Transcript Hospital waste and Health care facilities based infections

Health care facilities
based infections
Dr. Ardini S Raksanagara,dr.,MPH.
Public Health Department
Faculty of Medicine
SPECIFIC LEARNING
OBJECTIVES
The student will be able :
 to illustrate safety hazards in the health care
facilities (C3)
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Define the nosocomial infections
Describe the source of Nosocomial infections
Describe the transmission of Nosocomial infections
Describe the standards precaution in infection control
practices
 Describe the additional precaution in infection control
practices
 To explain that health care workers are at risk of
acquiring infection through occupational exposure
Sub topics :
Health and Safety Hazards in the Health
Care Facilities
 Definition
 Source
 Transmission
 Precaution in infection control practices
 Care of health care workers
References
 Depkes RI: Pedoman Pengendalian
Nosokomial di Rumah Sakit,2001
 Bennet,Brachman ed., Hospital
Infections,Little Brown,1992
 WHO, Practical guidelines for infection
control in health care facilities, 2003
 Human diseases caused by work
associated exposure to microbial agents
are called occupational infections
 Exposure occurs among health care
workers in hospitals and laboratories
 Occupational infection can occur
following contact with infected persons,
as in the case of health care workers
 Infected with human tissue, secretion or
excretion
 US : more than 10 % of workers are health
care workers
 Hazards facing health care include :
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Biological hazards – contact with infectious agent
Chemical hazards
Physical hazards
Safety and ergonomic hazards
Violence
Psychosocial and organizational factors : stress,
shift work
Health care and clinical laboratory
 Increased risk of infection by organism whose
natural hosts are humans, as in the case of
hepatitis, rubella, AIDS, TBC and
staphylococcal disease
 Some infections may be transmitted through
close personal contact with infected patients
 Direct contact with the organism in culture or in
human tissue
Hazards in Health Care
Hazards
Example
Biological
Viral ( hepatitis B, C), HIV, AIDS
Bacteria : M. TBC
Chemical
Ethylene oxide, Formaldehyde,
Antineoplastic drugs, Waste anesthetic gases
Mercury
Physical
Patient handling, static postures
Ionizing radiation, Lasers
Psychosocial
Violence threat, restructuring, work stress
Shift work
1. Definition Nosocomial
Nosocomial infections :
 Are infections that develop within a
hospital , or
 Are produced by microorganism acquired
during hospitalization
The risk of nosocomial
infections
 Hospitalized patients
 Workers involved in their care
 The risk of infection :
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Renal dialysis
Laboratories
Nursing home
Institution for retarded
prisons
Nosocomial infections :
 May involve not only patients but also anyone
else who has contact with a hospital, including
;
- members of staff
- volunteers
- visitors
- workers
- salesperson
- delivery person
 The majority of nosocomial infections become
clinically apparent while the patients are still
hospitalized;
 However, the onset of disease can occur after
patient has been discharged
 Hepatitis B is an example of nosocomial
disease with a long incubation period; its
clinically onset usually occurs long after the
patient is discharged from the hospital
Type of nosocomial
diseases
1. Preventable infection
hand washing can prevent infection gram
negative organism from the urinary
collection
+ 30 %
2. Nonpreventable infection
is one that will occur despite all possible
precaution
exp. Infection in an immunosuppresed
patient due to his or her own flora
2. Source
Organism that cause nosocomial infections
come from
 Endogenous (Autogenous)
 Exogenous
1. Endogenous infections
 Are caused by the patient’s own flora
 Organism are brought into the hospital by
a patient
2. Exogenous infections
 Result from transmission of organism
from a source other than patient
The characteristic of a nosocomial disease
1
Sporadic
That cases occur occasionally an irregularly,
without any specific patterns
2
Endemic
the disease occurs with ongoing frequency in a
specific geographic area in a finite population
and over a defined time period
3
Hyperendemic
The disease refers to what appears to be a
gradual increase in the occurrence of a disease
in a defined area beyond the expected number
of cases
4
Epidemic
Is a definite increase in the incidence of a
disease above its expected endemic occurrence
5
Outbreak
Is used interchangeably with epidemic
- An increased rate occurrence but not at levels
as serious as an epidemic
3. Transmission
CHAIN OF INFECTION
 Infections results from the interaction between
an infection agent and a susceptible host
 This interaction called transmission
 means contact between the agent and
host
 The chain reaction
 three interrelated factors
The agent
Transmission
The host
Agents
 The majority of nosocomial infection
problems caused by bacteria and viruses
Transmission
 Describes the movement of organism
from the source to the house
Types of transmission
1. Contact spread disease
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1. direct contact
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2. indirect contact
2. Common-vehicle spread
3. Air borne spread
4. Vector borne spread
HOST
 The third link in the chain of infections
 Disease does not always follow the
transmission of infection agents to a host
 Various agent factors
 A variety of host factors
 Host factors that influence the development
of infections are
 The site of deposition of the agent
 The host defense mechanism
Entrance (port d’ entry)
 Sites of deposition
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Skin
Mucous membrane
Respiratory
Gastrointestestinal
Urinary Tract
Entrance (port d’ entry)
NO
Entrance
1
Skin
Disease/Agent
Leptospirosis, Staphylococcus,
HIV, Hepatitis B,
Pseudomonas Aeroginosa
2
Respiratory tract
Tuberculosis
3
Intestinal Tract
E. Coli, Shigella, Staphylococci
4
Placenta
Rubella, Toxoplasmosis
5
Urinary Tract
Cytomegalovirus (renal
transplantation)
4. Precaution in infection
control practices
Infection control practices (WHO) :
 Purpose : to provide comprehensive
information to health care workers in the
prevention and control of transmissible
infections
 Objective : to provide administrator and health
care workers with the tools to enable them to
implement the infection control program
effectively in order to protect themselves and
others from the transmission of infections
Infection Control Program :
 For reducing the risk of health care
associated or nosocomial infections
 Risk prevention program for patients and
staff
Infections Control
Practices
Infection control practices can be grouped
in two categories
1. Standard precaution
2. Additional (transmission based)
precaution
Standard precautions
 Require that health care workers assume that
the blood and body substances all patients are
potential sources of infection,
regardless of the diagnosis, or presumed
infectious status
Additional precaution
 Are needed for disease transmitted by air,
droplets and contact.
