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Isolation 2014

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Hosptal Isolation

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Isolation 2014

  1. 1. Dr . Ashraf Selim Consultant in Oral Surgery Infection Preventionist Member in IFIC , ESIC , EDA Principles of Hospital Isolation
  2. 2.  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  In 1969, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities Dr.T.V.Rao MD 2
  3. 3.  Changing Demands on Infection Control programme  Today's ICP needs knowledge of epidemiology statistics, patient care practices, occupational health, sterilization, disinfection, and sanitation, infectious diseases, microbiology, education and management 3
  4. 4.  Staff Training in ICP  Education programs for employees are one method to ensure competent infection control practices.  It is a unique challenge since employees represent a wide range of expertise and educational background.  The ICP must become knowledgeable in adult education principles and use educational tools and techniques that will motivate and sustain behavioral change. 4
  5. 5.  CHAIN OF INFECTION  Pathogen  Portal of entry  Susceptible host
  6. 6. Modes of Transmission Direct Transmission  Direct Contact  Droplet Indirect Transmission  Vehicle-borne  Vector-borne  Airborne Vertical transmission (mother to infant) Horizontal Transmission
  7. 7. INFECTIOUS DISEASE DETERMINANTS 1. Virulence (pathogenic properties) 2. Dose (number of microbes) 3. Resistance (body’s defense mechanism) 4. I C Procedures Affect ……?
  8. 8. October 18, 2000: 250-million-year-old bacteria revived
  9. 9. STANDARD PRECAUTIONS  Consideration of all patients as being infected with pathogens and therefore applying IC procedures to the care of all patients  Treat every patient as though infected with incurable disease  The Same IC Procedures Are Used For ALL Patients
  10. 10. Standard Precautions in Health Care Settings 1. Appropriate hand hygiene 2. Barrier protective equipment: – if splash, splatter, or sprays can be reasonably anticipated – choose appropriate PPE as needed: gloves, gown, mask, eye protection (face shield, goggles) 3. Proper use and handling of patient care equipment
  11. 11. 4. Proper environmental cleaning and disinfection. 5. Proper Handling of Linen 6. Adherence to Blood-borne Pathogens Standards 7. Proper patient placement 8. Respiratory Hygiene/Cough Etiquette 9. Safe injection practices
  12. 12. Transmission of Infections • Droplets: land directly on mucosal lining of nose, mouth, eyes of nearby persons or can be inhaled. • Highest exposures within 3-6 feet. • Airborne: aerosols become smaller by evaporation; small aerosols (≤ 5 microns) remain suspended for longer periods, if inhaled travel deep into the lungs. • Contact: Aerosols/ secretions contaminate nearby surface. Touch surfaces can infect self or others. Relative contribution of three routes varies with agent.
  13. 13. Expanded Isolation Precautions: Transmission-based Standards  When standard precautions are not enough  Additional measures based on mode of transmission  Contact Precautions  Droplet Precautions  Airborne Precautions
  14. 14. Modes of Transmission via Infectious Respiratory Secretions • Airborne: tuberculosis, measles, varicella, smallpox, SARS, avian influenza • Droplet: meningococcal meningitis, rubella, pertussis, common cold, SARS, influenza* • Indirect contact: (fomite) RSV, SARS • Influenza traditionally droplet, increasing evidence for airborne component
  15. 15. Hierarchy of Infection Prevention and Control Measures PPE Engineering Controls Protects only the wearer Elimination of Potential Exposures Administrative Controls Protects most people
  16. 16. Elimination of Potential Exposures • Example: patients with mild influenza like illness stay home
  17. 17. Engineering Controls • Physically separates the employee from the hazard • Does not require employee compliance to be effective • Examples: –Physical barriers at Triage –Airborne infection isolation room for patients with known or suspect airborne infectious diseases
  18. 18. Administrative Controls/ Workplace Practices • Policies, procedures, and programs that minimize intensity or duration of exposure – Examples: • signs on door of an airborne isolation room • triage, mask symptomatic patient • provide tissues/ masks/hand sanitizer to public • Standard procedures/ behaviors in caring for patients e.g. hand hygiene, HCW vaccination • Only as good as enforcement
