INFECTION CONTROL,hospital infections

INFECTION CONTROL Principles AND Practice:

INFECTION CONTROL Principles AND Practice Dr.T.V.Rao MD Dr.T.V.Rao MD 1

A Tribute to Ignaz Semmelweiss (1818-1865) :

A Tribute to Ignaz Semmelweiss (1818-1865) Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues Dr.T.V.Rao MD 2

History of infection control and hospital epidemiology in the USA:

3 History of infection control and hospital epidemiology in the USA Pre 1800: Early efforts at wound prophylaxis 1800-1940: Nightingale, Semmelweis, Lister, Pasteur 1940-1960: Antibiotic era begins, Staph. aureus nursery outbreaks, hygiene focus 1960-1970’s: Documenting need for infection control programs, surveillance begins 1980’s: focus on patient care practices, intensive care units, resistant organisms, HIV 1990’s: Hospital Epidemiology = Infection control, quality improvement and economics 2000’s: ??Healthcare system epidemiology modified from McGowan, SHEA/CDC/AHA training course Dr.T.V.Rao MD

Why do we need Infection Control??:

4 Why do we need Infection C ontrol ?? Hospitals and clinics are complex institutions where patients go to have their health problems diagnosed and treated But , hospitals, clinics, and medical/surgical interventions introduce risks that may harm a patient’s health Dr.T.V.Rao MD

What is Nosocomial Infection:

What is Nosocomial Infection Any infection that is not present or incubating at the time the patient is admitted to the hospital Dr.T.V.Rao MD 5

:

6 Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death Consequences of Nosocomial Infections Dr.T.V.Rao MD

Florence Nightingale:

Florence Nightingale It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm" Dr.T.V.Rao MD 7

Links to the Chain of Infection:

Links to the Chain of Infection Portal of Entry Susceptible Host Causative Agent Reservoir Portal of Exit Mode of Transmission Dr.T.V.Rao MD 8

Hospital Infections are Emerging challenges in Health Care:

Hospital-associated infections represent a serious and growing health problem. The Centers for Disease Control and Prevention (CDC ) estimates that 2 million people acquire hospital-associated infections each year and that 90 000 of these patients die as a result of their infections . A variety of hospital-based strategies aimed at preventing such infections have been proposed . Hospital Infections are Emerging challenges in Health Care Dr.T.V.Rao MD 9

Modern Hospital Infection Control:

Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," the first and only standards available for many years. At the same time, the Communicable Disease Center, later to be renamed the Centers for Disease Control and Prevention (CDC), began the first training courses specifically about infection control and surveillance Modern Hospital Infection Control Dr.T.V.Rao MD 10

CHAIN OF INFECTION:

CHAIN OF INFECTION Dr.T.V.Rao MD 11

Beginning of Accreditation :

Beginning of Accreditation In 1969, the Joint Commission for Accreditation of Hospitals--later to become the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities. Dr.T.V.Rao MD 12

CDC Initiates Hospital Infection Branch:

CDC Initiates Hospital Infection Branch In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice. Dr.T.V.Rao MD 13

First Data on Infection Control Efficacy:

First Data on Infection Control Efficacy In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented Dr.T.V.Rao MD 14

Committee Suggested:

Committee Suggested O ne infection control professional (ICP) for every 250 beds. An effective infection control physician. A program reporting infection rates back to the surgeon and those clinically involved with the infection. An organized hospital-wide surveillance system. Dr.T.V.Rao MD 15

Infection Control Challenges of Healthcare in 2000:

Decreasing reimbursement Increasing emerging infections Increasing resistant organisms Increasing drug costs Institute of Medicine Report--healthcare-associated infections Nursing shortage OSHA safety legislation Multiple benchmark systems FDA legislation on reuse of single-use devices Infection Control Challenges of Healthcare in 2000 Dr.T.V.Rao MD 16

The nature of infections:

The nature of infections Micro-organisms - bacteria, fungi, viruses, protozoa and worms Most are harmless [non-pathogenic] Pathogenic organisms can cause infection Infection exists when pathogenic organisms enter the body, reproduce and cause disease Dr.T.V.Rao MD 17

Modes of spread:

Modes of spread Two sources of infection: Endogenous or self-infection - organisms which are harmless in one site can be pathogenic when transferred to another site e.g., E. coli Exogenous or cross-infection - organisms transmitted from another source e.g., nurse, doctor, other patient, environment (Peto, 1998) Dr.T.V.Rao MD 18

