Infection Control

Dr. Kanwal Deep Singh Lyall

M.D. Micorbiology

Working definition of NI

Localized or systemic condition

1. that was not present or incubating at the time of admission to the hospital

2. that is acquired in a hospital or health care facility and

3. > 48 hours for most bacterial infections

– OPD patients, shorter hospital stays- manifest after discharge

Impact of NIs

• Leading cause of death

• Considerable economic costs

• Increased length of stay

• Direct costs to patients or payers

• Indirect costs due to lost work, increased use of drugs, the need for isolation, and the use of additional laboratory and other diagnostic studies

• Leads to imbalance between resource allocation for primary and secondary health care

• Transmitting MDR into community

Who is Responsible?

• Hospital management

• The physician

• The microbiologist

• The hospital pharmacist

• The nursing staff

• The central sterilization service

• The food service

• The laundry service

• The housekeeping service

Factors Influencing The Development of Infections in ICU

NI

The Microbial Agents

Patients susceptibility

Bacterial resistance

Environmental factors

Transmission Of Pathogens By Hands

Microorganisms on patient’s skin, clothing & other inanimate objects in surroundings

Organism transferred to hands of HCW

Organisms survive for several mins on HCW’s hands

Hands remain contaminated because hand hygiene is inadequate

Contaminated hands come into direct contact with another patient or inanimate object

Aims of Infection Control

• To reduce the microbial population of the hospital environment.

• To eliminate the danger of transmission of microorganism from one individual to another from hospital personnel to patient, from patient to personnel to patient and from patient to patient.

• To prevent hospital items from becoming sources of cross contamination

Types of Nosocomial Infections

• Urinary tract infections

• Respiratory infections

• Infections related to vascular access

• Surgical site infections

• Other Nosocomial infections

UTI - Portals Of Entry

Respiratory Tract Infections

CRBSI - Portals of Entry

Role of the housekeeping service

• The housekeeping service is responsible for the regular & routine cleaning of all surfaces

• Maintaining a high level of hygiene in the facility.

What Are Some General Tips To Remember About Sanitation?

Do…

• Follow recommended procedures and safe work practices

• Check product labels to know the potential hazards and safe work practices for all cleaning and disinfecting products you use.

• Wear PPE & clothing recommended by your supervisor.

• Use cleaning products appropriate to your workplace and according to the supplier's

• Always clean and wash surfaces/areas thoroughly before disinfecting them.

• Use germicides or diluted bleaches (e.g. sodium hypochlorite) to disinfect areas as required.

• Wash hands thoroughly with warm water and soap, after removing gloves.

• Report to your supervisor all spills, accidents, incidents, etc.

Don’t….

• Eat, drink, or smoke while using bleaches, cleaning agents, disinfecting agents, or other chemical products.

• Leave open containers of bleaches, paints and solvents in the washrooms or other areas used by other staff, students, visitors or other members of the public.

What Are Some Tips About Cleaning Blood And Body Fluids?

Body fluids to which

universal precautions apply

• Blood

• Vaginal secretions

• Semen

• Cerebrospinal fluid

• Synovial fluid

• Pleural fluid

• Peritoneal fluid

• Amniotic fluid

• Pericardial fluid

• Other body fluids containing blood

Universal precautions DO

NOT apply to

• Feces

• Tears

• Sputum

• Sweat

• Urine

• Vomitus

• Nasal secretions

Spillage

• Spillages are, by nature, highly unpredictable. • Contamination of the environment & risk of exposure

to infectious agents increases where the spillage is left unattended, or ineffectively managed.

• The person witnessing the event should deal with spillages immediately.

• Spillages consist of blood, body fluid or excreta and carry a risk of infection transmission.

• All spillages of blood or body fluid should be considered as potentially infectious.

• This will reduce the risk of exposure to infectious agents or further contamination.

Contd..• Infectious agents can survive for long periods of time in

spillages. • It is essential, therefore, that all staff receive training in

spillage management and, where possible, appropriate equipment is readily available.

• For the effective management of spillages in healthcare facilities, surfaces such as walls, floors and upholstery should be smooth, continuous and moisture repellent.

• Carpets should be avoided in all areas where patients are managed.

• All surfaces should be able to withstand frequent cleaning including cleaning with chlorine-based agents.

• Where possible, a spillage kit should be available to all staff containing:

Plastic aprons.

Gloves.

