Infection prevention & control general orientation Dr. Nahla Abdel Kader, MD, PhD. Infection Control Consultant, MOH Infection Control CBAHI Surveyor Infection Prevention Control Director KKH.

1. INFECTION PREVENTION & CONTROL
GENERAL ORIENTATION
١

2. Infection Control Overview
• Infection control (IC) is a quality standard
that is essential for the well being and safety of
patients, staff and visitors.
• It affects most departments of the hospital and
involves issues of quality, risk management, clinical
governance and health and safety.
• It is a discipline that applies epidemiologic and
scientific principles and statistical analysis to the
prevention or reduction in rates of Healthcare
Acquired Infections (HAIs).
٢

3. Hospital Acquired Infections
or
Healthcare Associated Infections
( HAIs )
An infection meeting the following criteria:
a) Not present or incubating on admission.
admission.
b) An infection incubating at the time of admission that is
related to previous hospitalization at the same facility or
identified in an admission following performance of a
procedure during a previous admission.
٣

4. HEALTHCARE ASSOCIATED
INFECTIONS
Remember
►Infection
in a hospitalized
patient
►Not present or incubating on
admission
►Hospital acquired infection
٤

5. Why now the urgent need for
Infection Control Program
► HAIs
are becoming more prevalent, especially
with the advent of more invasive procedures &
increase in use of immunosuppresive therapy.
► HAIs are preventable( can kill )
► HAIs are associated with prolonged morbidity.
► HAIs are associated with increased length of
stay & increased cost of care.
٥

6. TYPES OF HAIs
Devices Associated Infections
 Catheter Associated Urinary tract infections
(CAUTI)
 Central Line Associated Blood Stream Infections
(CLABSI)
 Ventilator Associated Pneumonia (VAP)
Procedure Associated Infections
 Surgical Site infections (SSI)
٦

7. Main Types of Infections
17%
44%
18%
10%
11%
UTI
SSI
BSI
Pneumo
Others
٧

8. Source Healthcare Associated
Infections
Patient’s
Own Flora
HAIs
Medical
Equipment
Staff Member
٨

9. KKH INFECTION CONTROL PROGRAM
KKH Infection Control Program is a
coordinated program designed by
the hospital to reduce the risk of
healthcarehealthcare-associated infections in
patients, visitors, and workers. It
describes the structure, authority
and functions of it.
٩

10. The GOAL
The goal of Infection Control Program is
to provide a safe healthy environment
through identification and reduction the
risks of acquiring and transmission of
HAIs among patients, medical staff,
administration staff, volunteers, students
and visitors.
١٠

11. Importance
of Infection Control Program
1. We have an obligation to reduce the morbidity
and mortality of our patients.
2. Accreditation requirements demand a strong
infection control program.
3. The infection control efforts are part of the ''
risk management'' efforts of any hospital.
4. Hospital outbreaks now occur frequently in the
average community hospital.
5. Financial deficit control has become a crucial
issue for many hospital.
١١

12.  Prevention of healthcare acquired infections is the
responsibility of all individuals and services providing
healthcare.
 Everyone must work cooperatively to reduce the risk
of infection for patients ,staff and visitors.
 Infection control programs are effective, provided they
are comprehensive and including surveillance and
prevention activities, as well as staff training.
 There must also be effective support at the national
and regional levels.
١٢

13. Infection Control is
Everyone’
Everyone’s Responsibility!
١٣

14. HOSPITAL ENVIRONMENT
HIV
CHIKENPOX
TB
١٤

15. How are infections transmitted?
١٥

16. How to Break the
Chain of Infection????
١٦

17. Standard Precautions Expanded Precaution Staff Protection
Primary strategy for
preventing transmission Transmission Based
of microorganisms to Precautions for patient
patients, They are
with suspected or
applied to all patients
confirmed
Hand hygiene &
communicable
Appropriate use of
disease
PPE
Employee
Health
Program
١٧

