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Biosafety in Health Care Practices to Prevent Health Care Associated Infections.pptx

  1. Hospital infection control (Biosafety in Health Care Practices to Prevent Health Care Associated Infections) By Dr. Rakesh Prasad Sah Associate Professor, Microbiology
  2. Components • Hospital Acquired Infection • Major Healthcare-associated infection Types • Sterilization and Disinfection • Biomedical waste management • Needle stick Injury • Antimicrobial Stewardship • Environmental Surveillance
  3. Hospital Acquired Infection • An infection acquired by a patient during hospital care which was neither present nor incubating at the time of admission. • Also called as “Nosocomial infection”.
  4. Factors affecting HAI • Immune Status • Hospital environment • Hospital organisms • Diagnostic or therapeutic interventions • Transfusion • Poor hospital administration
  5. Sources • Endogenous sources • Exogenous sources – Environmental sources – Health care workers – Other patients
  6. • E. coli • SARS-CoV-2 (COVID-19) • Candida albicans • Clostridium difficile • Blood borne (transfusion and Needle stick injury) • HIV • Hep-B • Hep-C Microorganisms
  7. Mode of Transmission • Contact • Droplet • Airborne
  8. Who is at Risk of Infection? Patient Healthcare worker Healthcare workers family Patient Patient Patient family HCW Patient
  9. Benefits of Infection Prevention and Control
  10. Infection Control Precautions • Used to reduce transmission of microorganisms in Hospital & laboratory • Includes – Standard Precautions • Hand hygiene • Personal protective equipment (PPE) – Transmission based precautions
  11. Prevention of HAIs • Standard Precautions • Include a group of infection prevention practices  apply to all patients, regardless of suspected or confirmed infection status in any setting in which healthcare is delivered. • Rationale: all blood, body fluids, secretions(except sweat), excretions, non-intact skin, and mucous membranes may contain transmissible infectious agents.
  12. Components of Standard Precautions • Hand hygiene • PPE (Personal protective equipment) • Spillage cleaning • Respiratory hygiene and cough etiquette • Transmission based precautions • Biomedical waste including sharps handling • Disinfection
  13. WHY is hand hygiene required?
  14. Hand Hygiene • Main source of transmission of infections • Most important measures to avoid the transmission of microbes.
  15. Hand hygiene • Hand hygiene – Hand rubbing – Hand washing • “My five moments of hand hygiene” – Hand rub with alcohols – Hand wash with soap and water
  16. “My five moments of hand hygiene” 1. Before touching a patient 2. Before a procedure 3. After a procedure or body fluid exposure 4. After touching a patient 5. After touching a patient’s surroundings
  17. In addition to the above, hand hygiene should be performed in the following non-clinical situations 1. Before eating/handling of food/drinks (whether own or patients) 2. After hands becoming visible soiled 3. After visiting a toilet 4. After blowing/wiping/touching nose or mouth 5. After putting on and removing personal protective equipment (PPE) 6. After handling laundry/equipment/waste
  18. Hand Rub with Alcohols • They are a suitable and effective alternative to hand washing with soap and water, provided the hands are visible clean. • If the hands are soiled, they should be washed using a soap and water first. • Alcohol hand rubs must not be placed near electrical sockets, switches or devices. • Alcohol must be thoroughly rubbed in until dry before undertaking any clinical procedure
  19. Hand wash with soap and water Alcohol hand rubs are not suitable: 1. When hands are visibly soiled 2. After using a rest room
  20. • Video
  21. Personal Protective Equipments (PPE)
  22. STEP OF DONNING 1. Hand Rub with sanitizer 2. Gown 3. Mask/respirator 4. Wear goggles/face shield 5. Gloves
  23. STEP OF DOFFING 1. Gloves 2. Goggles/Face shield 3. Gown 4. Mask/Respirator
