Transcript Special Populations - International Federation of

Special Populations
1. Identify special populations and their
specific features
2. Describe specific risk factors of each special
population that make it vulnerable to
healthcare-associated infections
3. For any special population, outline
additional methods for the prevention of
healthcare-associated infections
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Learning objectives
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• 60 minutes
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Time involved
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• Geriatrics
• Paediatrics
• Burns
• Behavioural health
• Ambulatory/Community care
• Immunocompromised populations
• Endoscopy
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Special populations
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• Hand hygiene
• Standard precautions/routine
practices
• Isolation/precautions
• Staff education
• Aseptic techniques
• Vaccination
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Basic Infection Prevention and
Control (IP&C) Strategies
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• Susceptibility of the elderly to infection is a
result of
• underlying illness
• multiple medications
• alterations in immune function
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Geriatrics - 1
• Residents of nursing homes or long-term care
facilities are particularly at risk
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• Most frequent problems
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Respiratory tract infections
Urinary tract infections
Gastrointestinal infections
Skin and soft tissue infections
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Geriatrics - 2
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• Swallowing disorders or poor gag reflex
with aspiration
• Impaired mucociliary clearance
• Increased esophageal reflux
• Immobility
• Dehydration
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Geriatrics – Respiratory Risk
Factors
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• Chronic oedema
• Venous insufficiency
• Unrecognised trauma
• Diabetes mellitus
• Dry skin
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Geriatrics – Skin Risk Factors
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• A significant cause of morbidity,
particularly in institutionalised older
persons.
• Pathogens may be spread by ingestion
of microorganisms or toxins from
1. an infected person
2. contaminated food or water
3. contaminated objects in the
environment, or
4. infected animals
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Geriatrics – Diarrhoea Risk Factors
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Infection
Urinary tract infection
Bronchitis and pneumonia
Pressure ulcers
Diarrhoeal illnesses
Prevention
Adequate hydration
Good personal hygiene
Mobilisation
Avoid bladder catheters
Vaccination
Cohorting patients with respiratory illness
Limiting group activities and communal dining during
influenza outbreaks
Mobilisation
Adequate hydration
Mobilisation
Keeping the patient dry
Providing nutritional support
Using antipressure devices
Early implementation of cohorting or room closure
Reinforcement of environmental disinfection
Hand hygiene
Isolation precautions
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Preventing infections
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• Youth and immature immune systems
make children more susceptible to
infections
• Close contact with patients, siblings
and family, uncontrolled body fluids,
and play areas create unique
opportunities for the spread of
infection
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Paediatrics
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• Children at higher risk for infections
• those in intensive care
• patients with cancer
• solid organ transplant and haematopoietic cell
transplantation recipients
• neonates
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Paediatrics - Risks
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Infection/Risks
Communicable diseases
Breast milk and infant formula
Toys
Viral respiratory and
gastrointestinal illnesses
Prevention
Vaccinate according to national
guidelines
Mothers should be instructed on
hygienic methods
Proper cleaning and disinfection of
breast pumps
Frequent cleaning of toys and
environment
Avoid high-risk toys, such as
soft/stuffed toys, that are
difficult to clean and dry
Patients should be screened;
isolation/precautions initiated
while awaiting a diagnosis.
