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EXPLAIN CONCEPTS OF INFECTION PREVENTION AND CONTROL IN RELATION TO CARE OF PATIENTS IN HOSPITAL.

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IPC is a scientific approach and practical solution, designed to prevent harm caused by infection to patients and health workers,

Infection control prevents or stops the spread of infections in healthcare settings.

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Refer to policies and procedures applied to prevent (minimize the risk) the spread of infectious diseases in the hospital environment through air, blood or body fluid, and contact including faecal oral and food borne.

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The overall goal of IPC is to achieve safe, effective healthcare practices at all levels of the health care facilities.

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Emerging and re-emerging of infectious diseases such as Viral Hemorrhagic Fevers (VHF) and Influenza.

The HIV/AIDS epidemic has increased the risk for transmission of infections in the health care settings due to the various procedures conducted in these facilities

Prevalence of HIV/AIDS in Tanzania is 4.8% (15 – 49yrs)

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Healthcare providers and communities are prone to infection transmission due to the following:

Routine invasive procedures

Exposure to infectious agents from health workers to patients/clients

Patients who are susceptible to infections because of compromised immunity

Services that are sometimes provided in congested physical settings

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1: Standard (universal) precautions

Are a simple set of effective practice guidelines designed to create a physical, mechanical or chemical barrier between microorganisms and a person aiming at preventing infections.

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Define common terms used in infection prevention and control

2: Infection is a disease state that results from the presence of pathogens (disease producing microorganisms) in or on the body.

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is the invasion of a host bodily tissues by organisms causing diseases.

Their multiplication, and the reaction of host tissues to these organisms and the toxins they produces

Larger organisms like macroparasites and fungi.

3: Nosocomial infection

Hospital acquired infections or may be expanded to include infections acquired within 24 hours of admission in a hospital, or infections that a patient is incubating at the time he/she comes to the hospital.

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It is the condition resulting from the presence of harmful microorganisms invading body tissues and the body’s response to their presence, potentially leading to the malfunctioning of various organs or tissues.

5: Asepsis

This refers to the absence of infected matter, freedom from infection or exclusion of microorganisms.

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6: Contamination

Introduction of microorganisms on sterile instruments.

7: sterilization

This is a process by which bacteria, spores and other microorganisms are destroyed.

8: Disinfection

Is the process of eliminating or reducing harmful microorganisms from inanimate objects and surface.

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9: Decontamination (“decon”) – The removal of harmful substances such as chemicals, harmful bacteria, or other organisms, from exposed individuals, rooms, and furnishings in buildings or in the outside environment.

10: Disease transmission – The process of the spread of a disease agent through a population.

11: Infection control – Measures practiced by health care personnel in health care facilities to prevent the spread of infectious agents.

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Urinary tract infections: Hospital associated urinary tract infections account for about 35-45% of the nosocomial infections

Hospital associated pneumonia: The most important are patients on ventilators in intensive care units

There is a high case fatality rate associated with ventilator-associated pneumonia, although the attributable risk is difficult to determine because co-morbidities are high.

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Surgical site infections

Surgical site infections are also frequent: the incidence varies depending on the type of operation and underlying patient status.

The main risk factor is the extent of contamination during the procedure (clean, clean contaminated, contaminated, dirty), which is to a large part dependent on the site of surgery, length of the operation, and the patient’s general condition.

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Hospital associated blood stream infection

Though less frequent than the other types of HAIs,hospital associated blood stream infections result in high case fatality rates-more than 50% for some microorganisms. Infection may occur at the skin entry site of the intravascular device, or in the subcutaneous path of the catheter (tunnel infection).

It is considerably dependent on how lines are handled and duration of lines.

Even peripheral lines are a potential source of line related infections.

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Other potential sites of infection

Skin & Soft tissue, Brain and meninges, gastrointestinal infections, Eye & ear infections (sinusitis, conjunctivitis), Endometrial and other infections of the reproductive organs following childbirth.

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Sources of infection in hospital/dental clinic

Patient

Operators (health care workers),

Environment.

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Learning Tasks

By the end of this session, students are expected to be able to:

Explain the chain of infection process

Differentiate the routes of diseases transmission.

Explain the spread of infection

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Is a disease state that results from the presence of pathogens (disease producing microorganisms) in or on the body.

An infection occurs as a result of a cyclic process, consists of six components, these components are:

Infectious agent

The source

Portal of exit

Mode of transmission

Portal of entry

Susceptible host.

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The first link in the chain of infection is the microbial agent, which may be a Bacterium, Virus, Fungus, and Parasite.

The ability of the infectious agent to cause disease depends on its pathogenicity, virulence, invasiveness and specify.

The Source

The source of organisms also called reservoirs is the elements in the environment, Inanimate objects, human beings, and animals are sources.

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The portal of exit provides a means for the microorganisms to leave the source.

In humans, common portals of exit or escape routes includes the respiratory, gastrointestinal, and genitourinary tracts, as well as breaks in the skin.

Blood and tissue can also be portals of exit for pathogens.

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Refers to the way in which the organism moves or is carried from the source to portal of exit.

The five main routes of transmission are

Contact

Vehicle

Droplet/Respiratory

Airborne

Vector borne

Portal of Entry

The portal of entry is the point at which organisms enter a new host.

The organisms must find a portal of entry to a host or it may die

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The urinary

Respiratory

Gastrointestinal tracts

The skin

Those are common portals of entry.

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Microorganisms can continue to exist only in a source that is acceptable (a host) and only if they overcome any resistance mounted by the host defenses.

Susceptibility is the degree of resistance to the potential host has to the pathogens

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How a pathogen is transmitted from one person to another?

The Infectious Disease Transmission Cycle

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Some organisms can be transmitted by more than one route

Direct contact – involves proximity between susceptible host and an infected person or a carrier, such as touching, kissing, or sexual intercourse

Indirect contact – involves personal contact with an inanimate object, such as touching contaminated instruments.

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Vehicle transmission-refers to the spread of infectious agents through non-living objects or substances that act as intermediaries between an infected source and a susceptible host. (food carry salmonella, blood carry hepatitis and HIV; drugs can carry bacteria from contaminated infusion supplies.)

Droplet transmission: occurs when infectious agent are spread through respiratory droplets that are expelled from the body of an infected person who is coughing, sneezing, or talking.

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Airborne transmission: Involves the spread of infectious agents through small particles or droplets that remain suspended in the air for extended periods, allowing them to be inhaled by others at a distance.

Vector borne transmission: such as mosquitoes, ticks, and lice, are non-human carriers that transmit organisms from one host to another

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Respiratory

Cough Sneeze

Fecal-oral Feces

Contaminated food,

Environment,

Hands Vector-borne

Transmitted by insects or other animals

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Proper infection prevention practices are fundamental for quality care

Standard precautions break the disease transmission cycle in one of the following four ways:

Reducing the number of infection-causing microorganisms present (e.g. through practicing hand hygiene, cleaning instruments and preparing skin prior to intravenous (IV) insertion)

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2: Killing or inactivating infection-causing microorganisms (e.g. through hand hygiene with an antiseptic or waterless, alcohol preparation or reprocessing of instruments)

3: Creating barriers to prevent infectious agents from spreading (e.g. through wearing PPE or covering mouth when sneezing)

4: Reducing or eliminating risky practices (e.g. by passing sharps using hands-free technique, using disposable gloves, disposing of syringes at point of use

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There are 5 components in the infection cycle. reservoir, portal of entry, susceptible host, the exit, vehicle of transmission

The transmission cycle can be interrupted in the following ways

Destroying the agent

Attacking the source

Interrupting transmission

Protecting the host.

