Infection Control - Women`s and Children`s Hospital
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Transcript Infection Control - Women`s and Children`s Hospital
Paediatric Infection Control
Jodie Burr
Infection Control Coordinator
Women’s and Children’s Hospital
Primary Role of Infection
Control
Prevent nosocomial infections
Reduce mortality, morbidity, and cost
Educate and advise
staff
patients
their
families
the community
Surveillance of nosocomial infections
Policy development, implementation and
assessment
IC Issues specific to
Paediatrics
Communicable diseases affect a higher
% of paediatric patients than adults
Developmental
immunity (increased
susceptibility) - acquire – spread
IC Issues specific to
Paediatrics
Paediatric personnel are at a greater
risk for exposure to communicable
diseases - immune status
Type
and amount of physical contact (eg
feeding, diapering)
IC Issues specific to
Paediatrics
May lack the mental / physical ability
to adhere to IC principles
lack
of hygiene
unable to understand / comply with IC
principles
IC Issues specific to
Paediatrics
More likely to have contact with
contaminated environmental surfaces
and objects
IC Issues specific to
Paediatrics
Parents and siblings
may
have the same infectious agent
involved in patient care – education
about transmission and IC principles
IC Issues specific to
Paediatrics
Types of pathogens and sites of
nosocomial infection differ from
adults.
Most common nosocomial infections
(paediatrics):
Viral infections of the upper respiratory tract
Viral infections of the gastrointestinal tract
Most common nosocomial infections
(adults):
UTI
IC Issues specific to
Paediatrics
Neonatal and ICU
Bacteraemias are the most common source
of nosocomial infection
Adult ICU
The lower respiratory tract is the
most common source of nosocomial
infection
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine,
2002, 19 (9):414-424
Incidence of Nosocomial
Infection
Incidence varies by age and hospital
unit:
Range: 0.2% - 23.5%
Paediatric ICU
Haematology Unit
Neonatal Unit
General Paediatric Unit
23.5%
8.2%
7.0%
1.0%
Highest in children aged 23 months or
younger
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19
(9):414-424
Additional Length of Stay
Duration of hospitalisation is longer for
children with nosocomial infections
Paediatric ICU
General Paediatric Units
26.1 days vs 10.6 days
9.2 days vs 3.5 days
Attributable cost of infection $13,000
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):414-424
Spread of Infection
Sources of infections
The host’s own (endogenous) flora
The hand’s of health care workers
Inanimate objects (fomites)
After being exposed to an infectious
agent:
Some people already have immunity and
therefore don’t develop an infection
Some people become asymptomatic carriers
Other people develop clinical disease (ie
infection)
Spread of Infection
The Susceptible Host
Varies with age
Underlying medical conditions
Nutritional status
Drug therapy
Trauma
Surgical procedures
Invasive or indwelling devices
Therapeutic and diagnostic procedures
Spread of Infection
3 main routes of transmission
Contact
Direct / Indirect
Most frequent means of transmission
Droplet
Generated during coughing, sneezing,
talking and during certain procedures
such as suctioning
Airborne
Generated by coughing, sneezing, OR by
mechanical respiratory aerosolisers, OR
by air currents
Standard Precautions
Apply to:
Blood
Non-intact skin
Mucus membranes
All body fluids (including sweat)
Regardless of whether there is
visible blood or body fluids
Hand Hygiene
The single most effective method in
the prevention of disease transmission
Healthcare workers think they wash
their hands more than what they do
80 % hospital acquired infections are
thought to be transmitted by hands
Hand Hygiene
Soap and Water
mechanical removal of most transient flora
and soil
minimal microbial kill
no sustained activity
15 seconds
Hand Hygiene
Antimicrobial Soaps
removes soil, removes transient and reduces
resident flora
may have sustained activity
15 seconds (antiseptic handwash)
60 seconds (clinical handwash)
2 minutes (surgical scrub)
Hand Hygiene
Alcohol Handrubs / Gels
very rapid kill
destroys transient and reduces resident
flora
no residual activity (except with antiseptic)
will not remove or denature soiling
15 seconds
Personal Protective
Equipment
Eye and/or facial protection (glasses,
goggles, face shields)
Gloves
Gowns
Masks
Assess the likely hood of contamination
and prepare accordingly
Assessment of Risk Factors
Your knowledge or experience with the
situation or procedure
The likely hood of exposure to blood or
body fluids at the time
The patients ability to cooperate
through out the procedure
Additional Precautions
May include:
Single room accommodation (ensuite for
some)
Special ventilation (negative, positive
pressure)
Special room cleaning
Dedicated patient equipment
Rostering of immune staff
Extended sterilization (or use of disposable
