Expanded Program Of Immunization

Expanded program of immunization •Launched in july 1976 •Objective was to reduce the morbidity and mortality among infants and children caused by the six childhood immunizable diseases. •Principles : 1. based on epidemiological situation; schedules are drawn on the basis of the occurrence and characteristics epidemiological features of dse. 2. whole community rather than individual is to be protected ,thus mass approach is utilized 3. immunization is a basic health service and such it is integrated in to the health services being provided for by the rural health unit Routine immunization schedules for infants Routine immunization schedules for infants vaccine

min. age at Number of Min. reasons 1st dose doses interval bet doses

1. bcg

Birth or anytime after birth

2. DPT

6 weeks

3. OPV

6 weeks

1

Bcg given at the earliest possible age protects against the possibility of infection from other family member

3

4 weeks

An early start with DPT reduces the chance of severe pertussis

3

4 weeks

The extent of protection against polio is increased the earlier the opv is given

4.hepatitis B

6 weeks

3

4 weeks

5. measles 9 months 1

An early start of hepatitis B reduce the chance of being infected and becoming carrier At least 80% of measles can be prevented by immunization at this age

School entrants BCG immunization shall be given to all school entrants both in public and private school regardless of the presence of BCG scar Tetanus toxoid immunization for woman vaccine Minimum age interval 1. TT1 As early as possible during pregnancy 2. TT2 At least 4 weeks later

Percent protected

Duration of protection

80% 80%

3. TT3

At least 6 months

90%

4. TT4

At least 1 year later

99%

5. TT5

At least 1 year later

99%

Infants born to mother will be protected from neonatal tetanus Gives 3 years protection for the mother Same as above Gives 5 years protection for the mother Same as above Gives 10 years protection to the mother Gives lifetime protection for the mother All infant born to that mother will be

protected

ISOLATION TECHNIQUE  separation of seriously ill patients from others to prevents spraed of an infection or protect patient from irritating environmental factors purposes/ objectives : 1. prevents transmission of infection 2. protect patient 3. protect environment Double Bagging :  used for contaminated items from an isolation room (except protective isolation)  one nurse inside the room , one nurse outside carry out this procedure  use for wet linen  for item that are being sent for contamination Procedure: 1. outside nurse placed used items in appropriate container linen in the linen hamper, glass, bottle , and jars to brown paper bag .do not fill bag to full ,carefully close and secure the bag 2. outside nurse: form an another bag spreading , to received the bag from the nurse inside 3. inside nurse: place bag holding contaminated items directly to the bag hold by outside nurse( careful to touch only inside of bag) 4. Outside nurse: hold over and carefully secure top of outside bag 5. mark the bag according to the policy of the institution .Indicates content of the bag 6. dispose the bag in proper place

Full bags are difficult to double bag

Protects your hands from contact to contaminated items inside the bag

So that proper sterilization or destruction process can be carried out

Nursing consideration:  dont put lids or cups or glass jars or bottles being sent to be sterilized because it will explode , might injury to the staff. CARING FOR LINEN: 1. Handled solied linen with glove hands 2. touch only inside of laundry bag with soiled linen 3. use double bagging

Types of isolation 1. strict isolation

2. respiratory isolation

3. tuberculosis/AFB isolation

4. contact isolation

5. enteric precaution

6. drainage secretion precaution

For self protection Maintain outside as clean as possible Proper decontamination can be carried out

Indications Highly transmissible disease by direct contact and airborne routes of transmission

Requirements -private room -gowns mask gloves -handwashing -double bagged technique for soiled linen Droplets transmission -private room -pt. with the same organism generally may share aroom -handwashing -labelled plastic bag are used for soiled particles Suspected or active TB -private room with negative pressure ventilation -mask -handwashing -procedure are not done unless pt had 2 weeks duration of tx. Infectious dse. Or multiple -private rm. resistant microorganism that -mask, gown ,gloves are spread by close or direct contact Infectious dse,transmitted -private rm.handwashing, through direct or indirect -gloves contact with infected feces Gowns shld. Be wear only if handling object with contaminated feces Pt. with infected wounds Gloves Gown are indicated only if clothing is likely to be contaminated

7. universal blood and body fluids precaution

Blood borne ,body fluids pathogens

-gloves -mask and protected eye gear -gown

COMMON DSE CONDITION AND ITS APPROPRIATE PRECAUTION Disease Isolation precaution Duration of precaution 1.AIDS Blood/body fluids Duration of illness 2. burns with infection Drainage DOI 3. diarrhea infectious Enteric DOI 4. diphtheria cutaneous Contact Until 2 lesion cultures are Diphtheria pharyngeal Strict negative 5. gastroenteritis Enteric DOI 6. hepatitis A Enteric For 7 days after onset of B Blood and body fluids jaundice C Blood/body fluids 7. herpes simplex Contact DOI 8. herpes zoster Strict DOI, until lesion are crusted 9. Measles respiratory For 4 days after onset of rash DOI in immunocompromised pt. 10. methicillin resistant Contact Until antimicrobials are staphylococcus aureus discontinued and culture are negative 11. meningitis H. influenza Respiratory For 24 hrs after start of effective therapy 12. mumps respiratory For 9 days bafter onset of swelling 13. pediculosis Contact For 24 hrs after start of effective therapy 14. pneumonia Strict -for 48hrs after start of S. Aureus effective therapy Streptococcus Strict - for 24hrs after start of Grp. A effective therapy 15. scabies

Contact

16. syphilis

Contact

17. tuberculosis pulmonary

Tuberculosis (AFB)

18. typhoid fever 19. varicella

Enteric Strict

For 24 hrs after starting effective therapy For 24hrs after starting effective therapy Usually 2-3 weeks after chemotherapy has been started DOI Until all lesion are crusted

SUMMARY Strict isolation -diphtheria pharyngeal -herpes zoster - pneumonia -varicella Enteric isolation -aseptic meningitis -diarrhea -gastroenteritis -hepatitis A -typhoid fever

Respiratory isolation -H influenza -measles -mumps -N.Meningitidis Blood /body fluids precaution - AIDS - hepatitis B -hepatitisC

Contact isolation -diphtheria cutaneuos -herpes simplex -MRSA -pediculosis -scabies -syphllis Tuberculosis AFB isolation - tuberculosis