challenges in healthcare and infection control

55
CHALLENGES IN HEALTHCARE AND INFECTION CONTROL DR LEE OI WAH PEG PERUBATAN UD 54

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Page 1: Challenges in healthcare and infection control

CHALLENGES IN HEALTHCARE AND

INFECTION CONTROL

DR LEE OI WAHPEG PERUBATAN UD 54

Page 2: Challenges in healthcare and infection control

Challenges

Prevention of infection

Early and accurate diagnosis

Effective treatment

Outbreak prevention and management

Page 3: Challenges in healthcare and infection control

Greatest challenge in infection control is ……….. Outbreak prevention and

management

Healthcare Associated Infections (HAIs)

Multidrug Resistant Organisms (MDROs)

MRSA E.coli VRE

Page 4: Challenges in healthcare and infection control

Our usual response has been…….

Surveillance

Control measures

BUT problem continues…….

Page 5: Challenges in healthcare and infection control

HISTORICALLY

SARS VRE H5N1

Page 6: Challenges in healthcare and infection control

New Challenges (continue)

Changing healthcare system- Rising healthcare costs- Length of stay- Moving healthcare from inpatient

to other settings - outpatient care, long term care facilities

Page 7: Challenges in healthcare and infection control

We need to be prepared!!HOW?

Page 8: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 9: Challenges in healthcare and infection control

CDC UNIVERSAL PRECAUTIONS (1987) Recommendations for Prevention of HIV Transmission in

Health Care Setting. Universal Blood and Body Fluid Precautions.

Universal Infection Control Precautions.

The entire focus: protection of HCW from parenteral, mucous membrane and non intact skin exposure to bloodborne pathogens (blood & blood stained body fluids)

Page 10: Challenges in healthcare and infection control

BASIC ELEMENTS OF STANDARD PRECAUTION Hand hygiene Correct usage of gloves Correct usage of PPE ~ goggle/shield ~ gown/apron ~ mask Cleaning/disinfection/sterilization Handling of clinical waste/linen/speciment Waste segregation Safe handling of sharps Handling of spillage

Page 11: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 12: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 13: Challenges in healthcare and infection control

CDCStandard Precautions & Additional precautions (1996)

Revised recommendations Focus - Protection of HCWs and to reduce transmission of infectious agents among HCWs (clinical & non-clinical), patients, relatives and environment.New addition : Respiratory hygiene

Protective environment

Hand hygiene

Page 14: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 15: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 16: Challenges in healthcare and infection control

RESPIRATORY HYGIENE

Page 17: Challenges in healthcare and infection control

RESPIRATORY HYGIENE

Cover your mouth and nose with tissue when you cough or sneeze

Throw your used tissue into the plastic bag

Throw the plastic bag into the clinical waste bin

Page 18: Challenges in healthcare and infection control

Hand hygiene with soap and water or alcohol hand rubs

Wear the surgical mask to protect other

Page 19: Challenges in healthcare and infection control

New category in Expanded PrecautionsProtective Environment (PE): for allogenic haemopoetic stem cell transplantation (HSCT)

patients Environmental controls

HEPA filtration of incoming air directed room air flow positive room air pressure relative to corridor well-sealed rooms (sealed walls, floors, ceilings, windows,

electrical outlets) 12 ACH (Air Exchanges per Hour) no carpets and upholstery, routine cleaning of sprinkler heads no dried / fresh flowers and potted plants

Other measures N95 mask for patients upon leaving room

NEW

Page 20: Challenges in healthcare and infection control

Routes of disease transmissionInfected humanInfected human

AirAirFood Direct Indirect Vectors WoundsFood Direct Indirect Vectors WoundsWater contact contactWater contact contact

Susceptible HumanSusceptible Human

Ref: Microbiology, Fundamentals and applicationsRef: Microbiology, Fundamentals and applications

Page 21: Challenges in healthcare and infection control

TRANSMISSION BASED PRECAUTIONS

Hayati S, ID HSB 2010

Page 22: Challenges in healthcare and infection control
Page 23: Challenges in healthcare and infection control

Definition of Healthcare Associated Infection Outbreak (Either One )

