infection control

Infection COntrol

Presented by-Jasleen Kaur Brar

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Infection• Infection is the entry & multiplication of an infectious agent in the tissues of the host • Bacteria, virues, fungus etc…

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Infection• One of the leading causes of

preventable death in hospital

• CDC estimates approx. 2 million preventable infections in hospital

• Importance of keeping hospitals clean and infection free is greater now than ever.

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Types of infections :-

• Primary & Secondary • Local & Systemic • Acute & Chronic • Nosocomial

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Who is at Risk of Infection??

Health care personals

Clients

Community

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Chain of Infection

In order for infection to spread, several steps (chain of infection) must occur. An infection will develop only if this chain remains intact.

Chain of Infection

Reservoir

Portal of Exit

Mode of transmission

Portal of Entry

Susceptible Host

Infectious agent

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BREAKING THE CHAIN OF INFECTION

prevent the transmission of

infection

Include entire spectrum of microbes Bacteria Viruses

Fungi Protozoa

INFECTIOUS AGENT

BREAKING THE CHAIN-1 OF INFECTION

http://www.whatsnextblog.com/germs.jpg

RAPID AND ACCURATE IDENTIFICATION OF ORGANISMS

Routinely send Blood cultures, urine culture , skin swabs, throat swabs, tracheal aspirate cultures.

Send Endotracheal Tube tip, Urinary catheter tip and central line tip for culture after removal.

BREAKING THE CHAIN 1 Cont…..

Control or elimination of infectious agents including:

• Proper cleaning by water and mechanical action with or without detergents.

• Disinfection• Sterilization of contaminated objects.

Sterilization and disinfection are physical processes, involving the use of heat, radiation, chemical processes, etc., which use various solutions or gases.


DISINFECTANTS HIGH LEVEL DISINFECTANTS • Activated Glutaraldehyde (cidex2%)• Sodium hypochlorite 1%.• Carbolic Solution 5%• Bleaching Powder 1%

LOW LEVEL DISINFECTANTS • Methylated spirit 70%• Betadine solution 10%• Savlon 1%

DISINFECTANTS


Regular Cleaning and Disinfection of• Bed Trolleys • I.V stands • Table & Chairs • Resuscitation equipments • Suction Apparatus • Ventilator tubings • Leads

•Infusion Pumps•Floor•Windows•Walls•Ceiling•Wash Basins•Drums for Biomedical Waste


For Sterilized Items:

Store at dry & clean place.Put date of sterilization.Use within 72 hrs of sterilization.Check date before use. Put indicator tape.Follow manufacturer’s advice for particular piece of equipment & their preferable method of sterilization.


BREAKING THE CHAIN-2 OF INFECTION

RESERVOIRS

It includes: Humans

Animals

The inanimate environment

(water, food, soil and soiled medical equipment)

EMPLOYEE HEALTH

Immunization of health personnel’s e.g. Hepatitis B vaccination.

Regular check up for early detection of any communicable disease

Restriction from work of patient contact when infected with communicable disease.


• Cleaning with hospital approved cleaner disinfectant e.g. phenol.

• Thorough cleaning of bed and bedside equipments before admitting new admission.

• Separate mops should be used for cleaning of the unit. (twice a day)

• Damp dusting should be done.

• Avoid Brooming.

• Drains should be patent.

ENVIRONMENTAL CLEANING


• Keep the bed sheets dry and clean.

• Change sheets every day.

• Do not shake blankets and linen in ICU area.

• Do not throw them on floor.

• Soiled linen counting should be done in separate place.

HANDLING OF LINEN BREAKING THE CHAIN 2 Cont…..

• Traffic should be restricted except for doctors, nurses & supportive staff.

• Allow only one attendant.(3-4hrs).

• Keep the doors and windows closed.

• Instruct the attendants about hand washing, disposal of waste , hygienic preparation of baby’s feed etc.

TRAFFIC CONTROL BREAKING THE CHAIN 2 Cont…..

• No personal clothing, flowers and eatables should be allowed.

• Mobile phones should not be allowed inside the area.

• Machines(X-Rays ,echo machines ,ultrasound machines) from outside should be cleaned with spirit before their use.


