HOSPITAL INFECTION CONTROL PROGRAMME.pptx

HOSPITAL INFECTION CONTROL

1. HOSPITAL INFECTIONS Concerns and Prevention Dr.T.V.Rao MD Dr.T.V.Rao MD' TMC Kollam Kerala 1

2. A Tribute to Ignaz Semmelweiss (1818-1865) Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues Dr.T.V.Rao MD' TMC Kollam Kerala 2

3. Hospital Infection Hospital infection is also called Nosocomial infection. It is the single largest factor that adversely affects both the patient and the hospital Dr.T.V.Rao MD' TMC Kollam Kerala 3

4. What is Hospital Acquired Infections Any infection that is not present or incubating at the time the patient is admitted to the hosp ital Dr.T.V.Rao MD' TMC Kollam Kerala 4

5. Why is infection such a problem even after 100 years since Lister and Pasteur ? 1. Advancing age of the patients, as they are more prone to infection. 2. Use of sophisticated and complicated equipment which is not easy to clean, disinfect or sterilize. 3. Increasing specialization bringing together patients susceptible to some type of infection. Dr.T.V.Rao MD' TMC Kollam Kerala 5

6. Increasing trends 4 . Increased use and empirical use of antibiotics resulting in drug resistance. 5. Higher rate of staff turnover makes it difficult to maintain uniform standards 6. Effective sterilization system as yet not fully understood by all concerned. Dr.T.V.Rao MD' TMC Kollam Kerala 6

7. Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death Dr.T.V.Rao MD' TMC Kollam Kerala 7 Consequences of Hospital Acquired Infections

8. Why Everyone Concerned with Hospital Infections The Centers for Disease Control (CDC) estimates that 2 million U.S. patients a year acquire hospital-related infections. Dr.T.V.Rao MD' TMC Kollam Kerala 8

9. The nature of infections Micro-organisms - bacteria, fungi, viruses, protozoa and worms Most are harmless [non-pathogenic] Pathogenic organisms can cause infection Infection exists when pathogenic organisms enter the body, reproduce and cause disease Dr.T.V.Rao MD' TMC Kollam Kerala 9

10. HAI - common bacteria Staphylococci - wound, respiratory and gastro-intestinal infections Escherichia coli - wound and urinary tract infections Salmonella - food poisoning Streptococci - wound, throat and urinary tract infections Proteus - wound and urinary tract infections (Peto, 1998) C.difficle an emerging pathogen Dr.T.V.Rao MD' TMC Kollam Kerala 10

11. HAI - common viruses Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Human immunodeficiency v irus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998 ) Dr.T.V.Rao MD' TMC Kollam Kerala 11

12. What is Infection Control Infection control is the discipline concerned with preventing nosocomial or healthcare-associated infection. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care. Dr.T.V.Rao MD' TMC Kollam Kerala 12

13. Beginning of Hospital Infection Programme Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," Dr.T.V.Rao MD' TMC Kollam Kerala 13

14. First Data on Infection Control Efficacy In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented Dr.T.V.Rao MD' TMC Kollam Kerala 14

15. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) In 1969, the Joint Commission for Accreditation of Hospitals--later to become the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities Dr.T.V.Rao MD' TMC Kollam Kerala 15

16. Beginning of AIDS Pandemic Necceciates Stronger Infection Control Protocols The second and certainly most significant factor influencing infection control at the time was the advent of acquired immunodeficiency syndrome (AIDS). HIV has been a challenge for education, risk reduction and resource utilization. Dr.T.V.Rao MD' TMC Kollam Kerala 16

17. Infection Control Challenges of Healthcare in 2000 Decreasing reimbursement Increasing emerging infections Increasing resistant organisms Increasing drug costs Nursing shortage OSHA safety legislations Multiple benchmark systems FDA legislation on reuse of single-use devices Dr.T.V.Rao MD' TMC Kollam Kerala 17

