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Infection Control Orientation Program

BY Dr. Nashwa Elsayed

Clinical Pathologist / Infection Control Specialist

MB.BCH M.Sc. of Clinical & Chemical Pathology Diploma in Infection Prevention & Control Diploma in Health Care Quality Management

Hospital Infection control (IC) is a quality standard that is essential for the well being and safety of patients, staff and visitors.

It affects most departments of the hospital and involves issues of quality , patient safety and risk management.

The main role of Infection Control Department is to the prevention or reduction in rates of Healthcare Acquired Infections (HAIs).

Importance of infection control program

We have an obligation to reduce the morbidity and mortality of our patients.

Accreditation requirements demand a strong infection control program.

Prevention of HCAI is the responsibility of all healthcare providers.

Everyone must work cooperatively to reduce the risk of infection for patients, staff even visitors.

Infection control programs do surveillance and prevention activities, as well as staff training.

HealthCare Acquired Infections (Nosocomial Infections)

C:\Users\Nashwa\Pictures\FullSizeRender (6).jpgHAIsChain of Infection

HCAIs infections occur when chain of infection occurs and requires the following:

Infectious agent

Reservoir

Portal of exit

Mode of transmission

Portal of entry

Susceptible host

Chainof Infection375ecb5e7f4c5dec3a031af709c16aec.jpgSTANDARD PRECAUTIONS

STANDARD PRECAUTIONS

The basic requirements for infection prevention and control

Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.

Based on the principle that all blood, body fluids, secretions, non intact skin, mucous membranes & excretions except sweat may contain transmissible infectious agents.

Designed to be used for the care all patients regardless of their diagnosis

** Standard Precautions include:

Hand hygiene.

Use of PPE

Laboratory specimens safe handling.

Cleaning of patients rooms.

Patient placement (Isolation techniques).

Handling & disposal of contaminated item.

Safe injection practices.

Hand Hygiene

Objective of hand washing:

To remove/reduce the number of microorganisms on the hands.

To reduce the risk of transmission of infection to patients and personnel.

To reduce the contamination of the environmental surfaces

Why hand hygiene ??

The health care environment is contaminated.

All health care work involves hands.

Hands are contaminated.

Hands spread germs.

Patients are vulnerable to infection.

Indication for hand hygiene

WHO opportunities / 5 moments for hand hygiene:

Before patients contact .

Before aseptic task.

After blood, body fluids exposure risk.

After patient contact .

After contact with patient surroundings / environment

* Other opportunities for hand hygiene:

When the hands visibly soiled.

After removing gloves.

Before leaving patient room.

Before and after eating or preparing food .

After use of toilet, blowing nose, sneezing.

Methods of Hand Hygiene

Hand washing:

Washing hands with plain ( non-antimicrobial ) soap and water.

2. Alcohol-based hand rubs:

Rub the hands by a solution that contains 60% to 95% alcohol and is designed to be applied to hands to reduce the number of viable microorganisms on the hands.

3. Surgical hand antisepsis:

An antiseptic hand wash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora.

* Wash hands for minimum of 40 to 60 seconds .

* Alcohol based hand rub for a minimum of 20 to 30 seconds.

Remove jewelries

Wet hand with running water then apply liquid soap (for hand washing) .

Or apply Alcohol gel (for alcohol based hand rub).

why???

How ???

C:\Users\Nashwa\Pictures\infection control\13059416_1253173561376885_540678112_n.jpgC:\Users\Nashwa\Pictures\infection control\13020078_1253173504710224_28188403_n.jpgUse of PPE

Laboratory specimens

Handle all specimens with gloves.

Place laboratory specimens in designated , appropriately sealed containers .

Label container with appropriate patient data.

Transfer to the laboratory in upright position and as promptly as possible.

Ensure that the request form has complete information.

Cleaning of patients rooms

Should be daily and after patient discharge

**cleaning as housekeeping policies

KFH have:

Hydrogen Peroxide machine

Hygieno machine

Patient placement (Isolation techniques)

*Patient who carry a risk of transmission to other:

Patient with uncontained secretions, excretions or wound drainage.

Patient with suspected viral respiratory tract or gastrointestinal tract infections

** Place that patient in a single patient room when available .

Handling / disposal of contaminated items

contaminated items ???

Needles & Sharps.

Linen.

Medical waste.

Patient care equipment.

Linen

Linen should be handled & transported in a manner to prevent contamination to patient & environment

Place linen in an impermeable designated bag and close the bag securely.

Wrap wet linen in another piece of linen to avoid soaking of bag.

Disposal of waste

** Waste generated by health care activities includes a broad range of materials:

From used needles and syringes to soiled dressings , body parts , diagnostic samples , blood, chemicals , pharmaceuticals , medical devices and radioactive materials

Health care waste ??

1. Non hazardous waste (non medical waste)

- Food waste produced from kitchen or patients room

- Administration waste (paper ,empty pens..)

Any non infectious or hazardous waste except isolation rooms waste

2. Hazardous medical waste :

Infectious medical waste

- sharp medical waste

Human body parts and tissues waste

- chemical and pharmaceutical medical waste

- Radioactive medical waste

Disposal of sharps

Avoid recapping or bend needles

Dispose needle in proper sharp containers

Avoid handling needles or sharp to another staff

Wear gloves to lower the risk of exposure to blood in prick happens

Close sharp container when it is full

Dont put needles & sharps even of non infectious patient in plastic bags as this is very dangerous for housekeeping & cleaners

Cleaning of Patient care equipment

Commonly used equipment must be cleaned and disinfected between patient.

Do not reuse disposable equipment.

**NO USE OF SINGLE USE **

Ensure reusable equipment is transported in leak proof container to CSSD for reprocessing before using on another patient.

