PREVENTION OF TRANSMISSION OF COMMUNICABLE DISEASES

Transcription

1 PREVENTION OF TRANSMISSION OF COMMUNICABLE DISEASES Sandra Pinzón. Andalusian School of Public Health Antonio Rodriguez. Albolote Correctional Centre (Granada)

2 What is the main and most effective measure to prevent the spread and transmission of infection?

3 Hand washing Hand washing is the main and most effective measure to reduce and prevent the transmission of infectious agents. Requirements: Basin near the working areas, with lever or pedal taps to no action with hands Liquid soap. Do not use soaps. Disposable paper towels. Do not use cloth towels.

4 Hand washing TYPE OF WASHING OBJETIVES INDICATIONS MATERIAL Wash hands with soap and water Delete: Dirt Organic matter Transient flora of the hands When hands are dirty or contaminated with blood and other bodily fluids. After using the bathroom Before and after eating or smoking. Liquid soap Paper towels Washing with alcohol solutions Delete: Organic matter Transient flora Part of the resident flora on the hands Before and after tending to a patient. After contact with body fluids, mucous, membranes, wounds. After removing gloves. Alcoholic solution with dispenser

5 Activity 2. Hand washing: practical exercise International Organization for Migration. Introduction to basic counseling and communication skills: IOM training manual for migrant community leaders and community workers. Geneva, 2009

6 Hand washing

7 Hand washing

8 Hand washing

9 Hand washing

10 Hand washing

11 Safety measures Acin-Garcia EJ, Garcia-Solis M, Carrera-Francés A, Cosín-Marquina JD, Lario-Marigil A, Martínez- Aguiñiga ME, Moreno-Moreno MR, Parreño-Oñate D, Pérez-Tonda MD. Standards of hygiene and recommendations for the prevention and control of STIs in correctional institutions. Government of Spain. Ministry of Interior and Ministry of Health and Consumer Affairs. Madrid, 2007

12 Safety measures Standard: for all patients' care, no matter what they have been diagnosed with or their alleged state of infection. Based on transmission: for patients that are suspected to or are infected by pathogens that are transmitted via air, droplet, contact with skin or other contaminated surfaces.

13 Standard safety measures Single room: when the patient contaminates the environment or for patients whose conduct disorder does not allow them to maintain adequate personal hygiene. Washing hands: Before and after contact with patients, bodily fluids and contaminated materials. Use antiseptic soap for isolated patients and outbreak control. Before and after throwing gloves away, even if the gloves are not broken.

14 Wearing gloves Wear disposable gloves when you are going to touch blood, bodily fluids, discharges, excretions and contaminated materials. Also if you are going to touch mucous membrane or wounded skin. Remove gloves quickly after using them and wash your hands before touching materials or surfaces and before being in contact with another patient. Wearing gloves is not a substitute for washing hands.

15 Other means of protection Use masks and eye protection in procedures that could cause blood or bodily fluid to splash or spray. Use a clean, non sterile gown to protect your clothes and skin from being contaminated. Wash your hands before and after putting your gown on. Disinfect blood or bodily fluid stains with a solution of 100 ml bleach per liter of water or aldehyde group if the fomites are metallic. Leave for 10 minutes and clean.

16 Other means of protection Bed clothes, underwear,etc. that is stained with bodily fluids or blood should be treated with care and be placed directly into plastic bags for them to be transported and washed. Do not throw them on the floor as they could be a source of microorganisms. Crockery does not require special precautionary measures. Reusable plates and utensils should be washed with cleaning products and hot water.

17 Handling cutting aparatus and needles Throw them into containers that are especially for cutting apparatus. Never re-place a cap onto used needles. Do not point the end of a needle or cutting tool at your body. Do not remove used needles from syringes. Do not try to bendor break them

18 Safety measures based on transmission These safety measures will always be applied in addition to standard safety measures. They do not substitute them, they complement them. There are three types: 1. AIRBORNE transmission 2. DROPLET transmission 3. CONTACT transmission

19 1 Airborne transmission This applies to patients that are suspected to or are diagnosed with an illness that is droplet or airborne transmissible (<5 microns): Tuberculosis Chickenpox Measles

20 Patient location Isolate the patient in an individual room, with air ventilation directly outside. Outside ventilation can be complemented with air re-circulation systems with filters that retain bacteria. Air should be changed at least six times per hour Mop the room everyday, preventing dust from raising. The patient must wear a mask when the door is opened.

21 Respiratory protection Respiratory protection: highly efficient masks must be worn by all staff members that come into contact with the patient. Staff which are not immune to Measles or Chickenpox must not enter in the patient's room. Avoid moving the patient to other areas. When this can not be avoided, the patient must wear a mask. Anyone who is in contact with the patient must wear a mask.

