PREVENT NOSOCOMIAL INFECTION and prevent

Infection and prevention

1. PREVENT NOSOCOMIAL INFECTION BY VELORY

2. LEARNING OUTCOMES Prepare surgical instruments Prepare patient for surgery Dispose theatre waste

3. Unit outline Definition Theatre layout Operating theatre checklist Examples and causes of nosocomial infections Surgical instruments Surgical packs and sets Surgical instruments preparation and packaging

4. Surgical procedure manuals Decontamination and waste management in Theatre Safety practices in operating theatre e.g., Hand washing Infection control, personal protective gears Communicable and no-communicable diseases Operating theatre ethics and etiquette

5. Introduction Nosocomial Infections They are also called health care associated infections (HCAIs)/ hospital acquired infections They are infections acquired in the hospital or other health care facility that were not present during the time the patient was admitted Include those infections that become symptomatic after the patient has been discharged as well as among medical personnel Most of these infections are transmitted by medical personnel who fail to practice proper hand washing procedures or change of gloves

6. Infection occurs when pathogen(s) spread to a susceptible patient host. In modern healthcare, invasive procedures and surgery, indwelling medical devices, and prosthetic devices are associated with these infections. The etiology of HAI is based on the source or type of infection and the responsible pathogen, which may be bacterial, viral, or fungal.

7. Causes of nosocomial infection • Urinary catheters. These are tubes inserted through urethra into the bladder • Breathing machines. Ventilators are machines that help in breathing by pushing air in and out of the lungs • Central lines.—Cannulas • Not cleaning properly before surgery.

8. Nosocomial infections causes: Deterioration in health Prolong hospital stay Affect the client’s overall well being Lead to death.

9. The most common pathogens that causes nosocomial infections are; - Staphylococcus aureus - Pseudomonas aeruginosa -E. coli. Some of the common nosocomial infections are urinary tract infections, respiratory pneumonia, surgical site wound infections, bacteremia, gastrointestinal and skin infections

10. INFECTION PREVENTION AND CONTROL(IPC)

11. IPC is the utilization of procedures and techniques in order to minimize the spread of infection. It is also defined as the collective process of efforts made by the health care providers and clients to minimize the risk of infection or prevent the transmission of infectious agents. Infection control practices are aimed at controlling or eliminating the sources of infection. It is the responsibility of every worker to protect themselves and clients by using infection control practices

12. Terminologies Pathogen : An agent that causes disease, especially a living microorganism such as bacterium or fungus Pathogenicity : Is the potential capacity of certain species of microbes or viruses to cause a disease Virulence : The degree of pathogenicity within a group or species of parasites as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host Colonization : The multiplication of micro – organism on or within a host that does not result in cellular injury

13. Infection: Successful invasion and multiplication of micro – organisms in body tissue that results in cellular injury. These micro – organisms are called infectious agents. Communicable Agents : Infectious agents that are capable of being transmitted to a client by direct or indirect contact, through a vehicle (vector) or airborne route. Communicable Diseases : Diseases produces by these agents

14. Flora : Micro – organisms on the human body. There are of two types:- Resident( normal) Flora : Micro–organisms that are always present, usually without altering patient’s health. They can’t be removed with only hand washing with soap, but friction does (rubbing/scrubbing) Transient flora : They are episodic, attaching to the skin for a brief period of time but do not continually live there. Acquired through direct contact with organism or environmental surfaces, easily removed on hand washing

15. Infection transmission cycle/chain Agent : An entity that is capable of causing disease. Are categorized into; Biological Agents : Living organisms that invade the host e.g. bacteria, virus, fungi, protozoa and rickettsia Chemical Agents : Substances that interact with the body e.g. pesticides, food additives, medications and industrial chemicals Physical Agents : Factors in the environment that are capable of causing disease e.g. heat, noise and radiation

16. Host : Simple or complex organism that can be affected by an agent Susceptible Host : A person who lacks resistance to an agent and is thus vulnerable to disease Compromised Host : A person whose normal defense mechanisms have been impaired and is therefore susceptible to infection

17. Environment : Includes any other thing other than the host and agent. Environmental factors affecting/influencing the chain of infection include food, water, plants, animals, housing conditions, weather etc. Reservoirs (source): Natural habitat of a micro–organism where it grows and multiplies Vector : Invertebrates that transmit pathogens e.g. mosquitoes, snails, tsetse flies

18. Portal of exit : Route of exit from a reservoir or source Mode of transmission : Channels through which micro – organisms are transferred to susceptible individual Portal of entry : Point at which micro – organisms enter the host

