Infection Prevention in Hospitals

INTERNATIONAL PATIENT SAFETY GOAL # 5

 BACKGROUND

• Hospitals are a place of healing and recovery. But they are also a
place where infections can spread easily if proper precautions
aren’t taken.
• Globally, healthcare-acquired infections are an all-too-frequent
occurrence, affecting one out of every 20 to 30 patients.
• Fortunately, with everyone working together, the risk of infection
can be greatly minimized.
 Learning Objectives

After completion of this session, the learners will be able to:

• Recognize patient safety as an important nursing responsibility in
global health care systems.
• Apply required knowledge in preventing and/or minimizing
infection.
• Perform appropriate behaviors required to prevent health care
associated infections.
• Demonstrate required competence to provide patients with safe
care
 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
 Why infection prevention and control is
relevant to patient safety?

• The spread of infection in health-care settings today affects

hundreds of millions of people worldwide.
• In the health care settings, infection is one of adverse events;
some of infections are preventable.
• Through improved infection prevention & control, infection can be
minimized. Therefore, improved infection prevention and control
can facilitate health care providers reach the goal of patient
safety.
 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.
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
 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
 Required Knowledge

• Knowledge of the extent of the problem;

• Knowledge of the main causes, modes of transmission, and
types of infections.
 Required Attitudes

• Being an effective team player.

• Commitment to preventing HAIs
 Required Skills

• Apply Universal/Standard Precautions*

• Use personal protection methods
• Know what to do if exposed
• Encourage others to use universal precautions
• Report breaks in technique that increase patient risks
• Observe patients for signs and symptoms of infection
 INFECTION CONTROL PROCESSES

• Standard Precautions are designed to reduce the risk of

transmission of micro-organisms from both recognized and
unrecognized sources of infection in the hospital.
• Standard Precautions applies to all patients regardless of their
diagnosis.
Standard Precautions shall be implemented when contact with
any of the following are anticipated:
• Blood
• All body fluids, secretions and excretions, with the exception of
sweat regardless of whether or not they contain visible blood.
• Non-intact skin(this includes rashes)
• Mucous membranes
 Main Sources of Infection

• Infections are caused by bacteria, fungi or viruses entering the body through
one or more of the following routes.
person-person via hands of health-care providers patients and visitors;
personal equipment (e.g. stethoscopes, computers) and clothing;
environmental contamination;
airborne transmission;
carriers on the hospital staff;
rare common-source outbreaks
 Campaigns to Decrease Infection Rates

• Recognizing this worldwide crisis, WHO established the

campaign Clean hands are safer hands
• Prevent antimicrobial resistance campaign in health-care settings
 The four major HCAIs

• Catheter associated Urinary tract infection(CAUTI)

• Surgical site Infection (SSI)
• Catheter related blood stream infection (CRBSI)
• Ventilator Associated Pneumonia (VAP
 Four Ways to 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.
 Prevention in Hospitals and Clinics

Studies show infections are minimized when hospitals/clinics:

• Are visibly clean;
• Use increased levels of cleaning during outbreaks;
• Use hypochlorite and detergents during outbreaks.
 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
• Decontamination refers to the process for physical removal of blood, bodily fluids and
the removal or destruction of micro-organisms from the hands.
 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
 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.
 Effective Handwashing Technique

• Wet hands under 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.
 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.
 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.
• Masks should be worn if an airborne infection is suspected or
confirmed to protect an immune compromised patient.
 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
 Proper use of PPE is a crucial step in controlling of HAIs

• The threat of emerging infectious diseases has highlighted the need for
effective PPE for HCW to protect both HCWs and patients.
• PPE is a critical component in the hierarchy of controls used to protect HCWs
from infectious hazards.
• Allow end user to select the right PPE for the procedure
• Increase compliance
identify gaps in HCW PPE, and barriers to proper use.
End-user input is important!
• Patients, staff, and visitors all play a role in preventing the spread of infection
in a hospital through education and collaboration

.
 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
 Required Performance

Healthcare Workers 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
 Encourage Others to Participate in Infection
Control

• HCWs may routinely observe staff who:

apply inadequate technique in handwashing
fail to wash hands
routinely violate correct infection control procedures
 What are the risk factors for infection?