Spread - entry and exit routes:

Spread - entry and exit routes Natural orifices - mouth, nose, ear, eye, urethra, vagina, rectum Artificial orifices - such as tracheostomy, ileostomy, colostomy Mucous membranes - which line most natural and artificial orifices Skin breaks - either as a result of accidental damage or deliberate inoculation/incision (May, 2000) Dr.T.V.Rao MD 19

HAI - common bacteria:

HAI - common bacteria Staphylococci - wound, respiratory and gastro-intestinal infections Escherichia coli - wound and urinary tract infections Salmonella - food poisoning Streptococci - wound, throat and urinary tract infections Proteus - wound and urinary tract infections (Peto, 1998) Dr.T.V.Rao MD 20

HAI - common viruses:

HAI - common viruses Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Human immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998 ) Dr.T.V.Rao MD 21

Components of Infection Control Programme:

The important components of the infection control programme are: ·Basic measures for infection control, i.e. standard and additional precautions; · education and training of health care workers ; · protection of health care workers, e.g. immunization ; identification of hazards and minimizing risks ; · routine practices essential to infection control such as aseptic techniques, use of single use devices, reprocessing of instruments and equipment, antibiotic usage, management of blood/body fluid exposure, handling and use of blood and blood products, sound management of medical waste ; Components of Infection Control Programme Dr.T.V.Rao MD 22

Need For Control programme?:

E ffective work practices and procedures, such as environmental management practices including management of hospital/clinical waste , support services (e.g., food, linen), use of therapeutic devices ; surveillance ; · incident monitoring ; outbreak investigation ; infection control in specific situations; and research . Need For Control programme? Dr.T.V.Rao MD 23

Developing Infection Control Programme:

Every infection control program should develop a well-defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. It should include a statement of authority, and should review patient demographics including geographic locations of patients served by the healthcare system Developing Infection Control Programme Dr.T.V.Rao MD 24

Administrative control measures Assignment of responsibilities:

Administrative control measures Assignment of responsibilities Responsibility on implementing, monitoring, enforcing, evaluating, and revising infection control programs on a routine basis including linkage to TB diagnostics and other communicable Infections Dr.T.V.Rao MD 25

Infection control committee:

An infection control committee provides a forum for multidisciplinary input and cooperation, and information sharing. This committee should include wide representation from relevant departments: e.g. management, physicians, other health care workers, clinical microbiology, pharmacy, sterilizing service, maintenance , housekeeping and training services. The committee must have a reporting relationship directly to either administration or the medical staff to promote programme visibility and effectiveness. Infection control committee Dr.T.V.Rao MD 26

Prevention of Hospital Infection-Planning:

Prevention of H ospital Infection-Planning LIFECYCLE OF IC PLAN Develop Evaluate Revise Implement Implemented, monitored and enforced IC plan Educated and trained HCW to ensure good work practices Counselling and screening HCW periodically Evaluated and revised plan 4 times Dr.T.V.Rao MD 27

The Infection Control Team:

The Infection C ontrol T eam Consist of at least an infection control practitioner who should be trained for the purpose ; carry out the surveillance programme ; develop and disseminate infection control policies ; monitor and manage critical incidents ; coordinate and conduct training activities. Dr.T.V.Rao MD 28

Infection Control Committee Purpose:

29 Infection Control Committee Purpose Advisory Review ideas from infection control team Review surveillance data Expert resource Help understand hospital systems and policies Decision making Review and approve policies and surveillance plans Policies binding throughout hospital Education Help disseminate information and influence others Dr.T.V.Rao MD

Infection Control Committee - Represented:

30 Infection Control Committee - Represented Committee Representatives Hospital Epidemiologist Infection Control Practitioners Administrator Ward, ICU and Operating room Nurses Medicine/Surgery/Obstetrics/Pediatrics Central Sterilization Hospital Engineer Microbiologist Pharmacist Dr.T.V.Rao MD

Identify problems with polices and procedures Example: Pre- and Post-Operative Care create your protocols:

31 Identify problems with polices and procedures Example: Pre- and Post-Operative Care create your protocols Skin shaved the night before surgery Inappropriate peri-op antibiotic prophylaxis Instruments used for dressing changes submerged disinfectant Large containers of antiseptics, no routine for cleaning and refilling Eliminate shaving of skin the night before surgery Single dose peri-op antibiotic prophylaxis guidelines Use individual sterile packs of wound care instruments Use small containers of antiseptics; clean and dry containers before refilling Recommendation Problem Area Dr.T.V.Rao MD

