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Hospital Infection Control and Prevention Programme

Dr Wasana Kudagammana

Why and How?

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A Tribute to Ignaz Semmelweiss (1818-1865)

• Obstetrician, practised in Vienna

• Studied puerperal (childbed) fever

• Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems

• Reduced maternal mortality by 90%

• Ignored and ridiculed by colleagues

The very first requirement in a hospital is that it

should do the sick no harm

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What is Hospital Acquired Infections

• Any infection that is not present or incubating at the time the patient is admitted to the hospital

What we do?

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Why Everyone Concerned with Hospital Infections?

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• Additional morbidity• Prolonged

hospitalization• Long-term physical,

developmental and neurological sequelae

• Increased cost of hospitalization

• Death

Consequences of Hospital Acquired Infections

MICROORGANISMS

HEALTH CARE WORKER

BACTERIAVIRUSESPRIONSFUNGI

TRANSMISSION

CONTACTINOCULATIONINHALATIONINGESTION

Health Care Workers

Patient

Environment

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What is IC & Prevention?

• Infection control addresses – factors related to the spread of infections within the health-

care setting (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff)

• including prevention of acquiring new infections (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance)

– monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation)

– management (interruption of outbreaks)– immunization of HCW/Pt

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Contact!!!

Most important route

of transmission of HAI

is the direct contact

from the hands of health care

worker

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Break the Chain of Infections

Sources of HAIs

• Hands of staff – direct contact• Environment indirect contact• Contaminated instruments / equipment• IV lines – central & peripheral• Assisted ventilation equipment• Suction & drainage bottles• Urinary catheters• Wounds & wound dressings• Procedures

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Guidelines and recommendations

• Hand washing • Hospital environmental

control & instrument care

• Intravascular Device-Related Infections and its control

• Isolation Precautions• Immunization of HCW

Handwashing is the single most important procedure for preventing the transmission of nosocomial infections.

Simple evidence…

Hand hygiene is the single most effective measure to reduce HCAIs

1st principle of infection prevention

At least 35-50% of all nosocomial infections

associates with patient care practices:

• Hand hygiene and standard precautions

• Use and care of urinary catheters• Use and care of vascular access lines• Therapy and support of pulmonary

functions• Experience with surgical procedures

Handwashing …an action of the past(except when hands are visibly soiled)

Alcohol-based hand rub is standard of care

1. Recognized

2. Explained

3. Act

How to clean your hands…

BEFORE AFTER

Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. J Hosp Infect 2007;67:9-21

“My 5 Moments for Hand Hygiene”

Rub hands…it saves money

Clinical Guidelines/ Bundle care

1. Patient/Skin preparation for procedures – routine/invasive/minor/major

2. Prevention of infections related to IV catheters

3. Urinary catheterization

4. ET/Tracheal tube care

5. Wound care

6. Management of surgical drains etc

7. PD Catheter care …………..etc

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Eggimann and Pittet Sepsis Monitor 2000

Education-based, multimodal prevention strategy for devise related infections

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Good House Keeping a Boon to Infection Control

Remember: everything you touch has been touched by someone else

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Scientific Sterilization & Disinfection Practices Saves Lives

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Surveillance

• The key to success - ongoing monitoring /surveillance for nosocomial infections

• Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base

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Infection Control Programme and Documentation

• Goals of the infection control program need to be incorporated into the mission statement of the facility

• A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal!

Dr.T.V.Rao MD 33

Health Care Workers are at Risk – Need for Vaccination

• Health care workers may be exposed to certain infections in the course of their work

• Vaccines are available to provide some protection to workers in a healthcare setting

• Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B, measles, mumps and rubella;

Tetanus, diphtheria, pertussis; N. meningitides; and varicella.

• The problem of resources for proving Vaccines in Developing countries continues to be real problem, need additional economic resources

Alcohol-based handrub at point of

care

Access to safe, continuous water supply, soap and

towels

2. Training and Education

3. Observation and feedback

4. Reminders in the hospital

5. Hospital safety climate

+

+

+

+

• The 5 core components of the WHO Multimodal Hand Hygiene Improvement Strategy

1. System change

System change

EducationMonitoring performance

+ feedback

Reminders

Safety culture

A multimodal strategy

SAVE LIVES

Mu

lti m

od

al S

trat

egy

ryryry

Making healthcare

safer

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Save Lives ! Clean Your Hands!

Thank you!!!