INFECTION CONTROL COMMITTEE

Lung Center of the Philippines

TheThe

Hospital GangHospital Gang

ESCHERICHIA COLIgenerally lives a blameless life in the gut

but assumes a life of crime once he is allowed to roam in the hospital

PSEUDOMONAS Normally lives in soil and in water

storage tank. but, once he gets into the hospital, is notoriously difficult to remove

KLEBSIELLA. Lesser known resident of the intestine,

fond of hitchhiking on the hands of doctors and nurses. Known to take over entire wards.

STREPTOCOCCUS Still a common cause of throat infection

but also involved in more seriousoffenses against the rest of the person

PROTEUSA motile young bacterium, anxious to swim into the wrong places. Generally follows up

the dirty work of other bacteria

STAPHYLOCOCCUS AUREUSAlias Goldie the Grape, found

in the nose and on the hands of hospital staff but survives

for days in dusty places

SusceptibleHost

Pathogen Reservoir

Method ofTransmission

Place ofEntry

Place ofExit

Chainof

Infection

Breakingthe

Chainof

Infection

SusceptibleHost

Pathogen Reservoir

Place ofEntry

Place ofExit

Method of Transmission

Routes of Transmission in Healthcare Settings

Droplet

Contact

Airborne

Droplet Transmisson

• droplets generated from the source person primarily during coughing, sneezing & talking• droplets propelled a short distance through the air & deposited on the host’s eyes, nasal mucosa, or mouth• droplets do not remain suspended in the air

Direct - contact Transmission

• direct body surface-to-body surface contact & physical transfer of microorganisms between a susceptible host & an infected or colonized person

• can also occur between 2 patients

Indirect-contact Transmission

• contact of a susceptible host with a contaminated intermediate object, usually inanimate

• contaminated instruments, needles, or dressings, or contaminated hands and gloves

Airborne Transmission

• dissemination of airborne droplet nuclei (5 um or less) • suspended in the air for long periods of time• dispersed widely by air currents• special air handling and ventilation required to prevent transmission

Routes of Transmission Droplet Diphtheria (pharyngeal) Mycoplasma pneumoniaPertussisPneumonic plagueInfluenzaAdenvirusMumpsRubellaParvovirus B19 Invasive N. meningitidis disease (pneumonia, meningitis, sepsis)Invasive H. influenzae type b disease (sepsis, meningitis, pneumonia)

Contact

Enteric infections ( C. difficile, Shigella, hepatitis A)RSV, parainfluenza or enteroviral infectionsDiphtheria ( skin )ImpetigoPediculosisScabiesStaph. furunculosisHerpes simplex virusHerpes zoster (disseminated or in immunocompromised)Viral hemoorharrhagic (Ebola, Lassa, Marburg)

Airborne

TB

Measles

Varicella

Basic Principles of Infection Control

• Separate the infection source from the rest of the hospital

• Cut off any route of transmission

Standard Precautions• Previously called Universal

Precautions• Assumes blood and body fluid of

ANY patient could be infectious• Recommends PPE and other

infection control practices to prevent transmission in any healthcare setting

• Decisions about PPE use determined by type of clinical interaction with patient

Standard Precautions

• Designed to reduce the risk of transmission of microorganisms from both recognized & unrecognized sources of infection in hospitals

• Apply to : blood

all body fluids, secretions, & excretions except sweat, regardless of whether or not they contain visible blood non-intact skin mucous membranes

Transmission-based Precautions

• Droplet Precautions • Contact Precautions

• Airborne Precautions

Droplet Precautions

• Patient placement : - single room - cohorting ( keep at least 1 meter between patients’ beds)

• Use surgical or procedure mask.

• Patient transport : - limit patient movement - use of surgical mask by patient

Contact Precautions• Use gloves & gown for all contact with the patient or the patient’s environment.

• Use either disposable equipment or dedicate equipment to specific patients.

• HCWs should refrain from touching their eyes, nose, or mouth with potentially contaminated gloved or ungloved hands.

• Avoid contaminating environmental surfaces that are not directly related to patient care ( e.g. door handles, light switches ).

