Date post: | 07-May-2015 |
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Dr.T.V
.Rao M
D
1
CARING THE INFECTIOUS
PATIENTS DR.T.V.RAO MD
Florence Nightingale, Notes on Hospitals, 1863
It may seem a strange principle
to enunciate as the very first requirement
of a hospital that it do the sick no harm
Learning Objectives
1. Recognize patient safety as an important nursing responsibility in global health care systems.
2. Apply required knowledge in preventing and/or minimizing infection.
3. Perform appropriate behaviors required to prevent health care associated infections.
4. Demonstrate required competence to provide patients with safe care.
Main types of infections
Urinary track infections usually associated with catheters
Surgical infections Blood stream
infections associated with the use of an intravascular device
Pneumonia associated with ventilators
other sites
Health workers to be alert
Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhoea, rash, respiratory symptoms, draining wounds or skin lesions)
Global Infection Problems
According to WHO (2005), On average, 8.7% of hospital patients suffer
health care-associated infections (HAI). In developed countries: 5-10% In developing countries:
Risk of HAI: 2-20 times higher HAI may affect more than 25% of patients
At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.
Infection control in the Hospitals
Infection control and prevention uses a risk management approach to minimise or prevent the transmission of infection. Standard and additional precautions principles and practice are based on the mode of transmission of an infectious agent.
Chain of Infection
Pathogen
Reservoir
Portal of Exit
Mode
of
Transmission
Portal of Entry
Susceptible Host
Why Isolation?.. because transmission is easier to control than the source / host!
Practice basic Protocols with Universal
PrecautionsStandard precautions are work practices
required for the basic level of infection control. They include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, gowns, plastic aprons, masks, eye shields or goggles, appropriate handling and disposal of sharps and other contaminated or clinical (infectious) waste, and use of aseptic techniques.
What is Infection Control?
Patient to
Worker
Visitor
Patient
Worker toWorker
Visitor
Patient
Visitor toWorker
Visitor
Patient
Infectiousness Patients should be considered infectious if they
• Are coughing
• Are undergoing cough-inducing or aerosol-generating procedures, or
• Have sputum smears positive for acid-fast bacilli and they
• Are not receiving therapy
• Have just started therapy, or
• Have poor clinical response to therapy
Infectiousness in Tuberculosis patients
Patients no longer infectious if they meet all of these criteria:
•Have completed at least two weeks of directly-observed ATT; and Have had a significant clinical response to therapy and
•Have had 3 consecutive negative sputum-smear results;
Retreatment /MDR cases may take longer to convert The only objective criteria is negative bacteriology
Airborne Precautions
Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:
Tuberculosis
Measles
Chickenpox (until lesions are crusted over)
Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
Fate of DropletsOrganisms LiberatedTalking 0-200Coughing 0-3500Sneezing 4500-1,000,000
Droplets can remain suspended in the air for hours.
Droplet Precautions Apply to patients known or suspected to
be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:
Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)
Bordetella pertusis
For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
Standard precautions apply to all patients regardless of their diagnosis
bloodall other body fluids, secretions and
excretions (except sweat), regardless of whether they contain visible blood
non-intact skinmucous membranes (mouth and
eyes)standard precautions also apply to
dried blood and other body substances, including saliva.
Personal Protective Equipment
Gloves, aprons, gowns, eye protection, and face masks
Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.
Personal protective equipment
Masks should be worn if an airborne infection
is suspected or confirmed
to protect an immune compromised patient.
GlovesGloves must be worn for: all invasive procedures contact with sterile sites contact with non-intact skin or mucous membranes all activities assessed as having a risk of exposure to blood, bodily
fluids, secretions and excretions, and handling sharps or contaminated instruments.
Hands should be washed before and after gloving
Gloves
• Purpose – patient care, environmental services, other
• Glove material – vinyl, latex, nitrile, other• Sterile or nonsterile• One or two pair• Single use or reusable
PPE Use in Healthcare Settings
Gloves
Purpose – patient care, environmental services, other
Glove material – vinyl, latex, nitrile, other
Sterile or nonsterile One or two pair Single use or reusable
Do’s and Don’ts of Glove Use
• Work from “clean to dirty”• Limit opportunities for “touch contamination” -
protect yourself, others, and the environment– Don’t touch your face or adjust PPE with
contaminated gloves– Don’t touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Safe Use and Disposal of Sharps
Keep handling to a minimum Do not recap needles; bend or
break after use Discard each needle into a
sharps container at the point of use
Do not overload a bin if it is full Do not leave a sharp bin in the
reach of children
Do’s and Don’ts of Glove Use (cont’d)
Change gloves During use if torn and
when heavily soiled (even during use on the same patient)
After use on each patient
Discard in appropriate receptacle Never wash or reuse
disposable glovesPPE Use in Healthcare Settings
Required Performance
Nursing students need to: aapply universal precautions be immunized against
Hepatitis B use personal protection
methods know what to do if exposed eencourage others to use
universal precautions
Prevention through hand washing
how to clean hands
rationale for choice of clean hand practice
technique for hand hygiene protecting hands from
decontaminates promoting adherence to
hand hygiene guidelines
Face Protection
• Masks – protect nose and mouth– Should fully cover nose and mouth and prevent fluid
penetration• Goggles – protect eyes
– Should fit snuggly over and around eyes– Personal glasses not a substitute for goggles– Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protection
Face shields – protect face, nose, mouth, and eyesShould cover forehead, extend below chin and wrap around side of face
PPE Use in Healthcare Settings
Respiratory Protection
• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)
• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Respiratory Protection
infectious aerosols (e.g., Mycobacterium tuberculosis)
PPE types for respiratory protection
Particulate respirators Half- or full-face elastomeric
respirators Powered air purifying respirators
(PAPR)
Sequence* for Donning PPE• Gown first
• Mask or respirator• Goggles or face shield• Gloves
*Combination of PPE will affect sequence – be practical
PPE Use in Healthcare Settings
How to Don a Gown
• Select appropriate type and size
• Opening is in the back• Secure at neck and waist• If gown is too small, use two gowns
– Gown #1 ties in front– Gown #2 ties in back
PPE Use in Healthcare Settings
How to Don a Mask
• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with ties or elastic• Adjust to fit
PPE Use in Healthcare Settings
Safe Injection Practices
Outbreaks of hepatitis B and hepatitis C infections in US ambulatory care facilities have prompted the need to re-emphasize safe injection practices. All health care personnel who give injections should strictly adhere to the CDC recommendations - Safe Injection Practices which include:
Use of a new needle and syringe every time a medication vial or IV bag is accessed
Use of a new needle and syringe with each injection of a client Using medication vials for one client only, whenever possible
Contact precautions may be needed for germs that are spread by touching.
Everyone who enters the room who may touch the patient or objects in the room should wear a gown and gloves.
These precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched.
Some of the germs that contact precautions protect us from are C.difficileand norovirus, and respiratory syncytial virus (RSV). These germs can cause serious infection in the intestines.
Summary
Know the main guidelines in each of the clinical environments you are assigned.
Accept responsibility for minimizing opportunities for infection transmission.
Let staff know if supplies are inadequate or depleted.
SummaryEducate patients and families/visitors about
clean hands and infection transmission.Ensure patients on precautions have same
standard of care as others:frequency of entering the roommonitoring vital signs
Hepatitis B Vaccination a Must for all Health care
Professionals
Never forget to Wash your Hands
Yet there is no Substitute for HAND WASHING in
Prevention of Infections
Programme Created and Designed by Dr.T.V.Rao MD for Medical and Health Care
workers in Developing World Email