Sanitizer granules.

Clinical waste bags.

Blue roll / paper towels or disposable cloths

Blood Spillages

Please ventilate room well prior to using chlorine product.

Hypochlorite method

• Wear protective clothing

• Soak up excess fluid using disposable paper towels

• Cover area with towels soaked in 10,000ppm (1%) of available chlorine

• This is 1 part chlorine to 10 parts water, put water in container 1st then add chlorine

• Leave for at least 2 minutes

• Remove all organic matter and dispose of as clinical waste

• Clean area with hot water and detergent

• Dry area using disposable paper towels

• Dispose of protective clothing as above

• Wash hands

Decontamination Of Spills

Spot cleaning

• Wipe the spot immedately with a damp cloth, tissue or paper towel

• An alcohol wipe may be used

• Discard contaminated material

• Wash hands

Spillages of any body fluid containing blood

• Any body fluid containing blood should also be treated by the above process except urine or vomit stained with visible blood.

• In this case the excess urine/vomit must be mopped up with paper towels first.

• This is because if urine or vomit comes into direct contact with the chlorine product toxic fumes will be released.

• The room should be well ventilated (i.e. window open) before this procedure is carried out.

Spillage on Soft Furnishing or Contamination of Brass

• Put on protective clothing, as needed• Soak up as much of the spillage as possible using

kitchen roll or disposable paper towels.• Remove towels and debris and dispose of as clinical

waste.• Clean the area with hot water and a detergent using

paper towels or a disposable cloth• Dry area thoroughly• Dispose of protective clothing and cloths as clinical

waste• Wash and thoroughly dry hands.

Spillage from a Sharps Container

If used sharps are spilled from a sharps container,

the following procedure should be followed :

• Wear protective clothing

• Gather up spilled sharps using a dustpan & brush & put them into the appropriate sharps container

• Follow procedure as for blood spillage on floor area where sharps were spilled

• Dispose of protective clothing

• Wash hands

What Should You Know About Bio-hazardous Waste?

DO….

• Consider all biological wastes as infectious.

• Handle all contaminated wastes carefully to prevent body contact and accidental injury.

• Wear puncture-resistant gloves and safety boots appropriate for the situation.

• Dispose of infectious waste in a puncture-resistance container such as a bucket or box with a secure lid and lined with leak-proof, puncture-resistant plastic.

• Put a biological hazard symbol on the container.

• Wear leather gloves and empty waste paper baskets (or other containers) by holding container on the outside.

• DO NOT empty or carry the container by putting your fingers on the inside.

• Call your local public health department or police for further assistance.

Don’t….

• Do not load the container beyond its capacity.

• Do not compact infectious waste. This process may disperse the contamination.

• Do not mix infectious waste with regular garbage or trash.

• Do not reach into any waste container or receptacle which may contain hazardous waste.

Use of protective barriers

• Gowns

• Gloves

• Masks

• Cap

• Protective glasses or eye shields

• Plastic aprons

• Shoe covers

BMW Management

Colour Container Category

Green Green bin with Green plastic bag

General waste

Red Red bin with Red plastic bag

Cat. 3 – Microbiology & Biotechnology waste, Cat. 6 – Soiled waste, Cat. 7 – Solid waste (Plastic waste)

Yellow Yellow bin with Yellow plastic bag

Cat. 1 – Human anatomical waste, Cat. 2 – Animal waste, Cat. 3 - Microbiology & Biotechnology waste, Cat. 6 – Soiled waste

White White puncture proof container

Category 4 – Sharps (Needles, blades etc)

Black Black bin with Black plastic bag

Cat. 5 – Discarded medicines & Cytotoxic drugs, Cat. 9 – Incineration ash, Cat. 10 – Chemical waste

BMW ManagementGREEN BAG RED BAG YELLOW BAG WHITE

CONTAINER

BLUE BAG

Non Infectious

Waste

Infectious Waste Infectious Cotton/

Anatomical Waste

Sharp Waste

(Infectious)

Sharp Waste

(Non-

Infectious)

Paper Waste

Cartons

Packaging material

Plastic sheets

News paper

Waste food items

Blood bags

Gloves

Urine bags

Disposables like

Catheters, I/V Drip

sets, Ryles tube,

Airways etc.

