* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Lecture 2
Tuberculosis wikipedia , lookup
Antibiotics wikipedia , lookup
Cryptosporidiosis wikipedia , lookup
Traveler's diarrhea wikipedia , lookup
Toxoplasmosis wikipedia , lookup
Microbicides for sexually transmitted diseases wikipedia , lookup
Herpes simplex virus wikipedia , lookup
Onchocerciasis wikipedia , lookup
West Nile fever wikipedia , lookup
Herpes simplex wikipedia , lookup
Henipavirus wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Gastroenteritis wikipedia , lookup
Hookworm infection wikipedia , lookup
Leptospirosis wikipedia , lookup
Toxocariasis wikipedia , lookup
Anaerobic infection wikipedia , lookup
Trichinosis wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Marburg virus disease wikipedia , lookup
Clostridium difficile infection wikipedia , lookup
Neisseria meningitidis wikipedia , lookup
Dirofilaria immitis wikipedia , lookup
Schistosomiasis wikipedia , lookup
Sarcocystis wikipedia , lookup
Carbapenem-resistant enterobacteriaceae wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Hepatitis C wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Hepatitis B wikipedia , lookup
Neonatal infection wikipedia , lookup
Infection Prevention & Control Note for the Exam •This lecture was given Dec 2. It differs in some areas from the version in the notes. •The source for the exam questions is the posted notes version, although the same area may have been covered in this lecture. •These notes are provided for you to have a complete set from the course and as a source of information for the future. They also complement the previously posted notes on Infection Control and may be useful to augment your understanding of important issues in Infection Control. Learning Objectives The learner will: •Define healthcare acquired infection (nosocomial) •List 5 types of healthcare acquired infections •Differentiate between infection & colonization •Identify sources of healthcare acquired infection •List 7 host risk factors •Name 4 main routes of transmission Learning Objectives The learner will: •Describe methods to prevent transmission •Define antibiotic resistant bacteria •Discuss control measures for communicable diseases •Identify the single most effective tool to prevent healthcare acquired infection. The Theme Infection Entry into & multiplication of an infectious agent (pathogen) in the tissues of the host resulting in tissue damage/injurious effects. Subclinical – unapparent Clinical – apparent Colonization The presence of microorganisms in or on a host with growth & multiplication but without tissue invasion or damage. Nosocomial Infection •A result of hospitalization •Not present or incubating at time of admission Nosocomial Infection •May be exogenous – acquired from the environment, other patients or caregivers •May be endogenous – from patients’ own organisms Nosocomial Infections •UTI – urinary tract infection •SSI – surgical site infection •Pneumonia •Bacteremia •Infectious diarrhea - CDAD Exogenous Risk Factors UTI •Urinary catheterization – Indwelling – In/out catheterization •Contaminated drainage systems •Hands of care givers Exogenous Risk Factors SSI •Shave prep •Length of procedure •Contaminated surgical instruments •Nares & oropharynx of OR personnel •Contaminated solutions, antiseptics, dressings •Hands of personnel Exogenous Risk Factors Pneumonia •Intubation •Respiratory therapy equipment •Respiratory tract instrumentation •Hands of caregivers Exogenous Risk Factors Bacteremia •Intravascular access devices •Contaminated IV solutions •Contaminated multi-dose vials •Hands of caregivers Exogenous Risk Factors CDAD •Spore former •Contaminated environment •Antibiotic use •Hands of care givers Endogenous Risk Factors •Prolonged hospitalization •Immunosuppression •Co-morbidities – Diabetes – Malignancy – Renal insufficiency – Aspiration •Poor nutritional status •Altered GI flora •Obesity •Immobility •Extensive burns or wounds •Trauma •Age Chain of Infection Chain of Infection - Links Infectious Agent – Agent capable of causing disease – Bacteria, viruses, fungi, & parasites Reservoir – Place in which the infectious agent can survive but may or may not multiply. – Humans, animals, & the environment. • Patients • Healthcare personnel & healthcare equipment & environment Chain of Infection - Links Portal of Exit – Path by which the infectious agent leaves the reservoir Mode of Transmission – Method by which the organism reaches a susceptible host Chain of Infection - Links Portal of Entry – Means by which the an infectious agent enters the susceptible host – Similar to portal of exit Susceptible Host Modes of Transmission 1. Contact – Direct – Indirect – Droplet 2. Airborne 3. Vehicle 4. Vectors Infection Prevention •Modifiable risk factors (exogenous) •Routine practices •Barrier precautions •Hand hygiene Routine Practices (Health Canada,1999) •Hand washing/ hand antisepsis •Gloves •Gowns •Masks & eye protection/face shields •Accommodation •Patient care equipment •Environmental control Additional Precautions Respiratory Isolation Airborne spread •Single room •Special ventilation •Particulate respirator (N-95) •Varicella (chicken pox),TB Droplet spread •Surgical mask within 3 feet •Influenza, mumps, pertussis (whooping cough) Additional Precautions Contact Spread •Low infective dose •May be transmitted from intact skin •Potential for widespread environmental contamination Strict Isolation Contact Measures Enteric Measures Hand Hygiene The single most important measure to prevent the transmission of infection. Improved hand hygiene practices have been associated with reduced healthcare-associated infection rates. •Frequency •Technique Hand Hygiene – Resident Flora •Survive and multiply on skin •Inhabit deeper layers – Coagulase negative staphylococci – Diphtheroids – Staphylococcus aureus – Streptococci sp. – Candida sp. Hand Hygiene – Transient Flora •Colonize the superficial layers of the skin •Unable to multiply on skin •Usually have a short life span •May include highly pathogenic organisms •Frequently associated with infection •Easily removed •High incidence in HCW •Hands without healthy skin are more susceptible to becoming colonized with transient bacteria. Hand Hygiene Before: – beginning your work day – every patient contact – donning sterile gloves – inserting invasive devices – handling/preparing medications – feeding a patient – leaving the workplace/eating Hand Hygiene After: •Patient contact (even with patient’s intact skin) •Removing gloves •Contact with contaminated objects and equipment •Blowing nose/coughing/trips to the washroom Hands that are visibly soiled need to be washed with soap & water. Antibiotic Resistant Bacteria •Not new – first documented in the 50’s •An outcome of evolution •Bacteria devised mechanisms to survive •Overuse & misuse of antibiotics contributed to the problem Results •Multiply resistant strains •Lack of effective antibiotics •Transmissions from patient to patient (via hands of HCW & equipment) •Endemic in our institutions Antibiotic Resistant Bacteria Control Measures •Prevent patient to patient transmissions •Prevent hospital environmental reservoirs •Judicious antibiotic use •Research & future drug development