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Transcript
Infection Control Infection Control Hospital-acquired infections (HAIs) account for 2 million infections and 90,000 excess deaths annually. About 5% of all patients admitted develop an HAI. About 25% of mechanically ventilated patients develop pneumonia, and 30% (of those 25%) will die. 2 Infection Control Infection control procedures aim to ◦ Eliminate the sources of infectious agents ◦ Create barriers to their transmission ◦ Monitor the effectiveness of control All health care workers must take responsibility and follow procedures carefully. 3 Spread of Infection Three elements must be present for infection to spread: ◦ Source of pathogens ◦ Susceptible host ◦ Route of transmission 4 Spread of Infection Sources of Infectious Agents Humans are the primary source. Inanimate objects (e.g., contaminated medical equipment) can spread infection. Individuals in the hospital capable of being the source include workers, visitors, and patients. 5 Spread of Infection Susceptible Hosts Resistance to infection varies greatly from one person to the next. Host factors that increase the chance of infection are ◦ ◦ ◦ ◦ Poorly controlled diabetes Increased age Chemotherapy Placement of tubes and catheters 6 Spread of Infection Nosocomial Infections are those acquired in the hospital. Most nosocomial pneumonias occur in patients having chest or abdominal surgery. Those with a history of COPD, cigarette smoking, or obesity and with advanced age have the greatest risk for nosocomial pneumonia following major surgery. 7 Infection Control Strategies 1. Decreasing host susceptibility - Immunizations and chemoprophylaxis 2. Eliminating the source of the pathogens 3. Interrupting routes of transmission - Barrier/isolation precautions - Special equipment handling - Disposable equipment 8 What is the single best way to prevent the spread of infection? Staphylococcus aureus 9 Standard Precautions With Every Patient! Handwashing ◦ Before patient contact ◦ After any patient contact even if gloves are used 10 Gloves 11 Standard Precautions With Every Patient! Handwashing ◦ Before patient contact ◦ After any patient contact even if gloves are used Gloves ◦ If hands may become soiled with blood, body fluids, secretions, or excretions 12 Masks, Goggles, Face Shields 13 Standard Precautions With Every Patient! Handwashing ◦ Before patient contact ◦ After any patient contact even if gloves are used Gloves ◦ If hands may become soiled with blood, body fluids, secretions, or excretions Masks, Goggles, Face Shields ◦ If mucous membranes of the eyes, nose, and mouth may be splashed with blood, body fluids, secretions, or excretions 14 Gown 15 Standard Precautions With Every Patient! Handwashing ◦ Before patient contact ◦ After any patient contact even if gloves are used Gloves ◦ If hands may become soiled with blood, body fluids, secretions, or excretions Masks, Goggles, Face Shields ◦ If mucous membranes of the eyes, nose, and mouth may be splashed with blood, body fluids, secretions, or excretions Gowns ◦ If skin and clothing may be splashed with blood, body fluids, secretions, or excretions 16 Isolation Cart Contact Precautions Droplet Precautions Airborne Precautions 17 Contact Transmission Most frequent route for the spread of nosocomial infections Direct transmission ◦ Person to person transfer ◦ Staphylococcus Indirect transmission ◦ Fomites ◦ Pseudamonus aeruginosa 18 Routes of Infectious Disease Transmission 19 20 Contact Precautions Room: Private Hand washing: Standard precautions Gloves: Upon entry Remove before exiting Gown: Upon entry Remove before exiting Mask: Standard precautions 21 Droplet Transmission Large contaminated liquid droplets ◦ Coughing, sneezing, or talking Procedures ◦ Suctioning ◦ Bronchoscopy Can not travel more than 6 feet 22 Routes of Infectious Disease Transmission 23 24 Droplet Precautions Room: Private Hand washing: Standard precautions Gloves: Standard precautions Gown: Standard precautions Mask: Standard precautions & within 6 feet Transport: Patient must wear a mask 25 Airborne Transmission Small contaminated droplet nuclei (< 5μm) May remain suspended for a long period of time May be carried by air currents 26 Routes of Infectious Disease Transmission 27 28 Airborne precautions Room: Hand washing: Gloves: Gown: Mask: Transport: Private negative-pressure room Standard precautions Standard precautions Standard precautions NIOSH* approved upon entry Patient must wear NIOSH* mask •NIOSH: National Institute for Occupational Safety and Health •N95 mask 29 NIOSH* Approved N95 Mask 30 Protective Isolation Immunocompromised patients ◦ Private room ◦ Standard precautions ◦ Contact isolation Burn Patients ◦ Strict contact isolation 31 32 Disinfection and Sterilization Cleaning Cleaning is the first step in all equipment processing. It involves removing dirt and organic material. Failure to clean equipment properly can render all subsequent processing efforts ineffective. Soaps or detergents and water need to be used. If the item cannot be immersed in water it must be disinfected using a 70% ethyl alcohol solution. 33 Disinfection and Sterilization (cont.) Disinfection can involve either chemical or physical methods. 34 Disinfection and Sterilization (cont.) Chemical Disinfection Chemical disinfection involves the application of chemical solutions to contaminated equipment or surfaces. Equipment must be immersed in the solution for a set period of time. 35 Disinfection and Sterilization (cont.) 36 Sterilization Destroys all microorganisms Can be achieved with physical and chemical approaches Steam sterilization is most common and easiest. Low-temperature sterilization technologies include ethylene oxide, a colorless and toxic gas. 37 38 Equipment Handling Procedures SMALL-VOLUME NEBULIZERS (SVNs) Between treatments on the same patient, disinfect, rinse with sterile water, and air-dry SVNs. Between patients, replace SVNs with sterile or highlevel disinfected units. Use only sterile fluids for nebulization and dispense these fluids aseptically. When possible, use single-use medication vials. If using multidose vials, handle, dispense, and store them according to manufacturer's instructions and checking expiration dates. 39 Equipment Handling Procedures LARGE-VOLUME NEBULIZERS Always fill nebulizers with sterile distilled water. Fill fluid reservoirs immediately before use. Do not add fluid to replenish partially filled reservoirs. If fluid is to be added, discard the remaining old fluid first. Drain tubing condensate away from the patient and discard as contaminated waste; do not allow condensate to drain back into reservoir. Sterilize or high-level disinfect large-volume nebulizers between patients and after every 24 hours of use on the same patient. 40 Equipment Handling Procedures OXYGEN THERAPY DEVICES Humidifiers are not needed with flows less than 4 L/min. When needed and whenever possible, prefilled, sterile disposable humidifiers should be used. The tubing and oxygen delivery device should be changed between patients; prefilled, sterile, disposable humidifiers do not need to be changed between patients in high-use areas such as the recovery room. Prefilled, disposable humidifiers can be used safely for up to 30 days. 41 Equipment Handling Disposable Equipment An important alternative to continually reprocessing equipment Three major issues ◦ Cost ◦ Quality ◦ Reuse (raises significant safety concerns) 42