• Measures to be taken to avoid their entry into the unit i.e. by proper cleaning, sealing & draining.

• Patient diet should be kept in covered containers.

• Keep fly flappers on each bedside of patient.

• Fly trapper should be in working order.

• Pesticides sprays should be used weekly.

PEST CONTROL


• Use of safe drinking water-Purified• Use of Distilled water for Humidifiers

WATER


BREAKING THE CHAIN 3 OF INFECION

• PORTAL OF EXIT

BREAKING THE CHAIN 3 Contd..

• Practise aseptic precautions.• Avoid talking directly into the client’s face to

prevent droplet infections.• Wearing of masks is important once the nurse

herself has infection or deals with clients suffering from infections.

• Careful handling of wastes like urine, faeces, emesis and blood is important.

• Disposable gloves should be worn to prevent direct contact with wastes or infected materials.


•MODE OF TRANSMISSION

PHYSICAL BARRIERS

Cap Mask Gown Gloves


Transmission based precautions:

• Airborne precautions• Well ventilated, private room with door closed, should

be there for patient with respiratory bacterial or viral infection.

• Place client in a private room that has negative air pressure 6-12 air changes per hour.

• Wear masks when entering the room of a client who is known or suspected of having primary tuberculosis.

• Susceptible people should not enter the room of a client who has measles or chickenpox. If they must enter they should wear a respirator.

• Limit movement of client outside the room to essential purposes.

Droplet Precautions:• To be followed in case of Meningitis,

Diphtheria, pertusis, and influenza etc., mumps• Place client in private room.• If a private room is not available, place client

with another client who is infected with same organism.

• Wear a mask if working within 3 feet of the client.

• Limit movement of client outside the room to essential purposes. Place surgical mask during transport.

Contact PrecautionsTo be followed in case of cellulitis, acute diarrhea, bronchiolitis

etc.

• Place client in private room.• Wear gloves, Remove gloves before leaving client

room.• Clean hands immediately after removing gloves. Use

antimicrobial agent.• Wear gown when entering room if there is a

possibility of contact with infected surfaces or items or if the client is incontinent or has diarrhoea, colostomy or wound drainage not covered by a dressing.

• Remove gown in the client’s room.

• Proper Hand washing.• Separate utensils for each patient.• Store in air tight containers .• Separate refrigerator for food.

FOOD HANDLING


1. Primary contamination from improper sterilizing/packaging procedure.

2. Secondary contamination when fluid additives from contaminated multi dose containers are used.

3. Breaks in aseptic tech. most likely at connection in system.

4. Blood withdrawal through 3-way stop cock leaves residual blood in system providing medium for bacterial growth.

5. Flushing a blocked or malfunctioning I.V. Line may lead to contamination.

6. Prolonged use of site may result in phlebitis, septicemia

SEPSIS ASSOCIATED WITH I.V FLUID ADMINISTRATION

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DRUGS AND I.V.FLUID THERAPY• Aseptic Technique while catheter insertion.• Use of disposable syringes.• Meticulous cleaning of I.V puncture with spirit.

(3swab method)• Secure I.V. lines, well cover them with sterile pad.• Change I.V. site q48hrly or on indication.• Change of Administration sets-72 hrs Lipid based solutions-24 hrs Blood products-discard after use

• Keep them labeled with date and drug name.


PORTAL OF ENTRY


•Maintain integrity of skin and mucous membranes.•Proper positioning of tubings, etc. may prevent injuries and skin breakdown.•Turning and positioning of debilitated clients•Ensure personal hygiene of clients regularly.•Dispose of contaminated syringes and needles properly to prevent accidental injuries to hospital personnel as well as clients.•Proper handling of catheters, drainage sets etc. is essential.•Care should be taken while collecting and handling specimens.•Regular wound care is to be instituted properly to prevent infection.


SUSCEPTIBLE HOST

Host’s Susceptibility

Low Immunity Diseases : DM, Nephritis,

Malignancy(Leukemia), Severe Burns

Immunosuppressive drugs

Indiscriminate use of antibiotics and steroids


Protection of susceptible Host

Protecting normal defence mechanisms by:• The appropriate use of prophylactic antibiotics• Maintaining an adequate intake. • Care of invasive devices that breach the natural

defences. ( e.g. urinary catheter, intravenous lines)

• Encouraging deep breathing and coughing exercises.