Aims of Infection Control:

To review and approve a yearly programme of activity for surveillance and prevention ; to review epidemiological surveillance data and identify areas for intervention; to assess and promote improved practice at all levels of the health facility; to ensure appropriate staff training in infection control and safety management , provision of safety materials such as personal protective equipment and products; and training of health workers . Aims of Infection Control Dr.T.V.Rao MD 32

Education is the Real Strength of Infection Control programme :

Education programs for employees and volunteers are one method to ensure competent infection control practices. It is a unique challenge since employees represent a wide range of expertise and educational background. The ICP must become knowledgeable in adult education principles and use educational tools and techniques that will motivate and sustain behavioral change. Much has been written about the education of healthcare workers (HCWs). Education is the Real Strength of Infection Control programme Dr.T.V.Rao MD 33

Minimal Needs to Start Infection Control Unit:

Minimal Needs to Start Infection Control Unit 1 Organized surveillance and control activities 2. One infection control practitioner for every major Health Facility. 3. A Trained Hospital Epidemiologist 4. A system for reporting surgical wound infection rates and other infection back to the practicing surgeons and physicians. Dr.T.V.Rao MD 34

GUIDELINES for Effective Control of Infections:

Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device-Related Infections and its control * Isolation Precautions * Long-Term Care Facilities GUIDELINES for Effective Control of Infections Dr.T.V.Rao MD 35

GUIDELINES for Effective Control of Infections:

* Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately * Home care * Hospital Construction * Sterilization / Disinfection GUIDELINES for Effective Control of Infections Dr.T.V.Rao MD 36

Your Unwashed Hand a Great Concern to Your Patient:

Your Unwashed Hand a Great Concern to Your Patient Dr.T.V.Rao MD 37

Hand Washing is the Foundation of Infection Control:

Hand Washing is the Foundation of Infection Control Hand washing is the single most important procedure for preventing nosocomial infections. Hand washing is defined as a vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water. Although various products are available, hand washing can be classified simply by the nature of the products used: plain soap detergents A ntimicrobial containing products Dr.T.V.Rao MD 38

Hand Washing is the Foundation of Infection Control:

Hand Washing is the Foundation of Infection Control Hand washing with plain soaps or detergents (in bar, granule, leaflet or liquid form) suspends microorganisms and allows them to be rinsed off; this process is often referred to as mechanical removal of microorganisms. In addition, hand washing with antimicrobial containing products kills or inhibits the growth of microorganisms; this process is often referred to as chemical removal of microorganisms. Dr.T.V.Rao MD 39

Hand washing Technique:

Hand washing Technique For routine hand washing, a vigorous rubbing together of all surfaces of lathered hands for at least 10 seconds, followed by thorough rinsing under a stream of water, is recommended. Dr.T.V.Rao MD 40

Hand washing:

Hand washing Single most effective action to prevent HAI - resident/transient bacteria Correct method - ensuring all surfaces are cleaned - more important than agent used or length of time taken No recommended frequency - should be determined by intended/completed actions Research indicates: poor techniques - not all surfaces cleaned frequency diminishes with workload/distance poor compliance with guidelines/training Dr.T.V.Rao MD 41

Hand washing – Areas Missed:

Hand washing – A reas M issed Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger-webs, the palms and the thumbs . Dr.T.V.Rao MD 42

Successful Promotion in Hand Washing :

Successful Promotion in Hand Washing  Education Routine observation & feedback Engineering controls Location of hand basins Possible, easy & convenient Alcohol-based hand rubs available Patient education ( Improving Compliance with Hand Hygiene in Hospitals . Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381) Dr.T.V.Rao MD 43

Successful Promotion can Improve Hand Washing :

Successful Promotion can Improve Hand Washing  Reminders in the workplace Administrative sanctions ?? Change in hygiene agent (not in Winter) Promote and facilitate skin care Avoid understaffing and excessive workload Dr.T.V.Rao MD 44

Hand Hygiene Techniques Many Ways :

Hand Hygiene Techniques Many Ways Alcohol hand rub Routine hand wash 10-15 seconds Aseptic procedures 1 minute Surgical wash 3-5 minutes Dr.T.V.Rao MD 45

Advantages of Alcoholic Hand Wash:

