Hospital Infection Control: Basic Principles

Hospital Infection Control:Basic Principles Infection Control Committee

Protect the patients Protect the HCW, visitors, and others in the healthcare environment. cost effective and cost efficient. Goals for hospital infection control & prevention program

ICC Nursing service Medicine (ICU/telemetry) Pediatrics (Nursery/PICU) Surgery (OR) OB-GYN (DR) IHC Pharmacy Laboratory Pulmonary Dietary Radiology Housekeeping Facility Management/Engineering MMC Infection Control Committee

Infection Control Committee • Promote an adequate environment for the patient care program. • Strives to minimize the hazards of hospital-associated infections by: • prevention • investigation • reporting • control

The ICC has the following tasks: • Annual plan for infection control • Infection control policies. • Support the IC team & direct resources to address problems as identified • Ensure availability of appropriate supplies • Review epidemiological surveillance data & identify area for intervention.

The ICC has the following tasks (cont): • Promote improved practice at all levels of the health care facility • Training in infection control and safety. • New technology & new devices • Outbreak investigation • Link with other committees

ISOLATION PRECAUTIONS Guideline for Isolation Precautions in Hospitals Centers for Disease Control & Prevention Hospital Infection Control Practices Advisory Committee (January 1996; updated 2004)

Isolation Precautions – 2-Level Approach: • Standard Precautions - primary strategy 2. Transmission-Based Precautions

STANDARD PRECAUTIONS • reduce the risk of transmission of bloodborne pathogens • applies to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.

STANDARD PRECAUTIONS • a. Handwashing • b. Gloves • c. Mask, Eye Protection, Face Shield • d. Gown • e. Patient Care Equipment • f. Environmental Control • g. Linen • h. Occupational Health & Bloodborne Pathogens • i. Patient Placement

STANDARD PRECAUTIONS • a. Handwashing • between patient contacts • after touching blood, body fluids, secretions, excretions, and contaminated items • after gloves are removed

Hand Hygiene Technique 3. Palm to Palm with fingers interlaced 2. Palm of Right hand over back of left hand & vice versa 1. Palm to Palm 4. Back of Fingers to opposing palms with fingers interlocked 5. Rotational rubbing of right thumb clasped in left palm and vice versa 6. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa

STANDARD PRECAUTIONS • B. Clean & non-sterile gloves should be worn: • touching blood, body fluids, secretions, excretions, and contaminated items. • performing venipuncture & other vascular access procedures • Wash hands after removing your gloves

STANDARD PRECAUTIONS • Masks & protective eyewear, goggles or face shields should be worn during: • procedures that are likely to generate splashes/droplets of blood or other body fluids to prevent exposure of mucous membrane of the mouth, nose, & eyes.

STANDARD PRECAUTIONS • D. Gowns or aprons should be worn during: • procedures that are likely to generate splashes of blood or other body fluids

STANDARD PRECAUTIONS • Soiled patient-care equipment: - Wear gloves if visibly contaminated & practice routine hand hygiene • Environmental Contact: - Follow procedure for routine care, cleaning & disinfection of environment surface, especially frequently touched surfaces in patient-care areas.

STANDARD PRECAUTIONS • Needles and other sharps: • All HCW’s should take precautions to prevent injuries caused by needles, scalpel, & other sharp instruments or devices during procedures • when cleaning used sharp instruments • during disposal of used needles • when handling sharp instruments after procedures

STANDARD PRECAUTIONS Sharps Injuries • to prevent needle stick injuries, needles: • should not be recapped • should not be purposely bent or broken by hand • should not be manipulated by two hands (one hand scoop technique if required can be done)

STANDARD PRECAUTIONS • Handling soiled or contaminated linens -Always use gloves when handling linen. -Inspect for needles, syringes, etc while stripping. -Linen should not be placed on the floor. -Soiled linen should be placed directly in the cloth hamper. -Contaminated linen should be placed in a yellow doubled plastic bag sealed by a knot.

h. Occupational Health & Bloodborne Pathogens To prevent injuries when using needles, scalpels, & other sharp instruments or devices • Never recap used needles • Place used disposable syringes & needles, scalpel blades, & other sharp items in appropriate puncture-resistant containers for transport to reprocessing area. • Use mouthpieces, resuscitation bags as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.

