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Mandatory program for hospital professional staff

Mandatory program for hospital professional staff. Update infection control on SARS Management of Norovirus outbreak. Infection Control Team 26 November 2003. Standard Precautions & Transmission Based Precautions. 1970 first CDC isolation recommendation

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Mandatory program for hospital professional staff

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  1. Mandatory program for hospital professional staff Update infection control on SARS Management of Norovirus outbreak Infection Control Team 26 November 2003

  2. Standard Precautions & Transmission Based Precautions

  3. 1970 first CDC isolation recommendation 1983 CDC guideline for prevention and control of nosocomial infections Strict isolation, respiratory isolation, enteric precautions, contact isolation, tuberculosis(AFB) isolation, drainage / secretion precautions, and blood / body fluid precatuions. 1987 Universal precautions ( Universal blood and body fluid precautions ) - UP Body substance isolation ( BSI ) 1996 New CDC isolation guideline – Standard precautions ( combines UP & BSI )

  4. Guideline for Isolation Precautions in hospitals - CDC Two tiers of precautions • Standard Precautions • Transmission Based Precautions - Airborne - Droplet - Contact

  5. Standard Precautions Apply to all patients regardless of diagnosis or known infection status. Applicable to blood, all body fluids, secretions, and excretions, whether they contain visible blood or not ( except sweat ).

  6. Fundamentals of Standard Precautions Hand washing Gloves Clean, non-sterile gloves when touching blood, body fluids, secretions, excretions and contaminated items. Mask, eye protection, face shield Protect mucous membrane of eyes, nose and mouth if activities that are likely to generate splashes or spray of blood, body fluid, secretion and excretion. Gown Clean, non-sterile gown to prevent soiling of clothing. Patient care equipment Reusable equipment should be cleaned and reprocessed appropriately before and after use on patient.

  7. Environmental control Adequate routine cleaning, disinfection of environmental surfaces, equipment and frequently touched surface. Linen Handle, transport and process of soiled linen with care. Prevent sharp injuries Never recap used needle, bend or break the needle. Single-handed technique or mechanical device if recapping necessary. Use mouth pieces, resuscitation bag or other ventilation devices as alternative to mouth-to-mouth resuscitation method. Patient placement Place in private room if likely to contaminate the environment. E.g. poor hygiene. Housekeeping Routine daily cleaning. Airing of room or delay in admitting next patient is not needed.

  8. Airborne Precautions For patients known or suspected to be infected with microorganisms transmitted by air borne droplet nuclei ( small-particle residue ie. 5 um or smaller in size ) e.g. measles ( rubeola ), varicella ( chicken pox ) including disseminated zoster, TB.

  9. Airborne PrecautionsIn addition to Standard Precautions 1. Patient placement Private room ~ negative pressure in relation to surrounding area. ~ 6-12 air changes per hour. ~ appropriate discharge of air outdoors or high- efficiency filtration of air if recirculate. ( HEPA ) ~ Door kept closed. Anteroom – extra measure, no adequate data regarding the need.

  10. 2. Respiratory protection • Wear respiratory protection when entering the room of patient with known or suspected TB – N95 particulate respirator. • Susceptible persons should not enter room of patient known or suspected to have measles or chicken pox. • Persons immuned need not wear respiratory protection. 3. Patient transport • Limit movement. Minimize patient dispersal of droplet nuclei by wearing a surgical mask.

  11. Prevention of Airborne Transmission N95 respirator tested by HA: regular size (3M-1860R, 3M-8210); small size (3M-1860S, 3M- 9210, 3M-9320), Gerson brand model 2735S, and Kimberly Clark ‘duckbill’ models • Aerosol (Cough) Generating Procedure: • Negative Pressure Room • PPE

  12. Droplet precautions For patient known or suspected to be infected with microorganisms transmitted by large- particle droplets ( > 5 um in diameter ) that can be generated by patient during coughing, sneezing or talking, or performance of procedures. Transmission via close contact within 3 ft. e.g. meningococcal meningitis, influenza, parvovirus B19, rubella, mumps.

  13. Droplet precautionsIn addition to Standard precautions • Patient placement If private room or cohorting is not possible, place at least 3 ft. from other patients. • Mask When working within 3 ft. of patient. • Patient transport Minimize dispersal of droplet by wearing a mask.

  14. Contact Precautions For patients known or suspected to be infected or colonized with epidemio-logically important microorganisms that can be transmitted by direct or indirect contact. e.g. G.I, respiratory, skin or wound infection with multi-resistant bacteria.

  15. Contact PrecautionsIn addition to Standard Precautions • Patient placement If private room or cohorting not achievable, consider the epidemiology of the microorganism and patient population. • Gloves and handwashing Wear gloves when enter the room and remove before leaving patient environment. Handwashing after gloves removed.

  16. Gown Remove gown before leaving patient’s environment. • Patient transport Minimize risk of contamination of environment surface or equipment. • Patient care equipment When possible, dedicate use of non-critical patient-care equipment to a single patient. For reuse of common equipment,clean and disinfect before use on another patient.

  17. Faecal Oral Transmission • Areas requiring special attention: • Handling bed pans • Flushing of toilets • Clean up Spillage • Specimens Handling

  18. Clean up Spillage • Specimens Handling

  19. Hand washing

  20. Your hand is . . . • ASourceof undesired microorganisms (multiplying in and being shed from skin) • Main microbial vector of spread of infection.