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Paediatrics – Prevention
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• Have a major impact on cellular and humeral
immune systems; predispose patients to
infection
• Burn causes mechanical disruption of the
skin; allows skin and environmental
microbes to invade deeper tissues
• As burn size increases, the risk of infection
increases
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Burns
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• Strict aseptic technique
• Use of sterile gloves and dressing materials
• Wearing masks for dressing changes
• Spatial separation of patients, either using
single rooms or cubicles
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Burns – Prevention- 1
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• Hand hygiene before and after patient contact
• Standard precautions/routine practices
• Protective apparel (aprons, gowns) before each
patient contact
• Changing gloves when soiled and before
continuing with care at another site on the
same patient
• Cleaning and disinfection of reusable
equipment before use on another patient
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Burns – Prevention - 2
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• Restrict plants and flowers at the bedside
• Restrict non-washable toys (stuffed animals,
cloth objects) for paediatric burn patients
• Place catheters through unburned skin or
frequent change of the catheter to decrease
risk of infection
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Burns – Prevention - 3
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• Isolate patients colonised with
multiply resistant microorganisms
in single rooms or cubicles
• Hydrotherapy
• used routinely in some facilities; has
been associated with outbreaks
• Some prefer to use local wound care
with sterile saline solution instead
• If hydrotherapy used, shower tables
are less risky than immersion
• Rinse the tanks or equipment with
sodium hypochlorite after each use
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Burns – Prevention - 4
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• Behavioural health care provides
prevention, intervention and treatment
services in these areas
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•
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Behavioural Health
Mental health,
Substance abuse
Development disabilities
Sexualities
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• Practice standard precautions/routine
practices
• Staff working with children vaccinated for
typical childhood illnesses
• Inpatient influenza and pneumococcal
immunisation program for adults; children
up-to-date on immunisations
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Behavioural Health Prevention - 1
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• Prevent mixing of patient clothing; special
consideration for clothing of patients with
incontinence, wound infections, or lesions, and
suspected or confirmed cases of scabies or lice
• Provide patients with a caddy or basket to keep
personal toiletry items if they share a
bathroom
• Disposable paper mats for individual shower
use; protect from transmission of athlete’s foot
(Tinea pedis)
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Behavioural Health Prevention - 2
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Lice and scabies procedures
• Identification of illness
• Monitoring for transmission
• Treatment (includes staff monitoring of the application
of treatment) and follow-up
• Housekeeping procedures
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Behavioural Health Prevention - 3
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• Provide disposable razors for shaving;
discard after use in an appropriate
sharps container
• If electric shavers provided, have a protocol
for cleaning and disinfecting the shaver after
use
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Behavioural Health Prevention - 4
• For electroconvulsive therapy
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Hand hygiene
Use of gloves
Cleaning and disinfection of equipment
Bite blocks and laryngoscope blades require
high-level disinfection
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• Provision of health care to patients who
do not remain overnight
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Physician’s surgeries
Clinics
Dental surgeries
Diagnostic treatment centres
Physical and occupational therapy centres
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Ambulatory/Community Care
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• Overall risk of HAIs lower in
ambulatory/community settings than in
hospitals
• Visits are brief, environmental contamination
lower, less invasive procedures performed,
and population healthier
• Risks: waiting areas, procedures
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Ambulatory/Community Care
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Infection/Risks
Respiratory illness
Communicable diseases
(tuberculosis, chickenpox,
measles, mumps, rubella,
bacterial meningitis)
Toys
Instruments
Prevention
Respiratory hygiene /
respiratory etiquette
Wear a surgical mask and place
in a separate room with the
door closed
Limit sharing
Easily cleanable
Clean, disinfect/sterilise
properly; use of safer devices
to reduce the risk of needlestick injuries
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Ambulatory/Community Care
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Severe neutropenia of treatment regimens and
certain underlying diseases, and invasive
devices and procedures, result in a high
frequency of infection in these patients
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Immunocompromised
Populations - 1
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Four broad categories of risk factors:
1. Neutropenia (granulocytopenia)
2. Immune system defects
3. Destruction of protective barriers, e.g., skin
and mucous membranes
4. Environmental contamination/alteration of
microbial flora
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Immunocompromised
Populations - 2
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• Ventilation
• Construction/renovation
• Equipment
• Plants
• Play areas and toys
• Health-care workers
• Visitors
• Skin and oral care
