Download to read offline
Uploaded byDr Rajni Sabharwal
Transmission based precautions for prevention hospital acquired infections
This ppt explains the transmission based precautions to be followed for preventing hospital acquired infections.
Transmission based precautions for prevention hospital acquired infections
- 1. Transmission based precautions Dr.E. Rajni Sabharwal Professor, Dept. of Microbiology Mahatma Gandhi Medical College Jaipur, Rajasthan
- 2. Learning Objectives 1. Hospitalacquired infections & standard precautions 2. Describe transmission-based precautions 3. Discuss types: Contact, Droplet, Airborne and respective infection control measures 4. Case-based examples & MCQs
- 3. Select the correctanswer: HAIs are defined as • Infections acquired in hospital by a patient admitted for a reason other than the infection. • Infection not present or incubating at the time of admission • Symptoms should appear at least after 48 hours of admission. • All of the above
- 4. True/ False HAIs alsoinclude • Infections acquired in the hospital but symptoms appearing after discharge • Occupational infections among healthcare staff (eg NSI transmitted infections)
- 7. The preventive measuresfor HAIs can be broadly categorized into: Standard precautions Transmission- based or specific precautions.
- 8. Standard precaution: whichis the missing link? To be followed for • All patients • All specimens • All ????
- 9. Standard precaution All thetime to be followed for All patients All specimens All sharps
- 10. Components • Hand hygiene •Personal protective equipment • Biomedical waste management • Spillage cleaning • Disinfection of patient care linen & items • Environmental cleaning • Respiratory hygiene and cough etiquette • Safe use and disposal of sharp
- 11. Hand hygiene isrecommended before and after gloves use: A. True B. False
- 12. When Transmission basedprecautions (specific precautions) are being followed diligently, standard precautions need not be followed. A. True B. False
- 13. Transmission based precautions: •Additional precautions taken over and above SP • Not a substitute • Where standard precautions may not be sufficient and specific transmission is expected • Based on specific modes of transmission 1. Contact 2. Droplet 3. Airborne
- 14. Routes of transmission: CONTACTDROPLET AIRBORNE
- 15. Definition Agents transmitted throughthe particular mode of transmission Specific infection control measures.
- 16. Contact precautions: • Followedwhen there is evidence of HAI transmission by direct or indirect contact during patient care. • Direct transmission - from one person to another person without any intermediate object or person. Eg touching • Indirect transmission - through a contaminated intermediate: object (clothes, patient-care devices, environmental surfaces, fomite) or person
- 17. Agents transmitted throughcontact • Agents of diarrhea such as cholera, Clostridium difficile • MDROs – MRSA, CRE, VRE, MDR-NFGNB • Enterically transmitted hepatitis viruses (HAV and HEV) • Agents of conjunctivitis (e.g. adenovirus, gonococcus, Chlamydia) • Contagious skin lesions (eg abscess, infected ulcers) caused by GAS, Staphylococcus, HSV • Skin infestations (e.g. scabies)
- 18. IC Measures –Contact Precautions • Hand hygiene (hands acc fr majority of transmissions) • PPEs –gloves, gowns essential; ± surgical mask/protective eye wear; should wear upon entry & remove before leaving pt care area. • Equipment: Single use patient dedicated equipment/ proper disinfection • Patient placement – single isolation room with bathroom facility/cohorting • Cohorting – Patient with similar infections & with min 3 feet spatial bed separation. • Transfer of patients: only when strictly reqd; PPE for HCW & infected area of patients’s body to be covered. • Disinfection of the room: atleast daily& before use by next patient.
- 19. • Gloves areused when likely to touch blood, body fluids and contaminated items • Eye protection is required during procedures likely to generate droplet or splash of specimen on face.
