UNIT II PREVENTION OF INFECTION

1. UNIT II PREVENTION OF INFECTION Mrs.Indumathi Lecturer YNC

2. Introduction • Patient safety is a discipline in the health care sector that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. Patient safety is also an attribute of health care systems; it minimizes the incidence and impact of, and maximizes recovery from, adverse events (Emanuel et al., 2008) .

3. Introduction to Patient Safety: Background • Adverse medical events are widespread and preventable (Emanuel et al., 2008) . • Much unnecessary harm is caused by health-care errors and system failures. • Ex. 1: Hospital acquired infections from poor hand-washing. • Ex. 2: Complications from administering the wrong medication.

4. Introduction to Patient Safety:Goal • Prevent and/or minimize the adverse events and eliminate preventable harm in health care. • All health care professionals including nurses are responsible for ensuring patient safety

5. Global Infection Problems According to WHO (2005), • On average, 8.7% of hospital patients suffer health care-associated infections (HAI). • In developed countries: 5-10% • In developing countries: • Risk of HAI: 2-20 times higher • HAI may affect more than 25% of patients • At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

6. Health Care-Associated Infections (HAI) According to WHO: • HAI is also called “nosocomial”. • HAI is defined as: • an infection acquired in hospital by a patient who was admitted for a reason other than that infection. • an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.

7. Impacts of Health Care-Associated Infections (HAI) HAI can: • Increase patients’ suffering. • Lead to permanent disability. • Lead to death. • Prolong hospital stay. • Increase need for a higher level of care. • Increase the costs to patients and hospitals.

8. Preventing infections Requires health care providers who have: • Knowledge of common infections and their vectors • An attitude of cooperation and commitment • Skills necessary to provide safe care

9. Main Sourcesof Infection • Person to person via hands of health-care providers, patients, and visitors • Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) • Environmental contamination • Airborne transmission • Hospital staff who are carriers • Rare common-source outbreaks

10. Campaigns to Decrease Infection Rates • WHO “Clean hands are safer hands” campaign • Centers for Disease Control and Prevention (CDC) “prevent antimicrobial resistance” campaign in health-care settings • Institute for Healthcare Improvement (IHI) “5 million lives” campaign • Developing country focus

11. Main Routes for infections • Urinary tract infections (UTI) • Catheter-associated UTI(CAUTI)s are the most frequent, accounting for about 35% of all HAI. • SSI: about 20% of all HAI • Bloodstream infections associated with the use of an intravascular device)(CLABSI): about 15% of all HAI • Pneumonia associated with ventilators: about15% of HAI(VAP)

12. Types of Infections Burke J Infection control-a problem for patient safety New Eng Journal of Medicine (February 13, 2003)

13. Four Waysto Prevent HAI • Maintain cleanliness of the hospital. • Personal attention to handwashing before and after every contact with a patient or object. • Use personal protective equipment whenever indicated. • Use and dispose of sharps safely.

14. Prevention through Handwashing • Handwashing: the single most important intervention before and after patient contact. • Required knowledge and skills: • How to clean hands • Rationale for choice of clean hand practice • Techniques for hand hygiene • Protect hands from contaminants • Promote adherence to hand hygiene guidelines

15. Five moments for hand hygiene • Before patient contact • Before an aseptic task • After body fluid exposure even if wearing gloves! • After patient contact • After contact with patient surroundings

16. Your 5 moments for HAND HYGIENE

17. How to Clean Hands • Remove all wrist and hand jewelry. • Cover cuts and abrasions with waterproof dressings. • Keep fingernails short, clean, and free from nail polish.

18. Effective Handwashing Technique • Wet hands under tepid running water • Apply soap or antimicrobial preparation • solution must have contact with whole surface area of hands • vigorous rubbing of hands for 10–15 seconds • especially tips of fingers, thumbs and areas between fingers • Rinse completely • Dry hands with good quality paper towel.

19. How to use waterless handrub • Apply a palmful of product in cupped hand • Rub hands palm to palm • Right palm over left hand with interlaced fingers • Palm to palm with fingers interlaced • Backs of fingers to opposing palms with fingers intelocked • Rub between thumb and forefinger • Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa • Once dry your hands are safe.

20. Resources for Correct Handwashing Procedures • Your Five Moments for Hand Hygiene • http://www.who.int/gpsc/tools/5momentsHandHygiene_A3.pdf • How to handrub? How to handwash? • http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf

21. Personal Protective Equipment • Gloves, aprons, gowns, eye protection, and face masks • Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.

22. Personal protective equipment 2 • Masks should be worn • if an airborne infection is suspected or confirmed • to protect an immune compromised patient.

23. Gloves Gloves must be worn for: • all invasive procedures • contact with sterile sites • contact with non-intact skin or mucous membranes • all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. Hands should be washed before and after gloving

24. Safe Use and Disposal of Sharps • Keep handling to a minimum • Do not recap needles; bend or break after use • Discard each needle into a sharps container at the point of use • Do not overload a bin if it is full • Do not leave a sharp bin in the reach of children

25. Required Performance Nursing students need to: • apply universal precautions • be immunized against Hepatitis B • use personal protection methods • know what to do if exposed • encourage others to use universal precautions

26. Act to Minimize Spread of Infection-1 Before contact with each and every patient: • clean hands before touching a patient • clean hands before an aseptic task

27. Act to Minimize Spread of Infection-2 After contact with each and every patient: • clean hands after any risk of exposure to body fluids • clean hands after actual patient contact • clean hands after contact with patient surroundings

28. Encourage Others to Participate in Infection Control Students may routinely observe staff who: • apply inadequate technique in handwashing • fail to wash hands • routinely violate correct infection control procedures

29. Summary-1 • Know the main guidelines in each of the clinical environments you are assigned. • Accept responsibility for minimizing opportunities for infection transmission. • Let staff know if supplies are inadequate or depleted.

30. Summary-2 • Educate patients and families/visitors about clean hands and infection transmission. • Ensure patients on precautions have same standard of care as others: • frequency of entering the room • monitoring vital signs

31. References • World Health Organization. (2010). WHO Patient Safety Curriculum Guide for Medical Schools. • World Health Organization. (2010). Topic 1: What is patient safety? • World Health Organization. (2010). Topic 9: Minimizing infection through improved infection control. • Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008). What exactly is patient safety? Advances in Patient Safety, Vol. 1: Assessment. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=advances-emanuel-berwick_110 • Burke, J. P. (2003). Infection control — A problem for patient safety. The New England Journal of Medicine, 348, p. 651-656.