Airborne Precautions

Airborne Infection (AI)Isolation Room HCWs to use N95 Mask

Cough EtiquettePatient to wear surgical maskduring transport to other hospitalareas.

Environmental Infection Control

• remove & dilute the air by maximizing natural ventilation through open windows

• use of mechanical ventilation (window fans, exhaust systems)

• air filtration & ultraviolet germicidal irradiation

Natural Ventilation

Openwindows

Openwindows

doorbed bed bed

Direction of airflow under thedoor

Recommended Ventilation in Prevention of Airborne

Infections•Negative-pressure ventilation in rooms : air flow into room from adjacent

areas, exhaust air to the outside

•6 or more air changes per hour (ACH) desirable

•6 ACH 99% reduction of concentration of infectious particles

Negative Pressure Ventilation

door bed bed bed

Direction of airflow under thedoor ; negativepressure withrespect to corridor

air conditionerAirflow exhaust

Airflow intake

LCP Airborne Infection Isolation Units

RESPIRATORY

HYGIENE / COUGH

ETIQUETTE

NEW

Respiratory Hygiene / Cough Etiquette

• Cover the nose / mouth when coughing or sneezing.

• Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use.

• Perform hand hygiene after having contact with respiratory secretions and contaminated objects / materials.

CDC 2003

Standard Precautions• Hand Hygiene Hand washing

Alcohol-based hand rubs

• Personal Protective Equipment (PPE) Gloves Facial protection : mask face shield goggles Gown Foot protection

• Proper handling of needles & sharp devices.

HEALTH CARE WORKER’S HANDS

Probably the MOST common means by which spread of

infection by direct contact can occur

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Infects- newly operated

- the child, the chronically ill- the old patient

- ALL sick people- ALL hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Infects- newly operated

- the child, the chronically ill- the old patient

- ALL sick people- ALL hospital personnel

The Hand contaminates- the physicians’ instruments

- clean laundry- toiletries

- sanitary equipments- dishes and silver etc.

The Hand contaminates- the physicians’ instruments

- clean laundry- toiletries

- sanitary equipments- dishes and silver etc.

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel

The Hand Infects- newly operated

- the child, the chronically ill- the old patient

- ALL sick people- ALL hospital personnel

The Hand contaminates- the physicians’ instruments

- clean laundry- toiletries

- sanitary equipments- dishes and silver etc.

The Hand contaminates- the physicians’ instruments

- clean laundry- toiletries

- sanitary equipments- dishes and silver etc.

The Hand transfer Germs from:

bed sheets, dirty underwear, moist towels, sinks and

bathtubs, toiletries

The Hand transfer Germs from:

bed sheets, dirty underwear, moist towels, sinks and

bathtubs, toiletries

Hand Hygiene

• Required for Standard and Expanded Precautions

• Perform…• Immediately after removing PPE

• Between patient contacts

• Wash hands thoroughly with soap and water or use alcohol-based hand rub

Types of Hand Hygiene

Level 1 : Handwashing – plain soap + water

Level 2 : Hand Antisepsis - antimicrobial soap or alcohol-based products

Level 3 : Surgical Hand Scrub

HANDWASHING

• Considered to be one of the MOST important procedures in the prevention of hospital-acquired infection

• defined as vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under stream of water for at least 10 seconds

After removing gloves Before and after

patient contact After contact with

blood or body fluids from any patient

After taking blood pressure or vital signs from any patient

Handwashing – When?

After using bathroom

After blowing or wiping nose

Before preparing food

Before eating

Handwashing – When?

Handwashing Handwashing –– How? How?

