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Prevention of healthcare associated infections Sunil Esampalli MRCPCH, UK Overview Hospital acquired infections study Professional dressing Recommendations Healthcare associated Infections Nosocomial infections Hospital acquired infections 8.7% ( 14 countries, 55 hospitals- 1987)1 Health-care associated infection in Africa: a systemic review by WHO- 20112 - Prevalence 14.8% (2.5-14.8%) - Average European prevalence -7.1% - In Uganda- ? Ugandan data Lacor hospital, Gulu, Uganda – In 2011: prevalence of 28% (47% in surgical and 21% in paediatrics) Mulago hospital – MRSA from surgical wounds, 28.7% of all samples grew staphylococcal aureus and 31.5% of them were MRSA5. In Kisiizi (unpublished data)- 60% of surgical wounds grew staph aureus. No access to MRSA testing (oxacillin agar screen). Why should we be worried ? Increases length of stay Increases morbidity Increases mortality 1.7 million HAI, 90000 deaths – in US 20023 Financial burden Increased mortality in children staying >5 days “first do no harm” or, Latin phrase, “primum non nocere1860 Common HAI’s Surgical wound sites Surgical drains Central venous catheters IV Cannula sites Urinary catheters Common organisms Staphylococcus epidermidis Staphylococcus aureus – often MRSA Enterobacter species Pseudomonas Often these are resistant to commonly used antibiotics Common means of transmission Medical equipment Do we need to clean our medical equipment? Stethoscopes Pulse oximeter probes Cannula ports when accessing Dangling drip ends ??????? Medical equipment cleanliness 10 different commonly used equipment in paediatric ward Swabs were taken and cultured Equipment Organism 1 Organism 2 Stethoscope 1 Staph epidermidis Stethoscope 2 Staph epidermidis Stethoscope 3 Neiserria catarrhalis MUAC tape Staph epidermidis coliform Pulseox probe 1 Pseudomonas sps Bacteroides sps Pulseox probe 2 Staph epidermidis Pulseox probe 3 Staph epidermidis Knee hammer Staph aureus BP cuff Staph epidermidis Thermometer Staph aureus Is locally made alcohol based hand rub effective ? Re-swabbed after cleaning with alcohol rub Is alcohol based rub effective? Equipment Organism 1 Organism 2 Alcohol rub Stethoscope 1 Staph epidermidis Stethoscope 2 Staph epidermidis No growth Stethoscope 3 Neiserria catarrhalis No growth MUAC tape Staph epidermidis coliform No growth Pulseox probe 1 Pseudomonas sps Bacteroides sps No growth Pulseox probe 2 Staph epidermidis No growth Pulseox probe 3 Staph epidermidis No growth Knee hammer Staph aureus No growth BP cuff Staph epidermidis No growth Thermometer Staph aureus No growth No growth 100 % effective KISIIZI ALCOHOL HAND RUB FORMULAR FOR 20LITRES (WHO Formula I) Method of Preparation •Ensure cleaning of the 20 Liter ‘jerrycan’- Final container, and all the measuring cylinders and beakers has been done properly before production begins •Measure 145mL of Glycerol and pour into the final container •Measure 417 ml of 6% Hydrogen peroxide using the same cylinder you used to measure the glycerol so that it help rinse out all the glycerol since it is slightly viscous and pour into the final container. •Measure 16000mL of absolute Alcohol and power into the Final container •Top up to 20000mL with freshly distilled water •Label and allow to sit for 72 hours before use. Ingredients Quantities 1. Alcohol 95.5 % (absolute) 80% 16000mL 1. Glycerol 98%w/w 0.725% 145mL 1. Hydrogen Peroxide 6%v/v (0.125%) 417mL 1. Distilled Water (fresh) to 20000mL ABH cost- WHO survey4 2011 Clean Care is Safer Care- 2005 Thirty-nine sites from 29 countries (79% LIC and MIC) included in the final data analysis Commercially produced ABH – 2.5 to 8.5USD / 100mls dispenser Locally produced ABH- 1.6 to 2.2 USD / 100mls including dispenser and salaries White coat Professional dress (Am J Med 2005) Study done in 2005 in US. 76.3% favoured professional attire- white coat Scrubs 10.2% Business dress 8.8% Casual dress 4.7% African study The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. Uneke CJ1, Ijeoma PA. Swabs taken from cuffs and pockets 91.3% of coats had bacterial contamination Staphylococcus aureus, Gram negative bacteria and dipheroids Practice in the UK White coats Ties Long sleeves Watches bracelets Banned Bare below elbow policy since 2008 Cleaning equipment after every patient contact Strict hand hygiene- hand washing, alcohol rub Practice in the US Society of healthcare epidemiology of America (SHEA) Recommendations A bare below elbow policy Hanging white coat prior to contact patient contact Cleaning stethoscopes and other medical equipment before seeing next patient. Daily laundering of clothes that touch patients Recommendations Use alcohol rub Wash with soap + water -contact with body fluids Bare-below-the-elbow in all clinical settings No wrist watches/ jewellery/ bracelets- except for wedding rings White coat – wash everyday or don’t use it A nation wide HAI data collection is needed References 1. 2. 3. 4. 5. 6. Tikhomirov E. WHO programme for the control of hospital infections. Chemioterapia. June 1987. 6(3):148-51 Health-care associated infection in Africa: a systemic review by WHO2011 Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcareassociated infections in US hospitals, 2002. Public Health Rep. Mar 2007. 122(2):160-6. Local production of WHO-recommended alcohol-based handrubs: feasibility, advantages, barriers and costs -Joanna Bauer-Savage , Didier Pittet , EunMi Kim & Benedetta Allegranzi Prevalence of Methicillin resistant Staphylococcus aureus (MRSA) among isolates from surgical site infections in Mulago hospital- Kampala, Uganda. J Ojulong, T Mwambu, M Jolobo, E Agwu, F Bwanga, C Najjuka, D KadduMulindwa Summary HAI- cause increased morbidity/ mortality/ financial burden to patients and hospitals Patient safety is our priority Please don’t hesitate to tell your colleague to wash hands/ alcohol rub. Its everyone's responsibility THANK YOU ALL UPA & RCPCH !!