Universal precautions in ICU

Universal precautions are defined as simple infection prevention control measures that reduces the risk of transmission of blood borne pathogens through exposure to blood and body fluids among patients and health care workers

1. Dr.Nidhi Ahya ( Asst.Prof ) Cardio-Vascular & Respiratory PT DVVPF College of Physiotherapy, Ahmednagar 414111 Universal Precautions In ICU

2. OBJECTIVES Universal precautions Infection Spread of infection Prevention and control of infection Transmission based precautions

3. Definition: Universal precautions are defined as simple infection prevention control measures that reduces the risk of transmission of blood borne pathogens through exposure to blood and body fluids among patients and health care workers

4. INFECTION Infection is an invasion and multiplying of pathogenic microbes in the body tissues in which they are not usually present Infection occurs when a pathogen is able to overcome the barriers of the host

5. Nosocomial infection/ hospital-acquired infection: development favored by hospital environment 10% admissions to ICU acquire nosocomial infection 25% undergo mechanical ventilation develop pneumonia 30% die of lung infection

6. Elements for an infection to spread

7. MODE TYPE TRANSMISSION EXAMPLE Contact (Most common route of nosocomial ) Direct Body surface-to body surface between host & infected person. Mucus- to - mucus Touching contaminated hands HIV Staphylococcus aureus Indirect Host & fomites Contaminated needle & nebulizer HIV Droplet: discharge large contaminated liquid drop in air Travel short distance approx-3ft Coughing Sneezing Talking Strep pneumonia Airborne Droplet nuclei Dust particles TB, Measles Fungal infection Common vehicle Foodborne Hepatitis A Waterborne Cholera Vector borne Animal/insect Malaria

8. Spread of infection to the lungs

9. Infection control strategy

10. Maintenance of in-use equipment

11. Help to prevent cross infection Sterile fluid should be used for tracheal suction and to fill nebulizers and bubble humidifiers Sterile water should be used when rinsing equipments When multidose medication vials are being used, they must be handled, dispensed and stored according to manufacturer’s instructions Medications must not be used after expiry date

12. Infection control strategy

13. Principles / barriers/ isolation precautions Hand washing Personal Protective Equipment(PPE) Patient placement Transport procedures

14. Indications: In prolonged contact with patient Taking care of immune suppressed, patients in ICU Before & after touching wounds Contact with mucous membranes, body fluids, and secretions contaminated with blood & serous fluids

15. Efficient hand washing means cleaning the palms of the hands, around the wrist and the forearms, between the fingernails, around the cuticles and between the digits for no less than 15 seconds Rinsing is from forearm to fingertips Drying can be by cloth towels, paper towels, warm forced air or hand activated dryer

16. Hand antisepsis Wash using antimicrobial soap for 15-30 sec Decontaminate with waterless alcohol based hand rubs(3ml) for 15-30 sec Surgical hand antisepsis: Done for 2-3 min Detergent formulations – 2%-4% Chlorhexidine , 5%-75% Povidine Iodine, 1% Triclosan , 70% Alcoholic rub

17. WHY TO WEAR GLOVES?? Protects caregivers from contamination when contacting patients blood, body fluids, secretions, excretion, mucous membranes or non-intact skin. Protects patients from acquiring infection from colonized health personnel during invasive procedures Reduces the likelihood of cross contamination between patients via caregiver’s hand

18. PRINCIPLES Use of a pair of plastic disposable gloves Cover hand cuts with a band aid before gloving Wash hands immediately after removing gloves Dispose the gloves after use

19. HOW TO WEAR??? Wear the left glove first Bunch up the glove & pull onto the hands Ease the fingers

20. BOOTS Wearing foot wear covering entire sole protects the entry of microbes from the contaminated floors with blood and body fluids

21. HOW TO WEAR PPE

22. HOW TO REMOVE PPE

23. Use of disposable equipment Protective procedure Safe disposal of needles & syringes Safe system for hospital waste management disposal

24. DISPOSAL OF NEEDLES Never recap the needles Bending, reshaping should be prohibited All used reusable needles and sharps should be deposited in thick walled puncture resistant containers All used disposable syringes and needles should be discarded into bleach solution

25. PROCESS OF DISPOSAL OF HOSPITAL WASTE

26. According to the Rules waste generated in the hospitals is classified into ten categories: Human Anatomical waste Animal waste Microbiology & Biotechnology waste, Waste sharps Discarded medicines and Cytotoxic drugs, Soiled waste Solid waste Liquid waste Incineration ash Chemical waste

27. COLOUR CODING TYPES OF CONTAINER WASTE CATEGORY TREATMENT OPTIONS Yellow Plastic bags Human anatomical waste, Microbiology & Biotechnology waste, Solid waste(contaminated with blood body fluids) Incerination /Deep burial Red Plastic bags/Disinfected containers Microbiology & Biotechnology waste, Solid waste, W aste generated from disposable items such as tubing, catheters, etc Autoclaving/Chemical Treatment

28. Blue/White translucent Plastic bag/puncture proof container Waste Sharps (needles, syringes, scalpels blades, glass etc, Waste generated from disposable items Autoclaving/chemical treatment & destruction Black Plastic bag Discarded Medicines and Cytotoxic drugs , Incineration Ash , Chemical Waste (chemicals used in production of biological, chemicals, used in disinfection, as insecticides, etc) Disposal in secured landfill

29. Transmission-based(additional) precautions Expanded precautions Used with patients documented or suspected to have severe contagious infections for which standard alone are insufficient Always applied in addition to standard precautions Types :- Airborne infection isolation(Airborne precautions) Droplet precautions Contact precautions

30. DISEASES PATIENT PLACEMENT PPE & HANDWASHING PATIENT TRANSPORT PATIENT CARE EQUIPMENT AIRBORNE PRECAUTION TB, Measles, Histoplasmosis Private room Safe external air discharge Door closed Infection control Wear N95 Susceptible person should not enter the room Limited If required, use protective devices ---- DROPLET PRECAUTION Pneumonia Influenza Mumps Rubella Doors can be kept open Special air handling not required Wear mask within 3 feet ____DO____ ---- CONTACT PRECAUTION Hepatitis AIDS ---DO--- Use gloves and gowns Wash hands after removing ----DO---- single patient or patient cohort Else disinfection

31. Summary Universal precautions Infection Spread of infection Prevention and control of infection Transmission based precautions

32. QUESTIONS WRITE THE UNIVERSAL PRECAUTIONS. 3MARKS WRITE ABOUT THE INFECTIONS. 5MARKS

33. BYE BYE TO INFECTIONS ……………………. THANK YOU