Challenges in healthcare and infection control

transcript

CHALLENGES IN HEALTHCARE AND

INFECTION CONTROL

DR LEE OI WAHPEG PERUBATAN UD 54

Challenges

Prevention of infection

Early and accurate diagnosis

Effective treatment

Outbreak prevention and management

Greatest challenge in infection control is ……….. Outbreak prevention and

management

Healthcare Associated Infections (HAIs)

Multidrug Resistant Organisms (MDROs)

MRSA E.coli VRE

Our usual response has been…….

Surveillance

Control measures

BUT problem continues…….

HISTORICALLY

SARS VRE H5N1

New Challenges (continue)

Changing healthcare system- Rising healthcare costs- Length of stay- Moving healthcare from inpatient

to other settings - outpatient care, long term care facilities

We need to be prepared!!HOW?

Hayati S, ID HSB 2010

CDC UNIVERSAL PRECAUTIONS (1987) Recommendations for Prevention of HIV Transmission in

Health Care Setting. Universal Blood and Body Fluid Precautions.

Universal Infection Control Precautions.

The entire focus: protection of HCW from parenteral, mucous membrane and non intact skin exposure to bloodborne pathogens (blood & blood stained body fluids)

BASIC ELEMENTS OF STANDARD PRECAUTION Hand hygiene Correct usage of gloves Correct usage of PPE ~ goggle/shield ~ gown/apron ~ mask Cleaning/disinfection/sterilization Handling of clinical waste/linen/speciment Waste segregation Safe handling of sharps Handling of spillage

CDCStandard Precautions & Additional precautions (1996)

Revised recommendations Focus - Protection of HCWs and to reduce transmission of infectious agents among HCWs (clinical & non-clinical), patients, relatives and environment.New addition : Respiratory hygiene

Protective environment

Hand hygiene

RESPIRATORY HYGIENE

Cover your mouth and nose with tissue when you cough or sneeze

Throw your used tissue into the plastic bag

Throw the plastic bag into the clinical waste bin

Hand hygiene with soap and water or alcohol hand rubs

Wear the surgical mask to protect other

New category in Expanded PrecautionsProtective Environment (PE): for allogenic haemopoetic stem cell transplantation (HSCT)

patients Environmental controls

HEPA filtration of incoming air directed room air flow positive room air pressure relative to corridor well-sealed rooms (sealed walls, floors, ceilings, windows,

electrical outlets) 12 ACH (Air Exchanges per Hour) no carpets and upholstery, routine cleaning of sprinkler heads no dried / fresh flowers and potted plants

Other measures N95 mask for patients upon leaving room

Routes of disease transmissionInfected humanInfected human

AirAirFood Direct Indirect Vectors WoundsFood Direct Indirect Vectors WoundsWater contact contactWater contact contact

Susceptible HumanSusceptible Human

Ref: Microbiology, Fundamentals and applicationsRef: Microbiology, Fundamentals and applications

TRANSMISSION BASED PRECAUTIONS

Definition of Healthcare Associated Infection Outbreak (Either One )

1. Two or more associated cases occurs at the same time within same locality/department

2. Greater than expected rate of infection compared with the usual background case for the place and time

3. In certain newly emerging disease e.g. Legionnaires infection or anthrax, will only require 1 single case.

Why Infection Control? The rise in the rate of HAI over the past 20 The rise in the rate of HAI over the past 20

years (36%)!years (36%)! Various Impacts of HAIVarious Impacts of HAI To minimize risks to patients, staff and To minimize risks to patients, staff and

visitors from HAIvisitors from HAI To reduce hospital costs of treating HAI and To reduce hospital costs of treating HAI and

tying up hospital beds.tying up hospital beds. SENIC study: SENIC study:

18% increase in infections – no IC 18% increase in infections – no IC programmeprogramme

32% reduction in infections – with IC 32% reduction in infections – with IC programme.programme.

Predisposing factors for HAI Extended length of stay esp in

intensive care or HDU Length of antibiotic treatment Prior administration of broad spectrum

antibiotic esp. 3rd generation cephalosporins.

Proximity to another patient with multiple resistant organism (MRO).

Exposure to healthcare worker for a patient that carried MRO.

Ventilator-assisted pt.

RISK FACTORS FOR HAI Iatrogenic ~ hands of HCW

~ invasive procedures eg IV,

CBD , CVP etc Organizational ~ overcrowding

~ air-conditioning system

~ physical lay-out & staffing

pattern Patient related ~ chronic illness

~ immunosuppression

~ prolong stay in the ward

Common sites associated with etiological agents Urinary tract (UTI) Surgical wounds (SSI) Respiratory tract Skin (especially burns) (MRSA) Blood (bacteraemia) Gastrointestinal tract Central nervous system

Doctorrao’s ‘e’ learning series

The Principles of Infection Control

Hands Hygiene FoodFoodPracticePractice

ClothingClothing LinenLinen

EnvironmentEnvironmentEquipmentEquipment

DisposalDisposal

Infection control Every health worker plays a vital part

in helping to minimise the risk of cross infection

For example by making certain that hands are properly washed, the clinical environment is as clean as possible, ensuring knowledge and skills are continually updated and by educating patients and visitors.

