Transcript cleaning maintenance company business professionals cleanliness

Prevention of healthcare
associated infections
Sunil Esampalli
MRCPCH, UK
Overview
 Hospital acquired infections
 study
 Professional dressing
 Recommendations
Healthcare associated Infections
 Nosocomial infections
 Hospital acquired infections
 8.7% ( 14 countries, 55 hospitals- 1987)1
 Health-care associated infection in Africa: a systemic review
by WHO- 20112
- Prevalence 14.8% (2.5-14.8%)
- Average European prevalence -7.1%
- In Uganda- ?
Ugandan data
 Lacor hospital, Gulu, Uganda – In 2011: prevalence of 28%
(47% in surgical and 21% in paediatrics)
 Mulago hospital – MRSA from surgical wounds, 28.7% of all
samples grew staphylococcal aureus and 31.5% of them
were MRSA5.
 In Kisiizi (unpublished data)- 60% of surgical wounds grew
staph aureus. No access to MRSA testing (oxacillin agar
screen).
Why should we be worried ?
 Increases length of stay
 Increases morbidity
 Increases mortality
 1.7 million HAI, 90000 deaths – in US 20023
 Financial burden
 Increased mortality in children staying >5 days
 “first do no harm” or, Latin phrase, “primum non nocere1860
Common HAI’s
 Surgical wound sites
 Surgical drains
 Central venous catheters
 IV Cannula sites
 Urinary catheters
Common organisms
 Staphylococcus epidermidis
 Staphylococcus aureus – often MRSA
 Enterobacter species
 Pseudomonas
Often these are resistant to commonly used antibiotics
Common means of transmission
 Medical equipment
Do we need to clean our medical
equipment?
 Stethoscopes
 Pulse oximeter probes
 Cannula ports when accessing
 Dangling drip ends
???????
Medical equipment cleanliness
 10 different commonly used equipment in paediatric ward
 Swabs were taken and cultured
Equipment
Organism 1
Organism 2
Stethoscope 1
Staph epidermidis
Stethoscope 2
Staph epidermidis
Stethoscope 3
Neiserria catarrhalis
MUAC tape
Staph epidermidis
coliform
Pulseox probe 1
Pseudomonas sps
Bacteroides sps
Pulseox probe 2
Staph epidermidis
Pulseox probe 3
Staph epidermidis
Knee hammer
Staph aureus
BP cuff
Staph epidermidis
Thermometer
Staph aureus
Is locally made alcohol
based hand rub effective
?
Re-swabbed after cleaning with alcohol rub
Is alcohol based rub effective?
Equipment
Organism 1
Organism 2
Alcohol rub
Stethoscope 1
Staph epidermidis
Stethoscope 2
Staph epidermidis
No growth
Stethoscope 3
Neiserria catarrhalis
No growth
MUAC tape
Staph epidermidis
coliform
No growth
Pulseox probe 1
Pseudomonas sps
Bacteroides sps
No growth
Pulseox probe 2
Staph epidermidis
No growth
Pulseox probe 3
Staph epidermidis
No growth
Knee hammer
Staph aureus
No growth
BP cuff
Staph epidermidis
No growth
Thermometer
Staph aureus
No growth
No growth
100 %
effective
KISIIZI ALCOHOL HAND RUB FORMULAR FOR 20LITRES (WHO
Formula I)
Method of Preparation
•Ensure cleaning of the 20 Liter ‘jerrycan’- Final container, and all the
measuring cylinders and beakers has been done properly before
production begins
•Measure 145mL of Glycerol and pour into the final container
•Measure 417 ml of 6% Hydrogen peroxide using the same cylinder you
used to measure the glycerol so that it help rinse out all the glycerol
since it is slightly viscous and pour into the final container.
•Measure 16000mL of absolute Alcohol and power into the Final
container
•Top up to 20000mL with freshly distilled water
•Label and allow to sit for 72 hours before use.
Ingredients
Quantities
1.
Alcohol 95.5 % (absolute) 80%
16000mL
1.
Glycerol 98%w/w 0.725%
145mL
1.
Hydrogen Peroxide 6%v/v (0.125%)
417mL
1.
Distilled Water (fresh) to
20000mL
ABH cost- WHO survey4 2011
 Clean Care is Safer Care- 2005
 Thirty-nine sites from 29 countries (79% LIC and MIC)
included in the final data analysis
 Commercially produced ABH – 2.5 to 8.5USD / 100mls
dispenser
 Locally produced ABH- 1.6 to 2.2 USD / 100mls including
dispenser and salaries
White coat
Professional dress (Am J Med 2005)
 Study done in 2005 in US.
 76.3% favoured professional attire- white coat
 Scrubs 10.2%
 Business dress 8.8%
 Casual dress 4.7%
African study
 The potential for nosocomial infection transmission by
white coats used by physicians in Nigeria: implications
for improved patient-safety initiatives.
 Uneke CJ1, Ijeoma PA.
 Swabs taken from cuffs and pockets
 91.3% of coats had bacterial contamination
 Staphylococcus aureus, Gram negative bacteria and
dipheroids
Practice in the UK
 White coats
 Ties
 Long sleeves
 Watches
 bracelets
Banned
 Bare below elbow policy since 2008
 Cleaning equipment after every patient contact
 Strict hand hygiene- hand washing, alcohol rub
Practice in the US
 Society of healthcare epidemiology of America (SHEA) Recommendations
 A bare below elbow policy
 Hanging white coat prior to contact patient contact
 Cleaning stethoscopes and other medical equipment before
seeing next patient.
 Daily laundering of clothes that touch patients
Recommendations
 Use alcohol rub
 Wash with soap + water -contact with body fluids
 Bare-below-the-elbow in all clinical settings
 No wrist watches/ jewellery/ bracelets- except for wedding
rings
 White coat – wash everyday or don’t use it
 A nation wide HAI data collection is needed
References
1.
2.
3.
4.
5.
6.
Tikhomirov E. WHO programme for the control of hospital
infections. Chemioterapia. June 1987. 6(3):148-51
Health-care associated infection in Africa: a systemic review by WHO2011
Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcareassociated infections in US hospitals, 2002. Public Health Rep. Mar
2007. 122(2):160-6.
Local production of WHO-recommended alcohol-based handrubs: feasibility,
advantages, barriers and costs -Joanna Bauer-Savage , Didier Pittet , EunMi
Kim & Benedetta Allegranzi
Prevalence of Methicillin resistant Staphylococcus aureus (MRSA) among
isolates from surgical site infections in Mulago hospital- Kampala, Uganda. J
Ojulong, T Mwambu, M Jolobo, E Agwu, F Bwanga, C Najjuka, D KadduMulindwa
Summary
 HAI- cause increased morbidity/ mortality/ financial burden to
patients and hospitals
 Patient safety is our priority
 Please don’t hesitate to tell your colleague to wash hands/
alcohol rub.
 Its everyone's responsibility
THANK YOU
ALL
UPA & RCPCH !!