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Hani Masaadeh, MD, Ph.D 1 2 Healthcare epidemiology: Any activity that Improve patient care outcomes. Epidemiology, laboratory investigation, surveillance, device and procedure management, education and information. Standardized procedures. 3 Hospital acquired infections. Community acquired infections. 14 days of hospital discharge. Iatrogenic infections. 4 Infectious diseases (infections) can be divided into two categories depending on where the person became infected: (a) infections that are acquired within hospitals or other healthcare facilities (called healthcareassociated infections or HAIs)a and (b) infections that are acquired outside of healthcare facilities (called communityacquired infections). 5 Community-acquired infections are those that are present or incubating at the time of hospital admission. All other infections are considered HAIs, including those that erupt within 14 days of hospital discharge. 6 Over all around 5% of those admitted. Added $4.5 billion to healthcare. Things are much better now than before. Pathogens: Patients, healthcare professionals, visitors. Sinks, mobs, showerheads, flower pots. G+ cocci, G-ve bacilli, patients, environment. Resistant bacteria stays. MDRTB, VRE, MRSA, MRSE, HIV, Candida spp. protozoa 7 8 UTI (32%, 13%) Surgical Site Infections (22%, 8%) Lower Respiratory Tract Infections (15%, 36%) Blood stream infections, (15%, 31%) Clostridium difficile and AAD, PMC 9 Immunosuppressed patients: Age, aggressive medical or surgical interventions, prosthetic devices, organ transplantation. Women in labor or delivery, premature infants, diabetes and cancer pts, Steroids and chemotheraputic agents, and radiotherapy, immunosuppressed pts, renal dialasis or caths. 10 11 Increase drug resistant pathogens. Failure of healthcare professionals to follow infection control guidelines. Increase # of immunocompromised pts. Antibiotics abuse. False sense of security about antibiotics → neglect of aseptic techniques. Lengthy and more complicated surgery. Pts overcrowding and shortage of staff. Untrained healthcare professionals. Use of many immunosuppressed procedures. Over use of indwelling medical devices. 12 Strict compliance with infection control guidelines. Hands washing, Before and After. Sterilization and disinfection techniques. Filtration, UV light, isolation, gloves, masks, gowns whenever appropriate. Break the chain of infection. Ignas semmelweis and Josef Lister. 13 Medical: Prevent direct or indirect method of transmission. Frequent and thorough handwashing. Disinfection. Proper disposal of needles. Contaminated material and waste. 14 Surgical Asepsis: Keep objects and areas sterile. Medical vs surgical. Hospital areas and invasive procedures. Scrubing. Patient preparation. Instruments. Sharp items disposal. Floors and ventilation. 15 16 Prevent transmission of pathogens. All of hospitalized patients. Blood borne and moist body substance. Guidelines for handwashing. Gloves, masks, eye protection, gowns, soiled linen, needles disposal, sharp objects disposal. Resuscitation devices. Protect healthcare frofessionals from HIV and HBV. 17 18 19 20 The single most important procedure. Before and after patient contact. Between tasks for the same patient. After contamination with infected material. Even after wearing gloves. After gloves removal. Regular or antiseptic soap. Use fricion, circular motion. Paper towels or dry air. Alcohol swabs. 21 Healthcare workers must clean hands BEFORE and AFTER every patient contact. Alcohol – based hand gels / foam may be used as a substitute for when soap and water are not available. Gels / foam CANNOT be used if hands are visibly soiled or the patient is on isolation for Clostridium difficile diarrhea (not effective on spores). 23 Blood. Body fluids. Secretions. Excretions. Mucus membranes. Nonintact skin. Change between tasks. Wash hands after removal of gloves. 24 25 Splashes or sprays of blood or body fluids. Masks protects from large droplets. Gowns protects against splashes. Remove as soon as possible. Wash hands immediately. 26 Can,t be reused unless properly cleaned, disinfected or sterilized. Dispose single use items. Bag visibly contaminated articles. 27 Comply with adequate procedures. Routine care. Cleaning disinfecting surfaces. Beds and bedrails. Bedside equipment. Other frequently touched surfaces. 28 Usually contaminated with blood, body fluids, excretions, secretions. Handle, transport and process carefully. Prevent contamination to yourself or to others. 29 Needlestick injuries. Broken glass and other sharps. HIV, and HBV. Standard precautions. Safty procedures. Never resheath used needles using both hands, use one-handed scoop technique. Mechanical devices for needle disposale. Never remove needle by hand or break needles. 