Standard precautions
Treating all patients in the health care
facility with the same basic level of
standard precautions involves work
practices that are essential to provide a
high level of protection to patients, health
care workers and visitors
Standard precautions
These include the following :
1. Hand washing and antiseptic (hand hygiene)
2. Use of personal protective equipment when handling
blood, body substances, excretions and secretions
3. Appropriate handling of patient care equipment and
soiled linen
4. Prevention of needle stick/sharp injuries
5. Environmental cleaning and spills management
6. Appropriate handling of waste
Additional (Transmission
Based) Precautions
 Are taken while still ensuring standard
precautions are maintained
 Additional precautions include :
 1. airborne precautions
 2. droplet precautions
 3. contact precautions
Disease which are transmitted by this route
airborne
TB, measles, chicken pox, pulmonary
Precautions plaque
(droplet <5
micron)
droplet
Pneumonias, pertusis, diphteria, influenza
Precautions type B, mumps, meningitis
(droplet >5
micron)
contact
Infection with multiple antibiotic resistant
precautions organism, enteric infections, skin
infections
Exp.
- Place patient in a single room
- Wear protective equipment : mask,
gloves, gown
5. Care of health care
workers
 Health care workers are at risk of acquiring
infection through occupational exposure
 Hospital employees  transmit infections to
patients and other employee
 Immunization recommended for staff
- hepatitis A and B - rubella
- influenza
- tetanus
- measles
- diphteria
Occupational pulmonary
Tuberculosis
 Common occupational infection resulting from
repeated close contact with infected patients
 Staff laboratory  100 and 200 times more
likely than general public to develop TBC
 Health care workers in TBC treatment centers,
in laboratory and in veterinary clinics are
particularly affected
TBC
 Is caused by Mycobacterium tuberculosis
 Is transmitted occupationally by droplet
infection, contact with infected material
from humans (sputum) or animals
 Infectious patients disseminate the
organism when coughing, sneezing,
talking
 Tubercle bacilli may be presents in
 Gastric fluid
 Cerebrospinal fluid
 Urine
 Sputum
 Tissue specimens active lessions
Control and prevention
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Pre placement examination
Test tuberculin
Vaccinated with BCG if tuberculin test –
Periodic X-ray
Health education
Proper disposal of infected material
should be observed
Viral Hepatitis B and C
 The most frequently occurring work related
infectious disease in US
 Health care workers at great risk of infection 
contact with blood and body fluids of infected
persons
 The disease may pass into chronic active
hepatitis : liver cirrhosis, hepatic failure and liver
carcinoma
 Exposure to patients’ body fluids via
contaminated glassware and other contaminated
equipment exp. Needles
 Potential risk procedure : phlebotomy, dentistry,
 The route of transmission for Hepatitis B is
through body substances :
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Blood and blood product
Saliva
Cerebrospinal fluid
Peritoneal
Pleural fluid
Pericardial fluid
Synovial fluid
Amniotic fluid
Semen
Vaginal secretion
Other body fluid containing blood
 Prevention  hepatitis B immunization
Prevention of Hep.B Infection
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High risk  screened for HBs Ag
Immunization  Hepatitis B vaccine
Employee education
Appropriate sterilization and disinfection
procedure
 Reusable equipment should be autoclaved
 Disposable material should be disposed of in appropriate
containers
 Use protective clothing and gloves
 Minimize the contact with patient
Hepatitis A
 Is a risk for health care institution for the
retarded where personal hygiene is poor
 Virus is mainly transmitted by the fecal
oral route
 Careful hand washing by health care
personnel is the most important measure
for preventing
Exposure To Human
Immunodeficiency virus
(HIV)
 The route of transmission for HIV is person to
person via sexual contact, sharing of needles
contaminated with HIV, infusions that are
contaminated with HIV, transplantation of
organs or tissues that are infected with HIV.
 Risk reduction  standard precautions using
personal protective equipment, appropriate use
of safety devices, a needle disposal system
 Health care workers are at risk of
acquiring HIV via exposure to patients
infected blood or body fluid
 The greatest risk to medical personnel is
percutaneous exposure  needle stick
injury
Prevention
 Avoid contact with potentially infected blood, plasma or
secretion
 Hands or skin should be washed immediately and
carefully if blood contact occurs
 Mucous membrane, including the eyes and mouth
should be protected
 Contaminated surfaces should be disinfected with 5 %
sodium hypochlorite.
 Aseptic technique and sterilization
 Health education concerning transmission of blood
borne infections
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Sharp injuries
Meningococcal meningitis
SARS
Varicella, Influenza, Pertusiss, Diphteria,
Rabies