19. Mode of transmission-L2 There are two modes of transmission; - Direct Modes of Transmission -Indirect Modes of Transmission Direct Modes of Transmission 1. Contact Transmission : The most important and frequent mode of transmission. It involves direct physical transfer of an infectious agent to a susceptible host through direct contact with a contaminated object or contact with contaminated secretions

20. Airborne Transmission : Occurs when a susceptible host contacts droplet nuclei or dust particles that are suspended in the air

21. Why is it important to understand infection transmission chain? Note : The WHO’s guidelines demand that you should treat all patients as potentially infectious. (able to transmit infection) In the health care setting infection can be transmitted in the following ways: When the health care worker’s skin is pierced or cut by contaminated needles or other sharp instruments When the health care worker’s broken skin (cuts, scratches, rashes, chapped skin, fungal infections) comes into contact with the patient's blood or other body fluids When the patient's blood or other body fluids are splashed on the healthcare worker’s mucous membranes (eyes, nose, mouth)

22. WHO GUIDELINES ON IPC According to WHO guidelines, a health care provider should: (breaking the transmission chain & protecting susceptible host) Observe and maintain good personal hygiene and wear appropriate attire. Be vaccinated against vaccine preventable conditions, especially if you are working in high risk areas. If you work in vulnerable areas, for example areas where you handle cooked food, you should be periodically screened for certain diseases, such as typhoid. If you are suffering from infectious conditions and you are working with susceptible patients, for example, in an operating room, special care baby unit, or the ICU burns unit, you should be re- deployed until you are cleared of the infection.

23. Adherence to appropriate infection prevention practices breaks the cycle of spreading infections at the mode of transmission stage. This will: Prevent post procedure infections Result in high quality, safe services Prevent infections in service providers and supportive staff Protect the community from infections that originate in health care facilities Prevent the spread of micro-organisms that are resistant to antibiotics Lower the cost of health care services

24. Standard Safety precautions They are a set of clinical practice recommendations designed to help minimize the risk of exposure to infectious materials, such as blood and other body fluids by both patients and staff. They help break the disease transmission cycle at the mode of transmission step. They are also referred to as principles of medical asepsis

25. A standard precautions is are techniques & procedure that should be followed routinely at all times. It should apply to every patient regardless of their presumed infection status. This is because you will not be able to tell who is infected with viruses such as HIV or hepatitis

26. Standard safety precautions are: Hand washing Gloving Proper decontamination and sterilization Proper use of personal protective equipment or devices Proper handling and disposal of waste Labeling of all biohazards Environmental hygiene

27. HAND WASHING /HAND HYGIENE ‘Hand hygiene’ refers to both hand washing and hand decontamination with alcohol hand gels. Improving hand hygiene is the single best method that contributes significantly to the reduction of HAIs. Many health care professionals, including nursing staff, do not perform hand hygiene as often as is required or use the correct technique. This method is easy to follow and is an inexpensive procedure.  The purpose of hand washing is to remove soil, organic material and transient micro-organisms from the skin

28. Hands are a very efficient vehicle for transferring micro-organisms. Hand washing is the single most important procedure in preventing the spread of disease and microorganisms i.e. antibiotic resistance microorganisms (nosocomial infection) in settings across the continuum of health care. Washing your hands before and after contact with each patient is the single most effective method of preventing/decreasing transfer of micro-organisms between you and the patients within a health facility.

29. When to perform hand washing Before patient contact. Before contact with a susceptible patient site (such as those with an invasive device or wound). Prior to performance of invasive procedures (IV catheters, indwelling catheters). Before gloving/preforming sterile procedure. After exposure to body fluids or source of microorganism (blood, vomit, feces, urine and so on). Before and after removing gloves (wearing gloves does not remove the need to wash hands)

30. After patient contact. After contact with the patient’s immediate environment. When visibly soiled. At the beginning and end of every shift

31. Importance of performing handwashing MRSA – methicillin resistant staphylococcus aureus Common nosocomial infection in hospitals & long term care facilities. This staph aureus is resistant to methicillin NB; MRSA is easily transmitted by health care workers because it frequently colonizes the skin – VERY IMPORTANT TO WASH YOUR HANDS

32. VRE-vancomycin resistant enterococcus Enterococci are normally found in the bowel and female genital tract. They have been shown to persist in the environment for long periods of time (up to 7 days) on hands, gloves, equipment and surfaces such as bed rails, telephones, stethoscopes, etc. Cross-infection has been attributed to thermometers, commodes, movement of inadequately cleaned patient furniture. Transmission occurs directly via the hands of healthcare workers or indirectly from contact with contaminated environmental surfaces and patient-care equipment.

