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Paediatric Infection Control

Paediatric Infection Control. Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital. Primary Role of Infection Control. Prevent nosocomial infections Reduce mortality, morbidity, and cost Educate and advise staff patients their families the community

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Paediatric Infection Control

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  1. Paediatric Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital

  2. Primary Role of Infection Control • Prevent nosocomial infections • Reduce mortality, morbidity, and cost • Educate and advise • staff • patients • their families • the community • Surveillance of nosocomial infections • Policy development, implementation and assessment

  3. IC Issues specific to Paediatrics • Communicable diseases affect a higher % of paediatric patients than adults • Developmental immunity (increased susceptibility) - acquire – spread

  4. IC Issues specific to Paediatrics • Paediatric personnel are at a greater risk for exposure to communicable diseases - immune status • Type and amount of physical contact (eg feeding, diapering)

  5. IC Issues specific to Paediatrics • May lack the mental / physical ability to adhere to IC principles • lack of hygiene • unable to understand / comply with IC principles

  6. IC Issues specific to Paediatrics • More likely to have contact with contaminated environmental surfaces and objects

  7. IC Issues specific to Paediatrics • Parents and siblings • may have the same infectious agent • involved in patient care – education about transmission and IC principles

  8. IC Issues specific to Paediatrics • Types of pathogens and sites of nosocomial infection differ from adults. • Most common nosocomial infections (paediatrics): • Viral infections of the upper respiratory tract • Viral infections of the gastrointestinal tract • Most common nosocomial infections (adults): • UTI

  9. IC Issues specific to Paediatrics • Neonatal and ICU • Bacteraemias are the most common source of nosocomial infection • Adult ICU • The lower respiratory tract is the most common source of nosocomial infection Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):414-424

  10. Incidence of Nosocomial Infection • Incidence varies by age and hospital unit: • Range: 0.2% - 23.5% • Paediatric ICU 23.5% • Haematology Unit 8.2% • Neonatal Unit 7.0% • General Paediatric Unit 1.0% • Highest in children aged 23 months or younger Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):414-424

  11. Additional Length of Stay • Duration of hospitalisation is longer for children with nosocomial infections • Paediatric ICU • 26.1 days vs 10.6 days • General Paediatric Units • 9.2 days vs 3.5 days • Attributable cost of infection $13,000 Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):414-424

  12. Spread of Infection • Sources of infections • The host’s own (endogenous) flora • The hand’s of health care workers • Inanimate objects (fomites) • After being exposed to an infectious agent: • Some people already have immunity and therefore don’t develop an infection • Some people become asymptomatic carriers • Other people develop clinical disease (ie infection)

  13. Spread of Infection • The Susceptible Host • Varies with age • Underlying medical conditions • Nutritional status • Drug therapy • Trauma • Surgical procedures • Invasive or indwelling devices • Therapeutic and diagnostic procedures

  14. Spread of Infection • 3 main routes of transmission • Contact • Direct / Indirect • Most frequent means of transmission • Droplet • Generated during coughing, sneezing, talking and during certain procedures such as suctioning • Airborne • Generated by coughing, sneezing, OR by mechanical respiratory aerosolisers, OR by air currents

  15. Standard Precautions • Apply to: • Blood • Non-intact skin • Mucus membranes • All body fluids (including sweat) • Regardless of whether there is visible blood or body fluids

  16. Hand Hygiene • The single most effective method in the prevention of disease transmission • Healthcare workers think they wash their hands more than what they do • 80 % hospital acquired infections are thought to be transmitted by hands

  17. Hand Hygiene • Soap and Water • mechanical removal of most transient flora and soil • minimal microbial kill • no sustained activity • 15 seconds

  18. Hand Hygiene • Antimicrobial Soaps • removes soil, removes transient and reduces resident flora • may have sustained activity • 15 seconds (antiseptic handwash) • 60 seconds (clinical handwash) • 2 minutes (surgical scrub)

  19. Hand Hygiene • Alcohol Handrubs / Gels • very rapid kill • destroys transient and reduces resident flora • no residual activity (except with antiseptic) • will not remove or denature soiling • 15 seconds