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For bacteria, viruses and other infectious agents to successfully survive and spread, certain factors or conditions must exist, agent, reservoir, transmission, and susceptible host.

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Explain the infection cycle

Outline common routes of disease transmission

Explain the spread of infection

What are the component of the infection cycle

Explain how transmission cycle can be interrupted

Outline factors which enable infectious agent to survive and spread successfully.

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PRINCIPLES OF DISEASE PREVENTION AND CONTROL AND STANDARD PRECAUTION IN INFECTION PREVENTION

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At the end of this session student should be able to;

Define the term standard precaution

List the levels of diseases prevention and control

List the principles of disease prevention and control.

Explain the principles of standard precaution of IPC.

Explain the purposes of having standard precautions.

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Disease prevention and control is aimed at avoidance of problems or minimizing problem once they occur.

There are three levels of prevention: primary prevention, secondary prevention, and tertiary prevention.

Standard Precautions: Are simple set of effective practice guidelines (creating a physical, mechanical and clinical barriers) to protect health workers and patient from infection with a range of pathogens including blood borne pathogens.

The practices are used when caring for all patients regardless of diagnosis

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1: Attacking the Source

Treatment

Isolation – person with disease is not allowed to come into close contact with other people except those who provides care

Reservoir control – immunization of animals, killing of animal

Notification – immediately inform the local health authority

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Environmental sanitation

Personal hygiene and behavior change

Vector control – draining swamp, larvicide’s

Disinfection and sterilization

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Immunization

Chemoprophylaxis

Personal protection

Better nutrition

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This is done through

Through practicing hand hygiene, cleaning instruments and preparing skin prior to intravenous (IV) insertion)

Killing or inactivating infection-causing microorganisms (e.g. through hand hygiene with an antiseptic or waterless, alcohol preparation or reprocessing of instruments)

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PPE or covering mouth when sneezing)

Reducing or eliminating risky practices (e.g. by passing sharps using hands-free technique, using disposable gloves instead of none, disposing of syringes at point of use

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Disease prevention and control is aimed at avoidance of problems or minimizing problem once they occur.

There are three levels of prevention: Primary prevention, Secondary prevention, and Tertiary prevention.

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1: Primary Prevention

Defined as the action taken prior to the onset of disease which removes the possibility that the disease will ever occur.

It signifies intervention in the pre pathogenesis phase of the disease or health problem.

Primary prevention may be accomplished by measures of “health promotion” and “specific protection”.

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It includes the concept of “positive health” a concept that encourage achievement and maintenance of an “acceptable level of health that will enable every individual to lead a social and economically production life.

Primary prevention may be accomplished by measures designed to promote general health and well-being and quality of life of people or by specific protective measures

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Immunization

Environmental sanitation

Accident prevention

Protection from occupational hazards

Changes in life style

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Is an action which halts the progress of a disease as its incient stage and prevent complications.

The specific interventions are early diagnosis e.g. screening test, and case finding programs and adequate treatment

Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized diseases and treating it before irreversible pathological changes take place and reverse communicability of infectious diseases

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It thus protect others in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts

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It used when the disease process has advanced beyond its early stage.

It is defined as all measures available to reduce or limit impairments and disabilities and promote the patients adjustment to irremediable conditions.

Intervention that should be accomplished in the stage of tertiary prevention is disability limitation and rehabilitation.

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The goal is to prevent further deterioration (long term complications) of physical and mental function, and to have used whatever residual function is available for maximum enjoyment of and participation in life activities.

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Are simple set of effective practice guidelines (creating a physical, mechanical and chemical barriers) to protect health workers and patient from infection with a range of pathogens including blood borne pathogens.

The practices are used when caring for all patients regardless of diagnosis.

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Mechanical – high level disinfection by boiling or steaming and sterilization by using autoclaving or dry heat.

Physical barrier; personal protective equipment like gloves, masks, goggles.

Chemical; antiseptics and disinfectants

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For care of all persons, patients, clients, and staffs, regardless of whether or not they are infected.

For handling of blood and all other body fluids secretions, and excretions (except sweat) non-intact skin and mucus membrane.

To reduce the risk of transmitting microorganisms from known or unknown sources of infection e.g. patients, contaminated objects, used needles and syringes etc. within the health care system.

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To prevent patients/clients from hospital acquired infections or health care related infections

To protect health care workers (HCWs) from occupational infections.

To protect communities from acquiring infectious diseases.

To prevent environmental pollution

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Principles of standard precaution of IPC they are based on components and interventions of standard precautions:

Consider every person (patient or health workers) as potentially infectious and susceptible to infection.

Hand hygiene- this includes hand washing and hand antisepsis, antiseptic and hand scrub and surgical hand scrub.

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Process instruments by decontamination, cleaning and then either sterilize or (high-level disinfection) HLD using recommended

Use personal protective equipment (PPE) including gloves, masks, goggles, caps, gowns, boots and aprons.

Appropriate handling of sharps, patient resuscitation and patient care equipment and appropriately manage patient placement and environmental cleaning.

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Safe disposal of infectious waste materials to protect those who handle them and prevent injury or spread to the community.

Promptly and carefully clean up spills of blood and other body fluids after the spill event.

Process instruments by cleaning, and sterilization or high-level disinfection following recommended procedures

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Introduce cough etiquette to patients, caregivers and visitors with signs and symptoms of respiratory illness, including cough, congestion, rhinorrhoea, or increased production of respiratory secretions.

Triage technique should be applied to isolate patients and clients with respiratory problems

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UTILIZATION OF PRINCIPLES OF STANDARD PRECAUTION IN HEALTH CARE SETTING AND ASEPTIC TECHNIQUE IN CLINICAL SETTING

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In practice, utilization of standard precaution includes the following interventions

Hand washing before and after any direct contact with patients.

Don’t recap the needles.

Safe collection and disposal of needles (hypodermic and suture) and sharps (scalpel blades, lancets, razors, scissors) with required puncture proof and liquid proof safety boxes in each patient care area.

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Wearing a mask, eye protection and gown (sometimes a plastic apron if blood or other body fluids might splash.

Covering all cuts and abrasions with water proof dressing.

Promptly and carefully cleaning up spills of blood and other body fluids.

Using safe system for healthcare waste management and disposal.

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Learning Task: At the end of this session student should be able to;

Definition of Hand Washing and Aseptic Techniques.

Define terms hand hygiene and hand washing.

Outline indications for hand hygiene.

