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Hospital Hygiene and Infection Control.pptx
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- 2. • Explain theimportance of hospital hygiene • Describe nosocomial infections, their sources, and routes of transmission • Present standard and transmission-based precautions for infection control • Describe cleaning, disinfection, sterilization, and hand hygiene • Present measures to improve infection control • Describe components of an infection control program
- 3. KEY CONCEPTS Infection control •Infection control is the discipline concerned with preventing nosocomial or healthcare- associated infection, a practical (rather than academic) subdiscipline of epidemiology.
- 4. NOSOCOMIAL INFECTIONS • •Also called hospital-acquired infections (HAI) or hospital associated infections • • Infections not present in the patient at the time of admission but developed during the course of the patient’s stay in the hospital • • Infections are caused by microorganisms that may come from the patient’s own body, the environment, contaminated hospital equipment, health workers, or other patients. • • The risk of HAI is heightened for patients with altered or weakened immunity.
- 5. PREVENTING HEALTH CARE–ASSOCIATEDINFECTIONS • HAIs originally referred to those infections associated with admission in an acute care hospital (formerly called a nosocomial infection), the term now applies to infections acquired in the continuum of settings were . persons receive health care (e.g., long-term care, home care, ambulatory care). Infections that first appear 48hrs or more after hospital admission or • within 30 days after discharge.
- 6. IMPACT OF HEALTHCARE–ASSOCIATED INFECTIONS • These unanticipated infections develop during the course of health care treatment and result in: - significant patient illnesses and deaths (morbidity and mortality); - prolong the duration of hospital stays; - necessitate additional diagnostic and therapeutic interventions - generate added costs to those already incurred by the patient’s underlying disease.
- 7. ROUTES OFTRANSMISSION OFHOSPITAL ASSOCIATED INFECTIONS • Contact transmission • ✓ Direct contact (e.g., surgeon with infected wound in the finger • performing a wound dressing) • ✓ Indirect contact (e.g., secretion from one patient transferred to • another through hands in contact with contaminated waste) • ✓ Fecal-oral transmission via food
- 8. BLOODBORNE TRANSMISSION • E.g.,needle-stick injury – hepatitis B and C, HIV/AIDS • Hep B virus can live outside d body at least 7 days • Hepatitis C virus can live outside d body for 16h - 4 days
- 9. VECTOR TRANSMISSION • E.g.,insects or other pests in contact with excreta or secretions from infected patients and transmitted to other patients Droplet transmission (droplets from sneezing, coughing or vomiting are expelled to surfaces or to the air and fall typically within 2 meters of the source) ✓ Direct droplet transmission (droplets reach mucous membranes or are inhaled by others) ✓ Indirect droplet-to-contact transmission (droplets contaminate surfaces/hands and are transmitted to mucous membranes or other sites) – cold virus, respiratory syncytial virus
- 10. VECTOR TRANSMISSION • .g.,insects or other pests in contact with excreta or secretions from infected patients and transmitted to other patients • Droplet transmission (droplets from sneezing, coughing or vomiting are expelled to surfaces or to the air and fall typically within 2 meters of the source) • ✓ Direct droplet transmission (droplets reach mucous membranes or are inhaled by others) • ✓ Indirect droplet-to-contact transmission (droplets contaminate surfaces/hands and are transmitted to mucous • membranes or other sites) – cold virus, respiratory syncytial virus
- 11. • Airborne transmission(small contaminated particles as aerosols carried by air currents >2 meters from source) E.g.,Varicell zoster suspended in air and spread by inhalation, Staphylococcus aureus depositing in wounds
- 12. STANDARD PRECAUTIONS • Keycomponents – Hand hygiene – Use of PPE (gloves, face protection, gown) – Safe injection practices – Respiratory hygiene and cough etiquette – Safe handling of contaminated equipment and surfaces in the patient environment – Environmental cleaning – Handling and processing of used linens – Proper waste management.
- 13. STANDARDS OF HOSPITALHYGIENE • The hospital environment must be visibly clean, free from dust • and soilage, and acceptable to patients, visitors and staff. Increased • levels of cleaning, including the use of hypochlorite and detergent, • should be considered in outbreaks where the pathogen survives in • the environment and environmental contamination may contribute • to spread.
