Download Infection Control - Women`s and Children`s Hospital

Paediatric Infection Control
Jodie Burr
Infection Control Coordinator
Women’s and Children’s Hospital
Primary Role of Infection
Control
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Prevent nosocomial infections
Reduce mortality, morbidity, and cost
Educate and advise
 staff
 patients
 their
families
 the community


Surveillance of nosocomial infections
Policy development, implementation and
assessment
IC Issues specific to
Paediatrics

Communicable diseases affect a higher
% of paediatric patients than adults
 Developmental
immunity (increased
susceptibility) - acquire – spread
IC Issues specific to
Paediatrics

Paediatric personnel are at a greater
risk for exposure to communicable
diseases - immune status
 Type
and amount of physical contact (eg
feeding, diapering)
IC Issues specific to
Paediatrics

May lack the mental / physical ability
to adhere to IC principles
 lack
of hygiene
 unable to understand / comply with IC
principles
IC Issues specific to
Paediatrics

More likely to have contact with
contaminated environmental surfaces
and objects
IC Issues specific to
Paediatrics

Parents and siblings
 may
have the same infectious agent
 involved in patient care – education
about transmission and IC principles
IC Issues specific to
Paediatrics

Types of pathogens and sites of
nosocomial infection differ from
adults.

Most common nosocomial infections
(paediatrics):
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Viral infections of the upper respiratory tract
Viral infections of the gastrointestinal tract
Most common nosocomial infections
(adults):

UTI
IC Issues specific to
Paediatrics

Neonatal and ICU


Bacteraemias are the most common source
of nosocomial infection
Adult ICU

The lower respiratory tract is the
most common source of nosocomial
infection
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine,
2002, 19 (9):414-424
Incidence of Nosocomial
Infection

Incidence varies by age and hospital
unit:
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Range: 0.2% - 23.5%
Paediatric ICU
Haematology Unit
Neonatal Unit
General Paediatric Unit
23.5%
8.2%
7.0%
1.0%
Highest in children aged 23 months or
younger
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19
(9):414-424
Additional Length of Stay


Duration of hospitalisation is longer for
children with nosocomial infections
Paediatric ICU


General Paediatric Units
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26.1 days vs 10.6 days
9.2 days vs 3.5 days
Attributable cost of infection $13,000
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):414-424
Spread of Infection

Sources of infections
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The host’s own (endogenous) flora
The hand’s of health care workers
Inanimate objects (fomites)
After being exposed to an infectious
agent:

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
Some people already have immunity and
therefore don’t develop an infection
Some people become asymptomatic carriers
Other people develop clinical disease (ie
infection)
Spread of Infection

The Susceptible Host
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Varies with age
Underlying medical conditions
Nutritional status
Drug therapy
Trauma
Surgical procedures
Invasive or indwelling devices
Therapeutic and diagnostic procedures
Spread of Infection

3 main routes of transmission
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Contact
 Direct / Indirect
 Most frequent means of transmission
Droplet
 Generated during coughing, sneezing,
talking and during certain procedures
such as suctioning
Airborne
 Generated by coughing, sneezing, OR by
mechanical respiratory aerosolisers, OR
by air currents
Standard Precautions

Apply to:
Blood
 Non-intact skin
 Mucus membranes
 All body fluids (including sweat)


Regardless of whether there is
visible blood or body fluids
Hand Hygiene

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The single most effective method in
the prevention of disease transmission
Healthcare workers think they wash
their hands more than what they do
80 % hospital acquired infections are
thought to be transmitted by hands
Hand Hygiene

Soap and Water

mechanical removal of most transient flora
and soil
minimal microbial kill
no sustained activity

15 seconds
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Hand Hygiene
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Antimicrobial Soaps
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removes soil, removes transient and reduces
resident flora
may have sustained activity

15 seconds (antiseptic handwash)
60 seconds (clinical handwash)

2 minutes (surgical scrub)

Hand Hygiene

Alcohol Handrubs / Gels

very rapid kill
destroys transient and reduces resident
flora
no residual activity (except with antiseptic)
will not remove or denature soiling