Describe types of hand hygiene techniques (hand washing, hand antisepsis, antiseptic hand rub and surgical hand rub.

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Definition of Hand Washing and Aseptic Techniques

Hand washing: Is a process which mechanically removes soil and debris from skin and reduces the number of transient microorganisms using plain soap and water. (MOHSW,2007)

Hand washing with plain soap and clean water is as effective in cleaning hands and removing transient microorganisms as washing with antimicrobial soaps and causes less skin irritation.

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Aseptic technique: Are procedures that are practiced in a clinical/hospital setting to protect patients and the staff from being infected with pathogenic microorganisms and to prevent the contamination of people and their working environment in general.

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Hand hygiene: is an action intended to prevent hand-borne infections by removing dirt and debris and inhibiting or killing microorganisms on skin. It includes care of hands, nails and skin.

Hand rubbing: is performed using absolute Alcohol-Based Hand Rub (ABHR) preferably when hands are not visibly soiled

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Hand hygiene practices (hand washing, hand rub and surgical hand scrubbing) are intended to prevent hand borne infections by removing dirt and debris and inhibiting or killing microorganisms on skin.

Hand hygiene includes care of hands, nails and skin.

It significantly reduce the number of disease causing microorganisms on hands and can minimize cross contamination (e.g. from healthcare provider to patient)

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Hand washing also, is a key component in minimizing the spread of diseases hospital associated infections (HAIs) and in maintaining an infection free environment.

Hence failure to perform appropriate hand hygiene is considered to be a leading cause of nosocomial infections.

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Routine hand washing with liquid soap.

Hand washing with antiseptic agent.

Antiseptic hand rub using a waterless, alcohol-based antiseptic agent.

Surgical hand hygiene.

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Hand washing is a mechanical process of removing soil, debris and organisms from the skin using liquid soap and running water.

Four elements are essential for effective handwashing

Liquid soap

Running water

Friction

Drying

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Its similar to routine handwashing technique. The only difference is in the liquid soap or detergent as it contains an antiseptic agent (often clorhexidine, iodophors, or triclosan)

This technique should be used before and after

Examining or caring for highly susceptible patients

Performing an invasive procedure (e.g., intravascular device)

Leaving the room of patients on Contact Precautions(e.g., hepatitis A or E)

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If hands are not visibly soiled, the use of an alcohol hand rub.

Its more effective in killing transient and resident flora than hand washing with antimicrobial agents or plain liquid soap and water

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This procedure involves hand washing with water and liquid soap, and hand rubbing with alcohol-based hand rub and friction.

The purposes of surgical hand hygiene are;

To prevent wound contamination by microorganisms from hands and arms of surgeons and assistants.

To prevent the growth of microorganisms (rubbing with antiseptic before beginning surgical procedures)

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According to WHO, thousands of people die every day around the world from infections acquired while receiving health care.

Hands are the main pathways of germ transmission during health care.

Therefore Hand hygiene the most important measure for HCWs’ to avoid the transmission of harmful germs and prevent health care-associated infections during different procedures

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Is the most important precaution for the prevention of infections.

Washing hands with soap and water eliminates microorganisms from the skin and hands.

Hand washing helps stop the spread of germs between patients and staff.

It protects both the patients and the caregivers

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Hand hygiene should be done

Before; examining (direct contact) a patient/client, putting on sterile surgical gloves prior to invasive surgical procedures.

After; any situation in which hands may be contaminated such as handling soiled instrument, touching mucous membranes and having prolonged and intense contacts with a patient.

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Steps in Washing Hands

How to wash your hands.

It is important to wash your hands properly.

Make sure that you wash both your hands including the tips of your fingers, the palms of your hands and thumbs.

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The steps below explain how to wash your hands properly

Wet hands with water.

Apply enough soap to cover all surfaces of hand.

Rub hands palm to palm.

Right palm over back of left hand with interlaced fingers and vice versa.

Palm to palm with fingers interlaced.

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Back of fingers to opposing palms with fingers interlocked.

Rotational rubbing of left thumb clasped in right palm and vice versa

Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.

Rinse hands with water.

Use clean water to rinse both hands and forearms.

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Use towel to turn off tap.

Your hands are now clean

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Hand washing is done

Before and after patient contact.

When preparing food or serving food.

Before and after eating.

After removing gloves.

When hands are visibly dirty for any reason.

After using the toilet.

After contact with blood or body fluids.

After taking specimens to the lab.

After sneezing, coughing or blowing one’s nose

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Hand hygiene should be performed before and after every procedure.

All Health care workers to adhere SOP for hand hygiene at all settings.

Accurate preparation antiseptic hand rub kills transient and resident flora where hands are not visibly soiled

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Steps in wearing gloves

Always put gloves on clean, washed hands.

Remove all jewelry (rings, etc.) from hands.

Take a pair of clean gloves from the box. Check to see if there is any tear or breaks.

Put on gloves according to the corresponding hand

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Remove gloves by grasping the cuff and turning each glove inside-out as you remove it. (Be careful not to touch the outside surface of your glove with bare hands.)

Dispose of gloves in a proper receptacle.

Wash hands immediately after taking off the gloves.

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When to wear gloves

During phlebotomy procedures.

Performing surgical procedures.

Handling specimens.

Cleaning of hospital/laboratory environments.

Performing laboratory tests

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When to remove gloves

Answering phone calls.

Opening doors.

Writing.

After every procedure/patient.

Every time they become soiled/contaminated

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Learning Task: At the end of this session student should be able to

Define aseptic techniques.

Describe types of aseptic techniques.

Categories types of disinfectants and antiseptics according to their uses.

Demonstrate aseptic techniques (handling sterile instruments, decontaminate working area, scrubbing the operation site, draping

Demonstrate hand hygiene techniques (hand washing, antiseptic hand rub, surgical hand scrub)

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Aseptic technique

Are procedures that are practiced in a clinical/hospital setting to protect patients and Health workers from being infected with pathogenic microorganisms and to prevent the contamination of people and their working environment in general.

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Aseptic techniques include

Cleaning and disinfection.

Skin disinfection and antiseptics.

Prophylactic antibiotic.

Protective clothing.

Isolation.

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Hospital environment.

Equipment e.g. patients locker, beds, etc.

Hand washing is the most important precaution for the prevention of infections.

Decontamination (processing contaminated instruments and other items)

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Process instruments/equipments to make them safer for use.

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Processing of Instruments Involves

Decontamination –a process that makes inanimate objects safer to be handled by staff before cleaning:

It’s the first step in processing items and it involves soaking items in a 0.5% chlorine solution for 10 minutes.

Importance of decontamination.

Makes items safer to handle.

Makes items easier to clean.

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Decontamination tips

Use a plastic, non-corrosive, container for decontamination.

Do not soak metal instruments that are electroplated (i.e. not 100% stainless steel) even in plain water for more than an hour because rusting will occur.

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Processing instruments is the method that recommends to reduce disease transmission from soiled instruments and other reusable items so as make them safe for further use

Stages in processing instrument includes;-

Decontamination,

Cleaning,

Sterilization or high-level disinfection (HLD).

