7.Hospital Infection,OTdiscipline c

8/8/2019 7.Hospital Infection,OTdiscipline c

1/39

Hospital infection and

OT discipline

Professor Panna Lal Saha

Professor of Surgery & HeadDepartment of Surgery

BGC Trust Medical College

Chittagong


2/39

Definition

Nosocomial infections are

infections which are a result of

treatment in a hospital or a

healthcare service unit, but

secondary to the patient's

original condition.


3/39

Definition

Infections are considered

nosocomial if they first appear

48 hours or more after hospital

admission or within 30 days

after discharge.


4/39

Definition

Nosocomial comes from the

Greek word nosokomeion

() meaning hospital

(nosos = disease, komeo = to

take care of). This type of

infection is also known as ahospital-acquired infection (or

more generically healthcare-

associated infections).


5/39

Introduction

Nosocomial infections are even more

alarming in the 21st century as

antibiotic resistance spreads.Reasons why nosocomial infections

are so common include:

Hospitals house large numbers of

people who are sick and whoseimmune systems are often in a

weakened state;


6/39

Introduction

Increased use of outpatient

treatment means that people who

are in the hospital are sicker onaverage;

Medical staff move from patient to

patient, providing a way for

pathogens to spread;

Many medical procedures bypass the

body's natural protective barriers;


7/39

Introduction

Sanitation protocol regardinguniforms, equipment sterilization,washing, and other preventative

measures may be either unheeded byhospital staff or too lax to sufficientlyisolate patients from infectiousagents.

Patients are often prescribedantibiotics and other anti-microbialdrugs to help treat illness; this mayincrease the selection pressure for

the emergence of resistant strains.


8/39

Introduction

Thorough hand washing

and/or use of alcohol rubsby all medical personnel

before each patient

contact is one of the mosteffective ways to combat

nosocomial infections.


9/39

Introduction

More careful use of

anti-microbial agents,such as antibiotics, is

also considered vital.


10/39

Epidemiology

As many as 92 percent of deaths

from hospital infections could be

prevented. The most commonnosocomial infections are :

Urinary tract infection: 40%;

infection of the skin and mucous

membrane: 10.8%; infections of surgery site: 10.3%;

Pneumopathy : 10%.


11/39

Transmission

Microorganisms are transmitted inhospitals by several routes, and the

same microorganism may betransmitted by more than one route.There are five main routes oftransmission

Contact

Droplet

Airborne

Common vehicle

Vector borne


12/39

Transmission

Contact transmission, themost important and frequent

mode of transmission ofnosocomial infections, isdivided into two subgroups:

direct-contact transmissionand indirect-contacttransmission.


13/39

Transmission

Direct-contact transmission involves adirect body surface-to-body surfacecontact and physical transfer of

microorganisms between a susceptiblehost and an infected or colonized person,such as occurs when

A person turns a patient,

Gives a patient a bath, or

Performs other patient-care activities thatrequire direct personal contact.


14/39

Transmission

Indirect-contact transmission

involves contact of a susceptible

host with a contaminated

intermediate object, usually

inanimate, such as contaminated

instruments, needles, or dressings,

or contaminated gloves that are not

changed between patients.


15/39

Transmission

Droplet transmission occurs whendroplets are generated from the

source person mainly during coughing,sneezing, and talking, and during theperformance of certain proceduressuch as bronchoscopy. Transmissionoccurs when droplets containinggerms from the infected person arepropelled a short distance through theair and deposited on the host's body.


16/39

Transmission

Airborne transmission occurs bydissemination of either airbornedroplet nuclei of evaporated dropletscontaining microorganisms thatremain suspended in the air for longperiods of time or dust particlescontaining the infectious agent.Microorganisms transmitted byairborne transmission includeMycobacterium tuberculosis and therubeola and varicella viruses


17/39


18/39

Predisposition to

infection Factors predisposing a patient to

infection can broadly be divided

into four areas:

People in hospitals are usually

already in a poor state of health,

impairing their defense againstbacteria

Advanced age or premature

birth


19/39

Predisposition to

infectionAlong with immunodeficiency

(due to drugs, illness, or IR

radiation) present a general risk,

While other diseases can present

specific risks - for instance

chronic obstructive pulmonarydisease can increase chances of

respiratory tract infection.


20/39

Predisposition to

infection Invasive devices, for instance

intubation tubes, catheters, surgical

drains and tracheostomy tubes allbypass the bodys natural lines of

defence against pathogens and

provide an easy route for infection.

Patients already colonised onadmission are instantly put at

greater risk when they undergo an

invasive procedure.


21/39

Predisposition to

infection A patients treatment itself can leave

them vulnerable to infection

immunosuppression and antacidtreatment undermine the bodys

defenses, while antimicrobial therapy

(removing competitive flora and only

leaving resistant organisms) andrecurrent blood transfusions have also

been identified as risk factors.