18. Infection control was influenced by the reform of the Healthcare System Infection control programs had to encompass not only hospitals but also the long-term care facility, home health/hospice, rehabilitation facilities, free-standing surgical centers, and physician office practices. A dramatic shift in patient care practices occurred as greater than 65% of surgery cases were operated on in an outpatient setting. Dr.T.V.Rao MD' TMC Kollam Kerala 18

19. 19 Identify problems with polices and procedures Example: Pre- and Post-Operative Care create your protocols Skin shaved the night before surgery Inappropriate peri-op antibiotic prophylaxis Instruments used for dressing changes submerged disinfectant Large containers of antiseptics, no routine for cleaning and refilling Eliminate shaving of skin the night before surgery Single dose peri-op antibiotic prophylaxis guidelines Use individual sterile packs of wound care instruments Use small containers of antiseptics; clean and dry containers before refilling Recommendation Problem Area Dr.T.V.Rao MD' TMC Kollam Kerala

20. Challenging Issues Issues that will continue to impact infection control programs into the new millennium are a challenging combination of cost and clinical factors and increasing cost to treat infections, and financial impact of implementing new government regulations . Dr.T.V.Rao MD' TMC Kollam Kerala 20

21. Infection Control Committee and Antibiotic Policies are Back bone for reduction of Infections Dr.T.V.Rao MD' TMC Kollam Kerala 21

22. Your Unwashed Hand a Great Concern to Your Patient Dr.T.V.Rao MD' TMC Kollam Kerala 22

23. GUIDELINES AND RECOMMENDATIONS Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device-Related Infections and its control * Isolation Precautions Dr.T.V.Rao MD' TMC Kollam Kerala 23

24. Scientific Disinfection Practices Saves Several Lives * Long-Term Care Facilities *Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately * Home care * Hospital Construction * Sterilization / Disinfection Dr.T.V.Rao MD' TMC Kollam Kerala 24

25. Protecting Yourself from Blood-Borne Pathogens Dr.T.V.Rao MD' TMC Kollam Kerala

26. HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 000 Dr.T.V.Rao MD' TMC Kollam Kerala

27. Hepatitis C: 18 Persons per 1,000 Needle-sticks 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 00000000000000000 Dr.T.V.Rao MD' TMC Kollam Kerala

28. Hepatitis B is Most Infectious 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Dr.T.V.Rao MD' TMC Kollam Kerala

29. Safe Handling of Sharps Wear gloves when drawing blood or handling sharps—double glove for surgery Don’t recap! Don’t bend or break needles Never place used sharps on tables, beds, furniture Put used sharps immediately into a sharps container Dr.T.V.Rao MD' TMC Kollam Kerala 29

30. 30 Infection Control Committee - Represented Committee Representatives Hospital Epidemiologist Infection Control Practitioners Administrator Ward, ICU and Operating room Nurses Medicine/Surgery/Obstetrics/Pediatrics Central Sterilization Hospital Engineer Microbiologist Pharmacist Dr.T.V.Rao MD' TMC Kollam Kerala

31. Hand Washing is the Foundation of Infection Control Hand washing is the single most important procedure for preventing nosocomial infections.. Although various products are available, hand washing can be classified simply by the nature of the products used: plain soap detergents Antimicrobial containing products Dr.T.V.Rao MD' TMC Kollam Kerala 31

32. Successful Promotion in Hand Washing  Education Routine observation & feedback Engineering controls Location of hand basins Possible, easy & convenient Alcohol-based hand rubs available Patient education ( Improving Compliance with Hand Hygiene in Hospitals . Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381) Dr.T.V.Rao MD' TMC Kollam Kerala 32

33. Successful Promotion Can Improve Hand Washing  Reminders in the workplace Administrative sanctions ?? Promote and facilitate skin care Avoid understaffing and excessive workload Dr.T.V.Rao MD' TMC Kollam Kerala 33

