Hospital hygiene a detailed presentation.pptx

hospital hygeine

1. Hospital hygiene Nwachukwu shalom

2. Definition Hospital hygiene refers to the practices and procedures that are adopted in hospitals and other healthcare facilities to prevent the spread of infections and ensure a safe and clean environment for patients, healthcare workers and visitors. Good hygiene in hospitals plays a vital role in ensuring that patients do not catch dangerous infections and diseases, while also ensuring that germs and bacteria cannot spread to visitors and out into the general community. Prolonged patient stays lead to increased morbidity and mortality rates in many cases. Therefore, Healthcare-Associated Infections (HAI) represent a significant cost to hospitals and hinder patient care. Advanced microbial strain typing, hospital hygiene and infection control solutions are improving the way hospitals deal with HAI.

3. Nosocomial infections (hospital-acquired infections) These are infections that are not present in the patient at the time of admission to hospital but develop during the course of the stay in hospital. There are two forms: Endogenous infection, self-infection, or auto-infection. The causative agent of the infection is present in the patient at the time of admission to hospital but there are no signs of infection. The infection develops during the stay in hospital as a result of the patient’s altered resistance. Cross-contamination followed by cross-infection. During the stay in hospital the patient comes into contact with new infective agents, becomes contaminated, and subsequently develops an infection.

4. Classification of pathogenic germs Conventional pathogens Cause disease in healthy individuals in the absence of specific immunity. Examples: Staphylococcus aureus, Streptococcus pyogenes, Salmonella spp., Shigella spp., Corynebacterium diphtheriae, Mycobacterium tuberculosis, Bordetella pertussis, hepatitis A and B viruses, rubella virus, rotaviruses, human immunodeficiency virus (HIV). Conditional pathogens Cause disease, other than trivial local infections, only in persons with reduced resistance to infection (including newborn infants) or when implanted directly into tissue or a normally sterile body area. Examples: Streptococcus agalactiae, Enterococcus spp., Clostridium tetani, Escherichia coli, Klebsiella spp., Serratia marcescens, Acinetobacter baumannii , Pseudomonas aeruginosa, Candida spp. Opportunistic pathogens Cause generalized disease, but only in patients with profoundly diminished resistance to infection. Examples: atypical mycobacteria, Nocardia asteroides, Pneumocystis carinii

5. Routes of Transmission of Nosocomial Infections Contact transmission Direct contact (e.g., surgeon with infected wound in the finger performing a wound dressing) Indirect contact (e.g., secretion from one patient transferred to another through hands in contact with contaminated waste) Fecal-oral transmission via food • Bloodborne transmission E.g., needle-stick injury – hepatitis B and C, HIV/AIDS Vector transmission E.g., insects or other pests in contact with excreta or secretions from infected patients and transmitted to other patients Droplet transmission (droplets from sneezing, coughing or vomiting are expelled to surfaces or to the air and fall typically within 2 meters of the source) Direct droplet transmission (droplets reach mucous membranes or are inhaled by others) Indirect droplet-to-contact transmission: (droplets contaminate surfaces/hands and are transmitted to mucous membranes or other sites) – cold virus, respiratory syncytial virus Airborne transmission (small contaminated particles as aerosols carried by air currents >2 meters from source) E.g., Varicella zoster suspended in air and spread by inhalation, Staphylococcus aureus depositing in wounds

6. The prevention of nosocomial infection Principles Two basic principles govern the main measures that should be taken in order to prevent the spread of nosocomial infections in health-care facilities: separate the infection source from the rest of the hospital cut off any route of transmission

7. Types Of Infections Spread By Poor Hygiene In Hospitals There are several HAIs (hospital acquired infections) which can cause medical problems in patients. The most common of these are MRSA and C. Difficile. MRSA (or Methicillin Resistant Staphylococcus Aureus) is resistant to some types of antibiotics and can be found around the world. This infection is spread through contact with an infected surface and this is one reason why hand hygiene is so vital. MRSA spreads quickly to other patients and therefore, patients who are found to have MRSA are usually isolated to prevent further spread. Although MRSA doesn’t usually have a negative effect on healthy people, when people are ill or have a long term health condition, they can be severely affected. Clostridium Difficile, or C. Difficile is a bacteria which is present in the bowel of many people, and around 3% of healthy people carry it without it causing them any problems. However, in patients, these numbers increase to 36%, with the bacteria causing stomach pain, high temperature, nausea and diarrhoea. Hand washing is again very important to prevent the spread of this infection.

