Promotion of Infection Control in RCHEs

Infection Prevention and Control is Everyone’s

Business

Family/Visitors

CNA/PCA/CMA

Standard Precautions

Safety Measures

Infection Control n’ SafetyHospital

Our collective concern….

Long Term Care Facility

Definitions/Terms used

Microbes

Microbes are everywhere. They populate the air, the water, the soil, and have even evolved intimate relationships with plants and animals. Microbes that colonize the human body during birth or shortly thereafter, remaining throughout life, are referred to as normal flora.

Normal flora can be found in many sites of the human body including the skin (especially the moist areas, such as the groin and between the toes), respiratory tract (particularly the nose), urinary tract, and the digestive tract (primarily the mouth and the colon).

Normal Flora (Commensal)

However, areas of the body such as the brain, the circulatory system and the lungs are intended to remain sterile (microbe free).

Deposition & multiplication of microorganisms

No host responseNo harm

Colonization

Pathogens may inhabit without causing adverse effects

Deposition & multiplication of microorganisms

Cause adverse effects

Infection

Infections acquired while the person is in the healthcare institution / LTCF

Healthcare-associated (or ‘nosocomial’) infection

May manifest

- in hospital / LTCF

- after returning home

Endogenous (autogenous)- own bacterial flora

Exogenous - from a source other than the patient/own

Sources of Infection

Infection caused by microbes which the patient carries

- normal flora- septic areas

Self-infection or endogenous Infection

e.g. GNB of the intestine are a common cause of wound infection following abdominal surgery

Infection acquired from

residents staff other persons

Exogenous or Cross-infection

Respiratory tract

More frequent types of Infections in LTCF

Urinary tract Wounds –Decubitus ulcers

Gastroenteritis

Factors involved in Institution-associated Infection

Major elements leading to institutionally associated infections are:

1. Infectious agents

2. Susceptible hosts

3. Mode of transmission

The chain begins with the existence of a specific pathogenic microorganism.

Chain of Infection

Infectious agent

Reservoir

Portal of Exit

Mode of Transmission

Portal of Entry

Susceptible Host

HAI: How is it transmitted?

Routes of Infection

••••

Microorganisms are transmitted by several routes, and the same microorganism may

be transmitted by more than one route. There are 5 main routes of transmission: -

contact, droplet, airborne, common vehicle and vector-borne.

Precautions (isolation) are designed to prevent transmission of microorganisms by

these routes. The aim of isolation precautions is to decrease the risk of transmission

of microorganisms from infected or colonized patients to other patients, healthcare

workers and visitors in institutions.

Infection Control n’ Safety

air/ droplet food touch water vector

Points of entry

-:

-Look at the ways in which

diseases can be spread:

HAI: How is it transmitted?

SOURCES

SelfUTI, oral cavity

Cross-infectionother peoplewounds, catheters

Environmentequipmentfood, drugswater, air,etc.

PRINCIPAL ROUTES

Direct extension

Hands/airborne

Contact(etc)

Control: remove sources, block the routes, protect patients

Precautions are designed to break the transmission of microorganisms by the various routes. Its aim is to decrease the risk of transmission of microorganisms from one to another.

How do we interrupt the chain of infection?

• hospitals for the sick existed as early as 500 BC

• particularly in Asia, Egypt, Palestine & Greece

• separate rooms, good ventilation, cleaning and hot ovens to ‘sterilize’ instruments (Selwyn 1991)

The concept of Universal precautions was developed in the mid 1980’s as a result of the human immunodeficiency virus (HIV) epidemic. The Center for Disease Control and Prevention (CDC) recognized that there was an urgent need to create strategies

TRANSMISSION-BASED PRECAUTIONS

At the same time, a new isolation guidelines issued by CDC involve a two-level approach: Standard Precautions, which apply to all clients and patients attending healthcare facilities, and Transmission-Based Precautions, which apply only to hospitalized patients (Garner and HICPAC 1996).

In 1996, the definition and recommendations for Universal Precautions was revised and given the new name of Standard Precautions.