34. Computerized Surveillance Surveillance traditionally involved significant manual data assessment Increasingly, integrated computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. Dr.T.V.Rao MD' TMC Kollam Kerala 34

35. Formulating an Infection Control Plan Every infection control program should develop a well-defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. Dr.T.V.Rao MD' TMC Kollam Kerala 35

36. Infection Control Programme and Documentation Goals of the infection control program need to be incorporated into the mission statement of the facility. A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal Dr.T.V.Rao MD' TMC Kollam Kerala 36

37. Waste disposal Clinical waste - HIGH risk potentially/actually contaminated waste including body fluids and human tissue yellow p lastic sack, tied prior to incineration Household waste - LOW risk paper towels, packaging, dead flowers, other waste which is not dangerously contaminated black plastic sack, tied prior to incineration Follow local policy (May, 2000) Dr.T.V.Rao MD' TMC Kollam Kerala 37

38. Document Antibiograms With WHONET WHONET is a free Windows-based database software developed for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test results. Dr.T.V.Rao MD' TMC Kollam Kerala 38

39. Health Care Means In patient care and outpatient care Significant trends in healthcare are occurring everyday including new medical procedures ( i.e. , gene therapy, Stem cell therapy), new technology (multi-purpose intravenous catheters), and a shift from inpatient to outpatient care. Dr.T.V.Rao MD' TMC Kollam Kerala 39

40. Surveillance The key to ongoing monitoring is surveillance for nosocomial infections. Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base Dr.T.V.Rao MD' TMC Kollam Kerala 40

41. What we need and what to do One infection control professional (ICP) for every 250 beds. An effective infection control physician. A program reporting infection rates back to the surgeon and those clinically involved with the infection. An organized hospital-wide surveillance system. Dr.T.V.Rao MD' TMC Kollam Kerala 41

42. NEW TECHNOLOGIES IN HOSPITAL INFECTIONS Dr.T.V.Rao MD' TMC Kollam Kerala 42

43. Light technology to combat Hospital Infections A pioneering lighting system that can kill hospital superbugs – including MRSA and C.diff – has been developed by researchers at the University of Strathclyde in Glasgow, Scotland. The technology decontaminates the air and exposed surfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light. Dr.T.V.Rao MD' TMC Kollam Kerala 43

44. Light Technology to Combat Hospital Infections HINS-light is a safe treatment that can be easily automated to provide continuous disinfection of wards and other areas of the clinical environment. The pervasive nature of light permits the treatment of air and all visible surfaces, regardless of accessibility, either through direct or reflected exposure to HINS-light within the treated environment Dr.T.V.Rao MD' TMC Kollam Kerala 44

45. Medical Dressing Uses Nanotechnology to Fight Infection Scientists at the University of Bath and the burns team at the Southwest UK Pediatric Burns Centre at Frenchay Hospital in Bristol are working together with teams across Europe and Australia to create an advanced wound dressing. Dr.T.V.Rao MD' TMC Kollam Kerala 45

46. New Bandages Change Color If Infections Arise The dressing will work by releasing antibiotics from Nano capsules triggered by the presence of disease-causing pathogenic bacteria, which will target treatment before the infection takes hold. Dr.T.V.Rao MD' TMC Kollam Kerala 46

47. New Nanotechnology for Hospital Infection Control Receives FDA Approval SilvaGard can be used to treat virtually any medical device and its use does not alter the device's original properties. Due to these and other unique attributes, SilvaGard is expected to have a significant impact on the battle against hospital-related infections. Dr.T.V.Rao MD' TMC Kollam Kerala 47

48. Recent Studies on Infection Control and Prevention Dr.T.V.Rao MD' TMC Kollam Kerala 48

49. Long Sleeves x Short Sleeves Scientific studies showed there were no statistically significant differences found in bacterial or MRSA counts between physicians’ coats and newly laundered short-sleeved uniforms. The researchers’ findings sheds new light on British government agencies’ policies banning physicians’ white coats based on the belief that long sleeves carry more bacteria and pose a greater risk of bacterial transmission Dr.T.V.Rao MD' TMC Kollam Kerala 49

