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Key Points to Infection Control Dr. Medhat Lamfon Ministry National Guard Health Affairs – KAMC-WR The GOAL of an Infection Prevention and Control program is to reduce the risk of endemic and epidemic nosocomial infections in patients, visitors and staff. Endemic The usual incidence of disease within a geographic area during a specified time period. Epidemic An excess over the expected incidence of disease within a geographic area during a specified time period. Pandemic An epidemic that affects several countries or continents. Outbreak Synonymous with epidemic but a term often preferred when dealing with the public; does not evoke the same fear response as the term epidemic. Nosocomial Infection “Hospital Acquired Infection or Healthcare Associated Infection” ( HAI ) An infection meeting the following criteria: a) Not present or incubating on admission. b) An infection incubating at the time of admission that is related to previous hospitalization at the same facility or identified in an admission following performance of a procedure during a previous admission (e.g., a surgical site infection identified in a patient presenting to the emergency department 10 days after thoracic surgery). Chain of Infection Causative Agent Mode of Transmission How to Break the Chain of Infection???? Preventive Measures • Standard Precautions • Expanded Precautions (Transmission-Based Precautions) STANDARD PRECAUTIONS A method of infection prevention and control designed to be used for the care of all patients (regardless of their diagnosis), all personnel & visitors, in which all human blood and body substances (blood, body fluids, secretions, excretions, non-intact skin and mucous membranes) are considered potentially infectious. Used to break the chain of infection transmission & is used in conjunction with Isolation Precautions. REQUIREMENTS FOR STANDARD PRECAUTIONS HAND HYGIENE Before aseptic tasks After touching blood, body fluids, secretions, excretions, contaminated items. Immediately after removing gloves Between patient contacts After touching the environment, surfaces, equipment HANDWASHING- use of soap & water Alternative to hand washing ALCOHOL-BASED HANDRUB- Waterless, accessible and can be used as long as hands are not visibly soiled. 5 MOMENTS OF HAND HYGIENE Before patient contact Before aseptic tasks After body fluids exposure After patient contact After contact with patient surrounding/environment To effectively reduce the growth of germs on hands, handwashing must last 40-60 secs and should be performed by following all steps illustrated. To effectively reduce the growth of germs on hands, handrubbing must be performed 20-30 secs by following all steps illustrated. REQUIREMENTS FOR STANDARD PRECAUTION PERSONAL PROTECTIVE EQUIPMENT (PPE) GLOVES For touching blood, body fluids, excretions, contaminated items. For touching mucous membranes, non-intact skin Wash hands immediately after removal of gloves MASK, EYE PROTECTION, GOGGLES/FACE SHIELD To protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions, excretions. REQUIREMENTS FOR STANDARD PRECAUTION GOWN/PLASTIC APRONS To protect skin and prevent of clothing during procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions, excretions LABORATORY SPECIMENS Place specimens in designated, appropriately sealed containers Transfer to the lab in an upright position as promptly as possible REQUIREMENTS FOR STANDARD PRECAUTION RESPIRATORY HYGIENE OR COUGH ETIQUETTE ENVIRONMENTAL CONTROL CLEANING OF ROOM SHOULD BE DAILY AND AFTER DISCHARGE SAFE INJECTION PRACTICES PATIENT PLACEMENT REQUIREMENTS FOR STANDARD PRECAUTION HANDLING/DISPOSAL OF CONTAMINATED ITEMS Needles/Sharps (Reporting) Linen/Laundry Items Medical Waste What you will do if you have needle stick injury? First Aid If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid ,follow these steps: Percutaneous injuries : Wash needle sticks and cuts with soap and water. Then apply isopropyl alcohol 70% Bandage appropriately Mucocutaneous and non intact skin exposures : Flush splashes to the nose, mouth, or non-intact skin with water. Irrigate eyes with clean or sterile water or saline. Flush site for 10 minutes. 