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Immunocompromised
Populations - Risks
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Patient-focused
• Good oral and dental hygiene important
• oral cavity a reservoir for microorganisms
• severe mucositis predisposes the spread of
microorganisms into the bloodstream
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Immunocompromised
Populations – Prevention - 1
• Patients and family members, as well as
healthcare workers, should be taught the
importance of hand hygiene
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Staff-visitor-focused
• Screening programs for communicable infections,
especially during the appropriate “seasons” for
certain illnesses
• Restrict from direct patient care activities all
healthcare workers with communicable infections
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Immunocompromised
Populations – Prevention - 2
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• Environment-focused
• Isolation/precautions techniques are debateable; there
are insufficient data to recommend the use of additional
protective precautions
• Prevent dust accumulation with daily cleaning of
frequently touched horizontal surfaces
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Immunocompromised
Populations – Prevention - 3
• Avoid cleaning methods that generate dust
• Close doors to patient rooms while any vacuuming takes
place nearby
• Exclude plants and flowers
• Clean toys regularly and when visibly soiled or mouthed
• Avoid toys that cannot be washed or disinfected after use
• Immunocompromised patients should avoid construction
or renovation areas
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• Risks due to the complexity of the
instruments
• Microorganisms contaminating the
equipment might be introduced into the
patient, or patient’s own microorganisms
may be spread by the endoscope (rare)
• Outbreaks have been caused by
• inadequate cleaning/disinfection of endoscopes
or accessories between patients
• contaminated water rinses or contaminated
automatic endoscope reprocessors
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Endoscopy
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• Internal channels for air, water, aspiration,
and accessories exposed to body fluids and
other contaminants
• Cleaning is critical
• Six steps for re-processing:
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Cleaning
Rinsing
Disinfection
Rinsing
Drying
Storage
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Endoscopes
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• Set-up
• Endoscopic procedure room designated as clean areas
• Separate contaminated areas where accessories and
specimens are handled from clean counter areas
• Cleaning
• Manual cleaning important; include brushing, using a medical
grade, low-foaming, and neutral pH detergent
• Use automatic disinfection, rinsing, and drying of all exposed
surfaces of the endoscope, when available. Water for
automatic endoscope reprocessors should be free from
particles and microorganisms.
• Isopropyl alcohol for flushing endoscope channels as part of
the drying process
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Endoscopy Protocols - 1
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• Use single-use accessories when possible
• Discard rubber valves covering the working
channel after procedures involving the
passage of biopsy forceps, guidewires,
and/or other accessories
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Endoscopy Protocols - 2
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• Basic infection prevention strategies
apply, regardless of patient type or setting
• Additional strategies may be required for
special populations
• Strategies designed for hospitals may
need adapting for other health care
settings
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Key Points
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1. Geriatrics: SHEA/APIC Guideline: Infection prevention
and control in the long-term care facility, 2008.
http://www.apic.org/Content/NavigationMenu/Practice
Guidance/APIC-SHEA_Guideline.pdf
2. Endoscopes: Multisociety guideline on reprocessing
flexible gastrointestinal endoscopes: 2011.
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Additional Reading - 1
http://www.asge.org/uploadedFiles/Publications_and_Produ
cts/Practice_Guidelines/Multisociety%20guideline%20on%20
reprocessing%20flexible%20gastrointestinal.pdf and WGO-
OMGE and OMED Practice Guideline: Endoscope
Disinfection, 2005.
http://www.omed.org/downloads/pdf/guidelines/wgo_
omed_endoscope_disinfection.pdf
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1. Burns: European Practice Guidelines for Burn Care,
2002.
http://www.euroburn.org/e107_files/downloads/guidel
inesburncare.pdf
2. Ambulatory care: Infection Control Manual for
Ambulatory Care Clinics, Texas Department of State
Health Services, 2009.
http://www.dshs.state.tx.us/idcu/health/infection_cont
rol/manual/InfectionControlManual.pdf
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Additional Reading - 2
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1. Immunocompromised: Guidelines for Preventing
Infectious Complications among Hematopoietic Cell
Transplantation Recipients: A Global Perspective. Biol
Blood Marrow Transplant 15: 1143-1238 (2009).
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Additional Reading - 3
http://www.sheaonline.org/Assets/files/guidelines/2009_HSCT_Guideline.pdf
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1.
2.
Mobilisation of older patient is important measure in
prevention of urinary tract and respiratory tract infections
and pressure ulcers. T/F
Specific measures for prevention of burn wound infections
include:
a)
b)
c)
d)
3.
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Quiz
Hand hygiene before and after patient contact
Frequent change of vascular catheters in some circumstances
Disinfection of hydrotherapy tanks with sodium hypochlorite
solution
All of the above
Destruction of protective skin barriers is a risk factor for
highly immunocompromised patients. T/F
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• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
December 1, 2013
International Federation of
Infection Control
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