Advantages of Alcoholic Hand Wash Require less time Can be strategically placed Readily accessible Multiple sites All patient care areas Acts faster Excellent bactericidal activity Less irritating (??) Sustained improvement Dr.T.V.Rao MD 46

Antibiotic resistance Not a new problem - Penicillin in 1944 :

Antibiotic resistance Not a new problem - Penicillin in 1944 Hospital “superbugs” Methicillin Resistant Staphylococcus Aureus [MRSA] Vancomycin Intermediate Staphylococcus Aureus [VISA] Tuberculosis - antibiotic resistant an Emerging Global Concern Dr.T.V.Rao MD 47

MRSA:

MRSA Discovered in 1981 Found on skin and in the nose of 1 in 3 healthy people - symptomless carriers Widespread in hospitals and community Resistant to most antibiotics When fatal - often due to septicaemia Dr.T.V.Rao MD 48

Hospital Acquired Infections and Consequences:

Hospital Acquired I nfections and Consequences Incidence of 10% 5,000 deaths per year - direct result of HAI 15,000 deaths per year linked to HAI Delayed discharge from hospital Expensive to treat [£3,500 extra] Cost to NHS - £1 billion per year Effective hand washing is the most effective preventative measure Dirty wards and re-use of disposable equipment also blamed Dr.T.V.Rao MD 49

The nature of infection:

The nature of infection Micro-organisms - bacteria, fungi, viruses, protozoa and worms Most are harmless [non-pathogenic] Pathogenic organisms can cause infection Infection exists when pathogenic organisms enter the body, reproduce and cause disease Dr.T.V.Rao MD 50

Staff health:

Staff health Risk of acquiring and transmitting infection Acquiring infection immunisation cover lesions with waterproof dressings restrict non-immune/pregnant staff Transmitting infection advice when suffering infection Report accidents/untoward incidents Follow local policy (May, 2000) Dr.T.V.Rao MD 51

Waste disposal:

Waste disposal Clinical waste - HIGH risk potentially/actually contaminated waste including body fluids and human tissue yellow p lastic sack, tied prior to incineration Household waste - LOW risk paper towels, packaging, dead flowers, other waste which is not dangerously contaminated black plastic sack, tied prior to incineration Follow local policy (May, 2000) Dr.T.V.Rao MD 52

Spillage of body fluids:

Spillage of body fluids PPE - disposable gloves, apron Soak up with paper towels, kitchen roll Cover area with hypochlorite solution e.g., Milton, for several minutes Clean area with warm water and detergent, then dry Treat waste as clinical waste - yellow plastic sack Follow local policy (May, 2000) Dr.T.V.Rao MD 53

Standard Precautions:

Standard Precautions Hand hygiene Respiratory hygiene and cough etiquette Personal protective equipment (PPE) Based on risk assessment to avoid contact with blood, body fluids, excretions, secretions Safe injection practices Environmental control Patient placement Dr.T.V.Rao MD 54

Nosocomial Infections are great concern in Immune compromised Patients:

Nosocomial Infections are great concern in Immune compromised Patients Immunocompromised patients vary in their susceptibility to nosocomial infections, depending on the severity and duration of immunosuppression. Use of the two tiered system essential to break the “Chain of Infection”. Dr.T.V.Rao MD 55

Strengthen the Epidemiology:

56 Strengthen the Epidemiology Epidemiology is the scientific process applied to the control of infections in the healthcare setting. Dr.T.V.Rao MD

Areas of interest to a hospital epidemiologist:

57 Areas of interest to a hospital epidemiologist Surveillance for nosocomial infection bloodstream infections pneumonia urinary tract infections surgical wound infections Patterns of transmission of nosocomial infections Outbreak investigation Isolation precautions Evaluation of exposures Employee health Disinfection and sterilization Hospital engineering and environment water supply air filtration Reviewing policies and procedures for patient care Dr.T.V.Rao MD

Areas of interest to a Hospital Epidemiologist:

58 Areas of interest to a Hospital E pidemiologist Antibiotic use Antibiotic resistant pathogens Microbiology support National regulations on infection control Infection control committee Quantitative methods in epidemiology Dr.T.V.Rao MD

What is the role of healthcare epidemiology?:

59 What is the role of healthcare epidemiology ? Eliminate or minimize risks to a patient’s health organize care to minimize risk eliminate risk factors work around risk factors develop improved policies and procedures educate physicians and nurses regarding risks study risk factors to learn more about them and how to eliminate them Dr.T.V.Rao MD