Infection control 1—Achieving optimum hand hygiene. 2 – Using personal protective equipment. 3 – Safe handling and disposal of clinical

waste and bodily fluids. 4 – Achieving and maintaining a clean

clinical environment. 5 – Good communication, with other health

care workers, patients and visitors 6 – Training and education.

The chain of infection.

Source of infection

Method of spreading

Person at risk Point of entry

Breaking this chain by removing any part of it will control or stop the spread of infection

Contaminated surfaces increase cross-transmission

Breaking the chain…..

Surveillance and Outbreak investigation

~ An important role of ICN~ 30-60% of work time~Purpose of surveillance : 1. To establish the endemic baseline rates of NI. 2. To identify impending outbreak. 3. Convince clinical personnel - For implementation of infection control policies and protocol. 4. For evaluation of infection control measures.

5. Supportive evidence of quality.6. To defend malpractice.7. Satisfy regulators (accrediting bodies)8. Inter hospital comparison.

Purpose of surveillance

Establish background rateVerify diagnosisFormulate a case definitionIdentify cases

Outbreak control measures according to known mode of transmission and appropriate source control

Methods of surveillance

Passive/active Retrospective/prospective Observation/Questionnaires Reviews

Surveillance Studies Involves data collection 2 primary methods:

i) hospital-wide ii) targeted“Focused epidemiological studies” MRSA Multi-resistant gram negatives (Klebsiella,

Acinetobacter, E. Coli) Outbreak investigation

CASE FINDING

ActiveLab reportPatient chart reviewRegular review with ward staff.Nursing kardex /care planObservation chart (temp)Survey discharge patients

PassiveReport by ward staffDischarge record review.

Suspicion of an impending OB

Two or more patients are found to have an infection attributed to a same species of organism.

Multiple infection of a similar nature are reported by ward staff,

Emergence of organism not previously noted in the specific unit.

ROLE OF ICN IN OUTBREAK

Ward visit

~ Check for any breach in infection control

procedures.

~ Any deviation in the ward routine

environment eg ventilation, new staff,

influx of trainee

~ Studying each case /line list sequence of

~ Sampling when applicable

Collection of Data in Cross Infections Always collect information and document

information on 1 Patient details 2 Site and extent of infection 3 Date of admission – operative procedure first recognition of infection 4 Specimen and laboratory isolates and typing results

5 Ward and staff details. Doctorrao’s ‘e’ learning series

Liaise with clinical staff ~ Advise, recommendations, at hoc awareness program. ~ To stop further cross infection. ~ Discuss the possible control measure to be initiated. ~ Pt progress report.

Inform the administrator ~ Report incidence of OB to the management for decisions ~ Closing of ward. ~ Alternative ward to cohort the infected patients

ROLE OF STAFFS IN INFECTION CONTROL

Staff education ~ Familiarization with hospital infection control policies and procedures ~ On-going education, campaigns and

specialized education to increase awareness of illnesses, infection risks and preventive measures ~ Staff education is of UTMOST importance in infection control

Containment of Infection Good patient care practices

HANDWASHING Care of hospital equipment Infection control policies Prophylaxis of health care workers

Efficacy of Infection control

The Following measures will certainly control the infections

1 Sterilization 2 Hand washing 3 Closed drainage systems for urinary catheters.� 4 Intravenous catheter care

5 Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.

EMPLOYEE HEALTH PROGRAM

Objectives:1. To improve the safety of the hospital

environment2. To maintain the well-being of healthcare

workers3. To contain or reduce costs resulting from

absenteeism

Immunization Program Ensuring that staff are immuned to

vaccine preventable diseasesi) Immunization of new and currently

employed staffii) Continual review of immunization status

Sharp injuries and Post-exposure Management Prompt diagnosis and management is

important A hospital policy on reporting and

management should be made known to all staff

Record keeping

KEY ELEMENT FOR THE SUCCESS OF INFECTION CONTROL PROGRAM

Learn the expertise and skills required for the practice of infection control in hospitals

Collect data on hospitals-acquired infections in the country

Press the health authorities to provide resources and deploy full-time ICNs

Initiate training for IC personnel Initiate IC programmes at the local hospital

level Provide vehicles for collaboration and

continuing education.

“Above all, a hospital must do the patient no harm”

(Florence Nightingale)

The End. Thank you!!

There are 3 types of people in the world

Those who MAKE things happen

Those who LET things happen

Those who WONDERED what happened!

Challenges in healthcare and infection control

Health & Medicine