50. Involvement of Physicians More Important Physicians to be more involved and lead quality improvement efforts in their respective healthcare settings. One of the reasons for this lack of progress, they say, is inadequate physician engagement and leadership in quality improvement work. Peter Pronovost, MD, PhD, and Jill Marsteller, PhD, MP Dr.T.V.Rao MD' TMC Kollam Kerala 50

51. Scientific Documentation Reduces Hospital Infections Researchers evaluated the effect of an electronic medical record on the use of antimicrobial agents and infection rates of Clostridium difficile and MRSA . Results showed that implementation of an EMR significantly increased chart reviews and antimicrobial recommendations, leading to a decrease in antimicrobial use and MRSA as well as C. difficile infection rates. Dr.T.V.Rao MD' TMC Kollam Kerala 51

52. Impact of Hand Washing on Influenza Health experts believe a flu epidemic was averted last year because of regular hand-washing, suggesting healthcare facilities should promote hand-washing among staff and patients to prevent the spread of disease. The American Society for Microbiology and the American Cleaning Institute released a study in Sept. 2010 reporting that 85 percent of people washed their hands in public restrooms in 2008, the highest levels observed since the research began in 1996. Dr.T.V.Rao MD' TMC Kollam Kerala 52

53. Hand Hygiene Compliance Researchers have implemented a hand hygiene program driven by a behavioral change approach to increase hand hygiene compliance. . It included access to alcohol sanitizer, education as well as ongoing audit and feedback. Dr.T.V.Rao MD' TMC Kollam Kerala 53

54. Yet no Ideal Chemical Agent Researchers concluded that each prep agent has specific advantages and disadvantages and no one skin prep agent is superior in all clinical situations. Factors to consider when choosing a skin prep agent include surgeon preference and environmental risks. Dr.T.V.Rao MD' TMC Kollam Kerala 54

55. Hand Hygiene Techniques Many Ways Alcohol hand rub Routine hand wash 10-15 seconds Aseptic procedures 1 minute Surgical wash 3-5 minutes Dr.T.V.Rao MD' TMC Kollam Kerala 55

56. Advantages of Alcoholic Hand Wash Require less time Can be strategically placed Readily accessible Multiple sites All patient care areas Acts faster Excellent bactericidal activity Less irritating (??) Sustained improvement Dr.T.V.Rao MD' TMC Kollam Kerala 56

57. Hand washing – Areas Missed Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger-webs, the palms and the thumbs . Dr.T.V.Rao MD' TMC Kollam Kerala 57

58. Health Care Workers are at Risk – Need for Vaccination Health care workers may be exposed to certain infections in the course of their work. Vaccines are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitides; and varicella. Dr.T.V.Rao MD' TMC Kollam Kerala 58

59. Who will pay us ??? The problem of resources for proving Vaccines in Developing countries continues to be real problem, need additional economic resources Dr.T.V.Rao MD' TMC Kollam Kerala 59

60. Training Every One .. Is it a Easy Job ??? This is the single most important factor in the control of Hospital infection. A high sense of awareness and training goes a long way in controlling Hospital infection. Dr.T.V.Rao MD' TMC Kollam Kerala 60

61. Let us support our hospitals with clean hands Dr.T.V.Rao MD' TMC Kollam Kerala 61

62. Soap Water and Common sense are Best Antiseptics- William Osler Dr.T.V.Rao MD' TMC Kollam Kerala 62

63. Dr.T.V.Rao MD' TMC Kollam Kerala 63

64. Program file created by Dr.T.V.Rao MD for the benefit of Medical Nursing and Paramedical Professionals in Developing World [email protected] Dr.T.V.Rao MD' TMC Kollam Kerala 64