22/39

Prevention

Isolation: Isolation precautions are designed

to prevent transmission of microorganisms by common routesin hospitals. Because agent and hostfactors are more difficult to control,

interruption of transfer of microorganisms is directed primarilyat transmission.


23/39

Hand washing and

gloving

Hand washing frequently is called the single

most important measure to reduce the risks of

transmitting microorganisms from one person to

another or from one site to another on the same

patient. Washing hands as promptly and

thoroughly as possible between patient contacts

and after contact with blood, body fluids,secretions, excretions, and equipment or articles

contaminated by them is an important

component of infection control and isolation

precautions.


24/39

Hand washing and

gloving Although handwashing may seem like a

simple process, it is often performed

incorrectly. Healthcare settings mustcontinually remind practitioners andvisitors on the proper procedure inwashing their hands to comply withresponsible handwashing. Simple

programs such as Henry the Hand, andthe use of handwashing signals canassist healthcare facilities in theprevention of nosocomial infections.


25/39

Hand washing and

gloving All visitors must follow the same

procedures as hospital staff toadequately controlled the spread of

infections. Visitors and healthcare personnel

are equally to blame in transmittinginfections.

Moreover, multi-drug resistantinfections can leave the hospital andbecome part of the community floraif we don't take steps to stop thistransmission.


26/39

Hand washing and gloving

In addition to handwashing, gloves playan important role in reducing the risks oftransmission of microorganisms. Glovesare worn for three important reasons inhospitals.

First, gloves are worn to provide aprotective barrier and to prevent grosscontamination of the hands whentouching blood, body fluids, secretions,

excretions, mucous membranes, andnonintact skin; the wearing of gloves inspecified circumstances to reduce therisk of exposures to bloodbornepathogens is mandated by the OSHA

Bloodborne Pathogens final rule .


27/39

Hand washing and

gloving Second, gloves are worn to reduce the

likelihood that microorganisms present onthe hands of personnel will be transmitted to

patients during invasive or other patient-careprocedures that involve touching a patient'smucous membranes and non intact skin.

Third, gloves are worn to reduce thelikelihood that hands of personnelcontaminated with microorganisms from a

patient or a fomite can transmit thesemicroorganisms to another patient. In thissituation, gloves must be changed betweenpatient contacts and hands should bewashed after gloves are removed.


28/39

Hand washing and

gloving Wearing gloves does not replace the

need for handwashing, because

gloves may have small, non-apparentdefects or may be torn during use,

and hands can become

contaminated during removal of

gloves. Failure to change glovesbetween patient contacts is an

infection control hazard.


29/39

Aprons

Wearing an apron during patient

care reduces the risk of

infection. The apron shouldeither be disposable or be used

only when caring for a specific

patient.


30/39

Mitigation

The most effective of controllingnosocomial infection is to strategicallyimplementing QA / QC measures to the

health care sectors and evidence-basedmanagement can be a feasibleapproach. For those VAP/HAP (ventilatorassociated pneumonia/health careassociate pneumonia) diseases,

controlling and monitoring hospitalindoor air quality needs to be on agendain management whereas for nosocomialrotavirus infection, a hand hygieneprotocol has to be enforced.


31/39

OT DISCIPLINE


32/39

OT DISCIPLINE

In operation theatre properdress of patient, paramedics

and all doctors to wellmaintained

Dress includes pant, shirt footwear etc.

Area limitation should be wellmaintained


33/39

OT DISCIPLINE

OT to be designed such a way

that thorough fare must be

blocked

Limitation of movement by

everyone to be monitored


34/39

OT DISCIPLINE

Good hygienic practice in hospitals

and other medical institutions ismandatory to avoid or to minimise

nosocomial infections

Official recommendations for

hospital hygiene and infection

control is necessary


35/39

OT DISCIPLINE

Automatic door closers isessential for operation theatre.

Operation theatre areas musthave correct hand washingsystem in appropriately designedareas.

Recommendations regardingsurgical drapes and gowns shouldbe correctly maintained.


36/39

OT DISCIPLINE

No toilet facilities should be

maintained with in the actual OT

complex. Harmony to be maintained in

hygienic procedures between

nursing service and physicians.

Laminar air flow air conditioningsystems should be maintained in

whole ot complex area.


37/39

OT DISCIPLINE

Cleaning and disinfection after

single operations and at the end

of the operating day to be carriedout correctly .

Manual preparation and

disinfection / sterilization ofsurgical instruments to be

avoided.


38/39

OT DISCIPLINE

All the instruments and other

materials used in operationpurpose to be sterilized

For this protocol to be

maintained

Dress to be prepared such a way

that personal identity can be

easily evident.


39/39

Date post:	09-Apr-2018
Category:	Documents
Upload:	panna-saha
View:	223 times
Download:	0 times

7.Hospital Infection,OTdiscipline c

Documents