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Is a process that makes inanimate objects safer to be handled by staff before cleaning.

Decontamination process is done by soaking items in 0.5% chlorine solution for 10 minutes.

This step rapidly inactivates HBV, HCV and HIV and makes the items safer to handle and easier to clean.

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Use a plastic, non corrosive container for decontamination of instruments to help prevent:

Dulling of sharps (e.g., scissors) due to contact with metal containers.

Rusting of instruments due to a chemical reaction (electrolysis) that can occur.

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After decontamination,

Instruments should be rinsed immediately with cool water to remove visible organic

material before being thoroughly cleaned.

Large surfaces, such as pelvic examination tables or operating chairs must be wiped with disinfectant such as 0.5% chlorine solution.

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Cleaning is the physical removal of visible dirt and debris by washing, dusting, or moping contaminated surfaces by washing with soap, water and friction.

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Cleaning – refers to the physical removal of visible dirt and debris by washing, dusting, or moping contaminated surfaces.

Cleaning is important because it is an effective way to reduce the number of microorganisms, especially endospores that cause tetanus on soiled instruments and equipment. Neither sterilization nor HLD is effective without prior cleaning.

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Liquid soap is preferred because it mixes more easily with water than bar or powdered soaps.

Instruments should be washed with a soft brush in a soapy water to remove all foreign matter until they are visible clean.

Do not use abrasive cleaners (example vim) or steel wool.

Thorough rinsing removes any soap residue.

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After cleaning, rinse items in clean water until no detergent remains.

Air-dry items whenever possible.

Use heavy-duty gloves for cleaning instruments.

Wash hands after removing gloves.

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Those instruments with moving parts should be lubricated after drying.

Avoid oils that may protect bacteria during autoclaving.

Water soluble lubricant is recommended (Karl Zsort or Olympus instrument oil)

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Never use steel wool or abrasive powders on stainless steel instruments.

Never label surgical instruments by masking tape.

When instruments do stain in spite of all good care taken they can be cleaned by using a commercially available rust and stain remover.

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All new instruments are supplied without lubrication.

It is recommended that all be carefully washed and dried and any moving part lubricated.

Whenever cleaning, regardless of method, keep ratchets unlocked and box joints open.

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When instruments are no longer new, avoid as far as possible contact between stainless steel instruments and any of the following substances:

Barium chloride,

Aluminium chloride,

Bromide and iodine containing compounds

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Consider the item is contaminated when packaging is

Torn,

Damaged,

Wet,

Dropped on the floor and

when the expiry date has passed.

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HLD is the process that eliminates all microorganisms (including bacteria, viruses, fungi and parasites).

It does not reliably kill bacterial endospores, which cause diseases such as tetanus and gas gangrene

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HLD can be performed by

Boiling

Soaking in chemicals

Steaming

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A process that eliminates microorganisms (bacteria, viruses, fungi, parasites, bacterial endospores) from objects or instruments.

It can be done by

High-pressure steam (autoclave),

Dry heat (oven),

Chemicals or radiation.

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What does standard precaution means?

What is the rationale of wearing Personal Protective Equipment in relation to IPC?

Mention the principles of standard precautions?

Explain aseptic techniques different aseptic techniques used in the clinical setting

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PERSONAL PROTECTION EQUIPMENT (PPE) STERILIZATION AND

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Are equipment worn by a worker to minimize exposure to specific occupational hazards.

In health facilities it’s defined as a physical barriers that help to prevent the spread of microorganisms from:

Person to person.

Equipment/ instruments and environmental surfaces to people.

Using PPE is only one element towards complete safety at work, it does not guarantee a permanent or total protection but it reduces the chance of being affected while at work.

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They are used to protect patients and healthcare workers from microorganisms in healthcare settings

Control hazards at the source.

Eliminate hazards from work places’

Isolate hazards from workers.

Additional of safety feature to the existing equipment.

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Stands as a guard against skin infections and protects the skin from coming in contact with corrosive or harmful abrasive materials.

Facilitates redesigning of the work processes or purchasing new equipments.

With the emergence of AIDS, viral Hepatitis, Viral Hemorrhagic Fever, and the resurgence of tuberculosis in our country, use of PPE now has become of increasing importance for protecting staff

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Pre-contact control (the first and most important method because it prevents the hazards from reaching the worker)includes:

Substituting materials or process with that which are less hazardous.

Isolating from the hazardous processes.

Acquiring safer equipment

Point of contact control

Direct application of the PPE.

It is used when the pre-contact controls are not totally effective.

In health facilities, the daily practice is in this category and therefore the PPE is very important

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Gloves.

Masks/respirators.

Protective eye wear (face shield, goggles, or glasses)

Caps.

Gowns.

Aprons

Boots

Drapes and surgical gowns

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Head

Eyes

Face

Hands

Feet

Body

Hearing

Respiratory

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GLOVES

Protect hands of healthcare worker from infectious material and

Protect patients from microorganisms on staff members hands.

They are the most important physical barrier for preventing spread of infection.

Three types of gloves;-

Surgical gloves (sterile, single use)

Examination gloves (non sterile)

Heavy duty/utility/ household gloves

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Other types of gloves

Gauntlet gloves

(Elbow length gloves for obstetrics procedures)

Used when the hand and forearm need to be inserted into the vagina (manual removal of the retained placenta) or

Deep into the uterus to deliver the infant’s head.

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Help to protect the provider from significant blood and amniotic fluid contamination.

If not available, improvise it.

Double gloving

Helps to prevent blood to hand contact but is of little importance in preventing needle sticks.

Indications for double gloving are

When the procedure involves coming in contact with a large amount of blood such as vaginal deliveries, caesarean section and laparotomy.

For orthopedic procedures

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When contact with blood and body fluids is anticipated.

As additional measures not replacement of hand washing.

Not required for routine procedures with limited skin contact

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Examination gloves

Shall be worn during the following

For examination and non-surgical procedures Contact with blood or body fluid anticipated.

Handling visibly soiled items.

When health worker has non-intact skin

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Utility Gloves

These gloves are used for decontamination of large equipment, cleaning floors, walls, furniture such as beds, etc.

Gloves shall be changed between care activities and procedures with the same patient when soiled or contaminated

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Remove gloves before moving to another patient or after completing specific task.

Wash and dry hands immediately after removing gloves.

Except utility gloves do not wash decontaminate and reuse gloves.

Do not wear gloves while moving around unless transporting inserting an intravenous infusion/ laboratory equipment.

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Gowns

Avoid unnecessary use of gowns.

Gowns shall be used for protective isolation.

Don’t wear gowns outside work area.

Gowns shall not be worn outside the area for which they are intended/dental clinic

Wear long gowns to protect uncovered skin and protect clothes.

Clinical coats and scrub suits shouldn’t be worn outside work area, don’t transfer them to homes.

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Scrub suits or cover gowns are worn instead of, theatre attire.

A V-neck shirt must not be cut so low as to slide off the wearer’s shoulders or expose men’s chest hair.