  21. Characteristics

  22. Therefore . . . • Effective handwashing is the single most important infection control measure to protect patients in clinical areas from hospital acquired and cross-infections.

  23. Hand washing Objective : • Prevent hand-borne infection • Remove dirt, organic material and majority of transient flora. • by unmedicated detergent and water. Factors affecting proper handwashing • Availability of handwashing facilities : basin, water tap, ( water flow, temp.) detergent dispenser, towel. • Compliance : lack of time • Infectious lesions must be healed before hands regarded as safe.

  24. IC practice: Handwashing A matter of Motivation and Convenience ? • frequent • consistent • after gloves removal • antiseptics if indicated

  25. Effective hand washing CDC & HICPAC recommendation: • Soaps (medicated / unmedicated) & water should be used if hands are visibly soiled • If no visible dirt, use of waterless, alcohol-based hand rub for routine antisepsis • presurgical hand antisepsis, either methods are suitable HICPAC: Hospital Infection Control Practices Advisory Committee

  26. Efficacy of Handwashing Time taken+ Agents use+ Technique =

  27. Agents use Interrupting transmission of microorganisms

  28. Technique Types of Handwashing • Social handwashing 2. Hygienic hand disinfection 3. Surgical hand disinfection (Surgical scrub) A. Hygienic hand wash B. Hygienic hand rub

  29. 1. Social handwashing

  30. 2. Hygienic hand disinfection (hygienic hand wash & hand rub) Wash Rub

  31. … cont’d (Hygienic hand wash) • Wet hands first with water • Apply soap/ antiseptic lotions • Rub hands together vigorously ~ 15sec • Rinse with water • Dry thoroughly with disposable towel • Use towel to turn off the faucet. • Avoid using hot water • (increase risk of dermatitis)

  32. … cont’d (Hygienic hand rub) • Rubbing small portions ( 3-5 ml ) of antiseptic with all areas of hands & fingers to be covered, till hands dry. • Alcoholic rubs well suited for hygienic hand disinfection : 1. Antimicrobial performance is excellent. 2. No wash basin

  33. … cont’d (Hygienic hand wash Vs Hand rub) A recent study conducted in Switzerland confirms the effectiveness of hand rub: Lancet 2000; 356: 1307-12 • Handrub solution (alcohol-based 0.5% chlorhexidine gluconate and skin emollients) were distributed to all wards, • Holders were mounted on all beds to facilitate access, • HCWs were encouraged to carry a bottle in their pocket, Outcomes: • Overall nosocomial infection decreased (16.9% in 1994 to 9.9% in 1998); • MRSA rates decreased (2.16 to 0.93 per 10,000 patient-days) • Handwashing compliance increased to 48-66%.

  34. … cont’d (Hygienic hand wash Vs Hand rub) comparison with normal handwashing:

  35. Point to note : Skin dryness & irritation - by applying lotions & creams  irritant contact dermatitis due to handwashing or hand antisepsis Nail polish – No artificial fingernails or extenders when having direct contact with pts at high risk (e.g. ICU, O.T.) Keep natural nails tips short (<1/4-inch long) Glove use - Do not wear same glove for > one pt Change glove during pt care if moving from contaminated site to clean body site. Handwashing still require after removal of glove because contamination by small, undetected holes on gloves Wearing of jewellery – Should be limited Topping up of antiseptics – Do not add soap to a partially empty soap dispenser.  bacterial contamination of soap. (strongly recommended)

  36. Update for prevention of SARS

  37. Guidelines & Directives Adequate Facilities & Supplies Review & Update Effective Infection Control Communication & Training Enforcement & Drill

  38. SARS:Prevention Strategies Intelligence Hospital level Case Detection Infection Control HCW Visitors • Alert System • High Index of suspicion • Lab. Dx • Reporting to HAHO & DH • Patient Triage • Standard Precautions for ALL patients • Procedure & Risk related PPEs • SARS Alert • Health surveillance • Influenza Vaccination • Training & Drill • No visit in HR areas • Limit & Register in non-HR • Mask if symptomatic

  39. SARS:Mode of transmission • Contact secretions and excretions • Sources: fomites, patients BABF, Droplets • Droplets and aerosols • Portal of entry: Eye, mouth • Portal of Entry: Respiratory tract • Sources: Aerosols generated by nebuliser, cough.. • Special Attentions to: • Environment decontamination, esp. after spillage • Patient specimens handling

  40. SARS Guideline on PPE effective August 1, 2003

  41. SARS Guideline on PPE effective August 1, 2003(continued)

  42. Notes on Practices • Handwashing is most important • Use alcohol-based hand rub as alternative • Do not touch mask or face (esp. eyes, nose & mouth) without 1st washing hands thoroughly • Gloves must be changed after procedure and between patients. • No wash gloves & double gloves • Wash immediately and thoroughly if contaminated by patient’s body fluid or excretions • N95: • Should be fit checked every time when used. • Cautions when reuse

  43. Notes on Practices ( cont.) • Barrier-man is NOT recommended • Mask for patients and Visitors with respiratory symptoms • No visitors in High Risk areas • Limit and register visitors in other areas • Precautions in performing high risk procedures • Portering high risk patients with PPE and disinfection after use

  44. Staff Infectious Sickness Surveillance

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