  20. Personal Protective Equipment • Eye and/or facial protection (glasses, goggles, face shields) • Gloves • Gowns • Masks • Assess the likely hood of contamination and prepare accordingly

  21. Assessment of Risk Factors • Your knowledge or experience with the situation or procedure • The likely hood of exposure to blood or body fluids at the time • The patients ability to cooperate through out the procedure

  22. Additional Precautions • May include: • Single room accommodation (ensuite for some) • Special ventilation (negative, positive pressure) • Special room cleaning • Dedicated patient equipment • Rostering of immune staff • Extended sterilization (or use of disposable equipment) • Cohorting may be considered

  23. Multi-resistant organisms(MRO) • MRSA:Methicillin resistant Staphylococcus aureus • VISA:Vancomycin intermediate Staphylococcus aureus • VRSA:Vancomycin resistant Staphylococcus aureus • VRE: vancomycin resistant enterococci • ESBL:Extended spectrum beta-lactamase • MRGN:Multi-resistant gram negative • MRPA:Multi-resistant Pseudomonas aeruginosa • MRAB:Multi-resistant Acinetobacter baumanii

  24. Multi-resistant organisms (MRO) • Difficult to treat and control • Have the ability to cause infections, particularly in susceptible people • Have the ability to cause wound infections, bacteraemias and IV line sepsis • Can cause significant morbidity and mortality • Increased community awareness and expectations

  25. Factors that contribute to the acquisition of MROs • Staff - inadequate handwashing • Environmental - inadequate cleaning • Prolonged or inappropriate antibiotic treatment • Close proximity to a MRO patient • Extended hospital stay • Co-morbidities • ICU / Burns Unit

  26. Respiratory Syncitial Virus • Highly contagious and nosocomial infection common • Causes upper and lower respiratory infection • Usually occurs during winter • No vaccine at present • Can be re-infected during the same season • Transmitted by contact or droplet • Can survive for several hours in the environment

  27. Respiratory Syncitial Virus

  28. Rotavirus • Highly contagious and nosocomial infection is common • Usually a winter disease but pattern changing • Onset is sudden and lasts for 4 - 6 days • Mainly infants and children up to 3 years affected • Transmitted usually through contact • Can survive in environment for several hours

  29. Rotavirus

  30. Pertussis • Bacterial infection caused by Bordetella pertussis • Most dangerous to under 3 year olds • Contagious for 3 weeks or for 5 days after commencing erythromycin • Transmitted by contact and droplet • Symptoms - runny nose, cough, which may develop into a whooping cough • High particulate mask when in contact with patient

  31. Pertussis

  32. Meningococcal Disease • Bacterial infection caused by Neisseria meningitidis • Transmitted by contact or droplet • Non infectious after 24 hours of appropriate antibiotic therapy • Significant contacts traced and may be given prophylaxis

  33. Meningococcal Disease

  34. Measles • Complications more common and severe in chronically ill and very young children • Transmitted by droplet and contact with respiratory secretions • Infectious for 4 days before and after rash • Vaccination available • Notifiable disease

  35. Measles

  36. Rubella • In early pregnancy risk of teratogenic damage to fetus • Infectious for 7 days before and 7 - 15 days after onset of rash • Infants with congenital rubella may shed virus for several months or years • Transmitted by droplet route • Vaccination available • Notifiable disease

  37. Rubella

  38. Varicella Zoster VirusChicken Pox • Highly contagious • Most cases in children, over 90% of adult population is immune • Transmitted by droplet and contact • Infectious 2 days prior and 4 - 6 days after rash • Now a notifiable disease • Vaccination now available

  39. Varicella or Chicken-pox

  40. Congenital varicella • Caused by maternal varicella in early pregnancy (ie <20 weeks) • Risk of acquiring congenital varicella syndrome is 1 - 2% • Range and severity of symptoms vary greatly depending on when maternal varicella infection occurred • intrauterine growth retardation, skin abnormalities, incomplete development of fingers/toes. Brain degeneration, nervous system damage, eye abnormalities

  41. Congenital varicella

  42. Parvovirus B19 • Usually a mild rash disease • Also called Fifth Disease or “Slapped - Cheek” • Infectious prior to the rash • Transmitted by droplet route

  43. Parvovirus B19

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