Download Protect Your Patients and Yourself From

Global Health Prep Course 2008
Infection Prevention in Settings
with Limited Resources
W. Charles Huskins, MD, MSc
Mayo Clinic, Rochester, MN
November 8, 2008
Disclosures: None
Healthcare-associated infections in
settings with limited resources are…
A. Caused by agents typically
associated with infections in
tropical settings
67%
B. Infrequent because most care
is not
associated significant risk
C. Similar to those in settings
with adequate resources
21%
D. Unfortunate but mostly
unavoidable
10%
2%
A.
B.
C.
D.
Protect your patients!
Protect yourself!
Protect Your Patients and Yourself
From “community infections”
spread in healthcare settings
Infection
Organisms
Source/cause
Respiratory &
GI infections
RSV, influenza, etc
Rotavirus, etc
Giardia,
Cryptosporidium
Salmonella
Shigella
Vibrio cholera
Person-to-person, via direct,
indirect or droplet spread
Contaminated infant formula,
enteral feedings
Improperly prepared/stored food
Contaminated water
Contaminated surfaces
Systemic viral
infections
Measles, varicella,
rubella, mumps
Airborne spread from infected
persons
TB
M. tuberculosis
Airborne spread from
unidentified and/or
inadequately treated persons
Overcrowding
Inadequate Sinks and Supplies
for Hand Hygiene
Protect Your Patients and Yourself
From “community infections”
spread in healthcare settings
• Hand hygiene
– Use an alcohol-based hand rub in most situations
– Wash hands with soap & water if visible contamination
• Barrier precautions
– Wear gloves for contact with blood, body fluids, secretions,
excretions, mucous membranes, & non-intact skin
If limited in supply, use new gloves for contacts with blood & body
fluids and reused gloves for other types of contacts
If limited in supply, dip gloved hands in diluted household bleach
(0.05% chlorine concentration) for 1 minute between contacts;
remove soiling by washing with soap and water first.
– Wear goggles & mask if splashing/aerosolization possible
– Wear gowns if soiling of clothing is possible
Simple Solutions
to Improve Hand Hygiene
Alcohol-based hand rub &
container with clean gloves on cart
Cistern with clean water, soap &
clean, single use cloth towels on cart
WHO Clean Care is Safer Care
The First Global Patient Safety Challenge
http://www.who.int/gpsc/en/
Infection Control for Viral Hemorrhagic Fevers
in the African Healthcare Setting
• Detailed descriptions of IC
•
procedures for VHF
Practical descriptions of
general IC procedures
– Standard Precautions
– Isolation Precautions
– Disinfection of reusable
–
–
–
supplies & equipment
Disinfection water for
drinking, cooking & cleaning
Disposal of waste
Safe burial practices
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm
Protect Your Patients and Yourself
From “community infections”
spread in healthcare settings
• Additional measures for infections spread by
airborne or droplet contact
– Cohort patients with same disease
– Avoid cough-inducing procedures
– Ensure adequate ventilation
– Close doors and use out-facing window or wall fan to
–
direct air out of building
Ultraviolet germicidal irradiation may be appropriate in
some situations
WHO Guidelines for Preventing Spread of TB
in Healthcare Settings
http://www.who.int/tb/publications/who_tb_99_269/en/index.html
Initial Management of a
Patient with Suspected TB
• Provide face mask or tissues
• Instruct in cough hygiene – cover nose and mouth
when coughing or sneezing
• Dispose of tissues, cloths or masks in no-touch
waste receptacles after use
• Direct to a separate waiting area
• Deliver services quickly (ahead of the queue)
• Refer to a TB diagnostic & treatment facility
Protect Your Patients and Yourself
From bloodborne infections
Infection
Hepatitis, AIDS
Organisms
Hepatitis B & C
viruses
HIV
Source/cause
Blood products
Unsafe injection practices
Contaminated fluids/meds
& sharps
Malaria
Plasmodium sp.
Chagas Disease Trypanosoma cruzi
Blood products
Unsafe injection practices
Contaminated fluids/meds
Hemorrhagic
fever
Direct contact with blood,
body fluids, or mucous
membranes
Unsafe injection practices
Contaminated sharps
Ebola, Lassa Fever,
Marburg, etc
Protect Your Patients and Yourself
From bloodborne infections
• Blood products
– Eliminate unnecessary transfusions
– Screen products appropriately
– Administer products appropriately
• Injections
– Use sterile needles & syringes
– Prevent contamination of injection equipment and
fluids or medications
• Sharps injuries
– Avoid handling sharps
– Dispose sharps properly
http://www.who.int/injection_safety/toolbox/en/LeafletBestPracticesPrinter.pdf
http://www.who.int/injection_safety/toolbox/en/LeafletBestPracticesPrinter.pdf
Syringes for Injection Safety
Reuse Prevention Feature
Reuse & Needlestick
Prevention Features
Internal mechanism blocks plunger
once it is fully pressed.
Additional shield to cover needle
creating a protective cap
Internal mechanism cracks plunger
completely once it is fully pressed
Needle is pulled back inside the syringe
barrel upon retraction of the plunger
Protect Your Patients
From infections associated with invasive
devices and procedures
Infection
Organisms
Source/cause
Bloodstream Gram negative rods
infections
Staph. aureus
Candida
IV catheters
Contaminated fluids and
medications
Urinary tract
infection
Gram negative rods
Candida
Urinary catheters & open
collection systems
Surgical site
infection
Staph. aureus
Gram negative rods
Poor technique
Contaminated instruments
No/late/inadequate prophylaxis
Postpartum Gram negative rods
endometritis Anaerobes
Intrapartum exams
Contaminated instruments
No/late/inadequate prophylaxis
Etiology of Invasive Bacterial Infections in
Newborns 0-3 day in Hospitals, 1990-2004
GBS
E. coli
Klebsiella, Pseudomonas, Acinetobacter & other gram negative rods
S. aureus
Others
70
60
50
%
40
30
20
10
0
Africa (n=110)
Middle East (n=27)
South Asia (n=239)
South East Asia (n=91)
Latin
America/Caribbean
(n=41)
All developing regions
(n=508)
Zaidi AKM, Huskins WC, Thaver D, et al. Lancet 2005; 365:1175-88
Inappropriate Use
of Invasive Devices
Lack of Acceptable
Quality Supplies & Equipment
Contaminated IV Fluids
and Medications
Inadequate Sterilization/Disinfection
Procedures
Protect Your Patients
From infections associated with invasive
devices and procedures
• Invasive devices
– Eliminate unnecessary use
– Remove as soon as possible
– Use sterile devices and supplies
– Use aseptic technique during insertion and care
– Maintain closed systems
• Invasive procedures
– Eliminate unnecessary use
– Use sterile instruments and supplies
– Use aseptic/sterile technique
– Use peri-procedure antimicrobial prophylaxis as indicated
(clean-contaminated, contaminated, dirty procedures)
Infection Control Assessment Tool
A Standardized Approach for Improving
Hospital Infection Control Practices
• Modules for assessment and problem-solving regarding
– Infection control programs
– Practices: hand hygiene, isolation & standard precautions,
–
–
injections, IV catheters, fluids & meds, urinary catheters,
sterilization/disinfection
Areas: general wards, labor & delivery, surgery, ICUs
Ancillary services: microbiology, pharmacy, employee health,
waste management
• Developed and supported by
– Rational Pharmaceutical Management Plus Infection Control
–
Project team
USAID Rational Pharmaceutical Management Plus Project,
Management Sciences for Health, Washington DC