8. Some Standards of Hospital Hygiene The hospital environment must be visibly clean, free from dust and soilage, and acceptable to patients, visitors and staff. Increased levels of cleaning, including the use of hypochlorite and detergent, should be considered in outbreaks where the pathogen survives in the environment and environmental contamination may contribute to spread. Shared equipment in the clinical environment must be decontaminated appropriately after each use. • All healthcare workers need to be aware of their individual responsibilities for maintaining a safe environment for patients and staff. Regular cleaning will not guarantee complete elimination of microorganisms, so hand decontamination is required.

9. Air Hygiene Aerial dissemination of dust, droplets, and skin scales is a frequent transmission route for many pathogens, e.g. TB, MRSA, Acinetobacter, and C difficile spores. Ventilation, filtration, and disinfection are major environmental approaches to reduce pathogen concentration in air and to reduce the chance of airborne transmission. Ultraviolet germicidal irradiation (UVGI) is a technology able to inactivate a wide range of airborne pathogens e.g. influenza, measles, and TB. UVGI devices installed on the upper part of hospital rooms can significantly reduce the airborne concentration of pathogens in lower part of the rooms therefore interrupting the transmission of certain airborne diseases. However, some environmental factors, such as humidity, may influence the effectiveness of upper-room UVGI

10. Cleaning The most basic measure for maintaining hygiene in a healthcare facility Cleaning is the physical removal of visible contaminants such as dirt without necessarily destroying microorganisms Thorough cleaning with soaps and detergents can remove more than 90% of microorganisms Sterilization – rendering an object free from microorganisms; shown by a 99.9999% reduction of microorganisms High-level disinfection – destruction of all microorganisms except for large numbers of bacterial spores Intermediate disinfection – inactivation of Mycobacterium tuberculosis, vegetative bacteria, most viruses and fungi, but not bacterial spores Low-level disinfection – destruction of most bacteria, some viruses and fungi, but no resistant microorganisms such as tubercle bacilli or bacterial spores

11. Hand hygiene Poor hand hygiene practices have led to further spread of pathogens, not only among hospital staff, but also among visitors. Especially high levels of contamination have been discovered during the handling of bodily fluids, in respiratory care and direct patient contact, and even when gloves are worn, workers’ hands are not fully protected, which means that hand washing frequently is still vital. The introduction of alcohol hand gels for visitors to wards has also helped to reduce the level of infection among patients by up to 41%. Hand decontamination processes have been put in place before workers contact patients’ skin or food directly, before they change dressings or change invasive devices and then after caring for patients and after removing gloves. Not only has an emphasis been placed on hand washing over recent years, but the actual washing process to follow has now been specified, including the removal of any rings and false nails and a certain amount of time to wash hands for.

12. Measures for Improving Infection Control Wasteful practices that should be eliminated: routine swabbing of health care environment to monitor standard of cleanliness routine fumigation of isolation rooms with formaldehyde routine use of disinfectants for environment cleaning, e.g. floors and walls inappropriate use of PPE in intensive care units, neonatal units and operating theatres use of overshoes, dust attracting mats in the operating theatres, intensive care and neonatal unit unnecessary intramuscular and intravenous (IV) injections unnecessary insertion of invasive devices (e.g. IV lines, urinary catheters, nasogastric tubes) inappropriate use of antibiotics for prophylaxis and treatment improper segregation and disposal of clinical waste

13. Measures for Improving Infection Control No-cost measures: using good infection-control practices: use aseptic technique for all sterile procedures remove invasive devices when no longer needed isolate patients with communicable diseases or a multidrug-resistant organism on admission minimize the number of people in operating theatres provide education and practical training in standard infection control (e.g. hand hygiene, aseptic technique, appropriate use of PPE, use and disposal of sharps) provide hand-washing material throughout a health-care facility (e.g. soap and alcoholic hand disinfectants) use single-use disposable sterile needles and syringes use sterile items for invasive procedures

14. Essentials of the standard precautions to be used in the care of all patients A. Hand washing Wash hands after touching blood, secretions, excretions and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts. • Use a plain soap for routine hand washing. • Use an antimicrobial agent for specific circumstances. B. Gloves Wear gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin. C. Mask, eye protection, face shield Wear a mask and eye protection or a face shield during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. D. Gown Wear a gown during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. E. Patient-care equipment Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately. F. Environmental control Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces. G. Linen Handle used linen, soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, and that avoids transfer of microorganisms to other patients and environments. H. Occupational health and bloodborne pathogens Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices. • Use ventilation devices as an alternative to mouth-to-mouth resuscitation methods.

15. The end. Thank you for your attention.