Transcript Hygiene requirements for design and construction of modern health

Prevention of intra-hospital
infections
Nosocomial infection:
It is an infection acquired in a medical setting
in the course of medical treatment. It meets
the following criteria:
• 1 - Not found on admission
• 2 – Temporally associated with admission or
a procedure at a health-care facility
• 3 – Was incubating at admission but related
to a previous procedure or admission to
same or other health-care facility.
Impact of nosocomial infection?
• Increased morbidity (serious consequences and
permanent disability )
• The length of hospital stay is prolonged, on average
by 5–10 days.
• The risk of death approximately doubles in patients
who acquire hospital infection.
• Hospital-acquired infections are very expensive and
contribute significantly to the escalating costs of
health care. It has been argued that, even if
moderately effective, a hospital infection control
program is one of the most cost-effective and costbeneficial preventative
medical
interventions
currently available.
Definition of Nosocomial infection
The use of uniform definition is crucial if data from one hospital
are to be compared with those of another hospital (interhospital) or with an aggregated database (intra-hospital).
NI is a localized or systemic condition:
1- that results from adverse reaction to the presence of an
infectiuos agent(s) or its toxins and
2- that was not present or incubating at the time of admission to
the hospital.
For most bacterial NI, it become evident 48 hours or more (typical
incubation period) after admission. Because the incubation
period varies with type of pathogen, and extent of the
underlying condition, each infection should be assessed
individually for evidence that links it to hospitalization.
Important principles
upon which NI
definitions are based
First (available information):
The information used to determine the presence and
classification of an infection should be a combination of
clinical findings, laboratory evidence and supportive data.
Clinical evidence is derived from direct observation of the
infection site or review of other pertinent sources of data such
as the patient’s chart or medical record.
Laboratory evidence includes results of cultures, antigens or
antibody detection or microscopic examination.
Supportive data are derived from other diagnostic studies
such as: X-ray, US, CT, MRI, BAL, Endoscopy, ..etc
Second, (a physician’s or surgeon’s diagnosis)
The diagnosis of infection by the surgeon or physician
is derived from direct observation during a surgical
operation, endoscopic examination or other
diagnostic study or from clinical judgment. This
diagnosis could be an acceptable criterion for an
infection unless there is compelling evidence to the
contrary.
For certain sites of infections, however, a physician’s
clinical diagnosis in the absence of supportive data
must be accompanied by initiation of appropriate or
empirical antimicrobial therapy to satisfy the
criterion.
Goals for infection
control and hospital
epidemiology
There are three principal goals for hospital
infection
control
and
prevention
programs:
1. Protect the patients
2. Protect the health care workers, visitors,
and others in the healthcare environment.
3. Accomplish the previous two goals in a
cost effective and cost efficient manner,
whenever possible.
Most Common
Types of
Nosocomial
Infections
• These are infections that develop during hospitalization
and are present in patients at the time of admission.
• Most Common Types of Nosocomial Infections:
1. Urinary tract infections.
2. Surgical wound infections.
3. Lower respiratory Tract infections (primarily
pneumonia).
4. Bloodstream infections (septicaemia)
Nabeel Al-Mawajdeh RN.MCS
Modes of Transmission of Infections
1. Contact:
- Direct e.g., hands of hospital personnel.
- Indirect e.g., using contaminated objects.
2. Contaminated vehicles used in common for patients
e.g., instruments, contaminated food, water, solutions,
drugs or blood products.
3. Airborne e.g., aerosol, droplets or dust.
4. Vector borne: e.g., mosquitoes.
5. Blood borne: inoculation injury or sexual transmission
e.g., HBV, HIV.
Patients Most Likely to Develop
Nosocomial Infections
1.
2.
3.
4.
5.
6.
Elderly patients.
Women in labor and delivery.
Premature infants and newborns.
Surgical and burn patients.
Diabetic and cancer patients.
Patients receiving treatment with steroids,
anticancer drugs, antilymphocyte serum, and
radiation.
Nabeel Al-Mawajdeh RN.MCS
Patients Most Likely to Develop
Nosocomial Infections (Cont’d)
7.
8.
Immunosupressed patients (I. e., patients whose
immune systems are not functioning properly)
Patients who are paralyzed or are undergoing renal
dialysis or catheterization; quite often, these
patient’s normal defence mechanisms are not
functioning properly)
Nabeel Al-Mawajdeh RN.MCS
Major Factors Contributing to
Nosocomial Infections
1.
2.
3.
4.
5.
An ever- increasing number of drug-resistant
pathogens.
Lack of awareness of routine infection control
measures.
Neglect of aseptic techniques and safety
precautions.
Lengthy complicated surgeries.
Overcrowding of hospitals.
Nabeel Al-Mawajdeh RN.MCS
Major Factors Contributing to
Nosocomial Infections (Cont’d)
6.
7.
8.
Shortage of hospital staff.
An increased number of Immunosupressed
patients.
The overuse and improper use of indwelling
medical devices.
Nabeel Al-Mawajdeh RN.MCS
Prevention of Nosocomial Infections
1.
Education of hospital staff in:
- Hygiene in theatre, wards, kitchen…etc.
- Good surgical techniques.
- Frequent handwashing.
2. Proper sterilization and disinfection.
3. Special precautions and isolation of infective
patients.
Nabeel Al-Mawajdeh RN.MCS
Prevention of Nosocomial Infections
(Cont’d)
4.
5.
6.
Protective precautions for high risk patients, e.g.,
Immunosupressed.
Conservative antibiotic use.