• There are a number of factors that contribute to the high risk of infection in a healthcare
setting.
Because patients are in a state of reduced health, their immune systems
are often weakened; This leaves them more susceptible to infection.
• Additionally, they may have an open surgical wound, central line or catheter, all which
make it easier for bacteria to enter the bloodstream.
• Bacteria can also be quite resilient. If left alone, some bacteria are able to live on
surfaces for up to eight months.
• Patients, visitors, and staff may also contribute to this risk if they arrive with the flu.
• Finally, antibiotics can be a factor, with one in four prescribed inappropriately.
 How do we minimize the risk of infection in a hospital?

• Minimizing the risk of infection in a hospital begins with education and prevention.
• An infection control nurse works in tandem with hospital leadership to lead these
efforts.
• Patients, visitors, and staff all play a role in preventing infections.
• Secret surveyors and ongoing education reinforce compliance.
Making sure all surfaces are thoroughly disinfected and oversight for administering antibiotics.
• An antibiotic stewardship team reviews prescribed regiments for appropriateness
and effectiveness. This team involves the infection control nurse, pharmacist, and
medical director, among others.
 What about patients who arrive with an infection?

• Hospitals prepare for a patient with an infection before they arrive on site.
• Outside of the patient’s room will be a station containing all the necessary personal
protective equipment (PPE) to enter the room
• PPE is used when a patient has contagious organisms to prevent the spread of those
organisms.
• Signage is also posted on the patient’s door, alerting everyone of what precautions need
to be taken.
• Once the patient arrives, the infection control nurse meets with the patient. The nurse
provides education on what organisms they are dealing with and what protocols should
be followed.
• Once the patient arrives, the infection control nurse meets with
the patient. The nurse provides education on what organisms
they are dealing with and what protocols should be followed.
• Patients play a key role in their own safety by knowing the signs
of infection and encouraging everyone to keep their hands clean.
• Patients, staff, and visitors all play a role in preventing the spread
of infection in a hospital through education and collaboration.
 HOSPITAL OUTBREAK MANAGEMENT

1. Steps to be taken to investigate an outbreak

2. The appropriate departments, personnel and the hospital administration
should be notified and involved.
3. Additional cases must be searched for by examining the clinical and
microbiological records.
4. Specific control measures should be implemented as soon as the
cause of outbreak is identified.
5. A report should be prepared for presentation to the HICC
 CLEANING, DISINFECTION AND
STERILIZATION

• Cleaning is
• Disinfection is a process where most microbes are removed from defined
object or surface, except spores.
• Sterilization is
 GENERAL GUIDELINES FOR
DISINFECTION

• Critical instruments/equipment (that are those penetrating skin or mucous

membrane) should undergo sterilization before and after use. e.g. surgical
instruments.
• Semi-critical instruments/equipment (that are those in contact with intact
mucous membrane without penetration) should undergo high level disinfection
before use and intermediate level disinfection after use. e.g. endotracheal
tubes.
• Non-critical instruments/equipment (that are those in contact with intact skin
and no contact with mucous membrane) require only intermediate or low
level disinfection before and after use. e.g. ECG electrode
 FOGGING

• In patient care areas regular fogging is not recommended.

• Necessary decision is taken by in charge of concerned patient
care area
 ENVIRONMENTAL SURFACES

• Clean housekeeping surfaces on a regular basis.

• Disinfect environmental surfaces (e.g., bedside tables, bedrails, and
laboratory surfaces) on a regular basis and when surfaces are visibly soiled.
• Clean walls, blinds, and window curtains in patient-care areas when these
surfaces are visibly contaminated or soiled.
• Decontaminate mops heads and cleaning cloths regularly to prevent
contamination(at least daily)
• Do not use high-level disinfectants or liquid chemical sterilants for
disinfection of non-critical surfaces.
 Monitoring of biomedical waste management
practices

•A person or persons should be designated to be responsible for

establishing, monitoring, reviewing, and administering a plan for
the collection, handling, predisposal treatment, and terminal
disposal of regulated medical wastes.
 ISOLATION PRECAUTIONS

• Isolation precautions are needed to prevent the transmission of

pathogenic microorganisms within the healthcare setting.
• The patients of following disease categories should be treated
under isolation:
Severe influenza cases, SARS, Open case of tuberculosis,
Anthrax, diphtheria, Pertussis, Pneumonic plague, Chicken
pox, and patients infected with multidrug resistant bacterial
pathogens
 Patient placement

