HOSPITAL INFECTIONS

SKILLS IN PREVENTION

Dr.T.V.Rao MD

10/23/2012

Dr.T.V.Rao MD@Health care

The very first requirement in a hospital is that it should do the sick no harm

10/23/2012

Dr.T.V.Rao MD@Health care

A Tribute to Ignaz Semmelweiss

Ignaz Philipp Semmelweis

10/23/2012

Dr.T.V.Rao MD@Health care

New roles in HAI prevention

Hospitals should do the sick no harm USA model Basis of surveillance (Haley et al 1985)
Data Collection Application to Prevention & Control Analysis

HAI Surveillance nurses

Dissemination

Interpretation

Evaluation
10/23/2012

Planning Implementation
Dr.T.V.Rao MD@Health care 4

1st principle of infection prevention

at least 35-50% of all healthcare-associated infections are asociated with only 5 patient care practices: Use and care of urinary catheters Use and care of vascular access lines Therapy and support of pulmonary functions Surveillance of surgical procedures Hand hygiene and standard precautions
10/23/2012 Dr.T.V.Rao MD@Health care 5

Incidence of Healthcare associated infections

Lack of reliable data affects estimates on the burdenmillions worldwide every year No health-care facility, no country, no health-care system in the world is free of this problem
Developed world: 510% patients Developing countries: risk is at least 2 times higher and can exceed 25% ICU - 30% patients; attributable mortality as high as 44%
10/23/2012 Dr.T.V.Rao MD@Health care 6

Leading causes of death

53.9 million from all causes, worldwide

10/23/2012

Dr.T.V.Rao MD@Health care

Global Infection Problems

According to WHO (2005), On average, 8.7% of hospital patients suffer health care-associated infections (HAI). In developed countries: 5-10% In developing countries: Risk of HAI: 2-20 times higher
HAI may affect more than 25% of patients

At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.
10/23/2012 Dr.T.V.Rao MD@Health care 8

Health Care-Associated Infections (HAI)

According to WHO:
HAI is also called nosocomial. HAI is defined as:
an infection acquired in hospital by a patient who was admitted for a reason other than that infection. an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.
10/23/2012 Dr.T.V.Rao MD@Health care 9

Infection Control in developing countries

None/inadequate Infection Control infrastructure
Lack of strategic direction at national/local level Lack of resources/financial governance Well-organized, effective infection control programmes are confined to academic institutions, well-funded government and private hospitals Smaller hospitals in urban areas and hospitals in rural centres have less resources
None or inadequate infection control programme Lack of Microbiology Laboratory supports Availability of antimicrobial agents, hand hygiene products and hand washing facilities, Personal Protective Equipment and sterile goods

10/23/2012 Dr.T.V.Rao MD@Health care 10

Even though infection rates can be drastically reduced in most hospitals in developing countries, the rates cannot be reduced below 5% unless excessive costs are incurred irreducible minimum.
Ayliffe GAJ: Infection Control 1986;7:92-95
10/23/2012 Dr.T.V.Rao MD@Health care 11

Four Ways to Prevent HAI

1. Maintain cleanliness of the hospital. 2. Personal attention to handwashing before and after every contact with a patient or object. 3. Use personal protective equipment whenever indicated. 4. Use and dispose of sharps safely.
10/23/2012 Dr.T.V.Rao MD@Health care 12

Required Skills
Apply universal precautions* Use personal protection methods Know what to do if exposed Encourage others to use universal precautions Report breaks in technique that increase patient risks Observe patients for signs and symptoms of infection
10/23/2012 Dr.T.V.Rao MD@Health care 13

Main Sources of Infection

Person to person via hands of health-care providers, patients, and visitors Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) Environmental contamination Airborne transmission Hospital staff who are carriers Rare common-source outbreaks
10/23/2012 Dr.T.V.Rao MD@Health care 14

 Staff nurses play an important role in risk reduction by 1. paying careful attention to hand hygiene, 2. by ensuring careful administration of prescribed antibiotics, 3. and by following procedures to reduce the risks associated with patient care devices.
10/23/2012 Dr.T.V.Rao MD@Health care 15

COST SAVING MEASURES Unnecessary and wasteful practices

Routine
Microbiological Swabbing of environment Disinfectants for environmental cleaning e.g. floors & walls Fumigation of isolation room with formaldehyde

Unnecessary
Use of overshoes and dust attracting matt Personal Protective Equipment in the Intensive Care, & Neonatal Unit

Excessive/unnecessary use of
IM/IV injections Insertion of indwelling devices e.g. IV lines, urinary catheters, nasogastric tube Antibiotics both for prophylaxis and treatment
Damani NN. Journal of Hospital infection 2007; 65(S1): 151-154.
10/23/2012 Dr.T.V.Rao MD@Health care 16

NO COST MEASURES Good infection control practices

Aseptic technique for all sterile procedures Remove indwelling devices when no longer needed Isolation of patient with communicable diseases/multiresistant organism Avoid unnecessary Per Vaginal (PV) examination in women in labour Placing mechanically ventilated patients in a semirecumbent position Minimize number of people in operating theatre
Damani NN. Journal of Hospital infection 2007; 65(S1): 151-154.
10/23/2012 Dr.T.V.Rao MD@Health care 17

LOW COST MEASURES

Education and practical training in

Cost effective practices

Hand hygiene Aseptic technique Appropriate use of PPE Sharp use and disposal in robust containers

Provision of alcoholic hand rub and hand washing facilities for hand hygiene Use of adequately sterile items for invasive procedures Use of single-use disposable sterile needles and syringes Adequate decontamination of items/equipment between patients Provision of Hep B vaccination for healthcare workers Post exposure management of healthcare workers
Damani N.N .Journal of Hospital infection 2007; 65(S1): 151-154.
10/23/2012 Dr.T.V.Rao MD@Health care 18

HAND HYGIENE
- NO ARTIFICIAL NAILS - CLEANSING HANDS - THE MOST IMPORTANT MEANS OF PREVENTING THE SPREAD OF INFECTION
Germs dont have a chance with the proper use of these weapons.