Surveillance of infections in the hospital by infection
control staff.
Nabeel Al-Mawajdeh RN.MCS
SOURCES:
1.Patients own flora - Endogenous (50%)
Auto-Infection
( Greatest source of potential danger)
2.Environment - Exogenous(15%)
(Air-5%; Instruments-10%)
3.Another Patient/Staff - Cross Infection (35%)
METHICILLIN
RESISTANT STAPH
AUREUS (MRSA)
Resistant to Flucoxacillin and
usually others
May cause Wound infection
Bacteraemia
Skin/soft tissue infection
U.T.I.
Pneumonia etc.
Colonisation common:
Nose Axilla Perineum
Wounds/Lesions
Spread By:
Hands
Fomites
Aerosols
Becoming more common in the Community
Control:
Eradication of carriage
Barrier nursing
Screening of other patients Staff
RESISTANT GRAM NEGATIVE
ORGANISMS
Resistance to multiple antibiotics
Organisms:
E .coli
Proteus
Enterobacter
Acinetobacter
Pseudomonas aeruginosa
Cause:
Bacteraemia
U.T.I.
Pneumonia
Wound infection
Control:
Antibiotic Policy
Control of Infection Guidelines
Prevention of Cross Infection especially on high
risk areas
GENERAL PRINCIPLES
Good general ward hygiene:
- No overcrowding
- Good ventilation
- Regular removal of dust
- Wound dressing early in day
- Disposable equipment
 HAND WASHING
most important Before and after patient contact
before invasive procedures
Hospitalism
Be are what physical, psychical, infectious
disorders of health of man, conditioned
the features of medical service.
Hospitalism
Physical
Accident
Psychical
Hospital
infection
Hospital cultures are
adapted
sporadic
Hospital cultures are
no adapted
endemic
epidemic
Intrhospital (nosocomial,
hospital) infection
•
any clinically recognized disease of
microbial etiology is related to the stay,
treatment, inspection or appeal of man for
medical help in hospital.
Exciters of intrahospital (nosocomial, hospital)
infections
– Staphylococcus,
streptococci, blue pear
stick, coli bacillus,
salmonella, enter bacteria,
enter cocas and other de
bane ease pathogenic
microorganisms.
– And also viruses of flu,
adenovirus, enter virus,
exciters of viral hepatitis
ESCHERICHIA COLI
Distribution of certain exciter in
development of infection can be related to
the type of medical establishment
• In permanent establishments
of general surgical type are
gram-negative bacteria, in
particular blue pear
• in urology separations is a
coli bacillus, enter cocas and
others like that.
ESCHERICHIA COLI
Distribution of certain exciter in
development of infection can be related to
the type of medical establishment
• Blue pear sticks prevail in
separations.
• in separations new-born find
staphylococcus, enter cocas.
STAPHYLOCOCCUS
AUREUS
Sources of infection:
•
•
•
•
•
•
patients
personnel
visitors
apparatus
instruments
linen et cetera
Patients can be infected pathogenic factors both from an
external environment and own in the case of hyposthenic
immunity
Ways of infection`s patients
• air-dust borne;
• - (through the articles of examination, linen,
medical instruments, apparatus, hands of
medical personnel);
• - (at introduction of medicinal preparations,
solutions and others like that);
• -alimentary (products, water and others like
that).
Ways of transfer of intrahospital
infections
PATIENT
Objects
materials
animals and others
like that
Personnel
visitors
patients
Except for control after the observance of sanitary-hygienic
requirements in relation to apartments, personal hygiene it is
necessary to conduct:
-
timely exposure and
sanation of
transmitters of
pathogenic
staphylococcus: one
time in a quarter
obligatory inspection
of employees on the
transmitter of
pathogenic
staphylococcus for
the medical staff of
surgical separations
and maternity
• - safety measures at AIDS and disease mode,
measures of infection;
• - observance of rules of asepsis and
antiseptic;
Prophylaxis of in-hospital infections
Technical
measures
Sanitary
disease
measures
Disinfection and
sterilization
IMMUNISATION
Emergency
Architectonically
plan measures
Specific prophylaxis
Planned
Un specific prophylaxis
Measures of architectural plan
A rational location of
separations is on floors
Isolation of sections,
chambers, operating
blocks but other
Observance of streams
sick, personnel
Zoning of territory
Technical measures
Ventilation:
(reveal, drawing, mixed, condition)
Sanitary disease measures
Sanitary
educational work
is among a
personnel and
patients
Control is after
the sanitary state
and mode of
permanent
establishments
An exposure of
transmitters is
among a
personnel and
patients
Control is after the bacterial semi nation of in-hospital
environment
Disinfection and sterilization measures
Tooling
Use
chemical facilities
Use
physical methods
д
Contact Precautions
PPE
Gown and gloves
Don upon entry to room
Remove and discard before leaving
the room
Perform hand hygiene after removal
• Environmental measures/patient care equipment
– Clean patient room daily using a hospital disinfectant, with attention
to frequently touched surfaces (bed rails, bedside tables, lavatory
surfaces, blood pressure cuff, equipment surfaces).
– Use dedicated equipment if possible (e.g., stethoscopes, bp cuffs)
Droplet Precautions
• Patient placement
– Single room or cohort with patients with same infection
– If neither is possible, ensure patients are separated by at least
3 ft (1 meter)
– Surgical mask on patient when outside of patient room
– Negative pressure or airborne isolation rooms not required
PPE
• surgical mask
• Don upon entry into room
• Eye protection (goggles or face
shield) if needed according to
standard precautions