Healthcare-associated Infections Part-1.pptx

Healthcare-associated Infections Part-1 for 2nd year MBBS student

1. Healthcare-associated Infections Part-1 Dr Bhavika patel MBBS,MD Microbiology,DIPC Assistant Professor Department of microbiology GMERS MC, Valsad .

2. Learning objectives At the end of the session, the students will be able to understand: Healthcare-associated Infections Major HAI Types Prevention of HAIs Hospital Infection Control Committee

3. HAI DEFINITION 3 Infections acquired in hospital by a patient - admitted for a reason other than the infection. Infection - not be present or incubating at the time of admission Symptoms should appear at least after 48 hours of admission.

4. HAI DEFINITION (Cont..) 4 Also include: Infections acquired in the hospital but symptoms appearing after discharge Occupational infections among staff of the HCF (e.g. needle stick injury transmitted infections)

5. Burden of HAI 5 According to WHO, on average at any given time 7% of patients in developed countries and 10% in developing countries - acquire at least one HAI. Mortality- 10% of affected patients.

6. Factors Affecting HAIs 6 Immune status Hospital environment Hospital organisms Diagnostic or therapeutic interventions Transfusion Poor hospital administration

7. Sources of Infection 7 Endogenous source- involves patient’s own flora Exogenous source Environmental sources- Inanimate objects, air, water or food Health care workers- e.g. Hands of HCWs harboring MRSA Other patients

8. Microorganisms Implicated in HAIs 8 The ESKAPE pathogens- E nterococcus faecium S taphylococcus aureus K lebsiella pneumoniae A cinetobacter baumannii P seudomonas aeruginosa E nterobacter species

9. Microorganisms Implicated in HAIs (Cont..) 9 Other infections that can spread in hospitals include: Escherichia coli SARS-CoV-2 (COVID-19) Nosocomially -acquired Mycobacterium tuberculosis Legionella pneumophila , Candida albicans , Clostridium difficile diarrhea. Blood-borne infections - HIV, hepatitis B and C viral infections.

10. Modes of Transmission (discussed later) 10 Contact transmission Droplet transmission Airborne transmission

11. MAJOR HAI TYPES 11

12. MAJOR HAI TYPES- 4 common types 12 Catheter-associated urinary tract infection (CAUTI, 33%) Central line-associated blood stream infection (CLABSI, 13%) Ventilator-associated pneumonia (VAP, 15%) Surgical site infection (SSI, 31%).

13. Standard precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes These measures should be followed when providing care to or handling: All individuals, whether they appear infectious/ symptomatic or not All specimens (blood or body fluids) whether they appear infectious or not All needles and sharps whether they appear infectious or not

14. Elements of Standard Precautions Hand hygiene PPE Respiratory hygiene and cough etiquette Environmental cleaning Linen Disinfection of patient care items Patient placement and transport Biomedical waste management Safe injection practices Spillage management

15. Hand hygiene Hand rub Alcohol based (70–80% ethyl alcohol) and chlorhexidine (0.5–4%) based hand rubs 20–30 seconds I t gets evaporated of its own Indications: D uring routine patient care activities or taking rounds in the wards or ICUs except when the hands are visibly soiled with blood or other specimens

16. 2. Hand Wash Antimicrobial soaps (liquid, gel or bars) containing 4% chlorhexidine 40–60 seconds Indications: When the hands are visibly soiled with blood, excreta, pus, etc. Before and after eating After going to toilet Before and after shift of the duty When giving care to a patient with diarrhea Hand hygiene

17. 3. Surgical Hand Scrub U sing 4% chlorhexidine hand wash 3-5 min Indication: P rior to any surgical procedure and also in between the cases Hand hygiene

18. 5 moments of Hand hygiene

19. Personal Protective E quipment

20. Gloves Indications for glove use As a part of standard precautions Before a sterile procedure Anticipation of contact with blood or body fluid, regardless of the existence of sterile conditions and including contact with non-intact skin and mucous membrane As a part of contact precautions: Contact with a patient (and his/ her immediate surroundings) Heavy duty gloves: To protect from sharp injuries, mainly used by biomedical waste handlers

21. Indications for glove removal As soon as gloves are damaged Gloves are meant for single-use, must be changed in-between patients or patient care activities When there is an indication for hand hygiene Clinical situations where use of gloves is not recommended Examples : Measuring blood pressure, temperature, and pulse, while administering medications (oral or injections), during maintenance of IV cannula, during dressing and transporting patient, writing in the patient’s case sheet, etc Gloves