33. Scenarios where hand washing is performed Before: Putting on gloves Preparing or eating food* Touching your eyes, nose, or mouth Handling/administering medication Insertion of invasive devices

34. After: Contact with blood, body fluids, mucous membranes, secretions, excretions, or non-intact skin Removing gloves Touching surfaces or objects in the patient’s environment that may be contaminated (bed rails, bedside tables, light switches, etc.) Handling garbage Using the restroom* Blowing your nose, coughing, or sneezing

35. The three elements that are essential for effective hand washing are: Soap; Running water and Friction (rubbing/scrubbing)

36. Types of handwashing/hand hygiene Routine handwashing with Soap and running water Routine hand washing removes transient micro-organisms and soil, blood or other organic material from the hands. This method is appropriate in most situations and the hands should be washed as frequently as possible Vigorously rub soaped hands for 15-30 seconds and then rinse under running water. Plain water removes 50% of transient micro-organisms, while soap removes 80-90% of micro-organisms. After washing your hands you should dry them with a clean towel or air dry them.  NB: Shared towels can become contaminated quickly

37. Handwashing with antiseptic and running water Apart from removing transient micro-organisms, soil etc., this method also; Kills or inhibits the growth of resident micro-organisms. It may reduce the risk of infections in high risk situations, such as: When there is heavy microbial contamination Before performing invasive procedures such as vein punctures and other aseptic procedures Before contact with patients who have immune defects, for example, patients with burns, leukemia etc.

38. Alcohol hand rub Alcohol hand rub kills or inhibits the growth of most transient and resident micro-organisms but does not remove all micro-organisms or soil. It can be used when hand washing with soap and running water is not possible as long as hands are not visibly soiled with dirt, blood or other organic material

39. Surgical Hand Scrub It’s more than just rubbing hands in performing hand hygiene Scrubbing with antiseptic or soap and running water before beginning surgical procedures will help Prevent the growth of micro-organisms for a period of time.  Reduce the risk of infections to the patient if the gloves are damaged

40. Procedure of Surgical Hand Scrub Shorten the sleeves up to your elbow Remove wrist watch and any jewelries on your hands Assess hands for long & hang nails, cuts, or breaks in the skin and areas that are heavily soiled. Turn on the water tap Wet the hands by holding them under running water. Keep the hands and the forehands in the down position with elbows straight NB: Avoid touching the sides of the sink. If hands touch the sink, hand washing must be repeated

41. Apply enough soap to cover all the hand surfaces Scrubbing Steps; Rub the hands, palm to palm and then Right palm over the left dorsum with fingers interlaced and vice versa Palm to palm with fingers interlaced and then Back of fingers to opposing palms with fingers interlocked Rotational rubbing of clasped left thumb followed by left fingers, backward and forward in right palm and vice versa. Rotational rubbing of middle palm of left hand with tips of right hand and vice Rub from wrist to fore arm

42. Rinse thoroughly with running water with the hands bend at the elbow. Close the water using your elbow or disposable towel Use a clean/sterile towel for drying your hands thoroughly Maintain your hands above elbow line and at front of your body

43. Hand drying and conditioning Wet hands transfer micro-organisms more effectively than dry ones. Inadequately dried hands can also be prone to developing skin damage. Disposable paper hand towels should be used to ensure hands are dried thoroughly. Fabric towels are not suitable for use in health care facilities as these quickly become contaminated with micro-organisms. If used, should be single use and thereafter washed and sterilized

44. Key points for personal hygiene and compliance Keep nails short, clean and polish free. Restrain hair – hair falling forward may drop organisms. Avoid wearing wrist watches and jewelry. Avoid wearing rings with ridges . Do not wear artificial nails or nail extensions. Cover any cuts, abrasions or open wounds with a waterproof dressing. Wear short sleeves or roll up sleeves prior to hand hygiene (refer to local dress code or uniform policies).

45. CLINICAL ASSIGNMENT Hand Hygiene: Monitoring Compliance On a regular basis, observe different types of staff to make sure they are complying with recommended practices for hand hygiene What type of hand hygiene is done? (soap and water vs. alcohol-based hand rub) Is hand hygiene done before patient contact? After patient contact? If gloves are used, is hand hygiene done before the gloves are put on and after the gloves are taken off? Analyze the data to identify gaps in compliance and provide additional training as necessary