18. Practical Issues and Considerations
for Standard Precautions
► Hand
Hygiene.
► Personnel Protective Equipment (PPE).
► Safe Use of Sharps.
► Monitoring Staff Health.
► Cleaning and Disinfecting Patient Care
Equipment.
► Disposing
of Waste Safely.
► Cleaning the Environment.
► Removing Spills of Blood and Body
Fluids
١٨

19. ١٩

20. So Why All the Fuss About
Hand Hygiene?
Most common mode of transmission
of pathogens is via hands!
 Infections acquired in healthcare
 Spread of antimicrobial
resistance
٢٠

21. All health care’s works
care’
involve the hands
٢١

22. Hands are contaminated
Hands
spread
germs
٢٢

23. The health care environment
is contaminated
٢٣

24. Colonized or Infected:
What is the Difference?
► People
who carry bacteria without evidence
of infection (fever, increased white blood
cell count) are colonized
► If
an infection develops, it is usually from
bacteria that colonize patients
► Bacteria
that colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
~ Bacteria can be transmitted even if the
patient is not infected ~
٢٤

25. The Iceberg Effect
Infected
Colonized
٢٥

26. The inanimate environment is
a reservoir of pathogens
X represents a positive Enterococcus culture
The pathogens are ubiquitous
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+)
Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.
٢٦

27. The inanimate environment is
a reservoir of pathogens
Recovery of MRSA , VRE & ACINITOBACTER.
Devine et al. Journal of Hospital Infection. 2007;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2006
Walther et al. Biol Review, 2007:849-869
٢٧

28. Patients are vulnerable to
infection
٢٨

29. Hand Hygiene is the simplest, most
effective measure for preventing
HospitalHospital-Acquired Infections.
٢٩

30. 30% 40%
30%-40% of all HAIs are Attributed
to Cross Transmission:
Importance of Hand Hygiene?
٣٠

31. Types of Hand Hygiene
►Normal
hand washing
►Antiseptic hand washing
►Alcohol-based hand rub
AlcoholCan be used instead of hand
washing , if hands are not visibly
soiled with blood or any other
patient body fluids
►Surgical hand wash
٣١

32. Routine Hand Washing
٣٢

33. Antiseptic Hand Washing
٣٣

34. Samples taken before and after
antiseptic handwashing
٣٤

35. Waterless Hand Rub
“alcohol“alcohol-based hand rub
٣٥

36. Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
Guideline for Hand Hygiene in Health-Care Settings MMWR,2009. vol. 51, no. RR-16.
٣٦

37. Hand Hygiene Options
Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.
Apply to palm; rub
hands until dry
~ Use soap and water for visibly soiled hands ~
٣٧
~ Do not wash off alcohol handrub ~

38. Surgical Hand Wash
٣٨

39. ٣٩

40. ٤٠

41. Areas Most Frequently Missed
HAHS © 1999
٤١

42. ٤٢

43. Types of PPE used in Healthcare
Gloves
Masks
Head
Covers
Shoes
Covers
Gowns
Face
shields
Eye
protection
٤٣

44. Personal Protective Equipment
(PPE)
٤٤

45. ٤٥

46. Procedures
►Putting
on Gowns, Gloves, and
Mask
Gown: Put on gown so that its edges overlap in
back to cover clothing. Fasten closures.
Gloves: If worn with gown, pull up over cuffs of
gown to protect the wrists.
Mask: Apply mask over mouth and nose by
securing mask with ties so that it fits tightly over the
face.
٤٦

47. ►Removing
Gloves, Gowns, and Mask
Gloves: Remove gloves before exiting the patient
room by pulling them inside-out, so that the
insidecontaminated side is not exposed. Discard in trash
receptacle lined with red bag.
Gown: Unfasten closures, pull off sleeves and turn
gown to the inside so that the contaminated side is
not exposed. Place in red bag prior to washing hands
and exiting the room .
Mask: Remove mask and place in trash receptacle
lined with a red bag.
٤٧

