Lecture 8 - Sterilization Disinfection Ii Infection Control

Infection Control and Healthcare-related Infections

Dr. Eiman Mokaddas MD MRCPath Associate Professor Microbiology Department Faculty of Medicine 10/14/08

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Community v.s. Hospital-Acquired Infection  

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The risk of infection is always present Patient may acquire infection before admission to the hospital = Community acquired infection Patient may get infected inside the hospital = Nosocomial infection

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Factors affecting infectious process

The micro-organism

Infection The Host

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The environment

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Factors affecting infectious process 

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The micro-organism:  virulence, pathogenicity, invasiveness The host:  immunocompetent vs. immunocompromised  Immunized vs. non immunized (herd immunity) The environment:  cleanliness (water supply, hospital environment, hand hygeine)  overcrowding, improved socio-economic conditions

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World Alliance for Patient Safety

Global Patient Safety Challenge 2005-2006 ■

Healthcare-associated infections – – – – – – –

affect millions of patients worldwide every year more serious illness prolong hospital stay long-term disability high costs on humans and their families excess deaths massive additional financial burden

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Nosocomial Infections(NI) ( Helthcare-associated Infections (HAI

HCRI is defined as, “an infection that is not

present or incubating when a patient is admitted to a hospital or a healthcare facility.” (Infection Control Online) It is commonly referred to as a Healthcareassociated infection (HAI)

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Types of HAIs      

Urinary Tract Infections Respiratory Tract Infections Skin and soft tissue infections (wound) Catheter-related infections Septicemia Gastrointestinal infections

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Common features of HAIs 

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Associated with treatment or procedure e.g. surgery (wound infection), Urinary catheterization (UTI), Intravenous infusion (septicemia) Usually associated with antibiotic-resistant micro-organisms e.g. methicillin-resistant Staphylococcus aureus (MRSA)

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Prevention of HAIs

Infection Control Committee

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Prevention of HAIs

1. Education of medical, nursing and ancillary staff in the basic concepts of infection control:  Hand washing:  frequent hand washing is the most important measure to prevent cross-infection  Staff must be taught about the principles of hand hygiene

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Prevention of HAIs 

Applying hygiene in all aspects of health care: e.g. theatre, wound dressing, other surgical techniques, safe patient environment

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Education-based prevention of catheter-related infection

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hand rub at the point of care

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Before and after any patient contact Before and after glove use In between different body site care E.Mokaddas

Time constraint = major obstacle for hand hygiene

handwashing hand antisepsis 10/14/08

1 to 1.5 min

alcohol-based hand rub E.Mokaddas

15 to 20 sec

Prevention of HAIs

2. Sterilization and Disinfection policy:  Provision of sterile instruments, dressings etc..  Proper use of disinfectants in the hospital environment and antiseptics on the skin of patients and on the hands of staff including various methods of hand rubs  Use of disposable items such as syringes, catheters etc…

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Prevention of HAIs

3. Isolation Policy:  Single rooms for airborne infections  Source isolation; prevents spread of infection from infected patient  Protective isolation: prevents a susceptible patient (immunocompromised) from getting an infection

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Prevention of HAIs

4. Antibiotic Policy:  Rational use of antibiotics both for prophylaxis and treatment

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Prevention of HAIs

5. Surveillance: of infections within a hospital  Done by Infection Control team (nurse, officer)  To follow the spread of infections within a hospital  Monitor infection rate within selected units e.g. ICUs, Surgical wards, neonatal units etc…

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Surveillance Principle  

Surveillance is: “Information for Action” “If you don't use it, then do not ask for it!”

However:  “Good surveillance does not necessarily ensure the making of the right decisions, but it reduces the chances of the wrong ones” A. D. Langmuir (1963)

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Quiz 

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A patient with known blood borne pathogen was operated in the operating theatre, which involved the use of a flexible endoscope Question 1: What is usually done to the reusable items in the theatre?

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Quiz  

Question 2: Endoscopes are heat-sensitive equipments. How would you make it fit to be used for the next patient?

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Quiz 

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There was spillage of blood and body secretions on the theatre floor during operation. Question 3: How would you take care of the spillage?

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Quiz    

Question 4: To what group of disinfectants does gluteraldehyde belong? Question 5: What is the advantage and disadvantage of gluteraldehyde?

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Quiz      

Question 6: What type of disinfectant is hypochlorite? Question 7: What are the advantages and disadvantages of hypochlorite? Question 8: What are its uses?

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