S5: HAI Flashcards
Def of HAI
- are infections that are not present or incubating at time of admission to healthcare facility, Infections occur more than 48 h. after admission is considered HAI.
Def of Community-acquired infections
- are the infections that patients have outside the
hospital or become clinically apparent within 48 hours of the hospital admission or has had the infection when admitted to the hospital for some other reason.
Def of Infection Control
refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and health care facilities
INFECTION CONTROL is a multi- disciplinary responsibility.
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Burden of HAI
- Increased length of stay
- Prolonged therapy
- Increased direct costs
- High mortality (26% of all deaths in multihospital study were associated with an HAI).
- In USA, ….. million HAI occur annually, resulting in about ….., Costing USD …….. each year.
- The cost for drug-resistant MRSA patients over a 6-month period was 118% higher than the cost of treating drug-susceptible MRSA
- 2.5
- 250000 deaths.
- 28 billion to 33 billion
Epidemiology (Factors predispose to) HAIs
- Host factors
- Environmental factors
- Technology factors
- Human factors
Epidemiology (Factors predispose to) HAIs
- Host Factors
patients, healthcare personnel, and visitors
Epidemiology (Factors predispose to) HAIs
- Environmental Factors
The hospital environment promotes the spread of pathogen.
- The proximity to other pt
- Contamination of equipment
- Water contamination
- Unwashed hands of HCWs (80%) and insanitary environment.
Susceptible Host for HAI
❖ immunocopromized eg: HIV/AIDS, Malignancy, Transplants.
❖ Medications that alter normal flora, such as antimicrobial agent.
❖ Surgical procedures
❖ Radiation therapy
❖ Invasive devices such as urinary catheters, endotracheal tubes, central venous.
Epidemiology (Factors predispose to) HAIs
- Technology Factors
- Technologic advances in health care provide sophisticated methods of monitoring and caring for pt.
- These advances provide:
● new portal of entry
● alter normal flora
● increase antibiotic res
Epidemiology (Factors predispose to) HAIs
- Human Factors
- Number and skill level of caregivers have decreased (HCWs are busier than ever and lack of continuous training)
What are Micro-organisms involved in healthcare associated infections?
Study common sites of infection
❖The most common two micro-organisms involved in healthcare associated infections are Escherichia coli and Staphylococcus aureus (of which the resistant strain MRSA (methicillin-resistant Staphylococcus aureus)
❖ followed by Pseudomonas aeruginosa,
❖ Enterococcus species,
❖ coagulase-negative staphylococci
❖ Candida species.
The most common two micro-organisms involved in healthcare associated infections are …..
Escherichia coli and Staphylococcus aureus (of which the resistant strain MRSA (methicillin-resistant Staphylococcus aureus)
High Risk areas in health facilities are ……
in health facilities: acute care hospitals, ICUs, neonatal units, long term care facilities.
The Prevention of HAIs is the duty of IC program that includes …..
- Presence of an integrated program that include: IC Committee: formed of employees and with representatives from all department of the hospital and IC Team formed of doctor and one or more nurse practitioners.
IC Commitee
formed of employees and with representatives from all department of the hospital
IC Team
IC Team formed of doctor and one or more nurse practitioners.
5 main domains in infection control team duties
I) Improving hand hygiene practices in health care settings
II) Personal protective equipment.
III) Safe practice to prevent injury with sharp objects
IV) Isolation precautions
V) Environmental sanitation and Waste disposal
Healthcare-associated pathogens are most often transmitted from patient to patient ……..
- on the hands of healthcare workers
- It is the most important domain of infection control
….. is the most important domain of infection control
- Healthcare-associated pathogens are most often transmitted from patient to patient on the hands of healthcare workers
- It is the most important domain of infection control
When to wash your hands (5 moments to wash your hand)?
- Before touching a patient.
- Before aseptic procedure.
- After a procedure or body fluid exposure risk.
- After touching a patient.
- After contact with patient surroundings
Precaution in working in HC facilities
- Regarding Hand Hygiene
Why Is Adherence of Personnel to Recommended Hand washing so poor?
1- Heavy workloads (too busy)
2- Sinks are poorly located
3- Skin irritation caused by frequent exposure to soap and water: some types contain emollients to prevent irritation.
4- Hands don’t look dirty
5- Hand washing takes too long time.
Steps of washing hands
Once you’ve followed these hand washing steps, you should then thoroughly rinse with warm running water and dry with a clean, disposable paper towel.
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Paper towels are the most hygienic way to dry your hands, but automatic hand dryers may also be used in your workplace.
