Hospital Infection Control: Basic Principles Infection Control Committee.

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Hospital Infection Control:Hospital Infection Control:Basic PrinciplesBasic Principles

Infection Control CommitteeInfection Control Committee

Goals for hospital infection control & prevention program

1. Protect the patients

2. Protect the HCW, visitors, and others in the healthcare environment.

3. cost effective and cost efficient.

MMC Infection Control Committee• Nursing service• Medicine (ICU/telemetry)• Pediatrics (Nursery/PICU)• Surgery (OR)• OB-GYN (DR)• IHC• Pharmacy• Laboratory• Pulmonary• Dietary• Radiology• Housekeeping• Facility Management/Engineering

Infection Control Committee

Promote an adequate environment for the patient care program.

Strives to minimize the hazards of hospital-associated infections by:

prevention investigation reporting control

The ICC has the following tasks:

• Annual plan for infection control• Infection control policies.• Support the IC team & direct

resources to address problems as identified

• Ensure availability of appropriate supplies

• Review epidemiological surveillance data & identify area for intervention.

The ICC has the following tasks (cont):

• Promote improved practice at all levels of the health care facility

• Training in infection control and safety.

• New technology & new devices • Outbreak investigation• Link with other committees

ISOLATION PRECAUTIONS

Guideline for Isolation Precautions in Hospitals Centers for Disease Control & Prevention

Hospital Infection Control Practices Advisory Committee

(January 1996; updated 2004)

1. Standard Precautions

- primary strategy

2. Transmission-Based Precautions

Isolation Precautions – 2-Level Approach:

STANDARD PRECAUTIONS

• reduce the risk of transmission of bloodborne pathogens

• applies to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.

STANDARD PRECAUTIONS a. Handwashing b. Gloves c. Mask, Eye Protection, Face Shield d. Gown e. Patient Care Equipment f. Environmental Control g. Linen h. Occupational Health & Bloodborne

Pathogens i. Patient Placement

STANDARD PRECAUTIONS a. Handwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

PathogensPathogens i.i. Patient PlacementPatient Placement

a. Handwashing

– between patient contacts– after touching blood, body fluids, secretions,

excretions, and contaminated items

– after gloves are removed

Areas commonly missed in handwashing

Most frequently missed

Less frequently missed

Hand Hygiene Technique

1. Palm to Palm 2. Palm of Right hand over back of left hand & vice versa

3. Palm to Palm with fingers 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 hand in left palm and vice versa

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b. Gloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

B. Clean & non-sterile gloves should be worn:– touching blood, body fluids,

secretions, excretions, and contaminated items.

– performing venipuncture & other vascular access procedures

Wash hands after removing your gloves

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c. Mask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

Masks & protective eyewear, goggles or face shields should be worn during:– procedures that are likely to generate

splashes/droplets of blood or other body fluids to prevent exposure of mucous membrane of the mouth, nose, & eyes.

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

D. Gowns or aprons should be worn during:

– procedures that are likely to generate splashes of blood or other body fluids

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e. Patient Care Equipment f. Environmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

Soiled patient-care equipment:

- Wear gloves if visibly contaminated & practice routine hand hygiene

Environmental Contact:

- Follow procedure for routine care, cleaning & disinfection of environment surface, especially frequently touched surfaces in patient-care areas.

Needles and other sharps: All HCW’s should take precautions to prevent

injuries caused by needles, scalpel, & other sharp instruments or devices during procedures

– when cleaning used sharp instruments– during disposal of used needles– when handling sharp instruments after

procedures

Sharps Injuries to prevent needle stick injuries, needles:

– should not be recapped

– should not be purposely bent or broken by hand

– should not be manipulated by two hands (one hand scoop technique if required can be done)

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g. Linen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

Handling soiled or contaminated linens

-Always use gloves when handling linen.

-Inspect for needles, syringes, etc while stripping.

-Linen should not be placed on the floor.

-Soiled linen should be placed directly in the cloth hamper.

-Contaminated linen should be placed in a yellow doubled plastic bag sealed by a knot.

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h. Occupational Health & Bloodborne

Pathogens i.i. Patient PlacementPatient Placement

h. Occupational Health & Bloodborne Pathogens

To prevent injuries when using needles, scalpels, & other sharp instruments or devices

Never recap used needles Place used disposable syringes & needles,

scalpel blades, & other sharp items in appropriate puncture-resistant containers for transport to reprocessing area.

Use mouthpieces, resuscitation bags as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.

