Download 5. Infection control in health care facilities

Infection Prevention and Control
for Epidemic- and Pandemic-Prone
Acute Respiratory Diseases
Learning Objectives
 Describe basic infection-control principles.
 Discuss core infection-control measures in health-care
settings.
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Presentation Overview
Basic infection control principles
Core infection control measures
used in health care settings
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Basic Infection Control
Principles
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Aim of Infection Control
 Basic infection control measures reduce risk of
transmission of pathogens from a known or unknown
source
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Chain of Infection
+
Quantity of
pathogen
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Virulence
Routes of
transmission
Portal of
entry into
host
Susceptible
host
Routes of Transmission
 Contact: Infections spread by direct or indirect contact
with patients or the patient-care environment
(e.g., shigellosis, viral hemorrhagic fevers)
 Droplet: Infections spread by large droplets generated
by coughs, sneezes, etc. (e.g., Neisseria meningitidis,
pertussis)
 Airborne (droplet nuclei): Infections spread by
particles that remain infectious while suspended in the
air (TB, measles, varicella, and variola)
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Breaking the Chain of Infection
•Source control measures
-Cough etiquette, cleaning, disinfection
•Modes of transmission
-Contact: hand hygiene
-Droplet: distance from source >1 m
-Airborne: ventilation
-Vector: bednets
•Portal of entry into the host
-Adding barriers, e.g., PPE
•Host
-Strengthen host defences, e.g., vaccination
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Transmission of Epidemic- and Pandemic-Prone
Acute Respiratory Diseases
Seasonal Influenza in
Humans
SARS and Current Avian
Influenza in Humans
most likely route
most likely route (SARS)
possible (AI)
Airborne
possible during aerosol
generating procedures
possible during aerosol
generating procedures
Contact
possible
most likely route (SARS)
Droplet
H5N1: (bird to human), and
possible (human to human)
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Core Infection Control
Measures in
Health Care Settings
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Core Infection Control Measures
in Health Care Settings (1)
● Early recognition and reporting
● Infection control precautions
● Hand hygiene: alcohol-based hand rub, hand
washing
● PPE: gloves, gowns, masks/respirators, eye
protection
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Core Infection Control Measures
in Health Care Settings (2)
● Patient accommodation
● Environmental cleaning and waste
disposal
● Occupational health management
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WHO
Prevention is Primary
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CDC
Early Recognition in Health Care Facilities
Health care facility staff must quickly
identify and separate potential sources of
infection from susceptible hosts
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How to identify rapidly
Rapid identification of Patients with Epidemic- or PandemicProne Acute Respiratory Diseases:
 Clinical indications
– Severe acute febrile respiratory illness (e.g., fever > 38°C,
cough, shortness of breath)
– Exposure history consistent with ARD of potential concern
 Epidemiological indications
– History of travel to area affected by ARDs
– Possible occupational exposure
– Unprotected contact with ARDs patient(s)
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Infection Control Precautions
 Standard precautions
– Should be applied for ALL patients
 Transmission-based precautions*
– Contact
– Droplet
– Airborne
*Transmission-based precautions are often used empirically, according
to the clinical syndrome and the likely etiological agent
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Standard Precautions
•Hand hygiene
•Respiratory hygiene/cough etiquette
•Use of personal protective equipment (PPE)
•Prevention of needle sticks/sharps injuries
•Cleaning and disinfection of the environment
and equipment
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Droplet Precautions
 Protection against respiratory pathogens
transmitted by large droplets
 In addition to Standard Precautions:
– Use a medical mask when < 1 m of patient
– Maintain a distance ≥ 1 meter between infectious
patient and others
– Place patient in a single room or cohort with similar
patients
– Limit patient movement
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Contact Precautions
 Protection against contact with large droplets
 In addition to Standard Precautions:
– Use non-sterile, clean, disposable gloves, gown, apron
(only if gown is not impermeable)
– Use disposable or dedicated reusable equipment (which
must be cleaned and disinfected before use on other
patients)
– Limit patient contact with non-infected persons
– Place patient in a single room or cohort with similar
patients
Influenza Training Package
Airborne Precautions
 Protection against inhalation of tiny infectious
droplet nuclei
 In addition to Standard Precautions:
– Use particulate respirator
– Place the patient in adequately ventilated room (≥ 12
air changes per hour)
– Limit patient movement
 Use airborne precautions for performance of any
aerosol-generating procedures associated with
pathogen transmission
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Hand Hygiene
 Hand hygiene should be performed:
– before and after any direct contact with a patient
– after contact with blood, body fluids, secretions and
excretions
– after contact with items contaminated with blood, body
fluids, secretions and excretions, including respiratory
secretions
 Use alcohol-based hand rub or wash hands with soap
and water
– Wash hands if visibly soiled
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Respiratory Hygiene and Cough Etiquette
 Part of standard precautions
 Education of health care workers, patients and
visitors
 Source control measures (e.g., cover cough to
prevent dissemination of infectious droplets)
 Hand hygiene
 Spatial separation (> 1 meter) of persons with
acute febrile respiratory symptoms
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Personal Protective Equipment
Courtesy of K. Harriman
Types of PPE Used in Healthcare Settings
 Gloves – protect hands
 Gowns/aprons – protect skin and/or clothing
 Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from
airborne infectious agents
 Goggles – protect eyes
 Face shields – protect face, mouth, nose, and eyes
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PPE for Standard Precautions:
