negative sputum-smear results;

Retreatment /MDR cases may take longer to convert The only objective criteria is negative bacteriology

Airborne Precautions

Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:

Tuberculosis

Measles

Chickenpox (until lesions are crusted over)

Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)

Fate of DropletsOrganisms LiberatedTalking 0-200Coughing 0-3500Sneezing 4500-1,000,000

Droplets can remain suspended in the air for hours.

Droplet Precautions Apply to patients known or suspected to

be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:

Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)

Bordetella pertusis

For first 24 hours of therapy: Neisseria meningitides, group A streptococcus

Standard precautions apply to all patients regardless of their diagnosis

bloodall other body fluids, secretions and

excretions (except sweat), regardless of whether they contain visible blood

non-intact skinmucous membranes (mouth and

eyes)standard precautions also apply to

dried blood and other body substances, including saliva.

Personal Protective Equipment

Gloves, aprons, gowns, eye protection, and face masks

Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.

Personal protective equipment

Masks should be worn if an airborne infection

is suspected or confirmed

to protect an immune compromised patient.

GlovesGloves must be worn for: all invasive procedures contact with sterile sites contact with non-intact skin or mucous membranes all activities assessed as having a risk of exposure to blood, bodily

fluids, secretions and excretions, and handling sharps or contaminated instruments.

Hands should be washed before and after gloving

Gloves

• Purpose – patient care, environmental services, other

• Glove material – vinyl, latex, nitrile, other• Sterile or nonsterile• One or two pair• Single use or reusable

PPE Use in Healthcare Settings

Gloves

Purpose – patient care, environmental services, other

Glove material – vinyl, latex, nitrile, other

Sterile or nonsterile One or two pair Single use or reusable

Do’s and Don’ts of Glove Use

• Work from “clean to dirty”• Limit opportunities for “touch contamination” -

protect yourself, others, and the environment– Don’t touch your face or adjust PPE with

contaminated gloves– Don’t touch environmental surfaces except as

necessary during patient care


Safe Use and Disposal of Sharps

Keep handling to a minimum Do not recap needles; bend or

break after use Discard each needle into a

sharps container at the point of use

Do not overload a bin if it is full Do not leave a sharp bin in the

reach of children

Do’s and Don’ts of Glove Use (cont’d)

Change gloves During use if torn and

when heavily soiled (even during use on the same patient)

After use on each patient

Discard in appropriate receptacle Never wash or reuse

disposable glovesPPE Use in Healthcare Settings

Required Performance

Nursing students need to: aapply universal precautions be immunized against

Hepatitis B use personal protection

methods know what to do if exposed eencourage others to use

universal precautions

Prevention through hand washing

how to clean hands

rationale for choice of clean hand practice

technique for hand hygiene protecting hands from

decontaminates promoting adherence to

hand hygiene guidelines

Face Protection

• Masks – protect nose and mouth– Should fully cover nose and mouth and prevent fluid

penetration• Goggles – protect eyes

– Should fit snuggly over and around eyes– Personal glasses not a substitute for goggles– Antifog feature improves clarity


Face Protection

Face shields – protect face, nose, mouth, and eyesShould cover forehead, extend below chin and wrap around side of face


Respiratory Protection

• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)

• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)


Respiratory Protection

infectious aerosols (e.g., Mycobacterium tuberculosis)

PPE types for respiratory protection

Particulate respirators Half- or full-face elastomeric

respirators Powered air purifying respirators

(PAPR)

Sequence* for Donning PPE• Gown first

• Mask or respirator• Goggles or face shield• Gloves

*Combination of PPE will affect sequence – be practical


How to Don a Gown

• Select appropriate type and size

• Opening is in the back• Secure at neck and waist• If gown is too small, use two gowns

– Gown #1 ties in front– Gown #2 ties in back


How to Don a Mask

• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with ties or elastic• Adjust to fit


Safe Injection Practices

Outbreaks of hepatitis B and hepatitis C infections in US ambulatory care facilities have prompted the need to re-emphasize safe injection practices. All health care personnel who give injections should strictly adhere to the CDC recommendations - Safe Injection Practices which include:

Use of a new needle and syringe every time a medication vial or IV bag is accessed

Use of a new needle and syringe with each injection of a client Using medication vials for one client only, whenever possible

Contact precautions may be needed for germs that are spread by touching.

Everyone who enters the room who may touch the patient or objects in the room should wear a gown and gloves.

These precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched.

Some of the germs that contact precautions protect us from are C.difficileand norovirus, and respiratory syncytial virus (RSV). These germs can cause serious infection in the intestines.

Summary

Know the main guidelines in each of the clinical environments you are assigned.

Accept responsibility for minimizing opportunities for infection transmission.

Let staff know if supplies are inadequate or depleted.

SummaryEducate patients and families/visitors about

clean hands and infection transmission.Ensure patients on precautions have same

standard of care as others:frequency of entering the roommonitoring vital signs

Hepatitis B Vaccination a Must for all Health care

Professionals

Never forget to Wash your Hands

Yet there is no Substitute for HAND WASHING in

Prevention of Infections

Programme Created and Designed by Dr.T.V.Rao MD for Medical and Health Care

workers in Developing World Email

[email protected]

Health & Medicine

CARING THE INFECTIOUS PATIENTS