- 14. • ▪ Sharedequipment in the clinical environment must be • decontaminated appropriately after each use.All healthcare • workers need to be aware of their individual responsibilities for maintaining a safe environment for patients and staff. • ▪ Regular cleaning will not guarantee complete elimination of microorganisms, so hand decontamination is required
- 15. CLEANING • ✓ Themost basic measure for maintaining hygiene in a healthcare facility • ✓ Cleaning is the physical removal of visible contaminants such as dirt without necessarily destroying microorganisms • ✓ Thorough cleaning with soaps and detergents can remove more than 90% of microorganisms
- 16. • Sterilization andDisinfection • • Sterilization – rendering an object free from microorganisms; shown • by a 99.9999% reduction of microorganisms • • High-level disinfection – destruction of all microorganisms except for • large numbers of bacterial spores • Intermediate disinfection – inactivation of Mycobacterium tuberculosis, vegetative bacteria, most viruses and fungi, but not bacterial spores
- 17. • • Low-leveldisinfection – destruction of most bacteria, some viruses and fungi, but no resistant microorganisms such as tubercle bacilli or bacterial sporesMethods for Sterilization and Disinfection • • Autoclaving – use of steam under pressure (moist heat) • • Dry heat – relatively slow and requiring higher temperature compared to moist heat • Use of chemical sterilants and disinfectants • Others: low-temperature plasma with hydrogen peroxide gas, radiation sterilization, germicidal ultraviolet irradiation
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- 19. • An infectioncontrol committee should be multidisciplinary with • representation from management, doctors, nurses, other health workers, • clinical microbiology, pharmacy, central supply, maintenance, • housekeeping and waste management coordinator effectiveness.
- 20. ROLE OFTHE INFECTIONCONTROL COMMITTEE • – Annual work program of activities for surveillance and prevention • – Periodic review of epidemiological surveillance data and identification of areas for intervention • – Review of risks of new technologies, devices, and products • – Assessment of cleaning, disinfection, and sterilization • – Review of antibiotic use and antibiotic resistance • – Promotion of improved practices • – Provision of staff training in infection control and prevention • – Integration of healthcare waste management • – Response to outbreaks
- 21. INFECTION CONTROL TEAM •The infection control team is responsible for the day-to-day activities of the infection control programme. Health care establishments must have access to specialists in infection control, epidemiology, and infectious disease, including physicians and infection control practitioners.
- 22. THE INFECTION CONTROLTEAMSHOULD: • ● Consist of at least an infection control practitioner who should be trained for the purpose; • ● carry out the surveillance program • ● develop and disseminate infection control policies; • ● monitor and manage critical incidents; • ● coordinate and conduct training activities.
- 23. • ● Assesstraining needs of the staff and provide required training through awareness program, in-service education and on-the-job training; • ● Organize regular training programmes for the staff for essential infection control practices that are appropriate to their job description; • ● Provide periodic re-training or orientation of staff; and review the impact of training.
- 24. MEASURES FOR IMPROVINGINFECTION CONTROL IN HEALTH CARE DELIVERY • •Wasteful practices that should be eliminated: • routine swabbing of health care environment to monitor standard of cleanliness • routine fumigation of isolation rooms with formaldehyde • routine use of disinfectants for environment cleaning, e.g. floors and walls • inappropriate use of PPE in intensive care units, neonatal units and operating theatres • use of overshoes, dust attracting mats in the operating theatres, intensive care and neonatal unit
- 25. • unnecessary intramuscularand intravenous (IV) injections • unnecessary insertion of invasive devices (e.g. IV lines, urinary • catheters, nasogastric tubes) • inappropriate use of antibiotics for prophylaxis and treatment • improper segregation and disposal of clinical waste. • use aseptic technique for all sterile procedures • remove invasive devices when no longer needed • isolate patients with communicable diseases or a multidrug-
- 26. • avoid unnecessaryvaginal examination of women in labour • minimize the number of people in operating theatres • place mechanically ventilated patients in a semi-recumbent position. • provide education and practical training in standard infection control • (e.g. hand hygiene, aseptic technique, appropriate use of PPE, use and disposal of sharps) • provide hand-washing material throughout a health-care facility (e.g. soap and alcoholic hand disinfectants) resistant organism on admission
- 27. • use single-usedisposable sterile needles and syringes • use sterile items for invasive procedures • avoid sharing multi-dose vials and containers between patients • ensure equipment is thoroughly decontaminated between patients • provide hepatitis B immunization for health-care workers • develop a post-exposure management plan for healthcare workers • dispose of sharps in robust containers.