INFECTION CONTROL PRACTICES

Transcription

1 INFECTION CONTROL PRACTICES U N D E R S T A N D I N G T H E K E Y P O I N T S Dr Nik Azman Nik Adib Hospital Sultanah Nur Zahirah, Kuala Terengganu

2 It may seem a strange principle to enunciate as the very first requirement of a hospital that it do the sick no harm Florence Nightingale, Notes on Hospitals, 1863

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4 IGNAZ SEMMELWEIS In 1847, maternal death were 5 times higher in hospital than those delivered at home. In hospital, 1 st Clinic had higher mortality than 2 nd Clinic. Medical students, responsible for deliveries in 1 st Clinic, also performed autopsies at mortuary, while midwives, who worked in 2 nd Clinic, did not Demonstrated that routine hand washing could prevent the spread of puerperal fever

5 7 patients in developed and 10 in developing countries out of every 100 hospitalised patients will acquire at least one Healthcare Associated Infection (HAI). (WHO. 2015) In developing countries, , prevalence of HAI was 15.5 per 100 patients. Pooled overall HAI in adult ICU was 47.9 per 1000 patient-days (Lancet. 2011)

6 Healthcare Associated Infections (HAI) are preventable through implementation of best prevention and control practices. This will facilitate; the delivery of high quality health care for patients a safe working environment for healthcare workers. While the specific risks may differ, the basic principles of infection prevention and control apply regardless of the setting

7 GOAL OF INFECTION CONTROL To prevent the spread of infections from patient-to-patient patients to health care providers health care providers to patients health care providers to health care providers and to visitors and others in the health care environment

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10 GOAL OF INFECTION CONTROL To prevent the spread of infections from patient-to-patient patients to health care providers health care providers to patients health care providers to health care providers and to visitors and others in the health care environment CONSEQUENTLY To protect patients from HAIs, resulting in improved survival rates reduced morbidity associated with infections shorter length of hospital stay a quicker return to good health

11 FACTORS IN HEALTHCARE RELATED INFECTION Infection require 3 main elements

12 FACTORS IN HEALTHCARE RELATED INFECTION Host Factors Affect a person s risk of exposure and resistance to infection Patients usually in a poor state of health, with weakened defenses against infectious agents

13 FACTORS IN HEALTHCARE RELATED INFECTION Agent Factors An infectious agent bacterium, virus, fungus, parasite Majority bacteria Recently, viral infection SARS, H 1 N 1

14 FACTORS IN HEALTHCARE RELATED INFECTION Environment Factors Extrinsic factors animate and inanimate Animate healthcare personnel, other patients, visitors Inanimate medical instruments & equipment, surface, temperature, humidity

15 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission ~ the transmission of microorganisms and subsequent infection within a health care setting, with each link in the chain representing a factor related to the spread of microorganisms.

16 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Interaction occurs by means of contact between the agent and the host and is affected by the environment Breaking the chain of infection by interrupting transmission is the way to prevent infection

17 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Infectious Agent A pathogen that cause HAI Ability to cause an infection depends on Virulence, Pathogenicity, Infectious dose, Infectivity

18 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Reservoir Including persons with infectious diseases and contaminated medical devices or equipment

19 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Portal of Exit Path by which an infectious agent leaves the reservoir

20 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Mode of Transmission Movement of pathogen from reservoir to the host

21 MODES OF TRANSMISSION Contact Transmission Direct contact Indirect contact Droplet Airborne Transmission Vehicle Transmission Vector-borne Transmission

22 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Portal of Entry Path by which an infectious agent enter the host

23 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission Susceptible Host A person who lacking effective resistance to a particular pathogen

24 STANDARD AND TRANSMISSION BASED PRECAUTIONS 2 Tiered approach Standard Precautions Routinely apply basic infection prevention and control strategies to minimise risk to both patients and healthcare workers Transmission Based Precautions Effectively managing infectious agents where standard precautions may not be sufficient on their own specific interventions control infection by interrupting the mode of transmission

25 STANDARD PRECAUTIONS The minimum infection prevention practices that apply to all patient care. Essential to apply at all times because; people may be placed at risk of infection from others who carry infectious agents people may be infectious before signs or symptoms of disease are recognised or detected or before laboratory tests are confirmed in time to contribute to care People may be at risk from infectious agents present in the surrounding environment there may be an increased risk of transmission associated with specific procedures and practices

26 STANDARD PRECAUTIONS 1. Hand hygiene 2. Personal Protective Equipment 3. Safe handling and disposal of sharps 4. Safe handling of potentially contaminated equipment or surfaces in the patient environment 5. Respiratory hygiene and cough etiquette.

27 HAND HYGIENE

28 Starting/leaving work Handling of food/drink (own or patient s) Using computer in clinical area Contact with other patients Hand visibly soiled Visiting toilet Been in patient care areas during outbreak Removing gloves Blowing/wiping/touching nose and mouth

29 PERSONAL PROTECTIVE EQUIPMENT Variety of barriers, used alone or in combination. Selection based on assessment of the risk of transmission of infectious agents to the patient or carer. Factors to be considered; probability of exposure to blood and body substances type of body substance involve probable type and probable route of transmission

30 MANAGEMENT OF PHYSICAL ENVIRONMENT An association between poor environment hygiene and the transmission of infectious agents in healthcare setting. (Garner & Favero.1986, Dancer,1999)

31 MANAGEMENT OF PHYSICAL ENVIRONMENT

32 RESPIRATORY HYGIENE/COUGH ETIQUETTE Measures to prevent respiratory infections from transmitting Cough Etiquette cover mouth and nose when coughing or sneezing Use surgical mask use tissue to contain respiratory secretions and dispose them in a non touch disposal bin Perform hand hygiene after contact with respiratory secretions

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34 CHAIN OF INFECTION Susceptible Host Infectious Agents Reservoir Portal of Entry Portal of Exit Mode of Transmission

35 INFECTION CONTROL PRACTICES the key points All people within healthcare environment are at risk to infection Patients, Healthcare Personnel, Visitors Chain of interaction between factors results in infection Chain of Infection Breaking chain of infection is the way to control infection Infection Control 2 tiered approach Minimum infection prevention practices that apply to all patient care Standard Precaution

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