Ic lecture for general hospital orientation program updated

By Dr. Nashwa Elsayed
Clinical Pathologist, Infection Control Specialist, KFH Medina Lab Quality Coordinator

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BY
Dr. Nashwa Elsayed
Clinical Pathologist / Infection Control Specialist
MB.BCH
M.Sc. of Clinical & Chemical Pathology
Diploma in Infection Prevention & Control
Diploma in Health Care Quality Management

2. •Hospital Infection control (IC) is a quality
standard that is essential for the well being and
safety of patients, staff and visitors.
•It affects most departments of the hospital and
involves issues of quality , patient safety and risk
management.
•The main role of Infection Control Department is
to the prevention or reduction in rates of
Healthcare Acquired Infections (HAIs).

3. Importance of infection control program
•We have an obligation to reduce the
morbidity and mortality of our
patients.
•
•Accreditation requirements demand a
strong infection control program.
•
•

5. •Prevention of HCAI is the responsibility of
all healthcare providers.
• Everyone must work cooperatively to
reduce the risk of infection for patients,
staff even visitors.
•Infection control programs do surveillance
and prevention activities, as well as staff
training.
•

6. HealthCare Acquired Infections
(Nosocomial Infections)
HAIs

7. Chain of Infection

8. HCAIs infections occur
when chain of infection
occurs and requires the
following:

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11. STANDARD
PRECAUTIONS

12. STANDARD PRECAUTIONS
•The basic requirements for infection prevention and control
•Standard Precautions include a group of infection prevention
practices that apply to all patients, regardless of suspected or
confirmed infection status, in any setting in which healthcare is
delivered.
•Based on the principle that all blood, body fluids, secretions, non
intact skin, mucous membranes & excretions except sweat may
contain transmissible infectious agents.
•Designed to be used for the care all patients regardless of their
diagnosis
•
•

13. ** Standard Precautions include:
1. Hand hygiene.
2. Use of PPE
3. Laboratory specimens safe handling.
4. Cleaning of patients rooms.
5. Patient placement (Isolation techniques).
6. Handling & disposal of contaminated item.
7. Safe injection practices.
•

14. Hand Hygiene

15. Objective of hand washing:
•To remove/reduce the number of microorganisms
on the hands.
•To reduce the risk of transmission of infection to
patients and personnel.
•To reduce the contamination of the environmental
surfaces
•

16. Why hand hygiene ??
1. The health care environment is contaminated.
2. All health care work involves hands.
3. Hands are contaminated.
4. Hands spread germs.
5. Patients are vulnerable to infection.

17. Indication for hand hygiene
•WHO opportunities / 5 moments for hand hygiene:
1. Before patients contact .
2. Before aseptic task.
3. After blood, body fluids exposure risk.
4. After patient contact .
5. After contact with patient surroundings /
environment
•

19. * Other opportunities for hand hygiene:
•
•When the hands visibly soiled.
•After removing gloves.
•Before leaving patient room.
•Before and after eating or preparing food .
•After use of toilet, blowing nose, sneezing.
•

20. Methods of Hand Hygiene
1.Hand washing:
Washing hands with plain ( non-antimicrobial ) soap and water.
2. Alcohol-based hand rubs:
Rub the hands by a solution that contains 60% to 95% alcohol and
is designed to be applied to hands to reduce the number of viable
microorganisms on the hands.
3. Surgical hand antisepsis:
An antiseptic hand wash or antiseptic hand rub performed
preoperatively by surgical personnel to eliminate transient and
reduce resident hand flora.

21. * Wash hands for minimum of 40 to 60 seconds .
* Alcohol based hand rub for a minimum of 20 to 30
seconds.
Remove jewelries
•Wet hand with running water then apply liquid
soap (for hand washing) .
•Or apply Alcohol gel (for alcohol based hand rub).

22. why???

24. How ???

26. Use of PPE

29. Laboratory
specimens

30. •Handle all specimens with gloves.
•Place laboratory specimens in designated ,
appropriately sealed containers .
•Label container with appropriate patient data.
•Transfer to the laboratory in upright position and
as promptly as possible.
•Ensure that the request form has complete
information.