Scrub suites are not uniforms, they should strictly be worn as part of PPEs in specific areas

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Masks should be large enough to cover the nose, lower face, jaw and all facial hair (to contain it)

They are worn to contain moisture droplets expelled as HCWs or surgical staff speak, cough or sneeze.

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The tieback mask has four ties to fasten around the mouth and nose.

The ear loop mask has 2 elastic bands for fastening.

Surgical masks with attached face shields to protect against fluid and other splashes:

They are fluid resistant, light weight ideal for most procedures and isolation precautions when indicated.

Respirators are specialized types of masks, called particulate respirators (such as N-95)

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Uses of Caps

To keep hair and scalp covered so that flakes of skin and hair are not shed into the wound during surgery.

Should be large enough to cover all hair.

Protect both patient and healthcare worker from splashes of blood and body fluids

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Protective eyewear protects staff from accidental splashes of blood or body fluid by covering the eyes.

Types of Eye Wear

Plastic glasses with solid side shields

Goggles

Chin-length face shields.

Masks with clear vision

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Footwear is worn to protect feet from injury by sharps or heavy items, blood and fluids

To protect feet from injury

Things to consider

Rubber or leather boots are recommended because they protect better; should be kept clean and free of contamination from blood or other fluid spills.

Closed-toe, sturdy shoes should be worn in clinical areas only.

Wear shoes that cover appropriately, if there are no special shoes.

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Made of rubber or plastic.

Provides waterproof barriers along the front of the health worker’s body.

Should be worn when cleaning or procedure with blood and fluid products spills anticipated.

Should be thoroughly cleaned after procedure.

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A covering for head and neck with an opening for the face, typically forming part of a coat or cloak. The material should be plastic or waterproof.

A laminar flow cabinet or tissue culture hood is a carefully enclosed bench designed to prevent contamination of biological samples, or any particle sensitive materials

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Surgical drapes (sterile) made of cloth can be placed around a prepared surgical incision to create a work area. This area is often called the “sterile field,” it is NOT sterile.

Cloth drapes allow moisture to soak through and can help to spread organisms from skin, even after surgical cleansing with an antiseptic agent, into the incision

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Thus, neither sterile gloved hands nor sterile or high-level disinfected instruments and other items should touch drapes once they are in place.

Using towel drapes to create a work area around the incision limits the amount of skin that needs to be cleaned and reminds the surgical team not to touch the patient

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Once a sterile drape tou3hes the patient’s skin, it is no longer sterile.

Sterile cloth drapes do not replace good aseptic technique

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The table below explains the spread of Microorganisms from person to person (patients, healthcare staff, clients and community) and how this can be prevented by applying Personal Protective Equipment (PPE).

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Where

Microorganisms are

Found

How Microorganisms are Spread

Barriers to Stop

the

Spread of

Who the Barrier

Healthcare staff hands

Touching

Gloves, hand washing, or

waterless antiseptic

hand rub

Patient/client, staff and community

Hair and scalp

Shedding of skin and hair

Cap, mask, scrub suit,

cover gown, apron and drapes

Patient/client, staff and community

Nose and mouth

Coughing, talking, and sneezing

Mask

Patient/client, staff and community

Body and skin

Touching

Decontamination

Patient/client, staff

and community

Patients mucous

membranes and infected eyes

Touching

Gloves and eye wear

Patient/client, staff and community

Healthcare staff hands

Touching

Gloves, hand washing, or

waterless antiseptic hand rub

Patient/client, staff and community

Microorganisms are

Found

How Microorganisms are Spread

Barriers to Stop

the Spread of

Microorganisms

Who the Barrier

Protects

Non intact skin

Touching

Gloves,

antiseptic and

hand rub

Patient/client,

staff

and community

Patients blood

and

body fluids

Splashing/sprayi

ng,

touching

Eye wear, gloves

and

gowns

Patient/client,

staff

and community

Patients

unprepared

skin

Touching

Gloves, drapes

And apron

Patient/client,

staff

and community

Health facility environment

Accidental exposure with needles and scalpels

Footwear,utility

gloves, incineration for destroying sharp needles and scalpels

Patient/client, staff and community

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To remove goggles

Hold goggles with one hand lift the bottom from the back of the head to the front

If gloved hands are used, the gloves should not be contaminated with blood or other potentially infectious materials.

The order for removing if gloves, masks, eye wear and gowns are worn should be:

Protective eye wear

Mask

Gown

Gloves

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LEARNING TASK

At the end of this session student should be able to;

Describe physical sterilization and materials/equipment to sterilize.

Describe chemical sterilization and materials/equipment to sterilize.

Describe Gaseous sterilization and materials/equipment to sterilize.

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Disinfection: The process that kills pathogenic and other microorganisms by physical or chemical means.:

Low

Intermediate

High Level

Sterilization: Free from viable microorganisms.

This is actually just a probability.

Sterility Assurance Level (SAL)= 10-6th power, or 1:1,000,000 chance that a single viable microorganism is present on a “sterilized” item

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Physical Sterilization.

Chemical Sterilization

Gaseous Sterilization.

Filtration

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Physical Sterilization and Materials Sterilized

Physical Methods of Sterilization

Dry heat sterilization

Moist heat sterilization

Sterilization by filtration

Sterilizing by irradiation

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Is achieved by applying dry heat, organisms are killed by

Protein denaturation.

Oxidative damage.

Toxic effect of elevated levels of electrolytes

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Red Heat

Used to sterilize metallic objects by holding them in flame till they are red hot

Used for materials such as inoculating wires, needles and forceps.

Flaming

The article is passed over a flame without allowing it to become red hot

Used for materials such as mouth of culture tubes, cotton wool plugs and glass slide

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Incineration (Burning to Ash)

This is an excellent method for rapidly destroying materials

Used for materials such as soiled dressings, animal carcasses and pathological material

Hot Air Oven

Sterilization by hot air oven requires temperature of 160°C for one hour or 180°C for 30 minutes

Materials sterilized by this method are liquid paraffin, dusting powder and glass wares

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The lethal effect of moist heat is by denaturation and coagulation of proteins.

Moist Heat Sterilization Methods

Heating below 100ᵒC

Boiling at 100ᵒC

Autoclaving/Steam under Pressure (Temperature above 1OOᵒC)

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Heating below 100ᵒC

Boiling at 100ᵒC

Autoclaving/Steam under Pressure (Temperature above 1OO0C)

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Heating below 100ᵒC

Boiling at 100ᵒC

Autoclaving/Steam under Pressure (Temperature above 100ᵒC)

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Pasteurization

A method used to sterilize milk.

Temperature employed is either 63ᵒC for 30 minutes (Holder method) or 72ᵒC for 15 to 20 seconds (flash methods)

Organisms like mycobacterium, Salmonella and Brucella are killed.

Vaccine bath.

Used for killing non-sporting bacteria, this may be present in vaccines.

In a vaccine bath, the vaccine is treated with moist heat for one hour at 600C

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Tyndallization

This is a process by which the medium to be sterilized is heated at 100ᵒC for three consecutive days for 30 minutes.