22 Recommendations for the patient Lead a healthy, calm and relaxed life. Use disposable tissues to cough and sneeze and throw them away immediately. Do not smoke or smoke as little as possible. Do not cough towards the door or the window. Keep the room clean, by mopping (not sweeping). Air the room every day. Maintain personal hygiene by regularly washing hands.

23 2 Droplet transmission This applies to patients that are suspected to or are diagnosed with an illness that is droplet transmissible (<5 microns) by talking, coughing or sneezing. Influenza (Haemophilus influenzae) Meningitis (Neisseria meningitidis) Other bacterial infections: diphtheria, Mycoplasma pneumonia, whooping cough and scarlet fever. Some viral infections: flu and rubella

24 Safety measures Single room:if this is not possible, patients can be grouped, being separated at least a metre apart. Fulfil the standard safety measures. Everyone who enters the room and who works at a distance of 1 metre from the patient must wear a surgical mask. Only transport the patient when it is strictly necessary. When the patient is being transported, he/she must wear a surgical mask

25 3 Contact transmission This applies to patients which are suspected to or diagnosed with an illness that is transmitted by direct contact Patients colonised or infected by multiresistant bacteria Intestinal illnesses (Clostridium Difficile) Incontinent patients (E.Coli, Shigella, Hepatitis A, Rotavirus) Respiratory Syncytial Virus in children Skin infections (Impetigo, Pediculosis, Scabies, Herpes zoster), disseminated or in immunosuppressed patients

26 Safety measures Single room or grouping patients Cleaning the room, equipment and surfaces that are touched frequently daily. Always wear gloves on entering the room and when you have to touch infected material. Take the gloves off before leaving the patient area. Wash your hands with antiseptic soap or using alcoholic solution. Use a gown if you think that your clothes will come into contact with the patient, surfaces or objects. Take the gown off before leaving the patient area.

27 Safety measures Only transport the patient when strictly necessary. If the patient must be transported, ensure that safety measures are taken to minimise the risk of the microorganisms being transmitted to other people and contaminating surfaces and equipment. Care equipment should only be used by one patient. If this is not possible, then it should be clean, disinfected or sterilised before it is used by another patient

28 Isolating patients Acin-Garcia EJ, Garcia-Solis M, Carrera-Francés A, Cosín-Marquina JD, Lario-Marigil A, Martínez- Aguiñiga ME, Moreno-Moreno MR, Parreño-Oñate D, Pérez-Tonda MD. Standards of hygiene and recommendations for the prevention and control of STIs in correctional institutions. Government of Spain. Ministry of Interior and Ministry of Health and Consumer Affairs. Madrid, 2007

29 Organisation The doctor who is attending to the patient should indicate if the patient is to be isolated in addition to his/treatment. Upon suspecting illness, isolate the patient, do not wait for diagnosis to be confirmed A list should be made daily of all the patients in isolation, and reasons for such.

30 Informing the isolated patient The patient will always be informed About what the isolation involves Why he/she has been isolated How the isolation will be completed and if necessary, how he/she should wear a mask. Expected isolation period

31 Table for empirical safety measures SYNDROME OR CLINICAL CONDITION Diarrhoea Probably infectious acute illness in an incontinent patient or patient that uses nappies Meningitis Rash or exanthem, generalised by an unknown cause Petechial rash / ecchymosis with fever Vesicular rash. Maculopapular rash with coryza and fever Respiratory infections Cough/fever/pulmonary infiltrate localised to the apex or any localisation in HIV positive patient (or with risk of being so). Respiratory infections, especially bronchiolitis and croup in breast-fed babies and toddlers Skin infections and wounds Abscesses or suppurated wounds that can not be covered. SAFETY MEASURES FOR EMPIRICAL ISOLATION Direct contact Droplet Droplet Airborne and direct contact Airborne Airborne Droplet Direct contact

32 What should you do if you are accidentally exposed to a material that is contaminated with blood or bodily fluids?

33 Accidental exposure to a contaminated material How it occurs: Skin direct contact: Prick of needle Cutting Wounded skin Mucous membranes Risk of contracting: Hepatitis B Hepatitis C HIV

34 What steps should be taken? Being exposed to blood-borne diseases must be considered as an emergency. You should ensure that adequate post-exposure prophylaxis measures are taken, including antiretroviral medications during the first six hours and always within 72 hours. Prophylaxis against tetanus can be implemented after being exposed to hepatitis B and HIV. There are no efficient measures of post-exposure prophylaxis for hepatitis C.

