skin and/or clothing Gloves: protect the hands Goggles: protect the eyes

Transcription

1 Infection control measures Refers to policies and procedures used to minimize the risk of spreading infections, Infection control especially in hospitals and health care facilities. Is a multi- disciplinary responsibility. 1. Personal protective measure Measures 2. Safe work technique to prevent sharp injuries 3. Improving hand hygiene practices in health care settings Personal protective measure Definition Specialized clothing or equipment worn by an employee for protection against infectious materials Goal Improve personnel safety in the healthcare environment through appropriate use of PPE Equipment Mask, gown, gloves, goggle Sequence to donning Gown à Mask or respiratorà Google or face shield à Gloves Sequence to remove Glovesà Google or face shield à Gown à Mask or respirator. All of the PPE listed here prevent contact with the infectious agent, or body fluid that may contain the infectious agent, by creating a barrier between the worker and the infectious material. Aim Gloves: protect the hands Goggles: protect the eyes Gowns or aprons: protect the Face shield: protect the entire face. skin and/or clothing Respirator: protect the respiratory Masks and respirators: tract from airborne transmission of protect the mouth and nose infectious agents PPE Contaminated and clean area of PPE Contaminated outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, respirator and face shield are considered contaminated, regardless of whether there is visible soil. Also, the outside of the gloves are contaminated. Clean inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield. 1. At doorway, before leaving patient room or in the waiting room. 2. Remove respirator outside room, after door has been closed. Where to remove PPE The location for removing PPE will depend on the amount and type of PPE worn and the category of isolation a patient is on, if applicable. If only gloves are worn as PPE, it is safe to remove and discard them in the patient room. When a gown or full PPE is worn, PPE should be removed at the doorway or in an anteroom. Respirators should always be removed outside the patient room, after the door is closed. Hand hygiene should be performed after all PPE is removed. *Nb: Ensure that hand hygiene facilities are available at the point needed, e.g: sink or alcohol- based hand rub

2 Definition Causes of injuries Sharp safety practice Recapping Needle safe Importance of hand hygiene Resistance How hands can be contaminated? Safe work technique to prevent sharp injuries Sharps: any article can puncture or cut and used in patient care. eg; needles, syringes, scalpel blades, razors, forceps, broken tubes and glasses 1. Passing or transferring equipment 2. Recapping contaminated needles 3. Colliding with coworkers. 4. Decontaminating used equipment. 5. Sharps left in unusual places( laundry, mattresses, tables, trays and other surface) Be prepared Be aware Dispose with care Should be avoided when it is reasonable to do so. If recapping is necessary based on specific circumstances, a one- handed technique should be used One handed scoop technique 1. With one hand, hold the syringe with attached needle and scoop or slide the cap, which is lying on a horizontal surface, onto the needles sharp end. 2. Once the point of the needle is covered, you can tighten the cap; a. By pushing against an object, or b. By pulling the base of the needle cap onto the hub of the needle Proper & safe disposal of infected needles, sharp instruments & infectious materials During Cleanup Be accountable for sharps you use Look for sharps/equipment left behind Inspect container While disposing of sharp Keep hands behind sharps Never put hands or fingers into sharps container Visually inspect sharps container for overfilling After disposing of sharp Replace containers before they become overfilled Keep filled containers for disposal in a secure area Improving hand hygiene practices in health care settings Healthcare- associated pathogens are most often transmitted from patient to patient on the hands of healthcare workers Cleaning your hands before and after patient contact is one of the most important measures for preventing the spread of microorganisms in healthcare settings Why is adherence of personnel to recommend hand washing so poor? 1. Heavy workloads (too busy) a. The busier healthcare workers are, the less likely they are to wash their hands when recommended b. Nursing shortages have caused nurses to be busier than ever before 2. Sinks are poor located a. Sinks used for hand washing are often installed in inconvenient locations b. Personnel may fail to wash their hands when indicated because it is too much trouble to get to the sinks provided 3. Skin irritation caused by frequent exposure to soap and water a. Frequent hand washing with soap and water often causes skin irritation and dryness b. In winter months, the skin on the hands of some personnel may become so dry and cracked that bleeding occurs 4. Hands don t look dirty 5. Hand washing takes too long Pulling patients up in bed Touching the patient s gown or bed sheets Taking a blood pressure or pulse Touching a patient s hand Rolling patients over in bed Touching equipment: bedside rails, over bed tables, IV pumps