- 21. Droplet Precautions • Preventthe spread of infectious agents transmitted through droplet. • Respiratory droplets - large-particles (>5 µm in size) generated by a patient who is coughing, sneezing or talking. • Transmission via large droplets requires close contact (<3 feet) • do not remain suspended in the air - travel shorter distances. • Some agents transmitted by droplet can also be significantly transmitted by contact mode (influenza).
- 22. Agents transmitted throughdroplets • Diphtheria, Meningococcal meningitis, pertussis, pneumonic plague, Mycoplasma pneumonia • Streptococcal pharyngitis • Influenza virus • SARS-CoV2 (COVID-19) • Viral hemorrhagic fevers - Lassa, Ebola, Marburg viruses • Other viruses: Mumps, Parvovirus B19, Rhinovirus, Rubella, Adenovirus
- 23. IC Measures- DropletPrecautions • Hand hygiene vital • PPEs – Surgical mask (N95 when AGPs are performed); gown, gloves & eye protection as required. • Patient should wear mask at all time for source control. • Respiratory Hygiene/Cough Etiquette • Equipment: Single use patient dedicated equipment • Patient placement – Single isolation room or cohorting • Transfer of patients: only when strictly reqd; PPE for HCW • Disinfection of the room: daily to mitigate transmission.
- 25. Airborne Precautions • Preventthe spread of infectious agents transmitted through aerosols. • Aerosols are small-particles (<5µm) generated by an infectious person during coughing, sneezing, talking or aerosol generating procedures (e.g. intubation) • These smaller droplets remain suspended in air for long periods of time • May disperse to a distant place along the air current.
- 26. Agents transmitted throughaerosols • Mycobacterium tuberculosis • Measles virus • Varicella (chickenpox and zoster disseminated or in an immunocompromised host), monkeypox virus • Aspergillus (pulmonary aspergillosis), legionella • Aerosol-generating Procedures: Endotracheal intubation, open respiratory and airway suctioning, tracheostomy care, cardiopulmonary resuscitation, sputum induction and bronchoscopy
- 27. IC Measures –Airborne precautions • PPE – N95 respirator must • Patient Placement – Airborne isolation room (negative pressure room preferred.) door closed • Equipment: Single use patient dedicated equipment • Transfer of Patients- only when necessary. Appropriate PPE. • Respiratory Hygiene and Cough Etiquette • Visitors and Staff – restricted access; PPE before entering room. • Remove N95 after exiting room. • Disinfection of the room: daily to mitigate transmission.
- 29. SUMMARY OF APPLICATIONSOF STANDARD AND TRANSMISSION BASED PRECAUTIONS
- 30. Visitors Type Examples Singleroom or cohort Gloves Gown Mask Eye Protection Handling of equipment Standard Should be followed for : -all patients -all blood/ fluid -all sharps Not required As required * If soiling likely During procedures likely As required ** to generate droplet/ splash from blood & BF Reprocess on next patient or single use before reuse No additional precaution Contact MDRO’s C.difficile, Diarrhoeal pathogens Essential Essential Essential Surgical mask reqd if infectious agent is also transmitted by droplets As required ** Single use or Reprocess before reuse on next patient Same precautions as staff Droplet RSV, Mycoplasma ParaInfluenza, Pertussis, Plague Essential As If soiling required likely * Surgical mask essential As required ** Same as contact Restrict visitors Same precautions as staff Airborne Pulm TB, Chicken pox, Measles, SARS Essential (Negative As required pressure) * If soiling likely N 95 respirator essential As required ** Same as contact Restrict visitors & Same precautions Gloves are used when likely to touchblood, body **Eye protection is required during procedures
- 31. Case 1 • Groupactivity organized in common room of a long-term care facility where an elderly gentleman had symptoms of URTI. • Following this a cluster of URTI cases observed. • During the group activity, all sat in close proximity. • No availability of tissues. • No hand hygiene performed. • Symptoms were consistent with influenza, which was later confirmed by lab reports. • Which TBP should have been practiced ??