31. Cleaning of
patients rooms

32. •Should be daily and after patient
discharge
**cleaning as housekeeping policies
KFH have:
1.Hydrogen Peroxide machine
2.Hygieno machine
•

33. Patient placement
(Isolation
techniques)

34. *Patient who carry a risk of transmission
to other:
•Patient with uncontained secretions, excretions or
wound drainage.
•Patient with suspected viral respiratory tract or
gastrointestinal tract infections
** Place that patient in a single – patient
room when available .

35. Handling / disposal of
contaminated items

36. contaminated items ???
1. Needles & Sharps.
2. Linen.
3. Medical waste.
4. Patient care equipment.

37. Linen
•Linen should be handled & transported in a
manner to prevent contamination to patient &
environment
•Place linen in an impermeable designated bag
and close the bag securely.
•Wrap wet linen in another piece of linen to
avoid soaking of bag.
•

38. Disposal of waste
** Waste generated by health care activities
includes a broad range of materials:
From used needles and syringes to soiled
dressings , body parts , diagnostic samples ,
blood, chemicals , pharmaceuticals , medical
devices and radioactive materials
•

39. Health care waste ??
1. Non hazardous waste – (non medical waste)
- Food waste produced from kitchen or patient’s room
- Administration waste (paper ,empty pens..)
-Any non infectious or hazardous waste except isolation rooms waste
2. Hazardous medical waste :
-Infectious medical waste
- sharp medical waste
-Human body parts and tissues waste
- chemical and pharmaceutical medical waste
- Radioactive medical waste
•

44. Disposal of sharps
•Avoid recapping or bend needles
•Dispose needle in proper sharp containers
•Avoid handling needles or sharp to another staff
•Wear gloves to lower the risk of exposure to blood in prick
happens
•Close sharp container when it is ¾ full
•Don’t put needles & sharps even of non infectious patient in
plastic bags as this is very dangerous for housekeeping &
cleaners

45. Cleaning of Patient
care equipment

46. •Commonly used equipment must be cleaned and
disinfected between patient.
•
•Do not reuse disposable equipment.
**NO USE OF SINGLE USE **
•
•Ensure reusable equipment is transported in
leak proof container to CSSD for reprocessing
before using on another patient.

47. TRANSMISSION
BASED
PRECAUTIONS

48. ** Transmission Based Precautions applied in
addition to standard precaution to patients known
or suspected to be infected or colonized with
epidemiologically important or highly transmissible
pathogens:
1- Air borne transmission precautions.
2- Droplet transmission precautions.
3- Contact transmission precautions.
•

49. AIR BORNE TRANSMISSION
PRECAUTIONS
•Involves the dissemination of infectious nuclei
generated when an infected person coughs,
sneezes, or talks.
** The infectious nuclei :
•can stay suspend for extended period.
•can be widely dispersed by air currents.
•
•
•

50. Airborne Precautions

51. DROPLET TRANSMISSION
PRECAUTIONS
•Involves the transmission respiratory droplets generated
when an infected or colonized person coughs, sneezes or
talks.
•Or can be generated during certain procedures such as
suctioning and bronchoscopy.
** Droplets are:
•Travelled short distance less than 3 feet.
•Microorganisms are aerosolized and can be deposited on the
susceptible host’s conjunctiva, nasal mucosa and mouth.
•Deposited in surfaces ---- Contact transmission.
•

52. Droplet Precautions

53. CONTACT TRANSMISSION
PRECAUTIONS
•Contact Precaution In addition to Standard Precautions is intended
to reduce the risk or transmission of epidemiologically important
microorganisms transmitted by direct or indirect contact with the
patient and or patient’s environment.
•Patients diagnosed with the same microorganism can be placed in
the same room (Cohorting) assuming that no other infection is
present.
•Hands of HCWs are the most important contributors of indirect
contact
•

54. **Contact Transmission is the most important and frequent
mode of transmission in healthcare associated infections.
** It is divided into:
A.Direct Contact: involves direct physical contact between a
susceptible host and an infected or colonized person.
• Nurse or doctor to patient contact during routine care.
•Patient to patient.
•Patient to visitor contact.
B. Indirect Contact: involves the physical contact of a
susceptible host with a contaminated intermediate object or
person.