Based on Risk Assessment
 IF direct contact with blood & body fluids, secretions,
excretions, mucous membranes, non-intact skin
– Gloves
– Gown
 IF there is the risk of spills onto the body and/or face
– Gloves
– Gown
– Face protection (mask plus eye protection goggle
or visor; face shield)
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PPE for Transmission-Based Precautions
Used in addition to Standard Precautions
 Contact Precautions
– Gloves
– Gown
 Droplet Precautions
– Medical mask
 Airborne Precautions
– Particulate respirator
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+
Masks and Respirators:
Barriers and Filtration
 Surgical masks
– Protect against body fluids and
large particles
 Particulate respirators (e.g., N95)
– Protect against small particles
and other airborne particles
 Alternative materials (barriers)
– Tissues, cloth
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PPE for Persons Providing Care for Patients with
Acute Febrile Respiratory Illness, Including Patients
with Suspected or Confirmed AI Infection
HH Gloves Gown Medical
Mask
Entry to isolation
room/area, but no
anticipated patient
contact
Particulate
Respirator
Eye
Protection
Y
Risk
Asst
Risk
Asst
Risk
Asst
N
Risk
Asst
Close contact (< 1 meter)
with infected patient in or
out of isolation room/area
Y
Y
Y
Y
N
Y
Performance of aerosolgenerating procedure on
patient
Y
Y
Y
N
Y
Y
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PPE for Interviewing Exposed
Persons and Contacts of ARDs Patients
 Asymptomatic exposed persons and contacts (low-risk)
– Routine use of PPE not recommended
– Maintain 1 meter distance between interviewer and interviewee
– Use proper hand hygiene
 Symptomatic exposed persons (higher-risk)
– PPE recommended in community and health care facility:
Contact and Droplet Precautions
– In health care facility, person should be placed in adequately
ventilated room (≥ 12 air changes per hour), if possible
– Maintain a distance of > 1 meter, if possible
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PPE for Specimen Collection –
Exposed Persons
 Collecting respiratory specimens is a high-risk,
aerosol-generating procedure
 PPE recommended
– Gloves
– Gown
– Goggles or face shield
– N95 or higher level respirator
Influenza Training Package
CDC
Patient Accommodation
●Isolate patients with droplet or airborne spread
diseases from other patients
●Separate wards, areas, or establish rooms for
infectious patients where isolation facilities do not
exist
●Only those patients with epidemiological and clinical
information suggestive of a similar diagnosis should
share rooms
●Separate patients by at least 1 meter
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Patient accommodation: Natural Ventilation Room
1 meter
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Duration of IC measures for
Avian and Pandemic Influenza
 Adults and adolescents > 12 years of age – from
time of admission until 7 days after symptoms
resolved
 Infants and children ≤ 12 years of age – from
time of admission until 21 days after symptoms
resolved
 For immunocompromised patients, pathogen
shedding may be protracted
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Environmental Cleaning and Waste Disposal
•Environmental cleaning:
Use appropriate procedures for the routine
cleaning and disinfection of environmental and
other frequently touched surfaces
•Waste disposal:
Treat waste contaminated with blood, bodily
fluids, secretions and excretions as clinical
waste, in accordance with local regulations
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WHO
Waste Disposal
 Use Standard Precautions
– Gloves and hand washing
– Gown + Eye protection
 Avoid aerosolization
 Prevent spills and leaks
– Double bag if outside of bag is contaminated
 Incineration is usually the preferred method
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Autopsy Precautions for Influenza A
(H5N1)
 Follow standard PPE procedures for
autopsies
 Anyone handling a corpse should follow
standard precautions for blood and body
fluids
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Occupational Health Management
During an Outbreak
Monitor staff who work with patients with
an infectious disease of potential concern
for symptoms
Screen for symptoms of influenza-like
illness among staff reporting for duty
(fever, cough)
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WHO
Implementation of Core Infection Control
Measures During Rapid Containment
 Early recognition and reporting
 Infection control precautions
 Hand hygiene
 PPE: gloves, gowns, masks/respirators, eye protection
 Patient accommodation
 Environmental cleaning and waste disposal
 Occupational health management
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Hospital Preparedness: Key Points
 Apply standard precautions routinely in all health-care
settings
 Place all patients (suspected or confirmed with an
infectious ARD) in a room or area separate from other
patients
 Practice both standard and droplet precautions when
caring for patients with infectious ARD
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Important Components for HC Facility
Infection Prevention and Control Program
•Available supplies and equipment (PPE, disinfectants)
•Policies and guidelines for procedures
•Ongoing educational programs for healthcare facility
staff
•Process for monitoring staff health to identify and to
prevent staff-to-patient and patient-to-staff spread of
infection
Jamaica IC Guidelines
Infection Control for ARD in Heath Care Settings
Patient
Symptoms acute ILI
Infection control precautions
Standard and droplet precautions
+ Risk Factor
Investigation for ARD of
potential concern
Single room adequately
ventilated, if possible
Report to Public Health Authorities
Confirmed ARD of potential concern
Single room adequately ventilated (≥
12 air changes per hour), if possible
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Different
diagnosis
Reassess
precautions
Environmental Decontamination
 Cleaning MUST precede decontamination
 Disinfectant ineffective if organic matter is
present
 Use mechanical force
– Scrubbing
– Brushing
– Flush with water
Influenza Training Package
Environmental Decontamination:
Disinfecting
 Household bleach
(diluted)
 Peroxygen compounds
 Quaternary ammonia
compounds
 Phenolic disinfectants
 Chlorine compounds
(Chloramin B, Presept)
 Alcohol
– Isopropyl 70% or
ethyl alcohol 60%
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 Germicides with a
tuberculocidal claim on
label
 Others
Using Bleach Solutions
 First clean organic material from surfaces or items
 Wipe nonporous surfaces with sponge or wet cloth
– Allow to dry
 Use fresh diluted bleach daily!
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