Role of Nursing Staff in Hospital Infection Control : 1 Role of Nursing Staff in Hospital Infection Control Dr. Md Kamal Hussain
Consultant Hospital Management Hospital Associated Infections (HAI) or Nosocomial Infections : 2 Hospital Associated Infections (HAI) or Nosocomial Infections Infections that are acquired by the patient while they are in the hospital either from other patients, the hospital environment or members of the hospital staff
These infections are not incubating at the time of admission and usually manifest after 48 hours of admission or hospital contact
Some may manifest after discharge from the hospital Effect of Hospital Acquired Infections on Health Care : 3 Effect of Hospital Acquired Infections on Health Care Outcome of diseases is adversely affected
Increases morbidity and mortality
Increases average length of stay of patients (ALS)
Cost of health care increases significantly
Loss of effectiveness and productivity of the hospital services
Consumer Protection Act changes-all health care facilities including the government run hospitals have been included in its ambit
Bad reputation amongst the public Extent of the problem : 4 Extent of the problem In most health care facilities 0.8-8% of admitted patients requiring acute care develop HAI
At times these figures may be as high as 10%-30%
The maximum number of HAI occur in areas that care for critically ill patients
The highest incidence is observed amongst patients subjected to invasive procedures & those who are immuno-compromised Slide 5: 5 CDC, Atlanta - 2 million pts in US developed HAI
90,000 pts died
It's the fourth leading cause of death in US after heart disease, cancer and stroke," said Betsy McCaughey, the former lieutenant governor of New York, and a Ph.D. in public health policy.
Cost-additional $ 4.5-5.7 billion/yr
1/3 to ½ are preventable by taking certain precautions Role of Nursing Personnel in prevention of Hosp Infection : 6 Role of Nursing Personnel in prevention of Hosp Infection Nursing background helps her in her job with infection control
The physician might be more in tune with a disease and its process
The nurse is probably more in tune to hospital policy development and compliance, would like to see
More programs that educate nurses in epidemiology are required
This area has no formal learning track, and a recent increase in emerging and re-emerging infectious diseases will make the field all the more important
www.nurseweek.com Risk Factors For Hospital Associated Infections : 7 Risk Factors For Hospital Associated Infections Low resistance of patients to infections
Contact with infectious persons
Invasive procedures/ interventions
Inappropriate antimicrobial usage
Drug resistance of endemic microbes
Contaminated environment High risk areas in hospitals : 8 High risk areas in hospitals Nurseries,
Intensive care units,
Organ transplant units,
Delivery rooms &
Post op wards How Infection Perpetuates ? : 9 How Infection Perpetuates ? Exogenous Environment Endogenous Common Organisms : 10 Common Organisms Bacterial
Staphylococcus aureus-direct contact
E. coli-IV fluids & invasive devices
HIV, HCV, HBV, CMV-blood and blood products, body fluids and secretions, and contaminated needle stick injuries
Aspergillus spp for exogenous & that for endogenous infection is Candida albicans Commonly Occurring Sites of HAI : 11 Commonly Occurring Sites of HAI Wound infections
Respiratory tract infections
Urinary tract Infections
Largely depends upon the interventions the patient is subjected to
Bacteraemia in patients with indwelling vascular catheters & UTI in urinary catheterised pts
the specific area of patient care in the hospital, for eg. wound infections will be common in surgical wards respiratory tract infections will be common in ICU
the host factors (for eg. fulminant bacteraemia in neutropenic patients). Hospital Infection Control Program : 12 Hospital Infection Control Program Monitoring of hospital associated infections
-investigation and control of outbreaks if any
-monitoring of anti microbial resistance
Providing facilities to the hospital staff to maintain good infection control practices
Conducting on-going educational/training programmes for all cadres of hospital staff
Making provisions for staff health activities
Having a written document (manual) outlining the various infection control policies and procedures followed in the hosp and periodically updating it Hospital Infection Control Committee (HICC) : 13 Hospital Infection Control Committee (HICC) Chairman Medical Superintendent
Officer in charge Main O.T
One faculty member/specialist from medicine, surgery, paediatrics, gyne/obs, microbiology
One faculty member from Hospital Administration
Infection Control Nurses
Member Secretary: Faculty member /specialist from Hospital Administration/ Microbiologist
From within the HICC a Core Group should be formed on the lines of a Infection Control Team to look after day to day problems. It also implements the educational & training programme for the hospital staff.