STANDARD PRECAUTIONS a.a. HandwashingHandwashing b.b. GlovesGloves c.c. Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield d. Gownd. Gown e.e. Patient Care EquipmentPatient Care Equipment f.f. Environmental ControlEnvironmental Control g.g. LinenLinen h.h. Occupational Health & Bloodborne Occupational Health & Bloodborne

PathogensPathogens i. Patient Placement

Patient Placement:

- Prioritize for single-patient room if at increase risk of transmission of infection

- Likely to contaminate the environment

Respiratory Hygiene / Cough Etiquette (new TB guideline)

- Instruct symptomatic person to cover mouth/nose when sneezing/coughing

- Use tissue and dispose properly and avoid touching the receptacle bin

- Observe hand hygiene after soiling of hands with respiratory secretions

RESPIRATORYETIQUETTE

1. Standard Precautions Standard Precautions

2. Transmission-Based Precautions

- Applied to selected patients based on suspected or confirmed diagnosis

- Always implemented in conjunction with Standard Precautions

Isolation Precautions – 2-Level Approach:

Transmission- based precautions

Based on 3 major modes of transmission:

– Airborne Precaution

– Droplet Precaution

– Contact Precaution

Some diseases may require more than one isolation category

Indications for Transmission-based Precautions

Known or Suspected Diseases or Pathogens

Airborne– Measles– Tuberculosis, pulmonary or laryngeal– Varicella– Zoster (disseminated or

immunocompromised patient)– SARS– Viral hemorrhagic fever

Scenarios Requiring Airborne Precautions

– Vesicular rash– Maculopapular rash + coryza + fever– Cough, fever, upper lobe pulmonary

infiltrate– Cough, fever, any pulmonary infiltrate in an

HIV patient (or patient at risk for HIV)

Airborne Precautions

Private room, keep door closed at all times Negative air-pressure ventilation,

externally exhausted or HEPA filtered air if recirculated

Fitted respirator masks (N95 respirator) worn by susceptible HCW

Susceptible HCW should wear mask or avoid entering room

Patient should wear mask when transported out of isolation room

DROPLET PRECAUTIONS

Use for patients known or suspected to be infected with organisms transmitted by respiratory droplet (large particle >5um in size) that can be generated by the patient during coughing, sneezing and talking on the performance of cough inducing procedures.

Droplet – Diphtheria (pharyngeal), Pertussis– Meningococcal infections– HI meningitis, epiglottitis, pneumonia– Influenza– Mumps, Rubella (postnatal)– Mycoplasma pneumonia– Parvovirus B19– Adenovirus (infants, children)– Streptococcal (group A) pharyngitis, pneumonia, scarlet fever

Scenarios Requiring Droplet Precautions

– Meningitis– Petechial or ecchymotic rash with fever– Paroxysmal or severe persistent cough

(periods of pertussis activity)

Droplet Precautions

Private Room, may cohort patients with same diseases; if not possible have a distance of 3 feet between patients and visitors

Patient should leave the room only when necessary; If patient required to leave the room, must wear a surgical mask

Use mask (standard surgical mask) if within 3 feet of patient

Contact Transmission

Two Modes: – Direct- body surface to body contact and

physical transfer of micro-organisms; when doing physical exam, turning patients, giving the patient a bath, etc

– Indirect- contact of a susceptible host with a contaminated intermediate object (needles, instruments, dressings, hands)

Scenarios Requiring Contact Precautions

– Acute diarrhea

– Vesicular rash

– Respiratory infections in infants & young children

– History of infection/colonization with MDR organisms

– Skin, wound or UT infection in patient with recent hospital or nursing home stay

– Abscess or draining wound that cannot be covered

Known or Suspected Diseases or PathogensContact

1. Abscess (drainage not contained)2. Adenovirus (infants, children)3. Clostridium difficile intercolitis4. Conjunctivitis, acute viral5. Escherichia coli 0157:h7 colitis 6. Furunculosis (infants, children)7. Grp A Streptococcal major skin, burn or

wound infection8. Hepatitis A

Contact9. HSV (neonatal, disseminated, severe primary mucocutaneous)10. Impetigo11. MDR bacteria (e.g. MRSA, VRE, GISA, GRSA) infection or

colonization12. Parainfluenza infection (infants, children)13. Rotavirus14. Rubella, congenital15. Shigella (diapered/incontinent patients)16. Varicella17. Zoster (disseminated/immunocompromised)

Contact Precautions

Private room; cohorting permissible (Ensure that the patient are physically separated (>3 feet) from each other and provide curtain)