Handwashing procedure

• Running water• Soap• Friction• Alcohol-based hand rub

The Hands are moistened and 3The Hands are moistened and 3--5 ml formulation is applied to cupped hands. The 5 ml formulation is applied to cupped hands. The hands are then rubbed together 5 times as follows : hands are then rubbed together 5 times as follows :

Defined Technique for Hand WashingDefined Technique for Hand Washing

1. PALM to PALM1. PALM to PALM 2. Right Palm over 3. PALM t2. Right Palm over 3. PALM to PALMo PALMdorsum and vice versadorsum and vice versa fingers interlaced fingers interlaced

4. Back of4. Back of fingerrsfingerrs 5. Rotational rubbing of5. Rotational rubbing of 6. Rotational rubbing, 6. Rotational rubbing, to opposing palms, right thumb clasped into opposing palms, right thumb clasped in backwards and forwards backwards and forwards fingers interlocked left palm and vice versafingers interlocked left palm and vice versa with clasped fingers ofwith clasped fingers of

right hright hand in leftand in leftpalm anpalm and vice versad vice versa

Handwashing Steps

Wet hands and wrists.

Apply soap or alcohol-based hand rub.

Step 1

Handwashing Steps

Right palm over left , left over right.

Step 2

Handwashing Steps

Palm to palm , fingers interlaced.

Step 3

Handwashing Steps

Back fingers to opposing fingers interlocked.

Step 4

Handwashing Steps

Rotational rubbing of right thumb clasped in left palm and vice versa.

Step 5

Handwashing Steps

Rotational rubbing backwards andforwards with tops of fingers and thumb of right hand in left and vice versa.

Step 6

Handwashing Steps

Step 7

Rinse hands wellunder runningwater.

HYGIENIC HAND RUB• An alternative method

of hand disinfection if

hands are not visibly

soiled.

• A rapid and effective alternative to hand washing (e.g. ward rounds with no water and no wash basin)

HYGIENIC HAND RUB• Alcohol-based products are

more effective for standard handwashing or hand sepsis by HCWs than soap or antimicrobial soaps.

• Alcohol solutions containing 60% - 95% are most effective. Higher concentrations are

less potent.

(HICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force)

HYGIENIC HAND RUBALCHOLIC HAND

RUBS DO NOT CLEANSE,

therefore hands should be cleaned

with soap and water in the presence of visible

contamination

HYGIENIC HAND RUB

PROCEDURE: • Apply 3-5 ml of fast acting antiseptic (e.g.

alcohol hand rub containing glycerol as an emollient to

prevent excessive drying of hands).

• Rub hands together after application of alcohol-based products until all the alcohol has evaporated.

What infections can be caused by needlestick injuries?

Pathogens that pose the most serious health risks : • Hepatitis B Virus (HBV)• Hepatitis C Virus (HCV)• Human immunodeficiency virus (HIV) – causes AIDS

Preventing needlestick injuries is the best way to protect yourself from

these blood-borne infections.

Who is at risk of needlestick injury ?

Any worker who may come in contact with needles is at risk :

• doctors• nursing staff

• laboratory workers• housekeepers

What kinds of needles usually causeneedlestick injuries?

• Hypodermic needles• Blood collection needles• Suture needles• Needles used in IV delivery systems

What work practices increase the risk ofneedlestick injuries?

• Recapping used needles.• Transferring a body fluid between containers.• Failing to dispose of used needles properly in puncture-resistant sharps containers.

How can you protect yourself fromneedlestick injuries? (1)

• Avoid the use of needles where safe and effective alternatives are available.

• Use devices with safety features.

• Avoid recapping needles.

• Plan for safe handling and disposal of needles before using them.

• Promptly dispose of used needles in appropriate sharps disposal containers.

Syringes with Safety Features

Handling Needles & Other Sharps

• Handle all needles & sharp instruments with care.

• Use devices with safety features.

• Never recap used needles with hands.

• Recap needles using the “scooping” method.

• Plan safe handling and disposal before beginning any procedure using needles.

• Dispose of used needle device promptly in appropriate sharps disposal containers.

Proper Sharps Disposal

Puncture – resistant Container

How can you protect yourself fromneedlestick injuries? (2)

• Report all needlestick and sharps-related injuries promptly to the employees’ physician to ensure that you receive appropriate medical care.

• Tell your supervisor about any needlestick hazards you observe.

• Get a hepatitis B vaccination.

• Participate in training related to infection prevention.

PREVENTION IS

PRIMARY!

PREVENTION IS

PRIMARY!Protect patients…protect healthcare personnel…

promote quality healthcare!