- 32. • Influenza outbreakin long-term care facility → Droplet transmission • Assembling of large numbers of residents in a confined area in which droplet transmission occurred while sneezing, coughing or talking.
- 33. What are theother organisms transmitted by same mode? 1. Respiratory syncytial virus (RSV) 2. Mycoplasma pneumonia 3. Parainfluenza 4. Pertussis 5. Diphtheria 6. Plague 7. Meningococcus
- 34. Infection control measures: •HH • PPE • Patient placement • Equipment • Travel outside room • Disinfection of room • Education of residents, that if they feel unwell, to avoid participating in group activities • Displaying posters and signage on HH and respiratory hygiene
- 35. Case 2 • Apatient with CKD with DM & pulmonary TB reports to the outpatient deptt for getting dialysis done. Two days following dialysis, he developed fever and was admitted. • What TBP do you think need to be addressed?
- 36. What are theother organisms transmitted by same mode? 1. Chicken pox 2. Measles 3. SARS
- 37. Infection control measures: •HH • PPE • Patient placement • Equipment • Travel outside room • Disinfection of room • Displaying posters and signage on HH and respiratory hygiene
- 38. Use of appropriatePPEs • HCWs should use N95 mask • It is essential that the wearer is properly fitted and trained in its safe use • HCWs must perform fit check every time they put on N95 mask • Patient should wear Surgical mask • Patients should wear a correctly fitted surgical mask while they are being transferred and follow respiratory hygiene and cough etiquette
- 39. Case 3 • Apatient with CKD with DM with HT reports to the outpatient for getting dialysis done. Two days following dialysis, he developed fever and was admitted. Paired blood cultures sent. • He was started empirically on IV ceftriaxone. After four days, he developed fever with abdominal pain and profuse watery diarrhea with passage of > 5 episodes of unformed stool in 24 hours. • What TBP do you think need to be addressed?
- 40. Laboratory testing ofthe unformed stool was positive for C.difficile toxin. Other agents transmitted by same route: 1. Agents of diarrhea such as cholera, Clostridium difficile 2. MDROs – MRSA, CRE, VRE, MDR-NFGNB 3. Scabies etc
- 41. Infection control measures: •HH & PPE: Perform HH before and upon removal of gown and gloves and before exiting the patient’s room. Handwashing preferred. • Patient placement: Private room with a single use toilet or cohorting (placement with other patients diagnosed with CDI) • Equipment for patient use • Travel outside room • Disinfection of the room: atleast daily& before use by next patient. 1% freshly prepared hypochlorite. Ensure you cover all potential contaminated areas, including high-touch surfaces like doorknobs, light switches, and bathroom fixtures.
- 42. • C. diffsheds in faeces. Any surface, device or material that becomes contaminated with faeces could serve as a reservoir for the C. diff spores. Examples include: commode etc • EPA certified high level disinfectant. Sporicidal. • C. diff spores can transfer to other patients by the hands of healthcare personnel who have touched a contaminated surface or item. • When a patient transfers, notify the new facility if the patient has or had a C. diff infection
- 43. Hand wash isindicated in following situations A. When the hands are visibly soiled with blood, excreta, pus, etc. B. Before and after eating C. After going to toilet D. Before and after shift of the duty. E. All
- 44. True/False: • For preventionof aerosol transmission, respirator should be removed after leaving the patient room and closing the door. • Tell the right time for removal of PPE in case 3 (C. difficile)
- 45. Agents transmitted throughcontact : A. MRSA B. Scabies C. CRE(Carbapenem resistant Enterobacteriaceae) D. Agents of diarrhoea such as rotavirus, C. difficile E. All
- 46. Patients with similarinfection requiring contact precautions:- A. Can be placed together in the same room with a spatial separation of minimum 3 feet distance between the beds B. Shouldn’t be placed in the same room C. Patient movement can be done as and when required D. HCW may not wear PPE only while touching the patient
- 47.