55. Contact Precautions

56. MULTI DRUG RESISTANT ORGANISMS
(MDROs)
•MRSA (Methicillin Resistant Staph Aureus)
•VRE (Vancomycin Resistant Enterococci)
•CRE (Carbapenem Resistant Enterobacteria)
•PDRA (Pan Drug Resistant Acinitobacter)

57. ** Screen all patients who are :
1.Admitted to the ICUs
2.Transferred from other hospitals
3.Treated in another hospital / clinic within the past 6
months
4.Undergoing elective surgery ( 7-14 days preoperatively )
5.Undergoing hemodialysis or CAPD ( continuous ambulatory
peritoneal dialysis )
6.Roommate with positive patient not on precaution.
7.known to be previously MRSA positive culture results.
•

58. Site to screen :
•Anterior nares (MRSA)
•Any indwelling catheter site.
•Open skin area. eg pressure sores,
tracheostomy or surgical wound.
** All positive patient should be reported to
infection control department to isolate them
•

59. ISOLATION TRANSPORT CARD

60. BLOOD and BODY
FLUIDS SPILLAGE

61. •The disinfectant of choice for blood and body
fluid contaminated surfaces are Chlorine
generating disinfectants like Clorox.
•Mixing one part of Clorox to ten parts of tap
water (1:10 dilution) will provide 10,000
parts per million (ppm) available chlorine.
•** Make sure that solution is always freshly
prepared.
•

62. Prepare a “Spill Kit” :
•Protective clothing and gloves
•Shoe Cover
•Forceps
•Container of Sodium Hypochlorite (Clorox)
•Roll paper towels
•Yellow plastic bag for disposal of infectious
waste
•.
•

63. CLEANING PROCEDURE:
** Clean the spillage as soon as possible before it dries up
•Place “Wet Floor” sign near the area of spill
•Wear protective clothing and gloves
•Put on goggles if splashing is likely. Unprotected eyes allow easy
entry of infectious agents into the body.
•Put on shoe cover to protect shoes if they are likely to become
contaminated with the blood spill.
•If broken glass or any other sharp object is involved, use forceps to
pick them up and throw into a sharps container before any
cleaning or disinfecting is ever attempted.

64. •Using paper towels, wipe all the blood or body fluid from the
surface.
•Pour or spray the disinfectant solution on the area of spill and
leave for 3-5 minutes. This will ensure ample ‘contact time’ for
disinfection.
•Wipe clean with paper towels.
•Discard all contaminated paper towels into the infectious yellow
bag.
•All protective barriers should be disposed of as infectious waste.
•Wash hands with antiseptic detergent.
•Replace and replenish supplies on the “Spill Kit”.

65. MERS-CoV
“CORONA”

66. •Middle East Respiratory Syndrome (MERS) is
viral respiratory illness that is caused by a
coronavirus called MERS-CoV.
•
•Most people who have been confirmed to have
MERS-CoV infection developed severe acute
respiratory illness. They had fever, cough,
and shortness of breath.

67. CORONA Suspected case
(patients who should be tested for MERS-CoV)
** Adults (> 14 years)
I. Acute respiratory illness with clinical and/or radiological, evidence of
pulmonary parenchymal disease (pneumonia or Acute Respiratory Distress
Syndrome)
II. A hospitalized patient with healthcare associated pneumonia based on
clinical and radiological evidence.
III. Upper or lower respiratory illness within 2 weeks after exposure to a
confirmed or probable case of MERS-CoV infection
IV. Unexplained acute febrile (≥38°C) illness, AND body aches, headache,
diarrhea, or nausea/vomiting, with or without respiratory symptoms, AND
leucopenia (WBC<3.5x109/L) and thrombocytopenia
(platelets<150x109/L)

68. ** Pediatrics (≤ 14 years)
I. Meets the above case definitions and has at least
one of the following:
a. History of exposure to a confirmed or suspected MERS-CoV in the
14 days prior to onset of symptoms.
b. History of contact with camels or camel products in the 14 days
prior to onset of symptoms.
II. Unexplained severe pneumonia
•

69. Probable CORONA case
A probable case is a patient in category I or II
above (Adults and pediatrics) with inconclusive
laboratory results for MERS-CoV and other possible
pathogens who is a close contact of a laboratory-
confirmed MERS-CoV case or who works in a
hospital where MERS-CoV cases are cared for or
had recent contact with camels or camel’s products.