• Encouraging proper immunization of children and adult clients.


Maintaining healing processes:• Promotion of intake of a well balanced diet

containing essential proteins, vitamins, fats and carbohydrates.

• Institution of measures to improve appetite of the patient.

• Promotion of the client’s comfort and sleep.• Helping the client to identify method to relieve

stress


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CDC devised Guidelines to reduce the

transmission of Infection

(1996)

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STANDARD PRECAUTIONS IN MEDICAL AND SURGICAL ASEPSIS:

Hand washingGowning GlovingMask/capDisposing contaminated

equipments

5 MOMENTS FOR HAND HYGIENE

Types of Handwashing

• There are three kinds of handwashing used in the clinical setting, each of which is appropriate in different situations:

1.Handwashing with plain soap and running water

2. Handwashing with antiseptic soap and running water

3.Alcohol handrub

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Gloving:Barrier against

potentially infectious micro-organisms found in blood, other body fluids & waste

Double gloving provides added protection.

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Mask :

Mask should be changed after 20-30 minutes/ if it becomes moist

Mask should not be reused

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Disposing of contaminated equipments:

Decontamination to make items safer to handle

Cleaning to remove those materials interfering with sterilization

Sterilization to minimize risk of infection

Store items properly for further use

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SURGICAL

ASEPSIS

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Aseptic technique

Practices that help reduce the risk of

post procedure infections in clients

by decreasing the likelihood that

microorganisms will enter the body

during clinical procedures

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COMPONENTS :• Surgical scrub • Using barriers• Client preparation• Maintaining a sterile

field • Using safe operative

technique• Maintaining a safer

environment in the surgical/procedure area

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Surgical scrub

Help prevent this rapid growth

of microorganisms

Will reduce the risk of infections

• Warm water makes antiseptics

and soap work more effectively

• Scrubbing for at least 3-5

minutes.

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Surgical attire

acts as a barrier that protects clients from exposure to microorganisms that could cause infections include:

• Surgical Gloves• Caps• Masks • Gowns • Footwear

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Client prep for clinical procedures

• Clean with soap & water• Apply antiseptic &

gently scrub in circular motion

• Before giving injection, wipe with antiseptic solution

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Creating and maintaining a sterile field

A sterile field is an area created by placing sterile towels or surgical drapes around the procedure site and on the stand that will hold sterile instruments and other items needed during the procedure.

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To maintain the sterile field:

• Place sterile items within the sterile field.

• Do not contaminate sterile items when

opening, dispensing, or transferring them.

• Consider items located below the level of

the draped client to be unsterile.

• Do not allow sterile personnel to reach

across unsterile areas or to touch

unsterile items.

• Recognize that a sterile barrier that has

been wet, cut, or torn is considered

contaminated.

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Using safe operative technique

• Making small incisions

• Avoiding trauma to

tissue and surrounding

structures

• Controlling bleeding

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Maintaining a safer environment in the

surgical/procedure area• Limit the number of people who enter

surgical areas.• wear clean clothes, a mask, a cap, and

sturdy footwear. • Enclose the areas to minimize dust and

eliminate insects. • Air-condition the room, if possible. • Before a new client is brought into the

room, clean and disinfect all surfaces

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Control of Hospital Associated infections

The hospital-Associated infection Control Committee should be responsible for:

• monitoring of HAI • implementation of control measures

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ISOLATION SYSTEM

Isolation or barrier nursing is technique which is intended to confine the microorganisms within a given and recognized area.

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Universal precautions by Occupational Safety & Health Administration

• Disease Specific isolation method: certain practices are followed for each infectious disease.

• Client specific isolation: grouped into following categories

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A. STRICT ISOLATION:

Prevents transmission of highly contagious infections by air & contact like rabies

Gowns, plastic aprons, masks, and gloves should be worn.

Crockery & cutlery should be disposable. All other clinical equipment should be

sterilized. Hospital staff and visitors should be made

aware of the risks when attending such patients.