  19. 19. Personal Protective Equipment • Lowest level of hierarchy - requires employee compliance for efficacy • Means higher elements of hierarchy fail to adequately protect employee • May involve use of gowns, gloves, eye/splash protection or respirators • Last line of defense
  20. 20. Face Masks vs. N95 Respirators • Loose fitting, not designed to filter out small aerosols • Place on coughing patient (source control) • HCW should wear mask to – protect patient during certain procedures (e.g., surgery) – protect HCW • droplet precautions • Mask + goggles for anticipated spray/splash • Tight fitting respirator, designed to filter the air • Protects the wearer • HCW should wear when concerned about transmission by airborne route
  21. 21. Contact Precautions  Personal Protective Equipment  Gown & Gloves for all patient interactions  Don PPE on entry, discard before exiting room. (in addition to Standard Precautions)  Examples: MRSA, C difficile, Norovirus, other GI pathogens, RSV, antibiotic-resistant pathogens
  22. 22. Droplet Precautions  Single room preferred, no special ventilation  Patient: Mask if transport necessary. Instruct on respiratory hygiene/cough etiquette  HCWs wear surgical or procedure mask within 6 feet of patient. Eye protection if splash, spray anticipated (in addition to Standard Precautions)
  23. 23. Airborne Precautions  Airborne Infection Isolation Room (AIIR) if available  Patient: Mask if transport necessary (as tolerated).  Health care workers (HCWs):  N95 respirator prior to entry into room, discarded after exit.  Hand hygiene before & after don/doff.  Alert others if need to transfer (in addition to Standard Precautions)
  24. 24. Isolation Separation of a person or group of persons infected or believed to be infected with a contagious disease to prevent the spread of infection (usually associated with hospital setting) ( Source Isolation . Protective Environment is a special type of isolation to protect immunocompromised patient.
  25. 25. Goal of Isolation (Protection of / from) HCWs Other Patients Environment Visitors (Community) AIIR Airborne infectious Isolation Room PATIENT PE Protective Environment
  26. 26. Management of Environmental Surfaces 1. Cleaning and disinfecting non-critical surfaces in patient-care areas are part of Standard Precautions. 2. In general, these procedures do not need to be changed for patients on Transmission-Based Precautions. 3. The cleaning and disinfection of all patient-care areas is important for frequently touched surfaces, especially those closest to the patient.
  27. 27. 4. Also, increased frequency of cleaning may be needed in a Protective Environment to minimize dust accumulation. 5. In general, use of the existing facility detergent/disinfectant is sufficient to remove pathogens from surfaces of rooms where colonized or infected individuals were housed this includes those pathogens that are resistant to multiple classes of antimicrobial agents (e.g. MRSA , VRE. 6. Certain pathogens (e.g., rotavirus, noroviruses, C. difficile) may be resistant to some routinely used hospital disinfectants so higher concentrations may be needed.
  28. 28. Airborne Infectious Isolation Room AIIR 1. Negative Pressure room (suit ) with or without Anteroom and inside bathroom . 2. Minimum Differential Difference ≥ 2.5 Pascal (CDC 2007). 3. 12 ACH . 4. Minimum leakage maximum 1 inch under room door. 5. Air is exhaust to outside (No Recirculation ) OR must pass through HEPA filter in case of recirculation . 6. Pressure sensor with alarm is a must .
  29. 29. Isolation Area The optimum number of isolation rooms per facility ranges from 1 per 30 / 100 bed in general hospital . In Acute care 1 per 5 bed ( ICU , NICU )
  30. 30. - + - - - -
  31. 31. ++ - -
  32. 32. Verifying Negative Pressure 1- Smoke Tube Test 2- Tissue Test A thin strip of tissue should be held parallel to the gap between the floor and bottom of the door. The direction of the tissue‘s movement will indicate the direction of air movement. 3-Manometer
  33. 33. Protective Environment Positive IR It is the engineering and design intervention that deceases the risk of exposure to environmental fungi for severely Immunocompromised Allogenic Hematiopoietic stem cell Transplant (HSCT) during their highest risk phase usually the first 100 day and solid organ transplant.
  34. 34. 1. Positive pressure room in relation to corridor with inside bathroom with minimum 8 Pascal . 2. > 12 ACH is required . 3. Well sealed room. 4. Supply air must pass through HEPA filter. 5. Directed room airflow with air supply on one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room.