This method is used for sterilization of egg or serum containing media and some pharmaceutical preparations that cannot withstand higher temperatures.

Steam at Atmospheric Pressure (100ᵒC)

Free steam is used to sterilize culture media and some pharmaceutical preparations which may decompose if subjected to higher temperature.

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Autoclaving is the most commonly used method for sterilizing materials in the laboratory.

Requires the use of autoclave machines.

Materials to be sterilized should be placed in a bucket.

Articles to be reused should be washed after sterilization (e.g. culture media plates containing isolates.

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In this apparatus, material for sterilization is exposed to 1210C for 15 to 20 minutes at 15 lb pressure per square inch.

Saturated steam condenses on the surface of the micro-organisms and transfers its latent heat of vaporization. The organisms is rapidly destroyed by protein coagulation

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This is a method of sterilization useful for antibiotics solutions, sera and carbohydrate solution by using:

Glass sintered filters.

Zeist filters.

Membrane filters

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Chemicals as a Sterilizer

Mode of Action

Chemical substances act as sterilizing agents by

Coagulation of bacterial protoplasm

(e.g. heavy metals)

Disruption of cell membrane by chemical substances.

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They may alter physical and chemical properties of cell membranes, thus resulting in killing or inhibiting the bacterial cell:

Oxidation or burning out the bacterial protoplasm (e.g. halogens)

Affecting bacterial enzymes or coenzyme systems, thus causing interference of Bacterial metabolism.

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Alcohol (Ethanol)

Absolute alcohol is not a very effective sterilization agent.

when diluted to 70% it is effective as a skin sterilizer

Chlorine (hypochlorite solution or Jik)

It is the disinfectant of choice in microbiological laboratories with broad Spectrum activity against a wide range of microorganisms including spores and

viruses.

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Glycerol

50% glycerol solution will kill contaminating organisms

It is used for the preservation of certain viruses

Phenols and cresols (Lysol)

5% phenol/cresol is used mainly for discarded cultures, infected pipettes and Other infected materials.

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Ethylene Oxide

This is a highly penetrative, corrosive and microbicidal gas which is used in the industry for the sterilization of single use, heat sensitive medical devices such as prosthetic heart valves and plastic catheters.

Ethylene oxide sterilization is usually carried out at temperatures below 60ᵒC

Care must be taken because of the hazards, which include toxicity to personnel,flammability and explosion risk, as well as the effect of residual ethylene oxide in the sterilized product

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Formaldehyde gas

Is used to disinfect laboratory cabinets, baby incubators and anaesthetic machine

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Apply principles of infection prevention and control to manage linen.

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Definitions

Linens: Cloth items used in healthcare facilities by housekeeping staff, patients/clients

(bedding, towels, cleaning cloths, gowns, caps, masks, scrub suits, surgical gowns, drapes and wrappers).

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(Terms used interchangeably)

Cleaning products such as bar soap, liquid soap and powder soap

These substances lower surface tension, thereby helping remove dirt, debris and transient microorganisms from hands

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Linen from multiple sources within the hospital or clinic that has been collected and brought to the laundry for processing.

All items, regardless of whether or not they are visibly dirty or have been used in a surgical procedure, must be washed and dried.

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Process of inspecting and removing foreign, and in some cases dangerous objects

(e.g, sharps or broken glass)from soiled linen before washing.

This step is extremely important because soiled linen from the operating room or clinic

occasionally contains sharps (e.g. scalpels, sharp-tipped scissors, hypodermic and suture needles and towel clips).

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The key steps include

Collecting and transporting soiled linen

Sorting soiled linen

Laundering linen

Storing, ransporting and distributing clean linen

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Collect used linen in cloth or plastic bags or containers with lids.

If linen is heavily contaminated with blood or body fluids, carefully roll the contaminated area into the center of the linen and place in a leak-proof bag or container with a lid.

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It is not necessary to double -bag or use additional precautions for used linen from

patients in isolation.

Do not sort and wash soiled linens in patient care areas

Collect and remove soiled linen after each procedure, and daily or as needed from patient rooms.

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Transport collected soiled linen in closed leak-proof bags, containers with lids or covered carts to the processing area daily or more often as needed

Transport soiled linen and clean linen separately. If there are separate carts or containers available for soiled and clean linen, they should be labeled accordingly.

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The processing area for soiled linen must be separate from other areas such as those used

for folding and storing clean linen, patient care areas and food preparation areas.

In addition there should be adequate ventilation and physical barriers (walls) between the clean and soiled linen areas.

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Sorting must be carefully performed because soiled linen (large drapes and towel drapes) from the operating room or other procedure areas occasionally contain sharps (e.g.,scalpels, sharp-tipped scissors, hypodermic and suture needles and sharp-tipped towel

clips).

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All linen items (e.g., bed sheets, surgical drapes, masks, gowns) used in the direct care of a patient must be thoroughly washed before re-use.

Decontamination prior to washing is not necessary, unless linen is heavily soiled and will be hand washed.

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Workers should not carry wet, soiled linen close to their bodies even if they are wearing a plastic or rubber apron.

Hand washing linen

Step 1: Wash heavily soiled linen separately from non-soiled linen.

Step 2: Wash the entire item in water with liquid soap to remove all soils, even if not

visible.

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Use warm water if available.

Add bleach (e.g., 30-60 mL, about 2-3 tablespoons of 5% chlorine solution) to

aid cleaning and bactericidal action.

Add soap (mild acid agent) to prevent yellowing of linen, if desirable.

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Step 3: Check the item for cleanliness.Re-wash if it is dirty or stained.

Step 4: Rinse the item with clean water.

Machine washing linen

Step 1: Wash heavily soiled linen separately from non-soiled linen.

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Step 2: Adjust the temperature and time cycle of the machine according to manufacturer’s instructions and the type of soap or other washing product being used.

Both cold and hot water washing cycles that include bleach reduce bacterial counts in the linen.

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Step 3: When the wash cycle is complete, check the linen for cleanliness.

Re-wash if it is dirty or stained. (Heavily soiled linen may require two wash cycles).

Drying, checking and folding linen

For both hand and machine washed linens, the steps are the same.

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Air dry in direct sunlight, if possible, keeping the fabric off the ground, away from dust and

moisture.

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If present, the item must be discarded or repaired before re-use or storage.

(If there are any holes or many repaired areas, the item should not be used as a drape.It can be cut into pieces to be used a cleaning rags.)

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For example, if a clean, dry drape is acceptable, the drape can be ironed before placing it on a shelf or in a container for storage.

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Storing Clean Linen

Keep clean linen in clean, closed storage areas.

Use physical barriers to separate folding and storage rooms from soiled areas.

Keep shelves clean.

Handle stored linen as little as possible.

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Clean and soiled linen should be transported separately.

Containers or carts used to transport soiled linen should be thoroughly cleaned before used to transport clean linen.

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Clean linen must be wrapped or covered during transport to avoid contamination.

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Protect clean linen until it is distributed for use.

Do not leave extra linen in patients’ rooms.

Handle clean linen as little as possible.

