infection control protocols in hospital vap causi clapsi

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1. INFECTION CONTROL PROTOCOL IN ICU Presenter SOHAN RAJ NURSING OFFICER NEUROSURGERY ICU

2. INTRODUCTION “The very first requirement in a hospital that it should do the sick no harm" - Florence Nightingale Health care associated infections(HCAI)- economic loss, prolonged hospital stay & adverse patient outcomes . In most health care facilities the average incidence of HCAI is around 5-10 %

3. Measures practiced by health care personnel to prevent spread, transmission & acquisition of infection between clients, from health care providers to clients & from clients to HCP . Based on INFECTION CONTROL - DEFINITION Standard precaution Additional precaution

4. COMMON ORGANISMS BACTERIA Staphylococcus aureus Enterococcus Pseudomonas aeruginosa Klebsiella E- coli VIRUS HIV HBV HCV CMV

5. FUNGAL Candida albicans Aspergillus PARASITES Giardia lambia

6. Low resistance of patient to infections. Invasive procedures/interventions. Inappropriate anti-microbial usage. Drug resistance of endemic microbes. Contaminated environment. RISK DUE TO

7. STANDARD SAFETY MEASURES

8. STANDARD PRECAUTION Set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non- intact skin & mucus membrane STANDARD PRECAUTION STEPS Hand washing PPE Decontamination Waste disposal

9. HAND HYGIENE Hand washing is the single most effective measure in infection control. 80% of the diseases are spread through hands.

10. How to Handwash ?

11. HOW TO HAND RUB?

12. POINTS TO BE REMEMBERED Covering cuts & wounds Gloves is not a substitute for hand washing When a bar soap is used, it should be kept dry in soap case When liquid soaps are used, avoid topping off of the solution , dispenser should be kept clean

13. PERSONAL PROTECTIVE EQUIPMENT Gloves Gown Mask Protective eye wear Face shield Apron

14. SEQUENCE FOR DONNING PPE GOGGLES OR FACE SHIELD GLOVES GOWN MASK

15. SEQUENCE FOR REMOVING PPE

16. SAFE HANDLING OF SHARPS Never pass sharps from one person to another. Always dispose your own sharps. DO NOT RECAP needles. Dispose sharps in puncture proof container.

17. DISINFECTION Reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms or spores.

18. TYPE OF DISINFECTANTS High level disinfectants 2% glutaraldehyde ( cidex ) stabilised hydrogen peroxide 1% sodium hypochlorite Intermediate level disinfectants 0.1% sodium hypochlorite I odophores & phenolic solutions Low level disinfectants Q uateranary ammonium compounds

19. STERILIZATION Procedures , which would remove all microorganisms, including spores, from an object . Sterilization Methods Dry heat sterilization Moist heat sterilization Chemical sterilization Radiation sterilization

20. Safety bundles A “bundle” is a group of evidence based care components for a given disease that, when executed together, may result in better outcomes than if implemented individually.

21. CAUTIs Bundle Catheter-associated urinary tract infection Avoid unnecessay urinary catheters Insert using aseptic technique Maintain catheter using recommended guidelines (daily care) Review catheter necessity daily & remove promptly.

22. CLABSIs C entral line-associated bloodstream infection Hand hygiene Maximal barrier precautions Chlorhexidine skin antisepsis Optimal catheter site selection Daily review of line necessity with prompt removal of unnecessary lines Line secure with clean & intact dressing

23. SSI Bundle surgical site infection Appropriate use of antibiotics Appropriate hair removal Post operative glucose control Peri & postoperative normothermia

24. VAP Bundle Ventilator-associated pneumonia DVT prophylaxis GI prophylaxis Head of bed elevated to 30-45 º Daily sedation vacation Daily spontaneous breathing trail

25. BIO MEDICAL WASTE MANAGEMENT

26. DEFINITION Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO ) Waste management is the collection , transport, processing or disposal, managing & monitoring of waste material .

27. PURPOSES OF WASTE DISPOSAL To reduce hazardous nature of waste. To reduce volume of waste. To prevent misuse or abuse of waste. To ensure occupational safety & health .

28. LEGISLATION Ministry of environment & forests (MOEF) issued guidelines to the hospitals to ensure proper & safe disposal of bio medical waste. Bio medical waste management & handling rule came in to effect in 1998

29. Human anatomical waste Chemo drugs Soiled waste Expired or Discarded Medicines , soiled linen Contaminated Plastic Waste (Recyclable ) Waste sharps i ncluding Metals Glassware: Broken or discarded & contaminated glass including medicine vials & ampoules 36 General waste 3 BINS, 01 CONTAINER, O1 BOX

30. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL YELLOW Human anatomical waste Animal anatomical waste Solied waste Incineration or plasma pyrolysis or deep burial (d) Expired or discarded medicine Incineration at tem. >1200 0C Or Encapsulation or Plasma Pyrolysis (e) Chemical liquid waste (f) Linen Pre treatment before mixing with waste water. Non- chlorinated chemical disinfection followed by incineration BMW RULE 2016

31. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL RED Contaminated plastic waste ( Recyclable ) Autoclaving or micro-waving followed by shredding, sterilization & then sent to registered recyclers for energy recovery or for road making BMW RULE 2016

32. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL White ( Translucent Puncture proof, containers) Waste sharps including Metals Autoclaving & shredding & sent for final disposal to iron foundries. consent to operate from the State Pollution Control Boards or concrete waste sharp pit. BMW RULE 2016

33. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL Cardboard boxes with blue coloured marking Glassware: Broken or discarded & contaminated glass Metallic Body Implants Disinfection then Sent for recycling. BMW RULE 2016

34. WASTE MANAGEMENT 3R’s

35. WASTE SEGREGATION Done at the source of waste generation Responsibility of generator of waste. segregation as per categories applicable . Waste segregation

36. WASTE STORAGE Storage facility should have sufficient capacity. Location - within hospital premises . Untreated biomedical waste not to be kept beyond 48 hrs (Permission required for >48 hrs ).

37. WASTE TRANSPORTATION Points to be remembered: Before taking the bags it should be tied & labeled. Waste handlers should not touch any other articles. A covered cart with biohazard symbol to carry the waste to the central area of collection .

38. AIIMS-OUT SOURCING BY BIOTIC

39. TRAINING ON BIOMEDICAL WASTE MANAGEMENT Overall aim of training : To develop awareness of health, safety & environmental issues relating to health care waste. Roles & responsibilities of health care personnel in overall management program should be highlighted.

40. STAFF SAFETY CONSIDERATIONS Separate trolleys for transporting waste within the hospital. All workers involved in the work are aware of the hazardous nature of the work. P rovided with all protective equipment. Immunized against tetanus & hepatitis B.

41. ROLE OF INFECTION CONTROL NURSES Visits all wards & high risk units. Checking nursing supervisor’s register & records for cases suggestive of infection. Collection of sample from different areas of the hospitals & sending them to the lab.

42. ROLE OF INFECTION CONTROL NURSES(CONTD..) Daily visit to microbiology lab to ascertain results of sample collected. Monitoring & supervision of infection among hospital staffs. Training of nursing & paramedical personnel on correct hygiene practices & aseptic technique.

43. SUMMARY Infection control Chain of infection Standard safety measures Safety bundles Staff safety Role of infection control nurses

44. CONCLUSION This is the time to understand that infection control, standard precaution, hospital waste management are of great concern . The human element is more important than technology. Well trained, motivated staff can really work wonders. Strict adherence to simple infection control procedures go long way in controlling infection .

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