70. Confirmed CORONA case
•It is a suspected case with laboratory
confirmation of MERS-CoV infection.
•

71. BICSL
“Basic Infection Control
Skill License”

72. ** How to achieve BICSL ??
•N95 respirator Fit Test.
•PARP training.
•Hand hygiene.
•PPE.
•Influenza vaccine.
•Meningococcal vaccine.

73. Employee Health
Clinic
(Staff Clinic)

74. •The services provided in the KFH E.H.C C8
building
•E.H.C is open on Sunday to Thursday from 8 AM
to 3 PM.
•Involve all employees working in KFH.
•An employee must obtain authorization to visit
the clinic from his or her Supervisor or Service
Director.

75. When to visit EHC ??
1.Pre –employment health evaluation and
employee physical examination
2.Immunization
3.Management of work related health
problems
4.Treatment of minor illness
•

76. Pre –employment health evaluation
** Each new employee must complete pre-
employment health process prior to the first day of
work.
All new employee are required Screening:
•HBs Ag; Anti-HCV ;Anti-HIV ;Anti-VDRL; blood
group ; malaria parasite
•Tuberculosis (PPD Skin Test)
•Chest x-ray
•

77. Immunization
•Hepatitis B immunization is offered to all
employee who are considered at risk for
exposure to Hep B
•Rubella, Measles and Mumps Vaccine.
•Influenza Vaccine.
•Varicella Vaccine.
•Meningococcal vaccine.

78. Management of work related health
problems
•The E.H.C will provide diagnosis and treatment of
work related injuries ; illnesses and hospital
sponsored screenings for a particular health
problem
** Employees should report to E.H.C for the
Following:
1.Sharp injuries which occurred on work.
2.Blood and body fluid exposures.
•
•

79. What are Needle Stick
Injuries ???

80. ** Needle stick injuries are wounds caused by
needles that accidentally puncture the skin.
•Percutaneous Injury: A needle stick or cut
with a sharp object.
•Mucocutaneous Exposure: exposure of a
mucous membrane or chapped, abraded &
inflamed skin with blood, tissue or other
body fluids that are potentially infectious.
•

81. Hazards of needle stick injuries
** Accidental injection of blood-borne viruses is
the major hazard of needle stick injuries.
•Risk to acquire infection from infected blood:
1. Hepatitis B virus 30%
2. Hepatitis C virus 3%
3. HIV is about 0.3%
4.

82. Preventing Needle stick Injuries in Health
Care Settings
•These injuries can be avoided by eliminating
the :
1.Unnecessary use of needles,
2.Using devices with safety features,
3.Promoting education and safe work
practices for handling needles and
related systems.
•

83. Management of Needle
stick injury ???

84. First Aid
1. Percutaneous injuries (Needle stick/Sharp Injury)
• Allow the site to bleed
• Wash generously with soap and water
• Cleanse with alcohol wipes
• Cover with appropriate bandages
2. Mucocutaneous exposures (Body Fluid Exposure)
• Remove contaminated clothing (if necessary)
• Irrigate affected area with copious amounts of water (10 minutes)
•

85. Report the injury within 24 hours of the
incident
•for risk assessment and prophylaxis where
indicated.
•To support future compensation
documentation of any exposure is
essential & notification must be made
within 72 hours.

86. WORK RESTRICTIONS
•When to suspended from work ???
•Gastrointestinal Disorder
•Skin Infection and Rashes
•Herpes Zoster (Varicella)
•Communicable diseases ; ( e.g. chicken pox ; measles;
mumps ; hepatitis……etc.)
•Conjunctivitis
•Having symptoms after Contact with Confirmed
CORONA case
•

87. Thank
You