22. Donning of gloves Doffing of gloves

23. Surgical (3-ply) Mask Donning of mask Doffing of mask

24. Respirators N95 refers to ‘not resistance to oil and ability to filter off 95% of airborne particles’

25. Plastic aprons Disposable gowns Coverall Protective Body Clothing

26. Donning of coverall Doffing of coverall

27. Protective Eye/Face Wear Goggles , or face-shields To protect the mucous membranes of the eyes, nose, and mouth

28. Head Cover and Shoe Cover Head cover or cap used when spillage of blood is suspected Shoe covers Surgical shoes: protect HCWs from organisms present in floor Gumboots: for anticipated risk of sharp injuries

29. Donning of PPE kit

30. Doffing of PPE kit Discard into appropriate BMW bins Yellow bag Gown/coverall, mask/respirator, shoe cover and cap Red bag Plastic apron, goggles/face shield , gloves

31. Respiratory hygiene/ cough atiquette

32. Biomedical Waste Management Biomedical wastes are defined as wastes that are generated during the laboratory diagnosis, treatment or immunization of human beings or animals

33. WASTE CATEGORISATION

34. WASTE CATEGORISATION

35. WHAT GOES IN YELLOW BAG

36. WHAT GOES IN blue Puncture proof or leak proof Container Glassware–broken Contaminated glass Metallic Body Implants Medicine Vials, ampoules etc.

37. WHAT GOES IN WHITE PUNCTURE PROOF CONTAINER White (Translucent) –Waste sharps including metals –packed in puncture proof containers Needles, syringes with fixed needles Scalpels, Blades, lancet Suture needle, aluminum foil Any contaminated sharp object causing puncture/cuts Handed over to Waste Agency… when 2/3 full

38. Hazards from infectious sharps Infections acquired through puncture, abrasion or cut in the skin Leads to transmission of blood borne viruses (hepatitis B, C and HIV) HIV-0.3% HCV-3% HBV-30 %

39. CHEMICAL/LIQUID WASTE Liquid waste: To be treated with 1 to 2 % Hypochlorite Floor washing etc should be pre-treated onsite using 1 -2% Sodium Hypochlorite

40. Hazards from chemical waste Most chemicals are toxic, corrosive, explosive and flammable; can cause various physical injuries including chemical burns Mercury - heavy metal chemical used in thermometers and BP apparatus Pharmaceutical waste : It includes expired, unused, contaminated drugs, vaccines and sera etc.

41. Hazards from radioactive waste Radioactive wastes are materials contaminated with radionuclides Produced by radiology and nuclear medicine units such as in vitro analysis of body tissue and fluid, in vivo organ imaging and tumor localization

42. Bio-medical waste should be collected on daily basis from each ward of the hospital at a fixed interval of time There can be multiple collections from wards during day Collection times should be fixed and appropriate to the quantity of waste produced in each area of the health-care facility General waste should not be collected at the same time or in the same trolley in which bio-medical waste is collected Bio-medical waste collected by staff, should be provided with PPEs Collection of BMW

43. Labeling & Bar-coding

44. Transportation

45. Central collection area

46. BLOOD SPILLAGE MANAGEMENT

47. Safe injection practices Needles and syringes should not be used for more than one patient or reused to draw up additional medication Do not administer medications from a single-dose vial or IV bag to multiple patients Limit the use of multiple-dose vials, and dedicate them to a single patient whenever possible Speak up if you see a colleague not following safe injection practices Always use aseptic technique when preparing and administering injections Disposed immediately after use in puncture proof container

48. Patient placement and transport Determine patient placement based on: Routes of transmission of the known/suspected infectious agent, availability of single rooms and options for cohorting (patients with the same pathogen in the same room) Patients with higher risk for pathogen transmission are prioritize to be admitted in a single room (e.g., uncontained secretions, or wound drainage)

49. Healthcare workers transporting a patient with transmissible infection should contain the site of infection E.g. apply a dressing over a surgical site infection and offer a surgical mask for a coughing patient Health care workers should not wear PPE in hospital corridors Patient placement and transport

50. Disinfection of patient care items All patient care equipment that is soiled with blood, body fluids, secretions or excretions shall be handled in a manner that will prevent skin and mucous membrane exposure Wear PPE according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that is visibly soiled or may have been in contact with blood or body fluids Remove organic material from critical and semi critical instrument/devices before high level disinfection and sterilization to enable effective disinfection and sterilization process

51. Single use, disposable items must be disposed of properly Make sure that reusable equipment has been cleaned and reprocessed appropriately, prior to use on another patient Disinfection of patient care items

52. Linen services To control Hospital infection To supply uninterrupted supply of linen to user department To improve image of the hospital To provide comfortable and pleasant environment to patient and visitors of hospital by supplying clean linen

53. Activities in laundry Collecting and receiving dirty and soiled linen from wards and other dept. Sorting of linen Removing of blood strains Disinfection Washing and drying Repairing/sewing Pressing/calendaring and folding Storage Issue of material