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- Make sure you do not touch any part of the hand dryer with your clean hands, as you will risk transferring bacteria back onto them.
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Likewise, you should never use a reusable towel to dry your hands, as they can harbor dangerous levels of bacteria that transfer back onto your hands.
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If your taps have a push and release or automatic feature, use this as instructed. If not, you should use a disposable paper towel to turn off the tap
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Material used in washing hands
- Soap and water: should take 40-60 seconds for rubbing
- Alcohol-based (hand) rub take 20-30 seconds for rubbing till alcohol dries
Soap and water
Soap and water: should take 40-60 seconds for rubbing:
● Use soap and water if hands are visibly soiled
● Remove dirt and BBF (blood and bodily fluids)
Alcohol-based (hand) rub
Alcohol-based (hand) rub take 20-30 seconds for rubbing till alcohol dries
- Kills germs on contact
- Is readily available
Def of PPE
- Specialized Clothing or equipment worn by an employee for protection against infectous materials
Types of PPE
- Surgical glove
- Heavy-duty gloves
- Caps, gowns, scrub suits, or aprons
- Mask
- Google and glasses
- Closed boots or shoes
Use of Surgical glove
- When hands coming in contact with blood or other body fluids, mucous membranes or skin that is not intact.
- Before performing invasive medical procedures (e.g., inserting vascular devices or performing surgery).
Use of Heavy-duty gloves
non-medical uses.
Use of Caps, gowns, scrub suits, or aprons
- When handling contaminated waste.
- When performing procedures with possible contamination
- When handling patients with infectious disease
Use of Mask
- When handling patients with airborne or droplet infections.
- When performing procedures with the anticipation of aerosols.
- When handling medical waste.
Use of Google and glasses
Situations in which splashing of blood, body fluids, secretion or excretions is likely
Use of Closed boots or shoes
- Situations in which sharp instruments or in spillage infectious agents is likely.
- Indicated in high-risk areas (e.g., nursery, theatre, burn unit)
Sequence of donning PPE
- Gown first
- Mask or respirator.
- Google or face shield.
- Gloves
Sequence of doffing PPE
- Gloves.
- Google or face shield.
- Gown.
- Mask or respirator.
Instructions in PPE donning
Instructions in PPE Doffing
Types of Masks
- Surgical masks
- N95 masks
- Fabric/cloth masks
- Face masks with valves
compare between Surgical & N95 Mask in terms of:
- Name
- Fit
- Eff
- Use
Fabric/cloth masks
Trap droplets, easy to purchase or make, and can be washed and worn again.
Face masks with valves
They do a good job protecting the user, but because of the one-way valves, they don’t offer much protection to the people around the user
It’s also important to avoid touching their masks, and if they do, to sanitize or wash their hands after.
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Def of Sharps
any article can puncture or cut and used in patient care. e.g.; needles, syringes, scalpel blades, razors, forceps, broken tubes and glasses
Cause of Sharps injuries
- Passing or transferring equipment.
- Needle recapping.
- Colliding with coworkers.
- Decontaminating used equipment.
- Sharps left in unusual places(laundry, mattresses, tables, trays and other surface)
If recapping is necessary based on specific circumstances, use either: ……
- One-hand scope technique
- The neutral zone/ hands-free technique
One-hand scope technique
- With one hand, hold the syringe with attached needle and scoop or slide the cap, which is lying on a horizontal surface, onto the needles sharp end.
- Once the point of the needle is covered, you can tighten the cap; By pushing against an object, or By pulling the base of the needle cap onto the hub of the needle
The neutral zone/ hands-free technique
❖ The neutral or safe zone is a designated tool on a sterile field where a sharp can be placed and then picked up by the user. It is large enough to hold sharps
❖ Only one sharp should be in the neutral zone at a time.
Where is Red Cleaning equipment used?
Where is Green Cleaning equipment used?
Where is Blue Cleaning equipment used?
Where is Yellow Cleaning equipment used?
Cleaning Equipment in Bathrooms, Washrooms
Cleaning Equipment in Catering Department & Food Service
Cleaning Equipment in General Areas as wards, offices
Cleaning Equipment in Isolation Areas
Who are Standard Isolation precautions Applied to?
Uses of Standard Isolation precautions
They are designed to reduce risk of transmission of infection
What are Standard Isolation precautions applied to?
Applied to:
1) Blood
2) All body fluids
3) Non intact skin
4) Mucous membranes
Examples of Standard Isolation precautions
- Hand hygiene.
- Use of personal protective equipment (e.g., gloves, masks, eyewear).