48. ٤٨

49. ISOLATION PRECAUTIONS
Types of Isolation Precautions
1- Standard Precautions
Standard precaution (SP) is the primary
strategy for preventing transmission of
microorganisms to patients, They are
applied to all patients .
٤٩

50. Practical Issues and Considerations
► Hand
Hygiene.
► Personnel Protective Equipment (PPE).
► Safe Use of Sharps.
► Monitoring Staff Health.
► Cleaning and Disinfecting Patient Care
Equipment.
► Disposing of Waste Safely.
► Cleaning the Environment.
► Removing Spills of Blood
Fluids
and Body
٥٠

51. Expanded Precautions
Expanded precautions are designed for patients
with documented or suspected infection with
communicable or epidemiologically important
pathogens for which additional precautions
beyond SP are needed to interrupt transmission.
The aim of isolating a patient is to prevent
the spread of communicable
٥١

52. Types of
Expanded Precautions
Airborne Precautions
Pulmonary TB
Meseals
Chickenpox
Droplet Precautions
Meningitis
Influenza A
H1N1
Mumps
Contact Precautions
MDR
٥٢

53. ٥٣

54. ٥٤

55. ٥٥

56. ٥٦

57. ٥٧

58. CONTACT PRECAUTIONS
►
►
The patient is placed into a private room
whenever possible. Cohorting patients
with the same organism may be done if
needed.
A GOWN AND GLOVES MUST BE WORN BY
ALL ENTERING THE ROOM! THIS
INCLUDES VISITORS. Dietary staff that
are delivering trays are required to wear
gloves, not gowns.
►
When providing care, change gloves after
contact with any infective material such
as wound drainage.
►
Remove the gown and gloves and perform
hand hygiene before leaving the room
(take care not to touch any potentially
infectious items or surfaces on the way
out).
►
Dedicate the use of non-critical patientnonpatientcare equipment to a single patient. If use
of common equipment is unavoidable,
adequately clean and disinfect it before
use with other patients.
٥٨

59. Isolation Precautions
٥٩

60. Employee Health Program
PRE-EMPLOYMENT
SCREENING
IMMUNIZATION
WORK RESTRICTION
MANGEMENT OF
OCCUPATIONAL
EXPOSURE
TRANING IN EMPLYEE
٦٠
HAELTH & SAFTY

61. ٦١

62. OBJECTIVES
►What
the risk of exposure?
►How we can prevent the
exposure?
►If the exposure is already
done, what is the exposure
management plan?
٦٢

63. Bloodborne Pathogen Exposures
TYPES OF EXPOSURE
Percutaneous
Exposure
Mucous
Membrane
High Risk
Exposure
Moderate Risk
Exposure
.
Cutaneous
Low Risk
Exposure
٦٣

64. Exposure Control PLAN
The single most effective
measure to control the
transmission of Bloodborne
Pathogens is:
Standard
Precautions
Treat all human blood and other potentially
infectious materials like they are infectious
for Hepatitis B&C and HIV
٦٤

65. Safer Sharps
٦٥

66. SHARP INJURIES PREVENTION
►
Avoid rushing when handling needles and sharps.
►
Dispose all needles and other sharps promptly. Place used
disposable items in puncture resistant biohazard containers for
disposal.
DO NOT re-cap needles.
re► In the event recapping is unavoidable, the one-handed scoop
onetechnique or a needle recapping device shall be used.
►
Sharps containers shall be labeled as “sharps waste” and
biohazardous with international biohazardous symbol.
٦٦

67. ٦٧

68. ► Sharp
containers shall be filled up to
three quarters and taped closed or
tightly lidded.
► Sharps containers are placed in yellow
bags by housekeeping personnel for
storage and then processing.
► Sharps waste is disposed of in sharps
containers as close to site of use as
possible.
► In-patient rooms shall have wall
Inmounted “Sharps Container” system,
Container”
which is kept near the patient’s bed and
patient’
is securely locked.
٦٨