54. Environmental cleaning of the floor and surface of hospitals play a vital role in controlling the spread of infections General principles: Cleaning followed by disinfections Cleaning sequence Frequency of cleaning Frequency of cleaning for common situations Environmental cleaning

55. Cleaning followed by disinfections Cleaning: Always cleaning with a detergent is performed first, before applying disinfectant Disinfection: CDC recommends to use low- to intermediate-level disinfectants for environmental cleaning such as QAC, hypochlorite and improved hydrogen peroxide

56. Cleaning sequence Performed in correct sequence to prevent recontamination Cleaner to dirtier: The cleaner areas are cleaned first, followed by the dirtier areas; for e.g. low-touch surfaces should be cleaned first followed by high-touch surfaces High to low: Top area should be cleaned first, then proceed towards bottom (e.g. bedrails → bed legs and table surfaces → floors ) Inward to outwards: Clean the farthest point from the door first and then proceed towards the door

57. Frequency of cleaning depends upon Probability of contamination: e.g . heavily contaminated vs low-contaminated surfaces or instrument Vulnerability of population to infection: e.g . immunocompromised vs healthy adults Frequency of hand contact: e.g . high-touch vs low-touch surface

58. Frequency of cleaning for common situations Non-critical surfaces and floors can be cleaned 2–3 times a day Mattress used for patients should be cleaned weekly and after discharge Doors , windows, walls and ceiling should be cleaned once a month and spot-cleaning when soiled High touch areas such as doorknobs, elevator buttons, telephones, bedrails, light switches, computer keyboards, monitoring equipment should be cleaned more frequently, every 3–4 hours

59. Environmental cleaning All wards and units must have cleaning schedules Always wear utility gloves, plastic aprons, protective shoes and mask when cleaning Use damp or wet mop or cloth for walls, floors etc. Complete damp dusting before starting other cleaning in the room Change cleaning solution whenever it appears dirty Use separate equipment for high risk areas Decontaminate mop and other items after use

60. If possible, use a  double bucket system  when mopping the floors so that dirty water is not reused while mopping The first bucket contains clean water while the second bucket is used to squeeze out the water from the dirty mop following which the mop is dipped in the clean water and mopping done The  Three bucket system  should be ideally practiced and that the first bucket contains water with detergent used in the beginning The mop is then rinsed in the second bucket and dipped in the third bucket which can also contain a disinfectant and the mopping done again Environmental cleaning

61. Disinfection of Operation Theatre Environmental cleaning in operation theatre (OT) minimizes patients’ and HCWs’ exposure to potentially infectious microorganisms

62. Surface disinfection Cleaning should be performed first with a cleansing agent, followed by disinfection by using an aldehyde-based disinfectant Disinfection of OT is carried out in the following situations 1. First cleaning of the day (before cases begin) 2 . In between cases (cleaning 3 to 4 feet perimeter around the OT table) 3 . Terminal cleaning of OT after the last case 4 . Detailed wash-down of the OT complex once a week 5 . During renovation or construction of OT or nearby places

63. Fogging-aerial disinfection S praying of a disinfectant (e.g. glutaraldehyde, H2 O2 or QAC based product) with the help of a fogger machine The procedure takes around 1-2 hours, during which OT should be closed down and personnel need to be vacated Indication: Routine periodic fogging is not recommended, but is indicated only when any outbreak of infection is suspected or any change in infection control practice implemented or during renovation or construction of OT or nearby places

64. HOSPITAL INFECTION CONTROL COMMITTEE 73

65. HOSPITAL INFECTION CONTROL COMMITTEE 74 Provides a forum for multidisciplinary input and cooperation, and information sharing, required for hospital infection control and prevention. HICC is advisory to the MS and makes its recommendations to the MS.

66. HICC Constitution 75 Chairperson , MS Secretary , HOD, Microbiology HICO , representative from the Dept of Microbiology HICN - Hospital Infection Control Nurses Head of all the clinical (all medical and all surgical) departments Nursing Superintendent Head of the staff clinic

67. HICC Constitution (Cont..) 76 Operation Room Supervisor In-charge of Central Sterile Supplies Department (CSSD) In-charge of pharmacy In-charge of hospital linen and laundry In-charge of hospital kitchen Epidemiologist

68. Functions of HICC 77 HAI surveillance Develops a system for identifying, reporting, analyzing, investigating and controlling hospital-acquired infections. Antimicrobial stewardship program (AMSP) Policies: Reviews and updates the hospital infection control policies and guidelines from time to time. Education Staff health Outbreak management

69. Functions of HICC (Cont..) 78 Other departments: Communicates and cooperates with other departments of the hospital (e.g. pharmacy, CSSD ) Reviews risks associated with new technologies, and monitor infectious risks of new devices and products, prior to their approval for use. HICC Meetings: HICC shall meet regularly - not less than once a month and as often as required.

70. Thank you..