3 Hand washing products Soap and water Alcohol based hand rub Washing hands frequently with soap and water is Problems with soaps inconvenient often causes skin irritation time- consuming and dryness When compared to soap and water hand washing, alcohol- based hand rubs have the following advantages: take less time to use Solution with alcohol based hand rubs can be made more accessible than sinks Cause less skin irritation and dryness are more effective in reducing the number of bacteria on hands making alcohol- based hand rubs readily available to personnel has led to improved hand hygiene practices When you should wash your hands with soap and water nb Steps to wash hand in the right way Potential hazard of exposure to blood Wash your hands with plain soap and water, or with antimicrobial soap and water if: your hands are visibly soiled and contaminated before eating after using the restroom before And after any direct patient contact before And after removing gloves v When washing hands with plain or antimicrobial soap, it should take at least seconds of rubbing v When washing hands with Alcohol, continue rubbing till alcohol dries (20-30 sec ) 1. Palm to palm 2. Right palm over left dorsum, left palm over right dorsum 3. Palm to palm finger interlaced 4. Back of fingers to opposing palms with fingers interlocked 5. Rotational rubbing of right thumb clasped in left palm and vice versa 6. Rotational rubbing, backwards and forwards with clasped fingers of right hands in left palm and vice versa Biohazard agent in health care setting : BLOOD 1. Transmission of Blood borne infections: Viral e.g. HBV, HCV, HIV & Cytomegalovirus (CMV). Bacterial: Syphilis. Protozoal: Malaria. 2. Pyrogens in the transfused blood may lead to fever 3. Blood incompatibility a) ABO incompatibility b) Rh incompatibility 4. Allergic reactions. Safe blood Effective blood Strategies Blood free from blood borne pathogens. Properly handled and stored blood and blood components in order to preserve their natural properties & therapeutic benefits Strategies to provide safe effective & blood components 1. Donor screening 2. Blood screening 3. Proper processing

4 Donor screening Blood screening Indications to be a donor Healthy from years. Body weight above 50Kg. Hemoglobin level above 13gm/dl in male and 12gm/dl in female. They answer questions about their health and risk factors. Contraindications to be donor Relative / temporary deferred Absolute / permanent Allergy, fever, common cold, or sore throat on the day of donation. Minor surgery (for 6ms) Major surgery or blood transfusion (for 1 yr) Pregnant, lactating or menstruating women. Blood donation within 3months for males & 4 months for females Every donation is tested for infectious diseases hepatitis B surface antigen (HBsAg) hepatitis C antibodies HIV antibodies Syphilis antibodies. HIV infection. Multi partners & homosexuality Intravenous drug abuse. History of viral hepatitis. Under weight (<50Kg) Chronic diseases Blood grouping ABO Rh. Proper processing Handling of blood. Separation of blood into components. Storage of blood & blood components Occupational transmission of blood borne pathogens (HBV,HCV,HIV) CDC estimates ~385,000 sharps injuries annually among hospital- based healthcare personnel Occupational exposure (>1,000 injuries/day). Many more in other healthcare settings (e.g., emergency services, home care, nursing homes) Increased risk for blood borne virus transmission Costly to personnel and healthcare system 1. Needle stick & other sharps injuries. Route of exposure 2. Direct inoculation of virus into cutaneous scratches, skin lesions, abrasions or burns. 3. Direct inoculation of virus into mucosal surfaces. HBV HCV HIV Source patient is HBeAg 3% 0.3% Potential risk positive: 30% Source patient is HBeAg negative: Less than 6% Protection of Health Care Workers (HCWs) potentially exposed to HBV, HCV or HIV Prevention of occupational exposure to blood 1. Personal protective barrier Protection 2. Work techniques and safety devices 3. Sterilization and disinfection Vaccination against HBV infection : vaccination, response testing Proper management of exposure 1. Exposure reporting 2. Emergency management 3. Post exposure management

5 Sterilization and disinfection Vaccination Proper management exposure All spills of blood should be promptly cleaned by a person wearing gloves. Visible material should first be removed with disposable towels Area should be decontaminated with an appropriate disinfectant 1. Pre- employment vaccination : Three intramuscular doses of hepatitis B vaccine. 2. Post vaccination testing : Should be done 1 to 2 months after vaccination Persons who do not respond to the primary vaccine series should complete a second three- dose vaccine series and be evaluated to determine if they are responders N.B. * A responder: defined as a person with adequate levels of anti- HBs in serum ( anti- HBs is 10 miu/ml). 1. Exposure reporting : Report the exposure Exposure must recorded in person s medical record. 2. Emergency Management and Exposure Assessment : Puncture wounds and other cutaneous injuries should be washed with soap & water. Exposed oral and nasal mucous membranes should be vigorously flushed with water. Eyes should be irrigated with clean water, saline or sterile irrigants. Person whose blood or body fluid is the source of an occupational exposure should be evaluated for HBV, HCV & HIV. Post exposure Prophylaxis (PEP) for HBV : If the exposed person is unvaccinated: a. HB immunoglobulin (IG) (0.06 ml/kg IM). b. HB vaccine series. If the exposed person is previously vaccinated a. Measure the level of antibodies to HBs Ag. Post exposure Prophylaxis for HCV : Perform baseline testing and follow up testing (e.g. at 4-6ms) for anti HCV and liver enzymes. Confirm all anti- HCV testing results reported +ve by RIBA Post exposure Prophylaxis for HIV: The use of PEP with antiviral drugs as soon as possible should be considered.