1. Two or more associated cases occurs at the same time within same locality/department

2. Greater than expected rate of infection compared with the usual background case for the place and time

3. In certain newly emerging disease e.g. Legionnaires infection or anthrax, will only require 1 single case.

Page 24: Challenges in healthcare and infection control

Why Infection Control? The rise in the rate of HAI over the past 20 The rise in the rate of HAI over the past 20

years (36%)!years (36%)! Various Impacts of HAIVarious Impacts of HAI To minimize risks to patients, staff and To minimize risks to patients, staff and

visitors from HAIvisitors from HAI To reduce hospital costs of treating HAI and To reduce hospital costs of treating HAI and

tying up hospital beds.tying up hospital beds. SENIC study: SENIC study:

18% increase in infections – no IC 18% increase in infections – no IC programmeprogramme

32% reduction in infections – with IC 32% reduction in infections – with IC programme.programme.

Page 25: Challenges in healthcare and infection control

Predisposing factors for HAI Extended length of stay esp in

intensive care or HDU Length of antibiotic treatment Prior administration of broad spectrum

antibiotic esp. 3rd generation cephalosporins.

Proximity to another patient with multiple resistant organism (MRO).

Exposure to healthcare worker for a patient that carried MRO.

Ventilator-assisted pt.

Page 26: Challenges in healthcare and infection control

RISK FACTORS FOR HAI Iatrogenic ~ hands of HCW

~ invasive procedures eg IV,

CBD , CVP etc Organizational ~ overcrowding

~ air-conditioning system

~ physical lay-out & staffing

pattern Patient related ~ chronic illness

~ immunosuppression

~ prolong stay in the ward

Page 27: Challenges in healthcare and infection control

Common sites associated with etiological agents Urinary tract (UTI) Surgical wounds (SSI) Respiratory tract Skin (especially burns) (MRSA) Blood (bacteraemia) Gastrointestinal tract Central nervous system

Doctorrao’s ‘e’ learning series

Page 28: Challenges in healthcare and infection control

The Principles of Infection Control

Hands Hygiene FoodFoodPracticePractice

ClothingClothing LinenLinen

EnvironmentEnvironmentEquipmentEquipment

DisposalDisposal

Page 29: Challenges in healthcare and infection control

Infection control Every health worker plays a vital part

in helping to minimise the risk of cross infection

For example by making certain that hands are properly washed, the clinical environment is as clean as possible, ensuring knowledge and skills are continually updated and by educating patients and visitors.

Page 30: Challenges in healthcare and infection control

Infection control 1—Achieving optimum hand hygiene. 2 – Using personal protective equipment. 3 – Safe handling and disposal of clinical

waste and bodily fluids. 4 – Achieving and maintaining a clean

clinical environment. 5 – Good communication, with other health

care workers, patients and visitors 6 – Training and education.

Page 31: Challenges in healthcare and infection control

The chain of infection.

Source of infection

Method of spreading

Person at risk Point of entry

Breaking this chain by removing any part of it will control or stop the spread of infection

Page 32: Challenges in healthcare and infection control

Contaminated surfaces increase cross-transmission

Hayati S, ID HSB 2010

Page 33: Challenges in healthcare and infection control

Breaking the chain…..

Hayati S, ID HSB 2010

Page 34: Challenges in healthcare and infection control
Page 35: Challenges in healthcare and infection control

Surveillance and Outbreak investigation

~ An important role of ICN~ 30-60% of work time~Purpose of surveillance : 1. To establish the endemic baseline rates of NI. 2. To identify impending outbreak. 3. Convince clinical personnel - For implementation of infection control policies and protocol. 4. For evaluation of infection control measures.

Page 36: Challenges in healthcare and infection control

5. Supportive evidence of quality.6. To defend malpractice.7. Satisfy regulators (accrediting bodies)8. Inter hospital comparison.