- Respiratory hygiene / cough etiquette
- Sharps safety (engineering and work practice controls).
- Safe injection practices (i.e., aseptic technique for parenteral medications).
- Sterile instruments and devices.
- Clean and disinfected environmental surfaces.
Types of transmission based precautions
Contact, Droplet, and Airborne
Examples of Indications of Contact based precautions
Ebola virus disease, scabies and herpes simplex
Contact based precautions
- Patient should be in a private room or with a pt who has an active infection with the same organism (cohorting)
- Gloves must be worn when entering the room
- Gloves must be changed after having contact with any material that may contain high concentrations of the microorganism, such as wound drainage or fecal material
Indications of Droplet based precautions
- large particle droplets > 5 microns).
- Used for patients known or suspected to be infected with pathogens transmitted by large particles droplets expelled during coughing, sneezing, talking, or laughing.
Droplet based precautions
- Must also use standard precautions Ex: Flu, mumps, and pneumonia
- Patient should be in a private room
- If private room unavailable, a distance of at least 3 feet separate the infected patient and other Patients(cohorting) and visitors or use privacy curtain (Privacy curtains are used in shared rooms, emergency departments, pre-op, post-anesthesia care, and intensive care units to provide patients with needed privacy during dealing with health care staff and during family visits).
- Masks must be worn when working within 3 feet of the Patient
- Use of masks anywhere in the room is strongly recommended
- Patient should only be moved from the room with a surgical mask to minimize the spread of droplets
Privacy curtains are used in shared rooms, emergency departments, pre-op, post-anesthesia care, and intensive care units to provide patients with needed privacy during dealing with health care staff and during family visit
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Masks must be worn when working within ….. of the Patient
3 feet
- Use of masks anywhere in the room is strongly recommended
- Patient should only be moved from the room with a surgical mask to minimize the spread of droplets
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Indications of Air-borne isolation Precautions
- Used for pts known or suspected to be infected with pathogens transmitted by airborne nuclei (small particles of evaporated droplets that contain
microorganisms and remain suspended in the air)
Air-borne isolation Precautions
Sensor on Door of negative pressure room with alarm that goes on if door open more than ….
15 seconds.
Def of health-care waste
- Waste from all health care activities (biological and non-biological) which is generated as a result of patient diagnosis, immunization or treatment, and discarded and not intended for use.
Hazardous health-care waste
- Waste materials that come from sources that could be potentially contaminated with an infectious, chemical and/or radioactive agents which is about
10 - 25% of healthcare waste.
Types of health-care waste
General or non-infectious waste in the ….. container.
black
Infectious waste in the …. container.
yellow
Anatomical/pathological waste in the ….. container.
red
Sharps waste to the …. box
safety
Safety box
- The primary way to contain sharps is by using safety boxes in order to prevent injury.
- A safety box is a puncture- and leak-resistant container for disposal of sharps.
Why use a safety box?
- Sharps can cut or puncture the skin, and, if they are contaminated, they can cause infections or diseases, including hepatitis B, hepatitis C, and HIV.
- If not properly disposed of scavengers may also collect and reuse sharps waste.
How to use a safety box?
What goes in a safety box?
While disposing of sharps
- Inspect container
- Keep hands behind sharps
- Never put hands or fingers into sharps container
- RISKS OF SEROCONVERSION DUE TO SHARPS INJURY FROM A KNOWN POSITIVE SOURCE
HBV: 33%
HCV: 3%
H.I.V : 0.3%
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What protocol should be followed after any needle stick?
The exposure source should be evaluated
Appropriate management of any positive exposure is necessary
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Post-exposure prophylaxis: (needle stick injury from HIV +ve case)
ARV drugs should be given within … hours after exposure.
72
If needle stick injury is form unknown case ►►
don’t give preventive treatment
The treatment of confirmed case is ……
lifelong
HBV
- The treatment after exposure varies based on the vaccination status of the exposed individual and the HBV status of the patient:
HCV
- No treatment has been shown to prevent infection for workers exposed to HCV. Recommendations center on following workers after the injury and monitoring for HCV RNA in the serum.
Recommendations include:
Role of Hospital Epidemiologist
The healthcare epidemiologist of the 21st century is typically an infectious disease physician with a specialized set of skills and competencies.
Epidemiologic measures of HAI
- The healthcare epidemiologist of the 21st century is typically an infectious disease physician with a specialized set of skills and competencies.
- Outbreak investigation (refer to outbreak inv. session)
- Surveillance (HAI rates)
General rate
Specific rates
Done