STANDARD PRECAUTIONS • Patient Placement: - Prioritize for single-patient room if at increase risk of transmission of infection - Likely to contaminate the environment

STANDARD PRECAUTIONS • Respiratory Hygiene / Cough Etiquette (new TB guideline) - Instruct symptomatic person to cover mouth/nose when sneezing/coughing - Use tissue and dispose properly and avoid touching the receptacle bin - Observe hand hygiene after soiling of hands with respiratory secretions

RESPIRATORY ETIQUETTE

Isolation Precautions – 2-Level Approach: • Standard Precautions 2. Transmission-Based Precautions - Applied to selected patients based on suspected or confirmed diagnosis - Always implemented in conjunction with Standard Precautions

Transmission- based precautions • Based on 3 major modes of transmission: • Airborne Precaution • Droplet Precaution • Contact Precaution • Some diseases may require more than one isolation category

Indications for Transmission-based Precautions

Known or Suspected Diseases or Pathogens • Airborne • Measles • Tuberculosis, pulmonary or laryngeal • Varicella • Zoster (disseminated or immunocompromised patient) • SARS • Viral hemorrhagic fever

Scenarios Requiring Airborne Precautions • Vesicular rash • Maculopapular rash + coryza + fever • Cough, fever, upper lobe pulmonary infiltrate • Cough, fever, any pulmonary infiltrate in an HIV patient (or patient at risk for HIV)

Airborne Precautions • Private room, keep door closed at all times • Negative air-pressure ventilation, externally exhausted or HEPA filtered air if recirculated • Fitted respirator masks (N95 respirator) worn by susceptible HCW • Susceptible HCW should wear mask or avoid entering room • Patient should wear mask when transported out of isolation room

DROPLET PRECAUTIONS • Use for patients known or suspected to be infected with organisms transmitted by respiratory droplet (large particle >5um in size) that can be generated by the patient during coughing, sneezing and talking on the performance of cough inducing procedures.

Known or Suspected Diseases or Pathogens Droplet • Diphtheria (pharyngeal), Pertussis • Meningococcal infections • HI meningitis, epiglottitis, pneumonia • Influenza • Mumps, Rubella (postnatal) • Mycoplasma pneumonia • Parvovirus B19 • Adenovirus (infants, children) • Streptococcal (group A) pharyngitis, pneumonia, scarlet fever

Scenarios Requiring Droplet Precautions • Meningitis • Petechial or ecchymotic rash with fever • Paroxysmal or severe persistent cough (periods of pertussis activity)

Droplet Precautions • Private Room, may cohort patients with same diseases; if not possible have a distance of 3 feet between patients and visitors • Patient should leave the room only when necessary; If patient required to leave the room, must wear a surgical mask • Use mask (standard surgical mask)if within 3 feet of patient

Contact Transmission • Two Modes: • Direct-body surface to body contact and physical transfer of micro-organisms; when doing physical exam, turning patients, giving the patient a bath, etc • Indirect-contact of a susceptible host with a contaminated intermediate object (needles, instruments, dressings, hands)

Scenarios Requiring Contact Precautions • Acute diarrhea • Vesicular rash • Respiratory infections in infants & young children • History of infection/colonization with MDR organisms • Skin, wound or UT infection in patient with recent hospital or nursing home stay • Abscess or draining wound that cannot be covered

Known or Suspected Diseases or Pathogens Contact • Abscess (drainage not contained) • Adenovirus (infants, children) • Clostridium difficile intercolitis • Conjunctivitis, acute viral • Escherichia coli 0157:h7 colitis • Furunculosis (infants, children) • Grp A Streptococcal major skin, burn or wound infection • Hepatitis A

Known or Suspected Diseases or Pathogens Contact • HSV (neonatal, disseminated, severe primary mucocutaneous) • Impetigo • MDR bacteria (e.g. MRSA, VRE, GISA, GRSA) infection or colonization • Parainfluenza infection (infants, children) • Rotavirus • Rubella, congenital • Shigella (diapered/incontinent patients) • Varicella • Zoster (disseminated/immunocompromised)

Contact Precautions • Private room; cohorting permissible (Ensure that the patient are physically separated (>3 feet) from each other and provide curtain) • Clean, nonsterile gloves at all times • Handwashing after glove removal • Gownsat all times, unless patient is continent and contact of clothing with patient or environmental surfaces is not anticipated • Remove gloves and gowns before leaving room

Hospital Infection Control: Basic Principles