Responsibilities of the Infection Control Program:

60 Responsibilities of the Infection Control Program Surveillance of nosocomial infections Outbreak investigation Develop written policies for isolation of patients Develop written policies to reduce risk from patient care practices Cooperation with occupational health Education of hospital staff on infection control Ongoing review of all aseptic, isolation and sanitation techniques Eliminate wasteful or unnecessary practices Dr.T.V.Rao MD

Key elements of surveillance:

61 Key elements of surveillance Defining as precisely as possible the event to be surveyed (case definition) Collecting the relevant data in a systematic, valid way Consolidating the data into meaningful arrangements Analyzing and interpreting the data Using the information to bring about change adapted from R. Haley Dr.T.V.Rao MD

Areas of interest to a healthcare epidemiologist:

62 Areas of interest to a healthcare epidemiologist Surveillance for nosocomial infection Patterns of transmission of nosocomial infections Outbreak investigation Isolation precautions Evaluation of exposures Employee health Disinfection and sterilization Hospital engineering and environment water supply air filtration Reviewing policies and procedures for patient care Dr.T.V.Rao MD

Organizing for Infection Control:

63 Organizing for Infection Control Requires cooperation, understanding and support of hospital administration and medical/surgical/nursing leadership There is no simple formula: Every facility is different Every facility’s problems are different Every facility’s personnel are different The facility must develop its own unique program Dr.T.V.Rao MD

Methods to reduce cost of Nosocomial Infections :

64 Methods to reduce cost of Nosocomial I nfections Reduce incidence Reduce morbidity Shorten hospital stay Reduce costs of treating infections Reduce costs of preventative measures Stop ineffective control measures Dr.T.V.Rao MD

Universal infection control precautions:

Universal infection control precautions Devised in US in the 1980’s in response to growing threat from HIV and hepatitis B Not confined to HIV and hepatitis B Treat ALL patients as a potential bio-hazard Adopt universal routine safe infection control practices to protect patients, self and colleagues from infection Dr.T.V.Rao MD 65

Universal Precautions Include:

Universal Precautions Include Hand washing Personal protective equipment [PPE] Preventing/managing sharps injuries Aseptic technique Isolation Staff health Linen handling and disposal Waste disposal Spillages of body fluids Environmental cleaning Risk management/assessment Dr.T.V.Rao MD 66

Personal protective equipment:

Personal protective equipment PPE when contamination or splashing with blood or body fluids is anticipated Disposable gloves Plastic aprons Face masks Safety glasses, goggles, visors Head protection Foot protection Fluid repellent gowns (May, 2000) Dr.T.V.Rao MD 67

Personal protective equipment:

Personal protective equipment PPE when contamination or splashing with blood or body fluids is anticipated Disposable gloves Plastic aprons Face masks Safety glasses, goggles, visors Head protection Foot protection Fluid repellent gowns (May, 2000) Dr.T.V.Rao MD 68

Eliminate waste: Unnecessary microbiologic monitoring:

69 Eliminate waste: Unnecessary microbiologic monitoring Routine environmental cultures of walls, floors, air, sinks, or other hospital surfaces Routine cultures of healthcare workers nose and hands Clinical cultures which are not available to clinicians in time to help with decision making Also: Failure to generate annual summary of culture data to provide clinicians with data for empirical selection of antibiotics Dr.T.V.Rao MD

Practice Aseptic techniques:

Practice Aseptic techniques Sepsis - harmful infection by bacteria Asepsis - prevention of sepsis Minimise risk of introducing pathogenic micro-organisms into susceptible sites Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff Follow local policy (May, 2000) Dr.T.V.Rao MD 70

Antibiotic Prophylaxis in Surgery:

71 Antibiotic Prophylaxis in Surgery Potentially an important part of surgical wound infection prevention May also be a significant expense for the hospital What is the cost-benefit of prophylactic antibiotics? What is cost of wound infection? In money? In suffering? How effective is prophylaxis? How much can we spend to prevent a case of wound infection ? Dr.T.V.Rao MD

Sharps injuries:

Sharps injuries Prevention correct disposal in appropriate container avoid re-sheathing needle avoid removing needle discard syringes as single unit avoid over-filling sharps container Management follow local policy for sharps injury (May, 2000) Dr.T.V.Rao MD 72

Protecting Yourself from Blood-Borne Pathogens :