35 Procedure Protocol 1. Local preventive measures: Ensure that contaminated material is thrown away quickly, to avoid other workers or patients being exposed. Act immediately on the area exposed: Skin exposure Skin contamination Bleeding and wash with hot water and soap Wash with water and soap Mucous contamination Eyes: Wash with water Bathe with clean water, saline, sterile water or eye drops with povidone-iodine (10%) Topical products to be used for possible antiretroviral effect against HBV and HCV: Chlorhexidine gluconate and Povidone-iodine Do not apply corrosive products to the skin (bleach) or carry out aggressive tasks. Immediately change any clothes that may be dampened with the patient's blood or bodily fluids.

36 Procedure Protocol 2. Notifying the exposure to the relevant health authorities. 3. Determine the risk associated with exposure: Skin exposure Fluids on intact skin Bite without breaking the skin Fluids on wounded skin: eczema, dermatitis, abrasions, deep cut, open wound Skin wound - both the patient and the worker are bleeding Unidentified risk Unidentified risk Low-intermediate risk High risk

37 Procedure Protocol 3. Determine the risk associated with exposure: Skin exposure Scratching the surface of the skin with a sharp object, including needles from unknown origin Stab wound with a non-hollow needle Stab wound with hollow needle, and no visible blood Bite breaking the skin Stab wound with hollow needle and visible blood Stab wound with a long hollow needle with visible blood or a needle having been used recently Unidentified risk Low risk Low risk Low risk Intermediate risk High risk

38 Procedure Protocol 3. Determine the risk associated with exposure: Mucous membrane exposure Fluids in the eye or in the mouth Fluids that are not usually infected (if there is no presence of blood): saliva, urine, feces (including diarrhea) tears, perspiration, vomite, nasal secretion, sputum Infected fluids that have an intermediate transmission risk: semen, vaginal fluids, CSF, pleural liquid, peritoneal liquid, pericardial liquid, amniotic liquid, bodily tissue Infected fluids that have a high transmission risk: infected blood or bodily fluids that have infected blood Low risk Low risk Intermediate risk High risk

39 Procedure Protocol: 4. Ask the centre's health care staff to: Evaluate the source of the exposure: Find out if the patient is a carrier of HIV, HVB and/or HCV If the patient is HIV+, they must find out his/her immunity against viruses Evaluate the serologic condition of the person exposed Request a blood test to check for HBV, HCV and HIV Evaluate the need of an anti-tetanus vaccine Evaluate the need of implementing post-exposure prophylaxis Depending on the prevalence of HIV, HBV and HCV, act on the cases in which the serologic condition of the patient is not known Stop the prophylaxis if the blood test is negative

40 Procedure Protocol: 5. Follow ups with health care staff Basal treatment Treat the exposed area, identify exposure and risk, clinical and physical examination of the patient, decide if a post-exposure prophylaxis is required, request complementary tests. After 4-6 weeks Control tests and follow up of the post-exposure prophylaxis, clinical and physical examination, complementary tests. After 3 to 6 months Clinical and physical examination and complementary tests After 12 months Only in cases where transmission is high risk.

41 Vaccines Acin-Garcia EJ, Garcia-Solis M, Carrera-Francés A, Cosín-Marquina JD, Lario-Marigil A, Martínez- Aguiñiga ME, Moreno-Moreno MR, Parreño-Oñate D, Pérez-Tonda MD. Standards of hygiene and recommendations for the prevention and control of STIs in correctional institutions. Government of Spain. Ministry of Interior and Ministry of Health and Consumer Affairs. Madrid, 2007

42 Vaccination for adults workers and migrants Recommended vaccination Tetanus and diphtheria for adults Over 65s People who pose risk: intervenus drug users, people with tattoos etc. High risk patients: HIV diabetes, surgery, etc. Migrants Flu All people in the centre, workers and migrants. Pneumococcus Over 65s Immunocompetent individuals with risk of pneumococcus illness or complications due to chronic illnesses (cardiovascular, respiratory, diabetes, cirrhosis, alcoholism, etc.) etc.) People with HIV infection

43 Vaccination for adults workers and migrants Recommended vaccination Hepatitis A Hepatitis B People with chronic hepatitis processes or hepatitis B or C. Hemophilic patients that receive blood products. Family members or careers of patients with hepatitis A. People infected with HIV People with life styles that pose a high risk of becoming infected: men which have sexual contact with men, parenteral drug user. Food handlers People infected with HIV Immunocompromised patients with risk to HVB exposure People with frequent sexual contact or family contact with people Ag HBs+ People who pose a risk of contact with blood.

44 Vaccination for adults workers and migrants Recommended vaccination Adults that have not been vaccinated and who do not have any documented history of the illness and do not have any medical contraindications. Measles, rubella and mumps Adolescents and women from countries where the vaccine is limited. When measles vaccine is contraindicated, an accepted alternative is immunoglobulin, which can prevent and modify the course of the infection if it is administered in the first six days after exposure.

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