15 seconds
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Personal Protective
Equipment
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Eye and/or facial protection (glasses,
goggles, face shields)
Gloves
Gowns
Masks
Assess the likely hood of contamination
and prepare accordingly
Assessment of Risk Factors
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
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Your knowledge or experience with the
situation or procedure
The likely hood of exposure to blood or
body fluids at the time
The patients ability to cooperate
through out the procedure
Additional Precautions
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May include:
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Single room accommodation (ensuite for
some)
Special ventilation (negative, positive
pressure)
Special room cleaning
Dedicated patient equipment
Rostering of immune staff
Extended sterilization (or use of disposable
equipment)
Cohorting may be considered
Comparison of 20th Century Annual
Morbidity and Current Morbidity,
Vaccine-Preventable Diseases
20th Century
Annual Morbidity
Smallpox
2000*
Percent
Decrease
48,164
0
100
Diphtheria
175,885
4
99.99
Measles
503,282
81
99.98
Mumps
152,209
323
99.80
Pertussis
147,271
6,755
95.40
Polio (paralytic)
16,316
0
100
Rubella
47,745
152
99.70
823
7
99.10
1,314
26
98.00
20,000
167
99.10
Congenital Rubella Syndrome
Tetanus
H. influenzae,
type b and unknown (<5 yrs)
* Provisional Data
safer healthier people
TM
TM
Multi-resistant organisms
(MRO)

MRSA:
Methicillin resistant Staphylococcus aureus

VISA:
Vancomycin intermediate Staphylococcus aureus

VRSA:
Vancomycin resistant Staphylococcus aureus

VRE:
vancomycin resistant enterococci

ESBL:
Extended spectrum beta-lactamase

MRGN:
Multi-resistant gram negative
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MRPA:
Multi-resistant Pseudomonas aeruginosa

MRAB:
Multi-resistant Acinetobacter baumanii
Multi-resistant organisms
(MRO)
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Difficult to treat and control
Have the ability to cause infections,
particularly in susceptible people
Have the ability to cause wound
infections, bacteraemias and IV line
sepsis
Can cause significant morbidity and
mortality
Increased community awareness and
expectations
Factors that contribute to
the acquisition of MROs
Staff
- inadequate handwashing
Environmental
Prolonged
treatment
Close
- inadequate cleaning
or inappropriate antibiotic
proximity to a MRO patient
Extended
hospital stay
Co-morbidities
ICU
/ Burns Unit
Respiratory Syncitial Virus
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Highly contagious and nosocomial
infection common
Causes upper and lower respiratory
infection
Usually occurs during winter
No vaccine at present
Can be re-infected during the same
season
Transmitted by contact or droplet
Can survive for several hours in the
environment
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Respiratory Syncitial Virus
200
180
160
140
120
100
80
60
40
20
0
1998
1999
2000
2001
2002
2003
2004
Rotavirus
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Highly contagious and nosocomial
infection is common
Usually a winter disease but pattern
changing
Onset is sudden and lasts for 4 - 6 days
Mainly infants and children up to 3 years
affected
Transmitted usually through contact
Can survive in environment for several
hours
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Rotavirus
100
90
80
70
60
50
40
30
20
10
0
1998
1999
2000
2001
2002
2003
2004
Pertussis
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Bacterial infection caused by Bordetella
pertussis
Most dangerous to under 3 year olds
Contagious for 3 weeks or for 5 days
after commencing erythromycin
Transmitted by contact and droplet
Symptoms - runny nose, cough, which
may develop into a whooping cough
High particulate mask when in contact
with patient
Pertussis
Meningococcal Disease
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Bacterial infection caused by Neisseria
meningitidis
Transmitted by contact or droplet
Non infectious after 24 hours of
appropriate antibiotic therapy
Significant contacts traced and may be
given prophylaxis
Meningococcal Disease
Measles
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Complications more common and severe
in chronically ill and very young children
Transmitted by droplet and contact
with respiratory secretions
Infectious for 4 days before and after
rash
Vaccination available
Notifiable disease
Measles
Rubella
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In early pregnancy risk of teratogenic
damage to fetus
Infectious for 7 days before and 7 - 15
days after onset of rash
Infants with congenital rubella may shed
virus for several months or years
Transmitted by droplet route
Vaccination available
Notifiable disease
Rubella
Varicella Zoster Virus
Chicken Pox
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Highly contagious
Most cases in children, over 90% of
adult population is immune
Transmitted by droplet and contact
Infectious 2 days prior and 4 - 6 days
after rash
Now a notifiable disease
Vaccination now available
Varicella or Chicken-pox
Congenital varicella
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Caused by maternal varicella in early
pregnancy (ie <20 weeks)
Risk of acquiring congenital varicella
syndrome is 1 - 2%
Range and severity of symptoms vary
greatly depending on when maternal
varicella infection occurred
 intrauterine
growth retardation, skin
abnormalities, incomplete development of
fingers/toes. Brain degeneration, nervous
system damage, eye abnormalities
Congenital varicella
Parvovirus B19
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Usually a mild rash disease
Also called Fifth Disease or “Slapped Cheek”
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Infectious prior to the rash
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Transmitted by droplet route
Parvovirus B19