Protecting Yourself from Blood-Borne Pathogens Dr.T.V.Rao MD

HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle :

HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 000 Dr.T.V.Rao MD

Hepatitis C: 18 Persons per 1,000 Needle-sticks:

Hepatitis C: 18 Persons per 1,000 Needle-sticks 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 00000000000000000 Dr.T.V.Rao MD

Hepatitis B is Most Infectious:

Hepatitis B is Most Infectious 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Dr.T.V.Rao MD

Protect Yourself! Get a Hepatitis B Vaccination and keep your Vaccine Record:

Slide 77 Protect Yourself! Get a Hepatitis B Vaccination and keep your Vaccine Record 3 doses of Hepatitis B vaccine protect most people for a lifetime in Majority of Indivuasls But HCW blood banks, and dialysis should follow the updated Instructions The next dose at this facility will be given on Dr.T.V.Rao MD

Safe Handling of Sharps:

Safe Handling of Sharps Wear gloves when drawing blood or handling sharps—double glove for surgery Don’t recap! Don’t bend or break needles Never place used sharps on tables, beds, furniture Put used sharps immediately into a sharps container Dr.T.V.Rao MD 78

Disposal of Sharps: The Ideal :

Disposal of Sharps: The Ideal Immediately after use, put sharps in a leak- proof and puncture-proof container The container should be within arm’s length

Sharps Disposal (cont’d):

Slide 80 Sharps Disposal (cont’d) Disposal containers should be placed at all points of use Disposal bin should be rigid and should be leak and puncture proof Separate sharps from other waste so laundry workers or waste disposal staff do not get needlesticks Empty sharps containers when they are ¾ full Dr.T.V.Rao MD

Danger!:

Danger! Open containers of used needles like this put staff at risk each time they put a hand in to pick up one Keep your ward free of used sharps

Remember this Procedure… When Injures with a Needle:

Slide 82 Remember this Procedure … When Injures with a Needle If a needle pricks you or blood and/or body fluids enter your eye(s) or mouth Wash wounds with soap and water Flush eyes and mouth with water Check the patient record to see if the patient is HIV+, HIV- , or untested Check patient record for Hepatitis B or C infection Call the medical duty officer immediately Dr.T.V.Rao MD

Protecting Yourself from Blood-Borne Pathogens (cont’d):

Slide 83 Protecting Yourself from Blood-Borne Pathogens (cont’d ) Wear gloves Don’t recap needles Complete 3 doses of Hep B vaccine Eliminate unnecessary injections Dispose of sharps immediately after use to minimise handling that increases risk of needlesticks Substitute safer devices or tools whenever possible Report needlesticks Dr.T.V.Rao MD

Prion diseases:

Prion diseases Prions [“pree-ons”] - proteinaceous infectious particles Corrupted form of a normally harmless protein found in mammals and birds Causes fatal neurodegenerative diseases of animals and humans Animals: scrapie - sheep, bovine spongiform encephalopathy [BSE or Mad Cow Disease] Humans: Creutzfeldt-Jakob disease [CJD] Prions found in blood, tonsil and appendix tissue Dr.T.V.Rao MD 84

Prions and surgery:

Prions and surgery Prions cannot be destroyed by sterilisation Theoretical risk of cross infection from contaminated instruments and blood transfusion Dr.T.V.Rao MD 85

Wish to be Better Informed Internet sites:

Wish to be Better Informed Internet sites http://www.icna.co.uk/ http://www.nursing-standard.co.uk/ http://www.medscape.com/ http://www.anes.uab.edu/medhist.htm http://www.shef.ac.uk/~nhcon/ http://medweb.bham.ac.uk/nursing/ http://www.healthcentre.org.uk/hc/library/default.htm Dr.T.V.Rao MD 86

Resources: Where to get more information or help:

87 Resources: Where to get more information or help Training Courses Society of Hospital Epidemiologists of America (SHEA) Association of Professionals in Infection Control (APIC) National courses and congresses Books Textbooks: Bennett and Brachman - Wenzel - Mayhall APIC Curriculum and Guidelines CDC Guidelines Journals Infection Control and Hospital Epidemiology Journal of Hospital Infections American Journal of Infection Control Consulting services National: CDC, Ministry of Health Colleagues Dr.T.V.Rao MD

Slide 88:

Created by Dr.T.V.Rao MD for ‘e’ Learning resources to Medical and Paramedical Health Care Workers in the Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 88