Avoid shaking clean linen. It releases dust and lint into the room.

Clean soiled mattresses before putting clean linen on them.

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PRINCIPLES OF DISPOSING HAZARDOUS AND

NON HAZARDOUS MATERIALS

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Hazardous Materials/ Contaminated Waste

Contaminated waste is potentially infectious or toxic, if not disposed of properly.

Contaminated waste includes blood, body fluids, secretions and excretions, and items that have come in contact with them, such as sharps and used dressings, as well as medicines, medical supplies or other chemicals that may be toxic

Contaminated waste must be incineratred, burned or buried in designated contaminated/ hazardous waste areas.

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A non-contaminated waste poses no infectious risk to person who handles it. Examples of non-contaminated waste include paper, trash, boxes, food remains, and bottles and plastic containers that products delivered to the clinic.

Non-contaminated waste can be picked up by the local authorities for disposal in municipal waste sites.

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Safe management of health care waste (HCW) is a key issue to control and reduce nosocomial infections inside a hospital and to ensure that the environment outside is well protected.

Some wastes from health facilities, however are hazardous (intrinsic potential properties or ability of any agent, equipment, materials or process that can cause harm) if not disposed properly

Contaminated waste may carry microorganisms that can infect people who come in contact with it, as well as the community at large.

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Health care waste is defined as total waste generated by medical activities and includes both contaminated (potentially infectious/hazardous) waste and non-contaminated (non – infectious/ non-hazardous) materials

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Advise policies and practices to reduce healthcare waste generation through;

Restriction of purchase of supplies that produce a lot of healthcare waste

Use of recyclable products at the on site or off site

Good management and control practices e.g, pharmaceuticals and chemicals through centralized purchasing.

Frequent ordering of small quantities rather than large amounts at one time.

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Use of the oldest batch instead of the new (FEFO and FIFO) rules.

Use all contents in each open container before opening another container.

Frequent checking of expiry date at the time of delivery.

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The segregation of waste consists of separating the different waste materials based on the type, treatment and disposal practices.

Containers suitable for each type of waste should be available and used as intended.

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Segregation takes place at the point where waste is generated. Segregation of waste shall be applied uniformly throughout the country

Never sort mixed wastes(e.g. do not try to separate uncontaminated from contaminated wastes, or combustible from noncombustible, after they have been combined.

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The color coding system aims at ensuring an immediate and non-equivocal identification of the hazards associated with the type of healthcare waste that is handled or treated

In that respect, color coding system shall remain simple and be applied uniformly throughout the country

All healthcare facilities shall apply the following color coding system

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Proper disposal of contaminated waste minimizes the spread of infection to healthcare personnel and to the local community.

Infectious healthcare waste should be preferably incinerated, burned or buried.

Both the incinerator and burial site should be fenced with a gate and lock to prevent scavenging by both animals and people

Open piles of wastes should be avoided because they pose infection risks and fire hazards, produce foul odors, attract insects, are unsightly

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On-Site Treatment

This is applied by health facilities with adequate land space, particularly in rural settings.

Options that can be used for onsite treatment include single or double chapter incinerators (De Montfort incinerator), burying and burning in a designated pit.

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Treatment such as Autoclave, chemical disinfection and microwave irradiation are efficient techniques but they are basically pre-treatment methods which are capable of rendering small quantities of waste safe: however, the remains from such treatment require final treatment and disposal

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Width should be 1 to 2 meters

Pits shall be dug 1-2 meters wide and to depth of 2-5 meters, but at least 1.5 meters above the water table

The pit shall be fenced and located away from public areas

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Burying is placing waste into a pit and covering it with earth.

To build a waste burial pit, choose an appropriate site that is at least 50 meter away from any water source to prevent contamination of the source.

Pits shall be dug 1-2 metres wide and to depth of 2-5 metres, but at least 1.5 metres above the water table.

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Keep waste covered, and every time waste is added to the pit, cover it with a 10 to 30 cm layer of soil

When the level of waste reaches to within 30 to 50 of the surface of the ground, fill the pit with soil and dig another pit

Expired vaccines shall be encapsulated and buried, and not burned

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Incineration is the deployment of high temperature in burning waste (starting at 800°C)

Incineration reduces the volume of the waste and eliminates pathogens

Large scale incinerators that can reach very high temperatures are preferred to small scale

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Clear operation procedures, which shall be posted near the incinerator.

Trained operators

Reliable segregation system, so only infectious and non-polluting materials are incinerated

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Ash pit to safely dump the incinerator ash.

Regular maintenance and repairs

Adequate supply of fuel.

Easily accessible site from waste storage via a paved walkway.

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PVC plastic (e.g. bottle caps)

Mercury thermometers

Batteries

X-ray or photographic materials

Aerosol cans or gas receptacles

Glass vials (they can explode or if uncapped they melt and could block the incinerator grate)

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What are the different types of health care wastes?

What are the sources of hospital wastes and hazardous materials?

What are disposal methods of health care wastes and hazardous materials

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SAFE INJECTION

Safe injection: An injection that does not harm the client, does not expose the provider to any avoidable risk, and does not result in any waste material that is dangerous to the community

In healthcare settings, injuries can occur easily from sharp instruments, especially during surgical procedures.

Preventing injuries and exposure to infectious agents is mandatory

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Sharp instruments: Anything capable of puncturing the skin (scissors, needles, scalpels or blades, etc.)

‘Hands-Free Technique’: A safer method of passing sharp instruments during surgical procedures.

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Always use the ‘Hands-Free Technique’ for passing sharp surgical instruments.

Use a sterile kidney basin or other suitable container (safe or neutral zone)

The container is placed on the sterile field between the surgeon or clinician and assistant

The assistant puts individual instruments in the container as they are needed

The surgeon or clinician takes them from the container, and returns them to the container after using them.

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Use each needle and syringe only once.

Skin preparation for injections

If the injection site is visibly soiled, wash the site with soap and water and dry with a clean towel, and then give the injection.

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According to the World Health Organization and its Safe Injection Global Network (SIGN), swabbing of clean skin with an antiseptic solution prior to giving an injection is not necessary.

Clients receiving injections regularly (e.g. using Depo-Provera for contraception or insulin) should be taught to wash the injection site with soap and clean water just prior to coming to the clinic or receiving the injection at their home.

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Dispose of the needle and syringe in a puncture-resistant container placed within arm’s reach at point of use

Never leave a needle inserted in a vial cap (e.g. X-pen vial, chloramphenicol vial) to withdraw multiple doses.

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Minimize handling of injection equipment

Always keep fingers behind the needle

Do not disassemble the needle and syringe afteruse

Do not recap, bend or break needles prior to disposal.

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If necessary, a one-handed recap method should be used, for example, after drawing blood using Vacutainer® or blood gas:

First, place the cap on a hard, flat surface and remove hand from the cap.

Next, hold the syringe with one hand and use the needle to ‘scoop up’ the cap

Finally, when the cap covers needle completely, use the other hand to secure the cap on the needle.