  24. Spill management for Blood and Body Fluids • Bring the spill kit to the site of spillage – wear PPE (gloves, gown)  put ‘no entry’ sign board near the spill area. • Small volume (<10ml) – Wipe up spill immediately with absorbent material and discard into appropriate bin – Wipe the area with 10% sodium hypochlorite and allow it to dry – Remove PPE and perform hand hygiene
  25. • Large volume (>10ml) – Place disposable paper towels over spills to absorb the spillage and then pour 10% sodium hypochlorite on the top of absorbent paper towels and leave for 15mins – Remove the absorbent papers; put fresh disposable paper towels to clean the area and then discard these into appropriate waste bin Spill management for Blood and Body Fluids
  26. Respiratory hygiene/cough etiquette • Avoid patient careare as if you havea respiratory infection. Stay home if possible. Weara mask during hospitalvisits. Wash hands with soap and water
  27. Respiratory hygiene/cough etiquette • If no tissues are available, cough or sneeze into the inner elbow rather than the hand • Surgical masks can be used on the coughing person when tolerated and appropriate
  28. Respiratory hygiene/cough etiquette • Spatial separation, ideally > 6 feet, of persons with respiratory infections in common waiting areas when possible
  29. Transmission Based Precautions Introduction • Additional precautions taken over and above the std. precautions • where std. precautions may not be sufficient • Based on specific MOT
  30. Transmission Based Precautions • Hand Hygiene • Gown • Gloves Contact Precautions • Hand Hygiene • Mask Droplet Precautions • Hand Hygiene • Negative pressure room • N-95 Respirator mask Airborne Precautions
  31. Contact Precautions • Physical contact  infected  susceptible host • Apply to patients with any of the following conditions and/or disease  Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile)  Draining wounds  Uncontrolled secretions  Pressure ulcers or presence of ostomy tubes and/or bags draining body fluids  Presence of generalized rash  Highly contagious skin lesions  MDROs • MRSA (Methicillin resistant S. aureus) • VRE (Vancomycin resistant Enterococci)
  32. Precautions • Isolation – Individual room (optional) – Cohorting (desirable) – >3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients • Patient movement – Confined to room – If transfer req.  hand hygine, PPE, patient’s colonized area must be covered. • Patient dedicated equipment – Stethscope, b.p. cuff, nebulizer  for single patient  must be disinfected before re-use • Hand washing – Before and after contact • Environmental cleaning – Floor, clothes, toilet and equipment cleaning with appropriate disinfectant
  33. DROPLET PRECAUTIONS • Large particle respiratory droplets (≥5 microns) from a source patient – Coughing – Sneezing – Certain procedures (suctioning) • Respiratory viruses – Influenza – Parainfluenza virus – Adenovirus – RSV • Pertussis • Meningitis – N. meningitides – Group A streptococcus • Mycoplasma • C. diptheriae For first 24 hours of therapy
  34. Precautions • Isolation – Essential, if single room not available  cohorting spatial separation ≥ 3 feet – Negative pressure room (desirable) • Patient movement – Restricted movement of the patient – Wears surgical mask  while leaving room • Surgical mask  healthcare workers while entering the room • Perform hand hygiene – before and after touching – after contact with respiratory secretions and contaminated objects/materials; – note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
  35. Airborne Precautions • Airborne • Small-particle residue (≤5 μm) that remain suspended in the air for long periods of time – Varicella – Pulmonary TB – Measles – Chickenpox – SARS (severe acute respiratory syndrome) – Herpes zoster (until lesions are crusted over)
  36. Precautions • Isolation – Place immidiately in an airborne infection isolation room (AIIR) – Adequate ventillation with negative pressure facility (essential) • Patient movement  confined to the room all the time • PPE: – staff should wear high-efficiency masks (N95) before entering the room. – Patient may wear surgical mask all the time
  37. Will be discussed in other chapters • Biomedical Waste Management • Disinfection
  38. The Key - always be alert Put on protective gear when needed Thank you