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Transcript
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