30 31 An accidental injury by a sharp object contaminated with infectious material. Sharps include: Needles - Scalpels Broken glass - Exposed ends of dental wires Anything that can pierce, puncture or cut your skin. Blood or body fluid contamination of open cuts, nicks and skin abrasions dermatitis and acne mucous membranes of your mouth, eyes or nose. Indirect transmission, such as touching a contaminated object or surface and transferring the infectious material to your eyes, nose or open skin. Follow hospital Infection Control and Safety policies. The use of Universal Precautions and safety devices will decrease the incidence of occupational exposures. Universal Precautions consist of appropriate workplace practices engineering (safety) controls, and using Personal Protective Equipment (PPE). Hepatitis B is a serious liver infection caused by a specific virus, HBV. Hepatitis C is a viral infection of the liver. It was formerly called non-A non-B hepatitis. It is both an acute infection and, if the infection continues for more than six months (as it does in most), a chronic hepatitis. The human immunodeficiency virus attacks the body's immune system, causing the disease known as AIDS, or Acquired Immune Deficiency Syndrome. Soon after infection, the person may suffer from flu-like symptoms, fever, diarrhea and fatigue. A person infected with HIV may then carry the virus without developing further symptoms for several years. Ultimately, a person infected with HIV will almost certainly develop AIDS, at which time they may also develop AIDS-related illnesses. These include neurological problems, cancer, and opportunistic infections such as severe pneumonia, brain abscesses and infectious diarrhea. Use private rooms for patients who contaminate the hospital environment. Those who cann,t assist in providing proper hygiene or environmental control. 38 Hospital transmission by Airborne, Droplets, and Contact → Precautions in addition to standard precautions. Airborne precautions: Droplets or dust. TB, Rubella, and Varicell virus. Private room, negative pressure, HEPA filters. Can be placed with other pt with the same disease. Respiratory masks. 39 40 A form of contact transmission. Coughing, sneezing, and talking. Suctioning and bronchoscopy. Meningococci, MDR pneumococci, and influenzae. Standard precaution + private room. Can share room with another pt with the same pathogen.’ No need for air ventilation filtration. Masks if within 3 feet from the patient. 41 42 Most important and frequent. Direct contact transmission MRD bacteria, Cl. Difficile, RSV, Scabies, impetigo, chickenpox, viral hemorragic fevers. Private room beside the standard precautions. Wear gloves and change them immediately before leaving the room, wash hands. Gown. Indirect contact transmission. 43 44 45 46 47 TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Pulmonary and laryngeal TB are usually spread from person to person through contaminated droplet nuclei in the air. Extrapulmonary TB is generally not contagious. Infectious particles are released when people with pulmonary / laryngeal TB cough, sneeze or talk. Droplet nuclei are very small (1-5 microns in diameter) and stay suspended in the air for long periods of time. If these bacteria are inhaled, infection can occur. Patients or visitors with a "cough" should be encouraged to cover their cough. Tissues should be made available as needed. Employees should wear a fitted N95 respirator if patients have a productive cough bloody sputum, or are suspected of having active TB. TB as an example. Negative pressure rooms. HEPA filters. 50 51 Severely immunosupressed patients. Burns, leukemias, radiation treatment and leukopenic patients. Reverse isolation. Total protective environment (TPE). Private positive pressure room + HEPA. Sterile gowns, masks, gloves, caps, and shoe covers. Handwashing. 52 53 High quality fresh food. Refrigeration. Washing, preparing, and cooking, dispose if not eaten. Proper hands washing before eating and after using the rest room. Nasal and oral secretions disposal and washing hands after. Hair cover and wearing clean clothes and aprons. Periodic check for food handlers. Preventing with respiratory or GI disease from handling food or eating utensils. Cutting boards clean, wash cooking and eating utensils. 54 Any nonliving or inanimate object other than food. Patients gowns, bedding, towels, eating and drinking utensils, bedpans, stethoscopes, gloves, thermometers, ECG electrodes. Use disposables whenever possible. Disinfect equipment after use. One equipment for each pt. Single time use equipment or clean properly. Bed pans emptying and washing. Linen and soiled clothing in bags → laundry. 55 No leakage and proper sanitary condition. All waste should be removed ASAP. Address potential infectious items. Sharps disposal. 56 Infection control program is under the control of infection control committee. Representatives of the different departments of the hospital. Review the incidence of HAI infections in the hospital. Policy-making and review, pt and environment surveillance, outbreak investigation, education and reporting. 57 Monitoring types and numbers of pathogens isolated from hospitalized pts. Notifying the appropriate ICP about unusual # or type to investigate. Processing environmental and employees samples to pin point the source of pathogen. Biotype and antibiogram or molecular epidemiology. 