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Why is it Important?
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ICU account for 10% of total Hosp. beds. ICU population uses a significant percentage of total hospital health care resources. Incidence of Nosocomial infections in ICUs is 5-10 times higher than Gen. wds.
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Nosocomial infections are 1. Resistant to commonly used Ab. 2. Multidrugs resistant. Morbidity, Mortality, ICU stay, Cost.
NOSOCOMIAL INFECTIONS
(Hospital Associated Infections)
An infection acquired in a patient in a hospital or other healthcare facility in whom it was not present or incubating at the time of admission.
The normal host defense mechanisms of these critically ill ICU pts are often
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Disrupted by devices (Central lines/U. cath./ETT) Impaired by - Underlying Disease - Result of medical intervention. (H 2 blockers)
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Urgent & Frequent nature of pts needs. Infection control practices compromised. Multiple Health care teams.
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INFECTION CONTROL
Studies shows Nosocomical infections are preventable between 30 80% by proper pt care practices. Definition (Hospital Infection Control Manual 2005) SERIES OF PROCEDURES AND GUIDELINES TO PREVENT HOSPITAL ASSOCIATED (NOSOCOMIAL) INFECTIONS.
Effective programs are usually base on cooperation of many different Health Care Teams.
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Design & layout of ICU. Hand washing and aseptic precautions. Environment cleaning. Cleaning; Disinfection and Sterilization of Equipments / Furniture. Unit discipline. Waste disposal.
Quick and unimpaired access to patients. Source isolation, protective isolation or both. Facilities for hand washing and drying available at each bed. An 8 bed unit, with 2 divisions Each having 3 beds and isolation room (single bed) Adequate space between beds (3m between bed centers) Mechanical ventilation is desirable. Turnover of air (10/20 air changes/hr) keep airborne bact.
Isolation
Space
Ventilation
The finger nail area is associated with a major portion of the Hand Flora. The subungual are (under the finger nails) often harbour high No. of Micro-organisms.
Usually not implicated in Nosocomial infections Can cause minor skin infections Some can cause infections
After invasive procedures Sever immunocompromised Implantable device (Heart valve, Art. HJ)
These are not constantly isolated from most HCW But more frequently implicate as the source of HAIs Most common are
Staphylococcus aureus
Hand washing
Hand washing with plain soap is effective in removing most of transient microbial flora
The component of good hand washing
Using an adequate amount of soap/antiseptic agent Rubbing the hands together 15 sec
Rinsing under running water. Pat dry hands with paper towel or single use clothe towel ? Air dryers Good/ Bad
Hand washing
Purpose of hand washing
To Remove
Soil Organic material
Transient micro-organisms
Hand washing
Soap
Liquid soap is better than bar soap If only bar soap is available
Provide as small pieces just adequate for the day Place on a rack no water is retained
Antiseptic Products
2 - 4% Chlorhexidine gluconate (Good residual activity) 7.5% Povidone iodine
Hand washing
Waterless Hand rubs
Several studies have demonstrated superior efficacy over soap/Chlorhexidine hand wash. Time After Disinfection log 0 6 180 minutes 3.0 0 2.0 Alcohol-based handrub (70% Isopropanol) Antimicrobial soap (4% Chlorhexidine) Baseline Plain soap
% 99.9
Bacterial Reduction
99.0
90.0
1.0
0.0
0.0
Hand washing
Waterless Hand rubs
Advantages
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Disadvantages
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May cause drying of the skin Addition of emollients Odour may be irritant Use with dry hands
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Efficacy by dilution with water Activity may when use with soiled hands. Eg blood
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Hand washing
Recommendations on Hand Washing
Hands must be washed 1. Between direct contact with individual patients 2. Before performing invasive procedures 3. Before preparing, handling, serving or eating food, and before feeding a patient 4. When hands are visibly soiled 5. After situations or procedures in which microbial or blood contamination of hands is likely 6. Before wearing and after removing gloves 7. After personal body functions, such as using the toilet or blowing ones nose.