Soap / Water
10/23/2012 Dr.T.V.Rao MD@Health care

Alcohol-based hand hygiene products

19

Our 5 moments for HAND HYGIENE

10/23/2012

Dr.T.V.Rao MD@Health care

20

Hand keep your hands germ free Hygiene Two different ways to
Soap and water for 15 seconds. (Make bubbles while applying friction). Alcohol hand rub if no visible soiling present on hands.
Hand Hygiene is JCAHOs # 7 Patient Safety Goal Speak-up Campaign for Patients Encouraging patients to ask the Healthcare Worker (HCW) about handwashing!
10/23/2012 Dr.T.V.Rao MD@Health care 21

STANDARD PRECAUTIONS
Healthcare workers must treat all blood & body fluids as infectious.

10/23/2012

Dr.T.V.Rao MD@Health care

22

Transmission-based PRECAUTIONS
Always Communicate to others when patients are in isolation For any room entry don appropriate PPE Clean ANY shared equipment between Patients
Although Isolation Signs May Appear Different, ALL Will Have: - a STOP Sign - List of Room Entry PPE

10/23/2012

Dr.T.V.Rao MD@Health care

23

Lets now put the Spotlight on Misuse of Antituberculous Regimens

MDR - Tuberculosis
10/23/2012 Dr.T.V.Rao MD@Health care 24

Implementation
Holding seminar on antibiotic use Case studies on antibiotic use in departmental meeting Distribution & Reinforcement of the use of antibiotic guidelines
10/23/2012 Dr.T.V.Rao MD@Health care 26

Standard Precautions also include:

Hand Hygiene
Personal Protective Equipment
(PPE) gloves,gowns,masks,face-shields,goggles

Anticipate Your Exposure Use Sharp-Safety Devices Clean Surfaces Regularly Appropriate Waste Disposal
(Red bags, regulated medical waste)

10/23/2012

Dr.T.V.Rao MD@Health care

27

Safe Use and Disposal of Sharps

Keep handling to a minimum Do not recap needles; bend or break after use Discard each needle into a sharps container at the point of use Do not overload a bin if it is full Do not leave a sharp bin in the reach of children
10/23/2012 Dr.T.V.Rao MD@Health care 28

CDC RECOMMENDATION
1. Intensified environmental cleaning using 1:10 bleach : water solution 2. Equipment cleaned whenever visibly soiled 3. Items close to the patient should be cleaned daily 4. IV poles should be cleaned when the patient is discharged.

10/23/2012

Dr.T.V.Rao MD@Health care

29

BLOODBORNE PATHOGENS

The Big 3

HIV, HEPATITIS B AND HEPATITS C

SPREAD THROUGH CONTACT WITH BLOOD & BODY FLUIDS

Accidental puncture from contaminated needles and other sharps can result in transmission of Bloodborne pathogens.

HIGH RISK BEHAVIORS: Sharing Needles or other sharp objects Unprotected Sexual Contact Unclean Tattoo Parlors

Safety Needles, Devices and PPEs = Protection.

10/23/2012 Dr.T.V.Rao MD@Health care 30

Hepatitis B
Vaccinated: Unvaccinated: If you have received the vaccine (all 3 shots) and have developed immunity, virtually no risk for infection. Risk from single needlestick or cut 6-30% Depends on the Hepatitis (antigen of sources blood).

Hepatitis C
Limited studies available but risk seems to be about 1.8%.

HIV
Average risk for HIV infection to develop after needlestick or cut exposure to HIV blood is 0.3% Risk after exposure to HIV blood through splashes to eyes, mouth or nose is 0.1%

10/23/2012

Dr.T.V.Rao MD@Health care

31

IMMUNIZATIONS, INJURIES
-HEPATITIS B VACCINE -ANNUAL TB RISK ASSESSMENT

Employee Health

&

-Other vaccinations
- REPORT ALL INJURIES
10/23/2012 Dr.T.V.Rao MD@Health care 32

One more important thing!

Protect Yourself
Be sure you have been immunized against Hepatitis B since it is very easy to transmit!

10/23/2012

Dr.T.V.Rao MD@Health care

33

Patient family education is Important

Educate patients and families/visitors about clean hands and infection transmission. Ensure patients on precautions have same standard of care as others:
frequency of entering the room 10/23/2012 monitoring vital signs Dr.T.V.Rao MD@Health care

34

Discussion
Two-thirds of the problem may be improved by reinforcement on the use of antibiotic guidelines.
IMPACT guidelines/ Sanford guide/ Therapeutic guidelines antibiotics/ Production of local guidelines etc.

The remaining one-third may be improved by continuous medical education, training on making a correct diagnosis and fine tuning of the clinical skills.
No shortcut.
10/23/2012 Dr.T.V.Rao MD@Health care 35

In Conclusions
Identify unsafe, unnecessary and ineffective infection control practices Divert resources to apply basic evidence based practice in Infection control Implement simple & effective solutions according to local need and resources which are achievable and affordable

Simple measures do save lives !

10/23/2012 Dr.T.V.Rao MD@Health care 36

Please Visit me for More Articles of Interest on Infections at .

10/23/2012

Dr.T.V.Rao MD@Health care

37

 Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World
Email

doctortvrao@gmail.com

10/23/2012

Dr.T.V.Rao MD@Health care

38