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Do not over-fill sharps containers, filling them more than three-quarters (3/4) full may cause needle stick injuries

Manufactured sharps containers are available in some healthcare settings and are the best solution for safe sharps disposal.

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Puncture-resistant containers can be made from a readily available object such as a heavy cardboard box with an opening small enough to prevent someone from trying to remove the discarded sharp objects

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The principles of sharps disposal aims at preventing potential harm and transmission of disease from injury with a contaminated sharp object:

Always dispose sharps in a puncture-resistant container

Do not handle sharps carelessly, they should be disposed of directly, without manipulation (e.g., do not recap, remove or bend needles)

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Dispose sharps immediately after use at the point of use.

Ensure that sharps containers are readily available and conveniently located so that staff members do not have to carry sharp items any distance before disposal (preferably within arm’s reach)

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Sharps containers should be easy to see, recognize and use

Mark them clearly so that people will not unknowingly use them for disposing of garbage or discarding cigarettes

Don’t shake a container to settle its contents and make room for more sharps

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Don’t place containers in high traffic areas (corridors outside patient rooms or procedure rooms)

Use only a puncture-resistant, disposable sharps container

Dispose sharps container as a whole unit (incinerate, bury or encapsulate)

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Define safe injection?

Explain the principles of sharps disposal

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RISK IN NOSOCOMIAL INFECTION

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Nosocomial infection refers to “hospital acquired” infection or may be expanded to

include infections acquired within 24 of admission in a hospital

Are the infections that a patient is incubating at the time he or she comes to the hospital.

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Although the exact data for the transmission of nosocomial infections in Tanzania health facilities are yet to be determined

An average around 10% of all hospital patients will develop an infections as a result of their stay in hospital

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Maternal and newborn infections

Infections following surgery

Infection related to intravascular interventions

Urinary tract infections

Pneumonia

Infectious diarrhea

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The organisms causing most nosocomial infections usually come from the patient’s own body (endogenous flora).

They also can come from contact with staff (cross contamination), contaminated instruments and needles, and the environment (exogenous flora)

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The longer the client is in a health care facility, the greater is her/his risk of infection.

Exposure to the facility environment changes the client own normal body flora.

Risk factors that contribute to the development of nosocomial infections can be grouped into three categories: environment, therapeutic regimen, and resistance of the client.

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Environment

Hospital, outpatient clinics, extended care facilities, the home, and schools are reservoir of organisms that pose threat to the increasing number of clients who have decreased resistance.

The source of these organisms includes the air, other clients, families, and visitors, contaminated equipment, food and personnel.

259

Pneumonia and influenza can spread rapidly among clients and other people in all types of facilities.

Equipment that is not thoroughly cleaned, disinfected or sterilized can spread many pathogens

260

Multiple factors involved in therapies used to cure clients also can contribute to the risk of infection.

Drugs such as steroids, immunosuppressive agents, and cancer therapy, as well as prolonged use of antibiotics predispose clients to infection.

Equipment such as IV catheter, urinary catheters and feeding tubes that invade orifices provides routes for bacterial invasion

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Inadequate dressing techniques for wound can provide media for bacterial growth.

Identifying treatments that pose risk and discontinuing their use as soon as possible decrease the chance of nosocomial infection.

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Changes in the physical or psychological status of a client can affect his/her resistance to infection.

Any break in the integrity of the skin or mucous membrane increase the chance of infection. Stress, fatigue, poor nutrition and chronic illness also can decrease the client ability to ward off infection.

Adequate hygiene is important to decrease microorganisms on the skin that could contribute to infection risk.

263

APPLY AIRBORNE PRECAUTIONS FOR CLIENTS/ PATIENTS WITH KNOWN OR SUSPECTED RESPIRATORY INFECTIONS.

264

These precautions are designed to reduce the Nosocomial transmission of particles that can remain in the air for several hours and be widely dispersed.

They are used in addition to Standard Precautions for a patient known or suspected to be infected with microorganisms transmitted by the airborne route.

267

THE AIR BONE DISEASES INCLUDE

Tuberculosis.

Chicken pox (varicella virus).

Measles (Rubella virus).

Meningitis.

Pneumonia.

Acute laryngo-bronchitis.

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Use tissues to contain respiratory secretion

Cover the nose or mouth when coughing or sneezing

Instruct patients to cover their nose and mouth when coughing or sneezing with disposable tissues

Dispose the tissues in the nearest waste container.

Apply isolation technique properly

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Private room with Door closed

Room air is exhausted to the outside (negative air pressure) using fan or other filtration system

If private room not available, place patient in room with patient having active infection with the same disease, but with no other infection

(cohorting)

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RESPIRATORY PROTECTION

Wear surgical mask

If TB known or suspected, wear particulate respirator (if available)

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If chicken pox or measles

Immune persons—no mask required

Susceptible persons—do not enter room

Remove mask after leaving the room and place in a plastic bag or waste container with tight-fitting lid

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Limit transport of patient to essential purposes only.

During transport, patient must wear surgical mask.

Notify area receiving the patient.

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POST EXPOSURE PROPHYLAXIS (PEP)

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The risk of HIV transmission to medical personnel has been recognized since 1984.

Correct estimation of the likelihood of transmission following occupational exposure is

limited by relative infrequency with which HIV transmission to healthcare workers is reported.

The estimated risk of HIV transmission following a single need prick exposure is about

0.3%.

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POST – After

EXPOSURE –some one has come into contact with possible agents of disease or infection

PROPHYLAXIS –the means by which that person may still be able to prevent disease

It is the use of therapeutic agent to prevent infection following exposure to the pathogen For health care workers PEP is commonly considered for exposures to HIV and Hepatitis

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Clinicians

Nurses

Medical laboratory staff

Housekeeping staff

Laundry workers

Waste collected personnel

Patients and the community

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The likelihood of HIV infection following exposure is affected by the presence of certain Factors.

Type of contact intact skin or broken skin

Quality of blood

279

Host defenses

Post exposure prophylaxis

280

Wounds and puncture sites should be washed with soap and water

Exposed mucous membranes should be flushed with water

Post exposure evaluation (type of body fluid involved)

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Severity of exposure – quantity of blood, duration of contact

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LOW RISK EXPOSURE

Exposure to small volume of blood contaminated with fluid from a symptomatic HIV

patients with low viral titer.

Following an injury with a solid needle.

Any superficial injury or mucocutaneous exposure.

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HIGH-RISK EXPOSURE

Exposure to a large volume of blood or potentially infections fluids.

Exposure to flood or fluid contaminated with blood from a patient with high viral titer.

Injury with a hollow needle.

Deep and extensive injuries.

Confirmed drug resistance in source patients

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Clinical status assessment.

Screening for HIV status of the patient after consent.

Treatment should not wait for test result and should be commenced within 24 hours post exposure.

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Baseline testing of HIV antibody should be done to establish sero status of the healthcare worker at time of exposure

Repeat testing should be done at 6 and 12 weeks and 6 month post exposure regardless of the use of PEP

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Counseling the Healthcare Worker

Healthcare workers should be counseled about their personal risk and recommendation made to start PEP

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