Infection Control nurses: experienced nurses are appointed full time on this position (1 for 250 beds) Functions of the Infection Control Nurse : 14 Functions of the Infection Control Nurse Experienced nurses are appointed full time on this position
Regular visit to all wards and high risk units.
Checking nursing supervisor’s register & records suggestive of infection.
Collection and tabulation of daily data of incidence of hosp infection
Identification and location of pt
Date of admission
Date of infection
Type of infection
Cultures taken, antibiotics taken
Name of treating physician Functions of the Infection Control Nurse : 15 Functions of the Infection Control Nurse Ensuring that samples (bld, stool, urine, swab etc.) are collected and dispatched to laboratory in time.
Initiating the hospital infection control form while documenting nosocomial infections, the registration form used should be different from the routine investigation forms, so that minimum time is wasted in getting the culture and sensitivity reports.
Compilation of ward wise, discipline wise or procedure wise statistics Functions of the Infection Control Nurse : 16 Functions of the Infection Control Nurse Daily visit to microbiology laboratory to ascertain results of samples collected for Surveillance and to liase between microbiology and clinical departments
Monitoring and supervision of infection among hospital staff
Training of nursing aides and paramedical personnel on correct hygiene practices and aseptic techniques Surveillance of HAI : 17 Surveillance of HAI Surveillance involves the routine collection of data on infection, analysis of the data and feedback to hospital staff
OBJECTIVES OF SURVEILLANCE
1. Reducing infection rates in the hospital
2. Establishing endemic baseline rates
3. Identifying & containing outbreaks
4. Evaluating & monitoring all infection control measures
5. Monitoring antimicrobial susceptibility patterns
Dept of Microbiology carries out surveillance of HAI with the help of infection control nurses. Slide 18: 18 Laboratory records are analysed to determine the rates of infections in various areas of the hospital.
Presently the surveillance is passive and is based on the laboratory records of the culture positive cases.
Based on this crude infection rates (CIR) are calculated as follows
No. of infections (culture positive)
CIR= no. of culture positive cases x 100
The environmental surveillance activities include air sampling in critical & semi-critical areas (enumerated at the end of the chapter). No. of admissions Other activities of Infection Control Nurses : 19 Other activities of Infection Control Nurses Determination of the decontamination and disinfection process of the semi-critical items.
Sterility checks of the new pre-sterilized articles purchased by the hospital or the efficacy of the new disinfectant for purchase is done when desired by the Medical Superintendent.
‘In-use test’ of the disinfectants used in the hospital
sterility of TPN or any other sterile solutions in use.
Water testing – Bacterial cultures of tap water and water used in various equipment meant for the patients. Effective Control Measures : 20 Effective Control Measures Hosp planning/ design considerations at planning stage (nursing supdt)
Riggs pattern wards
Isolation rooms in ICU and acute care wards
Air lock/ ante room before entering rooms
Clean and dirty corridor should not be adjacent to each other
Adequate hand wash basins within pt care areas
Design to permit natural ventilation Effective Control Measures… : 21 Effective Control Measures… Administrative control
Rounds (at all levels)
Training to various nursing and paramedical personnel in aseptic techniques
Hand washing (rings, nails)
Decontamination of items of daily use- cheatle forceps, clinical thermometers, surgical dressings
Hosp Infection Control Committee Effective Control Measures… : 22 Effective Control Measures… People
Segregation of contaminated instruments
Disinfection practises-cleaning, low level disinfection, medium level, high level, sterilisation
Good Housekeeping Effective Control Measures… : 23 Effective Control Measures… Precautions for staff
Careful handling of soiled linen
Structural survey of the hosp-environmental, equipment etc Infection Control in Relation to HIV/ AIDS : 24 Infection Control in Relation to HIV/ AIDS STANDARD PRECAUTIONS
These precautions have been issued as guidelines by the Government of India
Washing of hands before and after all patient and specimen contact.
Handling of blood and body fluids of all patients as potentially infectious.
Wearing gloves for any contact with blood and body fluids
Placing used syringes immediately in nearby impermeable container; re capping or manipulating of used needles should not be done STANDARD PRECAUTIONS : 25 STANDARD PRECAUTIONS Wearing protective eyewear and mask if splashing of blood or body fluids is expected.