TRANSMISSION BASED PRECAUTIONS

** Transmission Based Precautions applied in addition to standard precaution to patients known or suspected to be infected or colonized with epidemiologically important or highly transmissible pathogens:

1- Air borne transmission precautions.

2- Droplet transmission precautions.

3- Contact transmission precautions.

AIR BORNE TRANSMISSION PRECAUTIONS

Involves the dissemination of infectious nuclei generated when an infected person coughs, sneezes, or talks.

** The infectious nuclei :

can stay suspend for extended period.

can be widely dispersed by air currents.

Airborne Precautions

C:\Users\Nashwa\Pictures\FullSizeRender (3).jpgC:\Users\Nashwa\Pictures\airborm isolation card.JPGDROPLET TRANSMISSION PRECAUTIONS

Involves the transmission respiratory droplets generated when an infected or colonized person coughs, sneezes or talks.

Or can be generated during certain procedures such as suctioning and bronchoscopy.

** Droplets are:

Travelled short distance less than 3 feet.

Microorganisms are aerosolized and can be deposited on the susceptible hosts conjunctiva, nasal mucosa and mouth.

Deposited in surfaces ---- Contact transmission.

Droplet Precautions

C:\Users\Nashwa\Pictures\FullSizeRender (4).jpgC:\Users\Nashwa\Pictures\droplet isolation card.JPGCONTACT TRANSMISSION PRECAUTIONS

Contact Precaution In addition to Standard Precautions is intended to reduce the risk or transmission of epidemiologically important microorganisms transmitted by direct or indirect contact with the patient and or patients environment.

Patients diagnosed with the same microorganism can be placed in the same room (Cohorting) assuming that no other infection is present.

Hands of HCWs are the most important contributors of indirect contact

**Contact Transmission is the most important and frequent mode of transmission in healthcare associated infections.

** It is divided into:

Direct Contact: involves direct physical contact between a susceptible host and an infected or colonized person.

Nurse or doctor to patient contact during routine care.

Patient to patient.

Patient to visitor contact.

B. Indirect Contact: involves the physical contact of a susceptible host with a contaminated intermediate object or person.

Contact Precautions

C:\Users\Nashwa\Pictures\contact isolation card.JPGMULTI DRUG RESISTANT ORGANISMS
(MDROs)

MRSA (Methicillin Resistant Staph Aureus)

VRE (Vancomycin Resistant Enterococci)

CRE (Carbapenem Resistant Enterobacteria)

PDRA (Pan Drug Resistant Acinitobacter)

** Screen all patients who are :

Admitted to the ICUs

Transferred from other hospitals

Treated in another hospital / clinic within the past 6 months

Undergoing elective surgery ( 7-14 days preoperatively )

Undergoing hemodialysis or CAPD ( continuous ambulatory peritoneal dialysis )

Roommate with positive patient not on precaution.

known to be previously MRSA positive culture results.

Site to screen :

Anterior nares (MRSA)

Any indwelling catheter site.

Open skin area. eg pressure sores, tracheostomy or surgical wound.

** All positive patient should be reported to infection control department to isolate them

ISOLATION TRANSPORT CARD

C:\Users\Nashwa\Pictures\airborn transport card.JPGC:\Users\Nashwa\Pictures\droplet transport card.JPGC:\Users\Nashwa\Pictures\contact transport card.JPGBLOOD and BODY FLUIDS SPILLAGE

The disinfectant of choice for blood and body fluid contaminated surfaces are Chlorine generating disinfectants like Clorox.

Mixing one part of Clorox to ten parts of tap water (1:10 dilution) will provide 10,000 parts per million (ppm) available chlorine.

** Make sure that solution is always freshly prepared.

Prepare a Spill Kit :

Protective clothing and gloves

Shoe Cover

Forceps

Container of Sodium Hypochlorite (Clorox)

Roll paper towels

Yellow plastic bag for disposal of infectious waste

.

CLEANING PROCEDURE:

** Clean the spillage as soon as possible before it dries up

Place Wet Floor sign near the area of spill

Wear protective clothing and gloves

Put on goggles if splashing is likely. Unprotected eyes allow easy entry of infectious agents into the body.

Put on shoe cover to protect shoes if they are likely to become contaminated with the blood spill.

If broken glass or any other sharp object is involved, use forceps to pick them up and throw into a sharps container before any cleaning or disinfecting is ever attempted.

Using paper towels, wipe all the blood or body fluid from the surface.

Pour or spray the disinfectant solution on the area of spill and leave for 3-5 minutes. This will ensure ample contact time for disinfection.

Wipe clean with paper towels.

Discard all contaminated paper towels into the infectious yellow bag.

All protective barriers should be disposed of as infectious waste.

Wash hands with antiseptic detergent.

Replace and replenish supplies on the Spill Kit.

MERS-CoV
CORONA

Middle East Respiratory Syndrome (MERS) is viral respiratory illness that is caused by a coronavirus called MERS-CoV.

Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness. They had fever, cough, and shortness of breath.

CORONA Suspected case
(patients who should be tested for MERS-CoV)

** Adults (> 14 years)

I. Acute respiratory illness with clinical and/or radiological, evidence of pulmonary parenchymal disease (pneumonia or Acute Respiratory Distress Syndrome)

II. A hospitalized patient with healthcare associated pneumonia based on clinical and radiological evidence.

III. Upper or lower respiratory illness within 2 weeks after exposure to a confirmed or probable case of MERS-CoV infection

IV. Unexplained acute febrile (38C) illness, AND body aches, headache, diarrhea, or nausea/vomiting, with or without respiratory symptoms, AND leucopenia (WBC