69. To safely recap needles use “the
one-hand”
one-hand” technique
Step 1
►
Place the cap on a flat surface, then remove
your hand from the cap.
Step 2
►
With one hand, hold the syringe and use the
needle to “scoop up” the cap.
Step 3
►
When the cap covers the needle completely,
use the other hand to secure the cap on the
needle hub. Be careful to handle the cap at
the bottom only (near the hub).
٦٩

70. VACCINATION
٧٠

71. IMMEDIATE CARE
OF INJURY
Risk
Reduction
Management
PLAN
MANGEMENTOF
EXPOSED
HCWs
INCIDENT
DOCUMENTATION
RISK ASSESMENT
٧١

72. ► The
employee concerned should immediately
wash away the contaminating fluid. If blood
or body fluids get in the mouth, spit out
and then rinse mouth with water several
times.
► If there is a puncture wound, wash with soap
and water and disinfected by Alcohol or
Betadine.
► If the eyes are contaminated (may be more
dangerous than an NSI) rinse well with tap
water or saline.
٧٢

73. ► Should
be in detail with
completion of the appropriate form.
► Report should include details of the incident
,date & time of incident , people involved
,any witnesses to the incident.
► All occupational exposures must be fully
documented to meet relevant legal
requirement.
٧٣

74. Exposed
HCWs
CHECK
Source
CHECK
HBsAg
Anti-HCV
Anti-HIV
Injury
Percutaneous exposure
( High Risk Exposure )
Mucous membrane
( Moderate Risk
Exposure )
Cutaneous- exposure
to non-intact skin
٧٤
(Low Risk Exposure)

75. ٧٥

76. ►Source
is –ve for HBV,HCV,HIV
Anti-HBs Ab titre
> 10 IU /ML
IMMUNE
< 10 IU /ML
NON IMMUNE
٧٦
POST-EXPORUE PROPHYLAXIS

77. Source is +ve or likely to be +ve
forHBV
forHBV
Anti-HBs Ab
+Ve
IMMUNE
- Ve
NON IMMUNE
POST EXPOSURE PROPHYLAXIS
٧٧

78. Post Exposure
Prophylaxis
Immunogluline
Vaccination
Follow up
٧٨

79. Clinical or serological
Evidence of acute
hepatitis
Seek for clinical advise
Repeat HBs Ag at
1 & 6 months
No plasma,bl,body tissue
donation.
Protect sexual partner.
Highest risk
٧٩
percuteneous
exporure,modify WP.

80. Source is +ve or
likely to be +ve for HCV
Screening
HCV-IgG
-Ve
-No infection
-Early infection
-False -ve
+Ve
-Current
infection
-past infection
-False +ve
Confirmatory
HCV-RNA by
real-time PCR
+ve
Confirms
active HCV
replication
-ve
Does not
confirm
absence of
٨٠
HCV
replication

81. Clinical or serological
evidence of acute
hepatitis
Seek for clinical advise
HCV-RNA by PCR repeated
After 2 months
HCV-IgG repeated after
6 to 9 months
No plasma,bl,body tissue
donation
Protect the sexual partner .
Hihgest risk percutaneous
exposure,modify WP.
٨١

82. Source is +ve or likely to be
+ve for HIV
► Postexporue
Prophylactic treatment is
indicated.
► It must be commenced as soon as possible
.preferably within hours rather than days .
► It should be administrated for 4 weeks.
► If PEP is offered & taken &the source is
later determined to be HIV -ve ,PEP should
be discontinued.
٨٢

83. Repeated HIV screening
at 1 & 3 & 6 months
Until screening for
seroconversion
is completed
٨٣

84. PREVENTION IS
PRIMARY !
٨٤

85. ٨٥

86. ٨٦

87. ٨٧