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B. CONTACT ISOLATION

• Prevents transmission of infections spread by close/ direct contact

• Private room • Hand washing • Wearing gown & Gloves while caring

etc

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C. Respiratory isolation

• Prevents transmission of highly transmissible infections spread by close contacts in case of respiratory diseases or infection spread by droplet infection e.g. Swine flu, influenza, T.B. etc.

• Wear gowns, gloves & masks before touching in case of drooling.

• Restrict numbers of visitors• Patients advised to cover nose and mouth

during coughing, talking, sneezing etc.• Keep reasonable distance from the

patients

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D. Enteric isolation

• Prevents infection transmission by direct or indirect contact with faeces.

• Gloves and gown worn when handling soiled articles.

• Thorough hand washing by patients and nurses with antiseptic soaps.

• Scrub nail beds.• Disinfection of soiled linen.• Ensure daily cleaning and disinfection

of articles

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E. Wound and skin isolation

• Prevents infection transmitted by direct or indirect contact with purulent material or drainage from an infected body site.

• Use gown and gloves.• Strict isolation for patients with

infected burns, rabies, tetanus, scabies

• Frequent and thorough hand washing.

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ROLE OF THE NURSE In controlling Infections

• Washing hands • Adhering to aseptic

techniques• Segregate contaminated

articles• Isolation of infected material• Periodical screening &

immunization• Surveillance of nosocomial

infections

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BIO MEDICAL WASTE MANAGEMENT POLICY

• Biomedical waste (management and handling) rules, 1998 are promoted by the ministry of environment and forest’s, govt. of India, under environment protection act, 1986.

• These rules apply to all persons who generate, collect, receive, store, transport, treat dispose or handle biomedical waste in any form.

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1.Infectious waste : Waste suspected to contain pathogens e.g. laboratory cultures; waste from isolation wards; swabs, or equipments that have been in contact with infected patients; excreta.

2.Pathological waste: Human tissues or fluids e.g. body parts; blood and other body fluids; fetuses

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3.Sharps: Sharp waste e.g. needles; infusion sets; scalpels; knives; blades; broken glass

4. Pharmaceutical waste: Waste containing pharmaceuticals e.g. pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticals ( bottles, boxes)

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5. Genotoxic waste Waste containing substances with genotoxic properties e.g. waste containing cytostatic drugs (often used in cancer therapy);

6. Chemical waste: Waste containing chemical substances e.g. laboratory reagents; film developer; disinfectants that are expired or no longer needed; solvents

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7. Wastes with high content of heavy metals: Batteries; broken thermometers; blood-pressure gauges; etc.

8. Pressurized containers:Gas cylinders; gas cartridges; aerosol canes

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9. Radioactive waste: Waste containing radioactive substances e.g. unused liquids from radiotherapy or laboratory research; contaminated glassware, packages, or absorbent paper; urine and excreta from patients treated or tested with radionucleides

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COLOR CODING & TREATMENT OF BIOMEDICAL

WASTE

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WASTE CATEGORY :• INFECTIOUS WASTE• PATHOLOGICAL WASTE• MICROBIOLOGY & BIOTECHNICAL WASTE• SOILED WASTE

TREATMENT • INCINERATION• DEEP BURIAL

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WASTE CATEGORY :• MICROBIOLOGY & BIOTECHNICAL WASTE• SOILED WASTE• SOLID WASTE

TREATMENT • AUTOCLAVING • MICROWAVING• CHEMICAL TREATMENT

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WASTE CATEGORY :• SHARP WASTE• SOLID WASTE

TREATMENT • AUTOCLAVING • MICROWAVING• CHEMICAL TREATMENT & DESTRUCTION• SHREDDING

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WASTE CATEGORY :• DISCARDED MEDICINE & CYTOTOXIC WASTE• INCINERATION ASH• CHEMICAL WASTE

TREATMENT • DISPOSAL IN SECURED LANDFILL

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Thank you!

infection control

Healthcare

infection infection

steps chain of infection

transmission of infection

infection free

infection reservoirs

risk of infection

regular cleaning

proper cleaning