Infection Control n’ Safety

STANDARD / TRANSMISSION BASEDPRECAUTIONS

The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) revised the "CDC Guideline for Isolation Precautions in Hospitals” with the following objectives:

-to be epidemiologically sound

-to recognize the importance of all body fluids, secretions, and excretions in the transmission of nosocomial pathogens

-to contain adequate precautions for infections transmitted by these routes of transmission

-to be as simple and user friendly as possible and

-to avoid confusion with existing infection control and isolation systems.

CDC, 2004HEALTHCARE INFECTION CONTROL PRACTICES ADVISORY COMMITTEE

STANDARD / TRANSMISSION BASED PRECAUTIONS

Airborne

Droplet

Common vehicle

Vector-borne

Contact

Airborne PTB; unknown viruses

Airborne transmission occurs by dissemination of either airborne droplet nuclei (small particle residue which are 5 micrometers or smaller in diameter) of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time.

Airborne and Droplet Infections

TRANSMISSION BASED PRECAUTIONS

Droplet borne Meningococcal, mumps, rubella

Droplets are generated from the source person primarily during coughing, sneezing, and talking and during the performance of certain procedures such as suctioning and bronchoscopy. Transmission occurs when droplets containing microorganisms generated from infected persons are propelled a short distance (within a 3 feet range) through the air and deposited on the host’s conjunctivae (membrane lining the eyelids and covering the eyeball), nasal mucosa, or mouth….

Airborne and Droplet Infections

TRANSMISSION BASED PRECAUTIONS

Contact precautions are used when an infectious agent--virus or bacterium--can be spread either by directly touching infected body fluid or an infected site, or by touching equipment contaminated by the infection. Eg

Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug resistant organisms- MRSA /VRE

TRANSMISSION BASED PRECAUTIONSContact precautions

Standard Precautions

Standard Precautions combine the major features of Universal Precautions and Body Substance Isolation and apply them to all patients receiving care, regardless of their diagnosis or presumed infection status.

Standard Precautions

Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognised and unrecognised sources of infection in the health care setting.

Handwashing

Barrier Precaution

Sharps

Environmental / Patient Care Equipment

Patient placement

Standard Precautions&

Rationale for Transmission-based Precautions

Components of Standard Precautions:

Hand Hygiene

The purpose of handhygiene is to prevent transmission of infectious agents from:

Patient to PatientPatient to Health Care workerHealth Care Worker to Patient

Hand Hygiene

Reinforced since 1840s

Most effective measure to reduce nosocomial transmission

After removal of gloves

If contaminated with blood and body fluids

ANTISEPTIC HANDWASH

at least 1 minute for an effective hand wash

use an antiseptic cleanser

prior to an invasive procedure(eg urinary catheterisation, placement ofintravascular catheters

SURGICAL HANDWASH

at least 3 minutes for an effective hand wash

use an antiseptic cleanser

prior to a surgical procedure

Hand Hygiene Technique

Effective Hand washing

Barrier Precaution

Protective barriers reduce the risk of exposure of the health care workers’ skin or mucous membrane to potentially infective materials.

Barrier Precaution

Examples:

GlovesPlastic apronsMasksGogglesFace shield

Should be appropriately applied to perform the intended task

All health care workers should take precautionsto prevent sharp injuries caused by:

needlesscalpelsand other used sharp instruments or objects

Handling of Sharps

Dispose of used needle devices promptly in appropriate sharps disposal containers

Avoid recapping needles.Plan safe handling and disposal before

beginning any procedure using needles

Use appropriate strength instrument

to remove needles, blade and all sharps

Do not bend or manipulate needles

When you sustain a sharp injury:

Sharps

1. Immediate Action

2. Subsequent Action

At the clinic

BLOOD SPILLS

STANDARD PRECAUTIONS&

RATIONALE FOR TRANSMISSION-BASED PRECAUTIONS

Patient placement

RATIONALE FOR ISOLATION PRECAUTIONS

•

Step-down

facility

Recognition of the epidemiology of diseases and its mode of transmission is pivotal for a variety of reasons.

The primary reason - naturally is to prevent the transmission of organisms…

Safety

Infections n’ Precautions

A risk assessment helps determine what

measures should be used and when to use

them

Infection Prevention And

Control

Safe

Thank You