Handling all linen soiled with blood and/or body fluids as infectious.
Processing all laboratory specimens as potentially infectious HAND WASHING : 26 HAND WASHING Objective: To decontaminate the hands to prevent transfer of infection from hands to patients and patients to hands of health care worker.
Before and after nursing or touching the patient.
Before and after use of gloves.
Before and after blood sampling, specimen handling.
Whenever hands are soiled with blood & body fluids.
Before and after caring for immunocompromised patients.
Before and after performing operations & procedures. Types of Hand Washing : 27 Types of Hand Washing Surgical hand washing
Hygienic hand washing
Social hand washing BIO–MEDICAL WASTE (BMW) MANAGEMENT : 28 BIO–MEDICAL WASTE (BMW) MANAGEMENT Proper Hospital waste management is one of the mainstays of prevention of hospital acquired infection
CATEGORISATION OF BMW
Hospital wastes may be categorized as mentioned below
Category 1 : Human Anatomical Waste
Category 2 : Animal Wastes
Category 3 : Microbiology & biotechnology waste
Category 4 : Sharps
Category 5 : Discarded medicines & cytotoxicwastes
Category 6 : Solid wastes (plaster casts & bandages soiled with blood & body secretions)
Category 7 : Plastics & disposables
Category 8 : Liquid Waste
Category 9 : Incinerator ash
Category 10 : Chemical wastes Health Hazards of Hospital Waste : 29 Health Hazards of Hospital Waste The hazards are:
Breeding of flies and insects
Proliferation of rodents
Transmission of infections viz.hepatitis B, HIV, other microbes
Re-circulation of waste
Loss of aesthetics
Nuclear waste hazards & carcinogenic effects Elements of BMW mgmt : 30 Elements of BMW mgmt Segregation
Final disposal Biomedical Waste Generation & Segregation Cycle : 31 Biomedical Waste Generation & Segregation Cycle COLLECTION & STORAGE TREATMENT DISPOSAL BURIAL SHREDDING AUTOCLAVE MICROWAVE INCINERATOR 1% HYPOCHLORITE Waste Disposal : 32 Waste Disposal Household Waste OPDs
Nuclear Medicine INCINERATOR MICROWAVE AUTOCLAVE COLLECTION CHEM TREAT STORAGE INSIDE HOSP DISPOSAL OUTSIDE HOSP MCD INCINERATION ASH LANDFILL STAFF HEALTH ACTIVITIES : 33 STAFF HEALTH ACTIVITIES The objectives of staff health service programme are :
Educating personnel about the principles of infection control and stressing individual responsibility for infection control.
Collaborating with the infection control team in monitoring and investigating potentially harmful infectious exposures and outbreaks among personnel.
Providing care to personnel for work related illnesses or exposures.
Identifying work-related infection risks and instituting appropriate preventive measures ELEMENTS OF INFECTION CONTROL PRACTICES OF STAFF : 34 ELEMENTS OF INFECTION CONTROL PRACTICES OF STAFF Coordination with other departments.
Medical evaluation: This includes medical examination before placement to ensure that personnel are not placed in jobs that would pose undue risk of infection to them, other personnel, patients, or visitors. Immunization history is important. Periodic evaluations are done for specific job assignments, for evaluation of work-related problems
Personnel health and safety education: education is provided for infection control program so that the staff understand its rationale & comply with the guidelines.
Immunization programs: Optimal use of vaccines to prevent transmission of vaccine-preventable diseases is advocated to HCW Slide 35: 35 Management of job-related illnesses and exposures: Guidelines for post-exposure use of vaccines / immunoglobulins
Decisions on work restrictions are followed as per the advice of the treating doctor
HIV : regimen for post-exposure prophylaxis for HIVas per the guidelines of NACO Slide 36: 36 Health counselling is undertaken to provide individually targeted information regarding
Risk and prevention of occupationally acquired infections.
Risk of illnesses or adverse outcome after exposure.
Management of exposure, including risks and benefits of post-exposure prophylaxis.
Potential consequences of exposures or communicable diseases for family members, patients and other personnel.
Management of occupational exposure of pregnant personnel to infectious agents
Maintenance of records, data management and confidentiality. Slide 37: 37 Emphasis is on Teamwork ! Slide 38: 38 Thank You