2. Reporting the Injury The employee should report the incident to his/her supervisor and complete a Safety Reporting System (SRS) report. The report should include: The date and time of the incident The location where the incident occurred The department where the employee works The source patient Medical Record Number (MRN), if known 3. If the source patient is known to be HIV-positive, the employee should go directly to the Emergency room immediately for further investigation. REQUIREMENTS FOR STANDARD PRECAUTION PATIENT CARE EQUIPMENT soiled patient-care equipment should be handled in a manner to prevent skin mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and to the environment. Reusable equipment must be cleaned/disinfected or reprocessed before use in the care of the another patient. Expanded Precautions (Transmission-based Precautions) Airborne Precautions Droplet Precautions Contact Precautions Contact Precautions Components: Hand hygiene Gown Gloves Examples: MRSA, VRE, MDRO etc RSV C. difficile, Norovirus (hand washing) Droplet Precautions Components: Hand hygiene Gown Mask (remove in room) Gloves Examples: N. meningitidis Influenza and other respiratory viruses Airborne Precautions Components: Hand hygiene Respirator (N95) -Remove mask outside of room -Keep door closed (Negative Pressure) Examples: M. tuberculosis Measles Varicella (Chickenpox) with contact Infection Prevention & Control Manual (Infection Prevention & Control Program) Table of Contents I II III IV V VI POLICY Joint Commission International Accreditation (JCIA) Standard ICM-I-01 Surveillance Prevention and Control of Infection (PCI) Infection Control Committee Responsibilities ICM-I-02 Infection Prevention and Control Program ICM-I-04 Reporting Communicable Diseases to the Ministry of Health ICM-I-05 Ministry of Health Reporting Forms ICM-I-06 STANDARD INFECTION CONTROL POLICIES Reporting Infections and Infection Concerns ICM-II-01 Requesting Infection Control Review and Consultation ICM-II-02 Standard Precautions ICM-II-03 Hand Hygiene ICM-II-04 Aseptic Technique ICM-II-05 Therapeutic Procedures ICM-II-06 ISOLATION PROCEDURES Epidemiology of Infection ICM-III-01 Isolation (Expanded) Precautions ICM-III-02 Contact Isolation Precautions ICM-III-03 Droplet Isolation Precautions ICM-III-04 Airborne Isolation Precautions ICM-III-05 Isolation System: A Quick Reference Guide ICM-III-06 Initiating and Discontinuing Isolation ICM-III-07 Single Room Use for Isolation Precautions ICM-III-08 Transporting Patients on Isolation Precautions ICM-III-09 Patients and Sitters in Isolation: Infection Control Education & ICM-III-10 Compliance Negative Pressure Room Monitoring ICM-III-11 Management of Influx of Airborne Infectious Diseases ICM-III-12 INFECTION CONTROL POLICIES RELATED TO SPECIFIC DISEASES Multidrug Resistant Organisms (MDRO) Management ICM-IV-01 Methicillin Resistant Staphylococcus Aureus (MRSA) Management ICM-IV-02 Vancomycin Resistant Enterococci (VRE) Management ICM-IV-03 Hepatitis A Virus Exposure Management ICM-IV-04 Viral Hemorrhagic Fever Management ICM-IV-05 Pediculosis / Scabies Management ICM-IV-06 Rabies Exposure Management ICM-IV-07 Rabies Specimen Acquisition, Handling, and Shipment to Ministry of ICM-IV-08 Agriculture Laboratory Management of Patients With Suspected Severe Acute Respiratory ICM-IV-09 Syndrome (SARS) Rapid MRSA Surveillance ICM-IV-10 Clostridium Difficile Infection Management ICM-IV-11 POLICIES RELATED TO TUBERCULOSIS Tuberculin Skin Testing: Administration and Interpretation ICM-V-01 Contact Tracing, Screening, and Treatment of Tuberculosis in Health ICM-V-02 Care Workers Management of Suspected/ Confirmed Cases of Infectious Tuberculosis ICM-V-03 Management of Patients with Infectious Tuberculosis in the Operating ICM-V-04 Room Tracing Contacts of Infectious Tuberculosis Patients Other Than Health ICM-V-05 Care Workers EMPLOYEE AND OCCUPATIONAL HEALTH POLICIES Occupational Health Program Services for Healthcare Workers ICM-VI-01 Pre-Employment Assessment ICM-VI-02 Immunization Guidelines For Healthcare Workers ICM-VI-03 Work Restrictions for Healthcare Workers Exposed To or Infected With ICM-VI-04 Infectious Diseases Pregnant Healthcare Workers ICM-VI-05 THANK YOU! Infection Prevention and Control Department KAMC-WR