Purpose of surveillance

Page 37: Challenges in healthcare and infection control

Establish background rateVerify diagnosisFormulate a case definitionIdentify cases

Outbreak control measures according to known mode of transmission and appropriate source control

Page 38: Challenges in healthcare and infection control

Methods of surveillance

Passive/active Retrospective/prospective Observation/Questionnaires Reviews

Page 39: Challenges in healthcare and infection control

Surveillance Studies Involves data collection 2 primary methods:

i) hospital-wide ii) targeted“Focused epidemiological studies” MRSA Multi-resistant gram negatives (Klebsiella,

Acinetobacter, E. Coli) Outbreak investigation

Page 40: Challenges in healthcare and infection control

CASE FINDING

ActiveLab reportPatient chart reviewRegular review with ward staff.Nursing kardex /care planObservation chart (temp)Survey discharge patients

PassiveReport by ward staffDischarge record review.

Page 41: Challenges in healthcare and infection control

Suspicion of an impending OB

Two or more patients are found to have an infection attributed to a same species of organism.

Multiple infection of a similar nature are reported by ward staff,

Emergence of organism not previously noted in the specific unit.

Page 42: Challenges in healthcare and infection control

ROLE OF ICN IN OUTBREAK

Ward visit

~ Check for any breach in infection control

procedures.

~ Any deviation in the ward routine

environment eg ventilation, new staff,

influx of trainee

~ Studying each case /line list sequence of

event

~ Sampling when applicable

Page 43: Challenges in healthcare and infection control

Collection of Data in Cross Infections Always collect information and document

information on 1 Patient details 2 Site and extent of infection 3 Date of admission – operative procedure first recognition of infection 4 Specimen and laboratory isolates and typing results

5 Ward and staff details. Doctorrao’s ‘e’ learning series

Page 44: Challenges in healthcare and infection control

ROLE OF ICN IN OUTBREAK

Liaise with clinical staff ~ Advise, recommendations, at hoc awareness program. ~ To stop further cross infection. ~ Discuss the possible control measure to be initiated. ~ Pt progress report.

Page 45: Challenges in healthcare and infection control

ROLE OF ICN IN OUTBREAK

Inform the administrator ~ Report incidence of OB to the management for decisions ~ Closing of ward. ~ Alternative ward to cohort the infected patients

Page 46: Challenges in healthcare and infection control

ROLE OF STAFFS IN INFECTION CONTROL

Staff education ~ Familiarization with hospital infection control policies and procedures ~ On-going education, campaigns and

specialized education to increase awareness of illnesses, infection risks and preventive measures ~ Staff education is of UTMOST importance in infection control

Page 47: Challenges in healthcare and infection control

Containment of Infection Good patient care practices

HANDWASHING Care of hospital equipment Infection control policies Prophylaxis of health care workers

Page 48: Challenges in healthcare and infection control

Efficacy of Infection control

The Following measures will certainly control the infections

1 Sterilization 2 Hand washing 3 Closed drainage systems for urinary catheters.� 4 Intravenous catheter care

5 Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.

Page 49: Challenges in healthcare and infection control

EMPLOYEE HEALTH PROGRAM

Objectives:1. To improve the safety of the hospital

environment2. To maintain the well-being of healthcare

workers3. To contain or reduce costs resulting from

absenteeism

Page 50: Challenges in healthcare and infection control

Immunization Program Ensuring that staff are immuned to

vaccine preventable diseasesi) Immunization of new and currently

employed staffii) Continual review of immunization status

Page 51: Challenges in healthcare and infection control

Sharp injuries and Post-exposure Management Prompt diagnosis and management is

important A hospital policy on reporting and

management should be made known to all staff

Record keeping

Page 52: Challenges in healthcare and infection control

KEY ELEMENT FOR THE SUCCESS OF INFECTION CONTROL PROGRAM

Learn the expertise and skills required for the practice of infection control in hospitals

Collect data on hospitals-acquired infections in the country

Press the health authorities to provide resources and deploy full-time ICNs

Initiate training for IC personnel Initiate IC programmes at the local hospital

level Provide vehicles for collaboration and

continuing education.

Page 53: Challenges in healthcare and infection control

“Above all, a hospital must do the patient no harm”

(Florence Nightingale)

Page 54: Challenges in healthcare and infection control

Hayati S, ID HSB 2010

Page 55: Challenges in healthcare and infection control

The End. Thank you!!

There are 3 types of people in the world

Those who MAKE things happen

Those who LET things happen

Those who WONDERED what happened!