Hand washing
Aseptic precautions
DEVICE RELATED NOSOCOMIAL INFECTION
that was in use within the 48-hour period before onset of infection. If the interval since discontinuation of the device is longer than 48 hours, there must be compelling evidence that infection was associated with device use.
Environment cleaning
Floors
Mop with GPD twice day Use 0.1% Hypochlorite if there is an outbreak of sepsis. Use separate mops for different cubicles. Dry the mops in sun light. Store them upside down. Wash mops in 0.1% Hypochlorite weekly. Damp dust with GPD once weekly. Damp dust with GPD daily and between patients. Dry with clean dry cloth.
Mops
Environment cleaning
Wash twice a day with GPD.
Telephone
Cleaning of Blood & Body fluids Spillages Wear heavy duty gloves
Soak up fluid using absorbent. (wadding, gauze, paper towels) Pour 1% Hypochlorite solution till it is well soaked.. Leave >10min. Discard absorbent as clinical waste. Clean area with detergent & water & dry. Discard gloves as clinical waste. Wash hands. Low risk body fluid (Faeces, Vomitus, Urine) Wear gloves. Soak up fluid using absorbent material. Clean area with detergent & water & dry. Discard gloves as clinical waste. Wash hands.
Cleaning
Removes many micro-organisms. Should also be done prior to sterilization & disinfection. Difficult to quantify other than visually.
Disinfection
Not necessarily all micro-organisms. Liquid chemical (detergent/antiseptic), UV light, Boiling water..
Sterilization
Moist heat, Dry heat, Ethylene Oxide gas, Liquid chemicals, Irradiation.
Bed/Bedrai Damp dust daily with GPD ls Clean with GPD & 0.1% Hypochlorite for Cupboards septic pts.
Mattresse Cover with impermeable material. Damp dust weekly with GPD. s
Wipe with GPD between patients and dry thoroughly. Replace torn mattresses. Clean with GPD & 0.1 % Hypochlorite for septic pts. Minimize the No. Other Furniture Damp dust weekly with GDP
Follow manufacturers instructions wherever possible. Wipe clean with GDP or 70% alcohol & dry daily and between pts. External filters should be changed between pts. Clean internal mechanisms including internal filters according to manufactures instruction
By authorized maintenance staff Should have user manual & maintenance records for each vent.
Proper decontamination according to the manufactures inst. is needed after ventilation of pt with
Tuberculosis, Resistant Gram-neg. organisms in RT, MRSA in RT, Definite fungal lung infections, Lobar and Community acquired pneumonias.
2. CSSD Clean with GDP & Autoclave 3. 2% Gluteraldehyde Immerse 30min & rinse with
sterile water; Store dry & covered.
2. CSSD Autoclave
all pts Use sterilized humidifiers for
3. CSSD 4. 2% Glutaraldehyde
For known or suspected infections such as TB
2. 1% Hypochlorite
Use in with/suspected TB Immerse for 30min & rinse with water
Wash blade with GPD & wipe with 70% Alcohol Wipe hand piece with 70% Alcohol. Store dry.
Nebulizers
Masks
Change daily / When soiled Change between pts.
Pts with/suspected TB
Methods :- SU
Methods :-1. CSSD If autoclavable send to CSSD after washing with GPD 2. 1% Hypochlorite Non-autoclavable ones, washed
with GPD and immersed for 30min
Method :- GPD Wash and dry between pts Method :- External Damp dust daily and between Pts Control panels GPD/Alcohol wipe
at the beginning of a shift
Clean daily and between pts Should not be taken from pt to pt without cleaning
Unit discipline
Aim is to achieve protective isolation of the pt
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Staff handling pts. must wash hands thoroughly before & after attending on pt. Staff coming in from other areas of hospital
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Staff and visitors with obvious infection should not enter. Visitors and staff should not touch anything unless it is absolutely essential to do so.
Waste disposal
WHO recommendations
Black Non infectious / Non Hazardous Yellow Infectious waste Sharp bin
Dedicated sink/commode for this purpose If there is no closed drainage system decontaminate before discharge into the drainage system.
Prevention is primary
Thank You.