• Appropriate patient placement is a significant component of isolation

precautions.
• Determine patient placement based on the following principles:
Route(s) of transmission of the infectious agent
Risk factors for transmission in the infected patient
Risk factors for adverse outcomes resulting from healthcare-associated
infection in other patients in the area.
Availability of single-patient rooms
Patient options for room-sharing
 ANTIMICROBIAL POLICY
AND
ANTIMICROBIAL STEWARDSHIP
• Antibiotic policy need to be prepared in consultation with
respective clinical departments.
• The annual antibiogram should be prepared by microbiology
department.
• Antibiotic susceptibility profile may beis analyzed regularly and
the common resistance patterns of the bacterial isolates to
be reported and discussed in the HICC meetings
• The antibiotic policy to be reviewed accordingly
 Antimicrobial Stewardship

• This aims to optimize antimicrobial use among patients in order

to reduce antibiotic resistance, improve patient outcomes and
safety, and ensure cost-effective therapy.
• At the healthcare facility level, antibiotic stewardship involves:
Implementing an antibiotic stewardship program;
Continuous monitoring and analysis of antibiotic usage, to
track changes in antibiotic resistance and to monitor effects
of containment strategies
 BIOMEDICAL WASTE MANAGEMENT

• The hospital should ensure that clinical and general wastes is

segregated at source and placed in color coded plastic bags and
containers prior to collection and disposal at the site of
generation in all patient care areas/clinical areas.
 OCCUPATIONAL HEALTH AND SAFETY

• Occupational health and safety includes the prevention, reporting

and management of sharps injuries, needle stick injuries and
other percutaneous exposures to blood and body fluids which
may potentially expose an employee to the risk of blood-borne
viruses.
 SHARPS INJURY MANAGEMENT

• Stop the procedure immediately and wash the wound with soap and water,
encourage bleeding the apply antiseptic.
• Immediately report to In Charge officer for First aid and emergency treatment
• ‘PEP’ is provided is casualty round the clock as per Hospital/MOH’s guidelines.
• Retention, if possible of the item and details of its source for identification
of possible infection.
• Investigation, determination and implementation of remedial measures.
• Needle Sticks/ Sharp injury should be recorded
 TRAINING OF ALL THE STAFF

• It is necessary to conductthe regular refresher training of all the

staff members of the hospital
 MANAGEMENT OF EXPOSURES TO HBV

• For percutaneous or mucosal exposures to blood, several

factors must be considered when making a decision to provide
prophylaxis, including the HBsAg status of the source and the
hepatitis B vaccination and vaccine-response status of the
exposed person
 One more important thing!

• Protect Yourself
• Be sure you have been immunized against Hepatitis B since it is
very easy to transmit!
 Infection Control Committee

• The Committee is an integral component of the patient safety

program of the health care facility, and is responsible for
establishing and maintaining infection prevention and control
• This committee should include wide representation from all
relevant disciplines or departments in the facility
 Structure

• Chairperson
• Secretary: Senior Microbiologist
• Members: Representation from Management/Administration
(Director of Hospital; Nursing Services; Medical Services; OT)
• Support Services: (OT/CSSD, House-keeping/Sanitation,
Engineering, Pharmacologist, Officer of Materials Department)
• Infection Control Nurse (s)
• Infection Control officer
 Infection Control Team

• The Infection control team should comprise of at minimum an

infection control officer, a microbiologist (if ICO is not a
microbiologist), and infection control nurse.
• ICT takes daily measures for the prevention and control of
infection in hospital.
 SURVEILLANCE OF HEALTHCARE
ASSOCIATED INFECTIONS

• Surveillance is one of the most important components of an

effective infection control program.
• It is defined as the systematic collection, analysis,
interpretation, and dissemination of data about the occurrence of
HCAIs in a definite patient population
Active surveillance of Healthcare associated
Infections (HCAI)

• Intensive care units

• Operating Theatre
• Dialysis Unit
• Laboratory/Microbiology
• Food handlers
• Drinking water
• Central Sterile Services Department
 Important Conclusions

• Nosocomial transmission of pathogenic bacteria creates a major

health burden
• Multifaceted interventions are needed for high level control: proper
hand hygiene is the cornerstone of prevention efforts
• Isolation of patients may place them at risk for errors of omission
• Implement simple & effective solutions according to local need and
resources which are achievable and affordable Simple measures do
save lives
• onne@siloamhospitals.com
• 081510050101