Infection Prevention and Control

Infection prevention and
control
By Tewodros Hailemariam
Megabit, 2014 E.C
Outline
• Introduction
• Hand hygiene
• Standard precaution
• Isolation
• Surgical prophylaxis
• Additional measures
Introduction
• Important role in pediatrics medicine
• Requires :-
-Functional infrastructure that collaborates with
the public health system.
-Wide spread immunizations.
-Use of appropriate techniques to prevent
transmission with in the general population & health
care institutions.
Intro. Cont…
• Health care associated infections (HAI) or
nosocomial infection: infections acquired
during hospitalization or in other health care
settings, such as nursing homes or ambulatory
surgical care centers.
• 3-5 % of admitted children acquire HAI---
highest in pts undergoing invasive procedures.
Intro. Con…
• Infection also acquired in ED, physician’s
office, day care and long term care settings.
• Medical device associated infection occur in
home & hospital as number of children sent to
home from hospital with IV catheters & other
medical devices in place increased.
Intro. Con…
• Susceptibility to HAI:-
- Host factors.
- Recent invasive procedures.
- Presence of catheters or other devices.
- Prolonged use of antibiotics.
- Contaminated physical environment.
- Exposure to other pts, visitors, or health care
providers.
Intro. Con…
• Host factors
- Anatomic abnormalities ( dermal sinuses, cleft
palate, obstructive uropathy)
- Abnormal skin
- Organ dysfunction
- Malnutrition
- Underlying diseases or comorbidities
Intro. Con…
• Invasive procedures:- introduce potential
pathogens by breaching normal anatomic host
barriers.
• IV & other catheters:-
- Direct access for sterile anatomic sites for
minimally pathogenic organisms.
- Adherent surfaces for microbial binding.
- Disrupt patterns of normally protective flow of
mucus. ( e.g nasotracheal tubes, …)
Intro. Con…
• Antibiotic use can alter the composition of
bowel flora & encourage the multiplication &
emergence of toxigenic or invasive organisms
already present in small numbers in the gut.
E.g C. difficle, salmonela spp
• Liberalization of visitation polices & in hospital
animal visitation increase HAI.
Intro. Con…
• Routes of transmission
- Hands (most common).
- Medical equipment, toys, hospital & office
furniture.
- Pagers, phones, computer keyboards, & even
neckties.
• HAIs prolong hospital stay & increase health
care cost
Hand hygiene
• Most important tool in IPC.
• Placing the hands under water & using friction
with or with out soap.
• 15 seconds scrub removes majority of
transient surface flora but doesn’t alter
deeper resident flora.
• A variety of hand gels & rubs can be used in
place of hand washing.
Hand cont…
• Water less hand hygiene increases hand hygiene
compliance & save time---- when hands are not visibly
soiled.
• Hand gels & rubs are effective in killing most microbes
but don’t remove dirt or debris & ineffective against
non enveloped agents e.g norovirus, C. difficle spores.
• Clean the hand before & after every pt encounter.
• Hand washing compliance studies showed physicians
are usually least compliant.
Standard precautions
• Formerly called universal precautions
• Intended to protect the health care workers
from pathogens & used whenever there is pt
contact.
• Involve use of barriers- gloves, gowns, masks,
goggles, & face shields as needed.
Isolation
• Decrease nosocomial transmission to staff &
other pts.
• Specific type of isolation depends on the
infecting agent & potential route of
transmission.
• Transmission by contact:- most common &
involves direct contact with the pt or contact with a
contaminated intermediate object.
Isol. Cont…
• Contact isolation:- requires use of gowns & gloves
when in contact with the pt or immediate
surrounding.
• Transmission by droplets:- propulsion of infectious
large particles over a short distance (< 3ft), with
deposition on another’s mucus membranes or skin.
• Droplet isolation:- requires use of gloves & gowns,
as well as masks & eye guards when closed than 3 ft
to the pt.
Isol. Con…
• Airborne transmission:- occurs by dissemination
of droplet nuclei (< or = 5 µm) or dust particles
carrying an infectious agent.
• Airborne infection isolation (AII):- requires the
use of masks and –ve pressure air-handling systems
to prevent spread of the infectious agent.
• For contact & droplet isolation, single rooms are
preferred but not required. Cohorting children
infected with the same pathogen is acceptable.
Surgical prophylaxis
• Antibiotics should be given when there is a
risk of postoperative infection.
• Types of surgical wound based on risk of
infection:-
 Clean wound: uninfected operative wounds where
no inflammation is noted at the operative site &
respiratory, alimentary, genitourinary tracts &
oropharynx are not entered.
Surgical cont…
 Clean-contaminated wounds: respiratory,
alimentary, or genitourinary tract is entered under
controlled conditions & don’t have unusual bacterial
contamination preoperatively.
 Contaminated wounds: include open, fresh &
accidental wounds; major breaks in otherwise sterile
operative techinque; gross spillage from the GI tract;
penetrating trauma occurring < 4 hrs earlier; &
incisions where acute non purulent inflammation
encountered.
Surgical con…
 Dirty & infected wounds: include penetrating
traumatic wounds > 4 hr before surgery, wounds with
retained devitalized tissue, clinical infection is
apparent or the viscera have been perforated.
Additional measures
 Aseptic technique
 Catheter care
 Prudent use of antibiotics (effective antibiotic
stewardship program)
 Periodic cleansing of the environment
 Disinfection & sterilization of medical
equipment
 Reporting of infections.
Addit. Con…
 Safe handling of needles & other sharp
objects.
 Limiting duration & number of catheters,
remove the catheters as soon as become
unnecessary.
 Employee health services.
Thank you

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