equipment)
Cohorting may be considered
Comparison of 20th Century Annual
Morbidity and Current Morbidity,
Vaccine-Preventable Diseases
20th Century
Annual Morbidity
Smallpox
2000*
Percent
Decrease
48,164
0
100
Diphtheria
175,885
4
99.99
Measles
503,282
81
99.98
Mumps
152,209
323
99.80
Pertussis
147,271
6,755
95.40
Polio (paralytic)
16,316
0
100
Rubella
47,745
152
99.70
823
7
99.10
1,314
26
98.00
20,000
167
99.10
Congenital Rubella Syndrome
Tetanus
H. influenzae,
type b and unknown (<5 yrs)
* Provisional Data
safer healthier people
TM
TM
Multi-resistant organisms
(MRO)
MRSA:
Methicillin resistant Staphylococcus aureus
VISA:
Vancomycin intermediate Staphylococcus aureus
VRSA:
Vancomycin resistant Staphylococcus aureus
VRE:
vancomycin resistant enterococci
ESBL:
Extended spectrum beta-lactamase
MRGN:
Multi-resistant gram negative
MRPA:
Multi-resistant Pseudomonas aeruginosa
MRAB:
Multi-resistant Acinetobacter baumanii
Multi-resistant organisms
(MRO)
Difficult to treat and control
Have the ability to cause infections,
particularly in susceptible people
Have the ability to cause wound
infections, bacteraemias and IV line
sepsis
Can cause significant morbidity and
mortality
Increased community awareness and
expectations
Factors that contribute to
the acquisition of MROs
Staff
- inadequate handwashing
Environmental
Prolonged
treatment
Close
- inadequate cleaning
or inappropriate antibiotic
proximity to a MRO patient
Extended
hospital stay
Co-morbidities
ICU
/ Burns Unit
Respiratory Syncitial Virus
Highly contagious and nosocomial
infection common
Causes upper and lower respiratory
infection
Usually occurs during winter
No vaccine at present
Can be re-infected during the same
season
Transmitted by contact or droplet
Can survive for several hours in the
environment
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
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Jan
Feb
Mar
Apr
May
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Nov
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Jan
Feb
Mar
Apr
May
Jun
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Aug
Sep
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Nov
Dec
Jan
Feb
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Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Respiratory Syncitial Virus
200
180
160
140
120
100
80
60
40
20
0
1998
1999
2000
2001
2002
2003
2004
Rotavirus
Highly contagious and nosocomial
infection is common
Usually a winter disease but pattern
changing
Onset is sudden and lasts for 4 - 6 days
Mainly infants and children up to 3 years
affected
Transmitted usually through contact
Can survive in environment for several
hours
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
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May
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Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Rotavirus
100
90
80
70
60
50
40
30
20
10
0
1998
1999
2000
2001
2002
2003
2004
Pertussis
Bacterial infection caused by Bordetella
pertussis
Most dangerous to under 3 year olds
Contagious for 3 weeks or for 5 days
after commencing erythromycin
Transmitted by contact and droplet
Symptoms - runny nose, cough, which
may develop into a whooping cough
High particulate mask when in contact
with patient
Pertussis
Meningococcal Disease
Bacterial infection caused by Neisseria
meningitidis
Transmitted by contact or droplet
Non infectious after 24 hours of
appropriate antibiotic therapy
Significant contacts traced and may be
given prophylaxis
Meningococcal Disease
Measles
Complications more common and severe
in chronically ill and very young children
Transmitted by droplet and contact
with respiratory secretions
Infectious for 4 days before and after
rash
Vaccination available
Notifiable disease
Measles
Rubella
In early pregnancy risk of teratogenic
damage to fetus
Infectious for 7 days before and 7 - 15
days after onset of rash
Infants with congenital rubella may shed
virus for several months or years
Transmitted by droplet route
Vaccination available
Notifiable disease
Rubella
Varicella Zoster Virus
Chicken Pox
Highly contagious
Most cases in children, over 90% of
adult population is immune
Transmitted by droplet and contact
Infectious 2 days prior and 4 - 6 days
after rash
Now a notifiable disease
Vaccination now available
Varicella or Chicken-pox
Congenital varicella
Caused by maternal varicella in early
pregnancy (ie <20 weeks)
Risk of acquiring congenital varicella
syndrome is 1 - 2%
Range and severity of symptoms vary
greatly depending on when maternal
varicella infection occurred
intrauterine
growth retardation, skin
abnormalities, incomplete development of
fingers/toes. Brain degeneration, nervous
system damage, eye abnormalities
Congenital varicella
Parvovirus B19
Usually a mild rash disease
Also called Fifth Disease or “Slapped Cheek”
Infectious prior to the rash
Transmitted by droplet route
Parvovirus B19