Bandages/ Dressings

Cotton Swabs

Plastic casts

Napkins soiled with

blood or body fluids of

patients

Linen material

Human tissues, organs,

body parts, placenta

Microbiological waste

Biotechnology waste

Animal waste

Mask & Caps

Needles should be

destroyed at

generation point

Lancets/ Blades

I/V Drip bottles

(Glass/ Plastic)

Injection Vials,

Ampoules

Syringes to be

dipped in 1 %

sodium

Hypochlorite after

destroying the tip

and with plunger

removed

NEEDLE STICK &

POST EXPOSURE PROPHYLAXIS

HCW/HCP EXPOSURE – NSI

An exposure that might place HCP at risk for HBV, HCV, or HIV infection is defined as • a per-cutaneous injury (e.g., a needle-stick or cut

with a sharp object) or • contact of mucous membrane or non-intact skin

(e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis)

- with blood, tissue, or other body fluids that are potentially infectious .

• Injuries from needles used in healthcare and laboratory settings may result in transmission of bloodborne pathogens to healthcare workers.

• The goal of this project is to reduce the anxiety, expense and lost productivity associated with these injuries by reducing needle-sticks

Cost Of Exposure

• Infectious diseases→ disability or death

• Psychological trauma →months of waiting, fear of outcome

• Altered lifestyle

• Side effects of prophylactic medications

• Job discrimination →Loss of employment, lack of compensation

Most Likely Causes

• Failure to use safety engineered needles• Unsafe work practices (recapping, removal of

phlebotomy tube holder)• Failure to dispose properly• Disposal system failures (overfull containers,

needles sticking out of containers or piercing sides)

Infections Transmitted By Sharps Injury

Blastomycosis MalariaBrucellosis

MycobacteriosisCryptococcosis Mycoplasmosis

Diphtheria Rocky Mountain fever

Ebola fever Scrub typhus

GonorrhoeaStaphylococcus aureus

Hepatitis BStreptococcus pyogenes

0%

5%

10%

15%

20%

25%

30%

35%

0.30%

3%

30%

Hepatitis B Virus Hepatitis C Virus HIV

Estimated Risk of Infection Following a Needle-stick from an Infected Source-Patient

Standard Precautions

• Barriers Protection• Hand washing• Safe techniques• Safe handling of

– Sharp items– Specimens– Spill of blood / body fluids

• Use of Disposable / Sterile items

Immediate Management of -NSI

• STOP THE PROCEDURE IMMEDIATELY!!!

• IMMEDIATELY clean Exposure site –The most important part of PEP

• Skin wounds should be washed with soap and running water

• No evidence that antiseptics are useful

• Caustic agents (bleach) may do more harm than good

• Flush mucous membranes thoroughly with water (no soap)

• Eyes irrigated with a liter of saline

Immediate Management of -NSI

• Report to the Casualty Medical Officer

• Promptly notify your supervisor.

• Fill out the Needle Stick Injury form

Exposure To Hep B – HCP Management

HCP Vaccinated

Antibody >10 iu/ml Antibody <10 iu/ml

No Addl T/T

Pt HBs Ag -ve Unknown Source Pt HBsAg +ve

HCP:Booster dose or Complete series

HCP:Booster dose or Complete series + HBIg

HCP Not Vaccinated

Immediate Vaccine –(within 7 days) Along

with HBIg (0.06 ml/Kg)

Blood Test immediately and at 6 mths

LFT and Anti HCV at 4 – 6 Mths

Interferon not recommended for prophylaxis

No Active Prophylaxis-Immunoglobulins not effective

Determine status of Source (Anti-HCV)

HEPATITIS C –

POST EXPOSURE MANAGEMENT

Post Exposure Prophylaxis For HIV

Rationale for HIV PEP

• HIV infects dendritic cells (DC) then regional lymph nodes

before becoming systemic

• AZT blocks infectivity of HIV infected DC

• Goal of PEP : halt viral replication before systemic infection

is established

• Retrospective study : Risk of Seroconversion: 81% lower in

HCP’s who took AZT PEP.

• Several animal studies showing efficacy

• Peri-natal prophylaxis has been effective

Hand Hygiene

• HAI paramount importance throughout the world

• Affects quality of care & patient safety

• Adds tremendous and needless costs to health care

• Hand Hygeiene - important procedure for preventing transmission of HAI

• ≈40% of HCP adhere to handwashing policies

Frequently Missed Areas When Handwashing

Your 5 Moments for Hand Hygiene

Thank You