58 How are Blood-borne Pathogens Transmitted? Blood-borne pathogens are transmitted primarily through blood and semen, although all body fluids and tissues should be regarded as potentially infectious. The most common modes of transmission are sexual contact, needle sharing, and to a much lesser degree, infusion of contaminated blood products. An infected woman can pass pathogens to her fetus. These organisms are not transmitted by casual contact touching or shaking hands eating food prepared by an infected person from drinking fountains, telephones, toilets, or other surfaces. Follow hospital Infection Control and Safety policies. The use of Universal Precautions and safety devices will decrease the incidence of occupational exposures. Universal Precautions consist of appropriate workplace practices engineering (safety) controls, and using Personal Protective Equipment (PPE). Clean affected area immediately. Notify your supervisor immediately. Complete an Incident/Accident form (to be signed by supervisor). Immediately report to Employee Health Service, Mon. - Fri., 8 a.m.- 4 p.m. All other times report to the Emergency Department Hepatitis B is a serious liver infection caused by a specific virus, HBV. HBV infection can range from mild to lifethreatening. The most common symptoms are fatigue mild fever loss of appetite vague abdominal pain. Only a minority experience jaundice. Because more than two-thirds of all cases have no symptoms, carriers are often not aware of their HBV status. Newer antiviral medications may allow many patients to enjoy prolonged viral-suppression periods. Hepatitis B has an incubation period of six weeks to six months. Hepatitis C is a viral infection of the liver. It was formerly called non-A non-B hepatitis. It is both an acute infection and, if the infection continues for more than six months (as it does in most), a chronic hepatitis. HCV infection can range from mild to life-threatening. The most common symptoms are loss of appetite nausea and vomiting vague abdominal discomfort changes in stool and / or urine color. Chronic infection, if it occurs, may be symptomatic or asymptomatic. Chronic hepatitis C is thought to eventually progress to cirrhosis (severe liver disease) or liver cancer in up to 50% of persons. HCV is spread through blood, blood products, body fluids, and at the time of birth. Persons at highest risk for infection include: users of intravenous drugs dialysis patients persons receiving unscreened blood or blood products health care workers frequently exposed to blood or blood products. However, about half of all reported cases have no identifiable source of infection Hepatitis C has an incubation period of two weeks to six months, most commonly within six to nine weeks. The human immunodeficiency virus attacks the body's immune system, causing the disease known as AIDS, or Acquired Immune Deficiency Syndrome. Soon after infection, the person may suffer from flu-like symptoms, fever, diarrhea and fatigue. A person infected with HIV may then carry the virus without developing further symptoms for several years. Ultimately, a person infected with HIV will almost certainly develop AIDS, at which time they may also develop AIDS-related illnesses. These include neurological problems, cancer, and opportunistic infections such as severe pneumonia, brain abscesses and infectious diarrhea. For all occupational exposures, EHS will provide counseling, monitor you for seroconversion and provide any necessary follow-up. There is no vaccine to prevent HIV infection. Data published by the Centers for Disease Control and Prevention (CDC) recommends post-exposure prophylaxis with a combination of agents. Recommendations from the CDC are frequently updated. That is why it is imperative that exposed persons seek treatment and evaluation immediately. High risk exposures include those that involve the blood of patients with far-advanced AIDS sustain deeper needle-stick injuries there are larger amounts of blood present on the exposing object. TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Pulmonary and laryngeal TB are usually spread from person to person through contaminated droplet nuclei in the air. Extrapulmonary TB is generally not contagious. Infectious particles are released when people with pulmonary / laryngeal TB cough, sneeze or talk. Droplet nuclei are very small (1-5 microns in diameter) and stay suspended in the air for long periods of time. If these bacteria are inhaled, infection can occur. Anyone can get TB but some are at higher risk for developing active disease. This includes elderly (have among the highest rates) HIV infected IV drug users people in close contact with infectious TB diabetics the chronically malnourished people from countries with high TB rates people with kidney failure people receiving cancer treatment employees or residents of long-term care facilities. TB usually affects the lung, but can occur at virtually any site in the body, including the brain and spine. The following symptoms indicate that a person could have TB disease: chronic productive cough feeling tired all the time weakness night sweats unexplained weight loss anorexia (loss of appetite) fever hemoptysis (coughing up blood) cavitary lesions on chest x-ray, especially in the upper lobes.