Clean, nonsterile gloves at all times Handwashing after glove removal Gowns at all times, unless patient is continent

and contact of clothing with patient or environmental surfaces is not anticipated

Remove gloves and gowns before leaving room

Essential Elements of Isolation Precautions

Airborne Droplet ContactRoom -Negative pressure

Private room w/ air exhausted to outdoors or thru high-efficiency filtration

-Door kept closed

-Private room

-Door may remain open

-Private room

- Dedicate use of non-critical patient-care items to a single patient

Airborne Droplet Contact

Mask -N95 Mask/ Portable Respirator for those entering room

-Surgical mask on patient for transport outside room

-For entering room surgical mask on patient for transport outside room

Gloves X X -when entering room

*When touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes, non-intact skin, remove promptly after use or before touching non-contaminated items & before next patient.

Gown X X -if clothing will contact patient, surfaces, items in room

-if patient has diarrhea, ileostomy, colostomy, uncontained wound drainage

-remove gown before leaving the room

Face Shield/

Eye Protection

-For procedures/activities likely to generate splashes/sprays of blood, body fluids, secretions/excretions

Transmission-Based Precautions for Hospitalized Patients

Category Single Room

Mask Gown Gloves

AIRBORNE Yes, neg. air P vent

Yes No No

DROPLET Yes* Yes, for close contact

CONTACT Yes* No Yes Yes

*Cohorting acceptable

A 20-yr old employee was admitted for blood-streaked sputum & weight loss. Chest-xray showed Cavitary Pulmonary Tuberculosis.

Facts about Tuberculosis

etiologic agent: mycobacterium tuberculosis

mode of transmission: respiratory droplet nuclei <5um or dust particles containing infectious agent

how transmitted: inhalation of infectious particles which remain suspended in air and travel long distances

duration of infectiousness: until 3 consecutive sputum smears are afb (-) or until 2-4 weeks after anti-tb drugs with good response

A 60-yr old woman was brought to the emergency room with the following pertinent PE findings: fever (T=39OC), shallow respiration with petechial and violaceous purpuric skin lesions on her lower extremities. The physician immediately suspected Meningococcemia. The patient became apneic and hypotensive and went into cardio-pulmonary arrest.

Facts about Meningococcemia

Etiologic agent: Neisseria meningitidis Mode of transmission: DROPLET How transmitted: Droplets containing

organisms propelled short distances (<3ft), deposited on host’s conjunctivae, nasal mucosa, mouth

Duration of infectiousness: until 24 hours after initiation of effective antibiotic therapy

A 15-yr old student was admitted for fever, loss of appetite, nausea and generalized body weakness. On physical examination, he had icteric sclerae and enlarged tender liver. He was diagnosed to have Hepatitis A infection.

Facts about Hepatitis A

Etiologic agent: Hepatitis A virus Mode of transmission: FECAL-ORAL How transmitted: Ingestion of

contaminated food or water Duration of infectiousness: 1-2 weeks

before onset of illness until 1 week after onset of jaundice

A 6-yr old boy developed low grade fever and vesicular rash on the face, chest and extremities. Onset of illness was 2 days after admission to the wards. The patient was diagnosed to have Varicella.

Facts about Varicella

Etiologic agent: Varicella virus Mode of transmission: CONTACT and

AIRBORNE How transmitted: Direct contact with skin

lesions, indirect contact with contaminated items or surfaces, airborne spread of respiratory tract secretions

Duration of infectiousness: 48 hours prior to skin rash until all vesicles have crusted

What Type of PPE Would You Wear?

Giving a bed bath?

Suctioning oral secretions?

Transporting a patient in a wheel chair?

Responding to an emergency where blood is spurting?

PPE Use in Healthcare Settings

Drawing blood from a vein?

Cleaning an incontinent patient with diarrhea?

Irrigating a wound?

Taking vital signs?

Giving a bed bath? Generally none

Suctioning oral secretions? Gloves and mask/goggles or

a face shield – sometimes gown

Transporting a patient in a wheel chair?

Generally none required Responding to an emergency

where blood is spurting? Gloves, fluid-resistant gown,

mask/goggles or a face shield

Drawing blood from a vein? Gloves

Cleaning an incontinent patient with diarrhea?

Gloves w/wo gown Irrigating a wound?

Gloves, gown, mask/goggles or a face shield

Taking vital signs?

– Generally none

INFECTION CONTROL is…

Hospital Infection Control: Basic Principles Infection Control Committee.

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